New Medications May Stop Your Recurrent Pericarditis

Pericarditis causes chest pain, makes exercise difficult

woman with chest pain

New medications may provide new options for pericarditis patients, including those in their teens.

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A common cause of chest pain in young patients, pericarditis is an inflammation of the sac or lining of the heart. Recurrent pericarditis can occur in up to 30 percent of pericarditis patients.

Some patients don’t respond well to traditional medications or have side effects from them. But new studies say new-generation treatments can end episodes of pericarditis for good.

New medicines

Specialists now look to drugs that modulate the immune system, hoping to stop the recurrent pericarditis rather than just treat the symptoms.

Medications such as interleukin receptor blockers, currently used for anti-inflammatory diseases such as rheumatoid arthritis (RA), act on moderating the immune system’s inflammatory response to a variety of triggers.

A multi-center, retrospective study analyzed anakinra, which is an interleukin receptor blocker-type drug. Researchers looked at the outcomes of 15 patients who had already received colchicine and prednisone for recurrent pericarditis.

The results, published in the Journal of Pediatrics, say anakinra reduced inflammatory factors and allowed patients to wean themselves off of steroid treatments. Researchers concluded that anakinra was safe and effective in long-term prevention of repeated bouts of pericarditis.

According to a letter published in the Annals of Rheumatic Diseases, researchers in Greece also reported that patients had a dramatic drop in recurrences of pericarditis after receiving treatment with anakinra.

[Tweet “New drugs offer hope for those with recurrent #pericarditis”]Another interleukin receptor blocker called canakinumab holds promise. Currently, trials are under way in Boston about canakinumab’s ability to reduce inflammatory factors in the cardiovascular system. Though the study focused on potential use for conditions such as atherosclerosis, canakinumab might help combat pericarditis as well.

Recurrent pericarditis strikes even young patients

Cardiologist Allan Klein, MD, Director of the Center for the Diagnosis and Treatment of Pericardial Diseases, says a large percentage of his younger patients have the recurrent, incessant form of the inflammatory disease.

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“Many of my patients are young adults or even teenagers and they can suffer debilitating pain that prevents them from exercising and that negatively impacts their quality of life,” he says.

Injury or viral infection can lead to acute pericarditis, says Dr. Klein, “Ninety percent of my patients have pericarditis following a bout with a virus such as the flu.”

Pericarditis can also occur after surgical procedures, trauma to the chest, or a bout of tuberculosis usually in developing countries, as well as autoimmune conditions such as Systemic lupus erythematosus (SLE) or RA.

Because there are many different potential causes and related conditions that occur with recurrent pericarditis and difficult management issues, it’s important to get a thorough evaluation by a pericarditis specialist.

Traditional treatments

Patients typically receive a combination of medications to fight repeated bouts of pericarditis, including:

  • NSAIDS or non-steroidal anti-inflammatory drugs, such as naproxen, ibuprofen, indomethacin
  • colchicine
  • Prednisone (steroids)
  • Triple therapy (all three)

Certain medications that contain steroids (prednisone) can cause side effects including facial swelling and a “buffalo hump”. “I have had young patients that will not go out of the house and have been home schooled due to the embarrassment of how it made them look and feel,” says Dr. Klein.

Ongoing research

Dr. Klein says researchers are constantly learning more about pericarditis and inflammatory processes in heart health. “The field of cardio-rheumatology is developing,” he explains.

He is analyzing the treatment and progress of more than 3,000 patients, and is involved in active research and analysis to further knowledge about auto-inflammatory and auto-immune diseases and to improve the care of patients with pericarditis.

One advancement is already in use in this area. Doctors use advanced imaging including strain echo as well as magnetic resonance imaging (MRI) to evaluate and stage severity of inflammation and to guide them in managing patients with pericarditis.  It is a new way to pick up inflammation and to plan how long to treat the patient with very slow tapering of the medications.

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