Idiopathische rekurrente Perikarditis

Zusammenfassung

Die idiopathische rekurrente Perikarditis (IRP) stellt ein herausforderndes Krankheitsbild für Diagnostik und Therapie dar. Die IRP betrifft 10–50 % der Patienten mit einer vorhergehenden Perikarditis, wobei die Ätiopathogenese häufig als immunmediiert verstanden wird. Die Hauptsäulen der Therapie bestehen aus Acetylsalicylsäure und nichtsteroidalen antiinflammatorischen Medikamenten (NSAR) plus Colchizin und niedrig-bis mittelhoch dosierten Kortikosteroiden als Zweitlinientherapie. Intravenöse Immunglobuline und Azathioprin stellen weitere Therapieoptionen dar. In Anbetracht möglicher Aktivierungen des Inflammasoms werden zunehmend mit Erfolg Biologika eingesetzt, die gegen Interleukin (IL)-1 vermittelte Mechanismen gerichtet sind. Erfahrungen zeigen Erfolge für die Behandlung der kortikosteroidabhängigen IRP mit Anakinra, einem IL-1-Rezeptor-Antagonisten. Die Prognose der pädiatrischen IRP ist generell gut mit seltenen Episoden einer Perikardtamponade und einem geringen Risiko der konstriktiven Perikarditis.

Summary

The idiopathic recurrrent pericarditis (IRP) displays a challenging disease regarding diagnostic and therapeutic issues. The IRP affects 10 to 50 % of patients with previous pericarditis. The etiopathogenesis is mainly autoimmune or autoinflammatory. The basics of therapy are aspirin and non-steroidal antiinflammatory-drugs (NSAID) plus colchicine. Low-dose to moderate-dose corticosteroids are second-line therapy. Alternatively, intravenous immunoglobulins and azathioprin may be administered. Considering the possible activation of the inflammasome in the etiopathogenesis of IRP, biologics directed against Interleukin (IL)-1-mediated mechanisms are successfully used, particularly, anakinra, an IL-1-receptor antagonist, in corticosteroid-dependent forms of IRP. The prognosis of IRP is generally good with rare events of pericardial tamponade and a low risk of constrictive pericarditis.

Schlüsselwörter

Idiopathische rekurrente Perikarditis - NSAR - Colchizin - Acetylsalicylsäure - Interleukin-1

Keywords

Idiopathic recurrrent pericarditis - NSAID - colchicine - acetylsalicylic acid - Interleukin-1

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