Scardapane Alessandra, Brucato Antonio, Chiarelli Francesco, Breda Luciana
Department of Pediatrics, University of Chieti, Via Vestini 5, 66100, Chieti, Italy,
Pediatr Cardiol. 2013;34(8):1989-91. doi: 10.1007/s00246-012-0532-0. Epub 2012 Oct 7.
Pericarditis may recur in up to 30 % of adult patients, but recurrent pericarditis is a rare disease in childhood. The etiology of the initial attack and the causes of recurrences often remain unknown. Recurrent pericarditis is accompanied by a high morbidity rate and may represent a challenge to the clinician due to problems in management. Therapeutic strategies are not specific and include nonsteroidal antiinflammatory drugs, corticosteroids, immunosuppressive drugs, colchicine, and pericardiectomy. Controlled trials have demonstrated that colchicine can reduce the recurrent rate of pericarditis, whereas early corticosteroid therapy promotes recurrences. Anakinra, a recombinant human interleukin-1β receptor antagonist, is a promising new biologic agent for the treatment of autoinflammatory diseases such as cryopyrinopathies, tumor necrosis factor receptor-associated periodic syndrome, and hyperimmunoglobulinemia D with periodic fever syndrome. This report describes an 11-year-old boy successfully treated with anakinra for a steroid-dependent recurrent pericarditis unresponsive to conventional treatment.
心包炎在高达30%的成年患者中可能复发，但复发性心包炎在儿童期是一种罕见疾病。初次发作的病因以及复发原因通常仍不明确。复发性心包炎发病率高，由于管理方面的问题，可能给临床医生带来挑战。治疗策略不具有特异性，包括非甾体抗炎药、皮质类固醇、免疫抑制药物、秋水仙碱和心包切除术。对照试验表明，秋水仙碱可降低心包炎的复发率，而早期使用皮质类固醇治疗会促进复发。阿那白滞素是一种重组人白细胞介素-1β受体拮抗剂，是一种有前景的新型生物制剂，可用于治疗自身炎症性疾病，如冷吡啉相关周期性综合征、肿瘤坏死因子受体相关周期性综合征和伴有周期性发热综合征的高免疫球蛋白血症D。本报告描述了一名11岁男孩，使用阿那白滞素成功治疗了对传统治疗无反应的类固醇依赖性复发性心包炎。
