The long journey of interleukin-1 in acute and recurrent pericarditis

For many years, pericarditis has been regarded as a Cinderella among cardiovascular disorders. However, acute pericarditis is diagnosed in 5% of patients admitted to the emergency room for chest pain.1 Pericarditis may be complicated by recurrences and up to 50% of patients experiencing a recurrence may have several flares. This dramatically impacts on patient’s quality of life, i.e. loss of workdays, limitation of activities of daily life and physical activity, increased number of emergency room admissions and outpatients’ visits.1 Based on these premises, research has investigated effective therapeutic approaches in the past decades. For a long time, treatment for acute and recurrent pericarditis was limited to nonsteroidal anti-inflammatory drugs (NSAIDs) that are considered as first-line treatments by latest European Society of Cardiology guidelines,2 although based on scant evidence.3 Colchicine is suggested as well as a first-line therapy for both acute and recurrent pericarditis. First evidence on colchicine dates back to 1987, when a short letter on The Lancet described the successful treatment of three young people with recurrent pericarditis (two idiopathic and one due to systemic lupus erythematosus) using colchicine based on a previous experience in patients with familial Mediterranean fever.4 Colchicine derives from the Colchicum autumnale plant and its history as a curative agent is very old. Initially used by Egyptians for joint pain, the Colchicum extract was described as treatment for gouty arthritis in the first century AD by Pedanius Dioscorides. Many other famous doctors, like Avicenna and Ambroise Paré, recommended this drug for its efficacy in the following centuries. After the positive results described in 1987, many randomized clinical trials investigated colchicine either in acute and recurrent pericarditis showing a clear benefit.5 Most of these trials were primarily focused on clinical aspects (resolution of symptoms and reduction/normalization of inflammatory biomarkers). However, translational studies and animal models of acute pericarditis were lacking, thus explaining the limited knowledge of this syndrome and the poor number of targeted treatments, the latter representing an urgent clinical need to address disease morbidity.