Pericarditis, how frequent are relapses?

Giulio Stefanini (Humanitas): "There is a possibility that the symptoms will recur for months or years, with strong stress among the causes"

ROME – “Unfortunately, being recurrent is precisely a characteristic of pericarditis. Precisely for this reason it should never be underestimated and must be treated intensely, not only in terms of anti-inflammatory therapy but also in prolonged over time”. Thus Professor Giulio Stefanini, interventional cardiologist at the Humanitas Clinical Institute and professor at Humanitas University, interviewed by Dire regarding the possibility of relapses in pericarditis, the inflammation of the membrane that protects and lines the heart called the pericardium.

THE CASE OF MINISTER CROSETTO

Just two days ago, meanwhile, the Minister of Defense, Guido Crosetto, was admitted to the San Carlo Nancy hospital in Rome for a new episode of pericarditis which returned in a more painful form compared to the previous one dating back to last February. “If the patient affected by pericarditis feels better and has inflammation indices that have returned to normal – continues Professor Stefanini – perhaps he tends to be less compliant with the continuation of therapy, while the duration of therapy over time remains important. It must be said that still to date, despite the availability of many pharmacological tools, we still do not have a properly developed therapy to attack pericarditis, rather we use powerful but broad-spectrum anti-inflammatory drugs. I mean we have the ‘blunt weapons’, but it is certainly still there so much to do in terms of treatment that prevents recurrence.”

But how frequent are relapses of pericarditis?

“In 15-25% of patients with idiopathic pericarditis the symptoms recur intermittently for months or years. So in 1 in 5 patients, quite a lot – the expert replies – The risk, moreover, is not just the recurrence but chronicity: if not treated adequately, pericarditis can become chronic, forming a context of chronic inflammation which permanently damages the sac attacked by the inflammation that surrounds the heart and which is called ‘pericardium'”. The adversary to be eliminated, therefore, is precisely the risk of chronic pericarditis.

In terms of prevention, however, what can be done?

“Unfortunately no, there are no primary prevention strategies and any statement is an opinion”, replies Professor Stefanini. When asked about possible triggers for a recurrence of pericarditis, Professor Stefanini says: “Any condition of strong stress, especially in a patient who has already had pericarditis, can reduce the immune response and consequently could favor the reappearance of acute processes of a new pericarditis”.

There are a series of anti-inflammatory drugs that “could be interesting” in the future, but how should pericarditis be treated?

“Like inflammation, therefore with a fairly intense anti-inflammatory therapy – replies Professor Stefanini – There are at least five categories of drugs: aspirin; non-steroidal anti-inflammatory drugs (the so-called ‘NSAIDs’), such as ‘high-dose ibuprofen; cortisone drugs; colchicine; drugs based on biological monoclonal antibodies.’ The choice of one or the other therapy depends on the “characteristics of the patient, there are some who cannot take certain drugs or who have adverse reactions, there is no therapy that is right for everyone. There are very specific protocols standardized, but we must always take into account how the individual patient responds to the therapy”.

Finally, regarding the treatment of pericarditis, there is “a lot of interest from the cardiovascular community, to the point that the European Society of Cardiology has developed guidelines precisely on this”, concludes the professor Stefanini.