Recurrent pericarditis: infectious or autoimmune?

Autoimmun Rev. 2008 Oct;8(1):44-7. doi: 10.1016/j.autrev.2008.07.024. Epub 2008 Aug 15.


The etiology and pathogenesis of idiopathic recurrent acute pericarditis (IRAP) remain controversial standing like a bridge that crosses infectious, autoimmune and autoinflammatory pathways. Anything may cause acute pericarditis; Echo-virus, and Coxsackie are the most frequently involved viruses, Mycobacterium tuberculosis and Coxiella burnetii the most common bacteria, but in 85% of cases it remains "idiopathic". Recurrences occur in up to 20-50% of patients. An immuno-mediated pathogenesis is suggested by the presence of pro-inflammatory cytokines in pericardial fluid, the presence of antinuclear autoantibodies (ANA) in sera of the patients, the occurrence of new autoimmune diagnoses and the good response to anti-inflammatory or immunosuppressive therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) must be used at recommended dosages, till the resolution of symptoms and normalization of C-reactive protein and erythrocyte sedimentation rate. Corticosteroids should be used rarely, at low doses, with an extremely low tapering and with osteoporosis prevention. Colchicine leads to a clinically important and statistically significant benefit, reducing recurrences by 50%. The long term outcome of IRAP is good, without evidence of constriction even after a very long follow-up.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antibodies, Antinuclear / biosynthesis
  • Antibodies, Antinuclear / immunology*
  • Bacterial Infections / immunology*
  • C-Reactive Protein / metabolism
  • Colchicine / therapeutic use
  • Coxiella burnetii
  • Drug Interactions
  • Enterovirus / immunology*
  • Enterovirus Infections / immunology*
  • Humans
  • Mycobacterium tuberculosis
  • Osteoporosis / prevention & control
  • Pericarditis / drug therapy
  • Pericarditis / etiology*
  • Pericarditis / physiopathology
  • Prognosis
  • Secondary Prevention
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antibodies, Antinuclear
  • C-Reactive Protein
  • Colchicine