Interleukin-1 inhibition with anakinra: a valuable ally to reverse constrictive pericarditis?

Acute pericarditis is an overall benign condition with a low in-hospital (~1.1%) and long-term mortality depending largely on the underlying aetiology.1 However, in terms of morbidity, acute pericarditis is definitely a highly problematic disease both for patients and treating physicians due to its potential short-term and long-term complications such as cardiac tamponade, recurrent pericarditis (RP), and transient or permanent constrictive pericarditis (CP).2 Notably, the rate of complications differs significantly between patients with secondary (specific) aetiologies such as malignant pericarditis, pericarditis in the context of autoimmune disorders, post-cardiac injury syndromes and so on, and the so-called idiopathic (presumably viral) pericarditis. In particular, in patients with acute pericarditis, the rate of RP and CP during a median follow-up of 60 months was 15%–30% and 0.8% respectively for the idiopathic forms versus 57% and ~8.3% respectively for the secondary forms.3 Further details on CP underlying aetiology and diagnostic approach are depicted in figure 1.1 3 Figure 1 Constrictive pericarditis aetiology, subtypes and diagnostic approach. CMR, cardiac magnetic resonance; CP, constrictive pericarditis, ECG, Electrocardiography, CT. computed tomography Taking into account the high rate of complications observed in secondary forms (non-idiopathic, non-viral) of acute pericarditis, it is self-explanatory that their prompt recognition and aetiology-based treatment are of paramount importance. Actually, in secondary cases the treatment of the underlying cause should be primarily directed to the specific cause rather to acute pericarditis itself with anti-inflammatory medications. According to the previous 2004 European Society of Cardiology (ESC) Guidelines on the Diagnosis and Management of Pericardial Diseases, all patients with acute pericarditis should be hospitalised and undergo an extensive aetiological search to exclude eventual secondary aetiologies.4 However, in the most recent 2015 relevant guidelines, the former recommendation was given only for patients with at least one of the high-risk criteria for poor outcome, namely, …