Successful use of anakinra for colchicine-intolerant, corticosteroid-dependent recurrent pericarditis secondary to postcardiac injury syndrome after pacemaker placement

A 54-year-old woman was referred to our centre for the third recurrence of colchicine-intolerant, corticosteroid dependent iatrogenic post-traumatic pericarditis after pacemaker placement 3 months prior to the first episode. The initial episode and each recurrence were associated with a pericardial effusion requiring drainage. Evaluation for pericardial infection, malignancy, autoimmune disease and pacemaker lead perforation was negative. After fourth recurrence and fifth pericardial drainage in 3 months, a trial of anakinra (interleukin-1 inhibitor), in addition to swift symptom resolution successfully prevented subsequent symptomatic and echocardiographic recurrence. Corticosteroids were tapered and eventually discontinued. At 4-month follow-up, the patient continues to be on daily anakinra 100 mg subcutaneous (SQ) daily without adverse effects.

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A Longitudinal 5-Year Follow-Up Study of Cognitive Function After First Episode Major Depressive Disorder: Exploring State, Scar and Trait Effects

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.575867 ◽

2020 ◽

Vol 11 ◽

Author(s):

Eivind Haga Ronold ◽

Marit Therese Schmid ◽

Ketil Joachim Oedegaard ◽

Åsa Hammar

Keyword(s):

Executive Function ◽

Depressive Symptoms ◽

Cognitive Function ◽

Cognitive Deficits ◽

Processing Speed ◽

First Episode ◽

Follow Up Study ◽

History Of ◽

Initial Episode

Major depression (MDD) is associated with cognitive deficits in processing speed and executive function (EF) following first episode (FE). It is unclear whether deficits are state or trait related. Studies following FE MDD over longer periods are lacking, making it uncertain how cognition and symptoms develop after the initial episode. The present study assessed cognitive function and symptoms 5 years following FE MDD. In addition, the study explored relationships between MDD symptoms, rumination, and cognitive deficits with regards to the trait, state, and scar perspective. Twenty-three participants with previous FE MDD, and 20 matched control participants were compared on Delis-Kaplan Executive Function System measures of processing speed and EF, in a 5-year longitudinal follow-up study. Correlations between current symptoms- and history of MDD, rumination, cognition were investigated. Findings indicated that cognitive deficits persisted with no clear signs of exacerbation after initial episode. Inhibition appeared independent of current and previous symptoms of depression. Processing speed was related to depressive- symptoms and rumination. In conclusion, results indicated persisting, stable deficits in both EFs and processing speed. Findings further suggest that depressive symptoms could be related to deficits in processing speed, indicating state effects. There was limited support for worsening of cognition after initial episode. Some aspects of EF like Inhibition could show persistent deficits independent of depressive symptoms indicating trait effects.

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Εκτίμηση μετατραυματικής διαταραχής στρες στην εφηβική ηλικία μετά από τροχαίο ατύχημα

10.12681/eadd/37778 ◽

2013 ◽

Author(s):

Διονυσία Τσουκαλά

Keyword(s):

Ptsd Symptoms ◽

Post Traumatic Stress ◽

The Third ◽

Significant Difference ◽

Gun Shot ◽

Post Traumatic ◽

Car Accident ◽

Ptsd Symptomatology ◽

Ptsd Severity

Study purpose. The purpose of this study was to assess Post-TraumaticStress Disorder (PTSD) symptoms in adolescents after an accident (includingmotor vehicles, fall, gun shot etc) and to continue a follow-up 3 and 6 monthsafter the accident. Additional purposes of this study were: a) to observe theprevalence of PTSD in adolescents in association to their trauma, b) toassess their PTSD severity, c) to observe the correlation between PTSDseverity and depression and d) to observe if there is an agreement betweenadolescents and parents as far as the adolescents' PTSD severity andsymptoms are concerned.Population and method. The study sample was consisted of 60 adolescentsaged 11-18 years who were involved in a car accident and one of theirparents. Data collection was performed by filling out the Children's PostTraumaticStress Disorder Revision Inventory 2 (CPTS-RI) adolescentversion, Children's Post-Traumatic Stress Disorder Revision Inventory 2(CPTS-RI) parent version to assess PTSD, the Beck Depression Inventoryfor assessing depression and the State-Trait Anxiety Inventory for children(STAIC) to estimate the acute and persistent stress at three different periodsof time: four weeks, 3 months and 6 months after the accident.Results. At 4 weeks after the accident, 100% of the adolescents had fullPTSD symptomatology (partial PTSD was observed by parents in 75%), while63.3% of adolescents had moderate PTSD (30% mild PSTD was observed byparents). In the third month PTSD percentages were approximately 88.3%. In61.7% of adolescents experienced mild PTSD and in 58.3% the parentsagreed. In the sixth month after the accident there was a significantimprovement in the severity of PTSD, but 23.3% had persistent mild PTSDand full PTSD symptomatology was diagnosed in 68.3%. The girls had moresevere PTSD symptomatology than boys (p = 0,002) 4 weeks after theaccident. In the sixth month the boys showed milder PTSD symptoms thangirls. There were statistically significant differences in PTSD severity betweenthe first and third month (p = 0,001) but not between the 1stand 6th month(p = 0.160). The parents' and adolescents' observations agreed the first month after the injury (p = 0.03) and it was observed that girls had strongerPTSD symptoms in the presence of their mother significantly (p = 0.04), whilethe boys did not (p = 0.64).A statistically significant correlation between the first month and thethird month was established, as well as between the first and sixth month (p =0.02) in the STAIC A-Trait scale (p = 0.03). Adolescents showed a decreasein anxiety during that specific moment. A statistically significant correlationwas also established between the 3rd and 6th months (p = 0.05) after theaccident with the STAIC A-Trait scale and the adolescents showedsignificantly reduced anxiety in stressful situations that they face in their dailylives. The girls showed higher scores on STAIC A-Trait than boys.Statistically significant difference was observed with the BECK inventorybetween the first and the third month (p = 0.07), the first and the sixth month(p = 0.02) and between the 3rd and the 6th month (p = 0.00).Conclusions. The main conclusions of the research study were that:a) girls had more severe PTSD symptoms than boys, while the disorder isassociated with the cause of the accident, with increased symptomatologyamong adolescents who had a motorcycle accident, b) a correlation betweenthe age of the adolescents, the cause of the accident and PTSD severity wasnot observed, c) the PTSD symptoms were more severe when theadolescents' mother was present 4 weeks, 3 months and 6 months after theaccident, d) there seemed to be an agreement in the observations betweenthe adolescents and their parents 4 weeks after the accident, but not at 3months and 6 months. Specifically, parents observed fewer symptoms thanthose adolescents in fact experienced, e) PTSD symptomatology rates werepersistent at 3 months and 6 months after the accident and f) rates ofdepression symptoms, while declining, remained significant at 3 months and6 months after the accident.

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Pacemaker Lead Perforation Mimicking Symptoms of Acute Pulmonary Embolism

Acute Medicine Journal ◽

10.52964/amja.0818 ◽

2020 ◽

Vol 19 (3) ◽

pp. 145-148

Author(s):

Azhar Farooqui ◽

◽

Thomas Key ◽

Ugochukwu Ihekwaba ◽

Kai Hogrefe ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Cardiac Pacemaker ◽

Low Molecular Weight ◽

Pacemaker Lead ◽

Medical Assessment ◽

Lead Perforation ◽

Treatment Dose ◽

Assessment Unit

Myocardial perforation is a rare yet serious complication following cardiac pacemaker or defibrillator device procedures. In this article, the authors describe a case of right ventricular pacemaker lead perforation presenting to our hospital’s medical assessment unit with a clinical presentation suggestive of an acute pulmonary embolism. Treatment dose low molecular weight heparin (LMWH) was commenced while awaiting CT scan. CT images were negative for PE however demonstrated RV lead perforation. Echocardiogram demonstrated pericardial effusion with the tip of RV lead in the pericardial free space. A rapid deterioration in the patient’s haemodynamics prompted an emergency pericardial drain insertion and successful RV lead re-position in the cardiac catheter lab. The patient recovered well and was discharged with routine pacemaker clinic follow-up.

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Recurrent pericarditis: a case report and literature review

Acta medica Lituanica ◽

10.6001/actamedica.v24i3.3550 ◽

2017 ◽

Vol 24 (3) ◽

pp. 159-166 ◽

Cited By ~ 1

Author(s):

Justina Katinaitė ◽

Birutė Petrauskienė

Keyword(s):

Clinical Symptoms ◽

Response To Therapy ◽

Patient Treatment ◽

First Episode ◽

Common Disease ◽

Recurrent Pericarditis ◽

Acute Pericarditis ◽

Pericardial Diseases ◽

Initial Episode ◽

Anti Inflammatory

Background. Recurrence affects about 30% (20% to 50%) of patients within 18 months after the initial episode of acute pericarditis resulting in subsequent rehospitalizations. Bearing in mind high treatment costs of patients admitted to hospital with acute and recurrent pericarditis, there is a need to optimize the treatment of both of these conditions. Materials and methods. We present a case of recurrent pericarditis. The first episode of pericarditis was diagnosed in 2006. Three months later the patient was hospitalized due to clinical symptoms suggesting recurrence of a past condition. Ten years after the initial episode of acute pericarditis the patient was hospitalized for the treatment of recurrent pericarditis. The search for etiology of the disease was unsuccessful, the patient received treatment with nonsteroidal anti-inflammatory drugs; empiric antimicrobial therapy was also administered. Results and conclusions. Acute pericarditis is the most common disease of the pericardium encountered in clinical practice. Colchicine has been demonstrated as a first-line drug to be added to conventional anti-inflammatory therapies in patients with a first episode of pericarditis or its recurrences in order to improve the response to therapy and reduce recurrences. Despite a large amount of new data, there are still several issues that require additional research and clarification, including the search for new individualized therapies, the best duration of treatment for patients with pericardial diseases, and optimization of patient follow-up in order to collect data on long-term outcomes that would allow shortening the duration of in-patient treatment and reduction of recurrences.

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Emerging Therapies for Recurrent Pericarditis: Interleukin‐1 inhibitors

Journal of the American Heart Association ◽

10.1161/jaha.121.021685 ◽

2021 ◽

Vol 10 (19) ◽

Author(s):

Saberio Lo Presti ◽

Tarec K. Elajami ◽

Reza Reyaldeen ◽

Chris Anthony ◽

Massimo Imazio ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Interleukin 1 ◽

Poor Quality ◽

Adverse Outcomes ◽

Current Evidence ◽

First Episode ◽

Inflammatory Disorder ◽

Recurrent Pericarditis ◽

Acute Pericarditis ◽

Beneficial Impact

Abstract Recurrent pericarditis (RP) is a complex inflammatory disorder associated with adverse outcomes and poor quality of life. After the first episode of acute pericarditis, a non‐negligible group of patients will fail to achieve complete remission despite treatment and will be challenged by side effects from the chronic use of medications like corticosteroids. The cause of RP remains unknown in the majority of cases, mainly due to a gap in knowledge of its complex pathophysiology. Over the past 2 decades, the interleukin‐1 (IL‐1) pathway has been uncovered as a key element in the inflammatory cascade, allowing the development of pharmacological targets known as IL‐1 inhibitors. This group of medications has emerged as a treatment option for patients with RP colchicine‐resistance and steroid dependents. Currently, anakinra and rilonacept, have demonstrated beneficial impact in clinical outcomes with a reasonable safety profile in randomized clinical trials. There is still paucity of data regarding the use of canakinumab in the treatment of patients with RP. Although further studies are needed to refine therapeutic protocols and taper of concomitant therapies, IL‐1 inhibitors, continue to consolidate as part of the pharmacological armamentarium to manage this complex condition with potential use as monotherapy. The aim of this review is to highlight the role of IL‐1 pathway in RP and discuss the efficacy, safety, and clinical applicability of IL‐1 inhibitors in the treatment of RP based on current evidence.

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Anakinra for constrictive pericarditis associated with incessant or recurrent pericarditis

Heart ◽

10.1136/heartjnl-2020-316898 ◽

2020 ◽

Vol 106 (20) ◽

pp. 1561-1565 ◽

Cited By ~ 2

Author(s):

Alessandro Andreis ◽

Massimo Imazio ◽

Carla Giustetto ◽

Antonio Brucato ◽

Yehuda Adler ◽

...

Keyword(s):

Constrictive Pericarditis ◽

Disease Duration ◽

Interleukin 1 ◽

Efficacy And Safety ◽

Recurrent Pericarditis ◽

Once Daily ◽

Increased Risk ◽

Colchicine Resistance ◽

Third Line

ObjectiveFrequent flares of pericardial inflammation in recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance may represent a risk factor for constrictive pericarditis (CP). This study was aimed at the identification of CP in these patients, evaluating the efficacy and safety of anakinra, a third-line treatment based on interleukin-1 inhibition, to treat CP and prevent the need for pericardiectomy.MethodsConsecutive patients with recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance were included in a prospective cohort study from 2015 to 2018. Enrolled patients received anakinra 100 mg once daily subcutaneously. The primary end point was the occurrence of CP. A clinical and echocardiographic follow-up was performed at 1, 3, 6 months and then every 6 months.ResultsThirty-nine patients (mean age 42 years, 67% females) were assessed, with a baseline recurrence rate of 2.76 flares/patient-year and a median disease duration of 12 months (IQR 9–20). During follow-up, CP was diagnosed in 8/39 (20%) patients. After anakinra dose of 100 mg/day, 5 patients (63%) had a complete resolution of pericardial constriction within a median of 1.2 months (IQR 1–4). In other three patients (37%), CP became chronic, requiring pericardiectomy within a median of 2.8 months (IQR 2–5). CP occurred in 11 patients (28%) with incessant course, which was associated with an increased risk of CP over time (HR for CP 30.6, 95% CI 3.69 to 253.09).ConclusionsIn patients with recurrent or incessant pericarditis, anakinra may have a role in CP reversal. The risk of CP is associated with incessant rather than recurrent course.

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AB0785 TREATING IDIOPATHIC RECURRENT PERICARDITIS WITH INTERLEUKIN-1 INHIBITORS - A SINGLE CENTER EXPERIENCE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4037 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1418.1-1418

Author(s):

P. Andel ◽

S. Brådland ◽

G. Haugeberg

Keyword(s):

Emergency Department ◽

Side Effects ◽

Interleukin 1 ◽

Optimal Treatment ◽

Daily Injection ◽

Second Line ◽

Recurrent Pericarditis ◽

Esc Guidelines ◽

Anakinra Treatment

Background:Pericarditis is a common disease with significant morbidity (1). Idiopathic pericarditis, where an underlying cause cannot be identified, makes up for 80% of cases in the Western World (1). Up to 30% of these patients experience recurrence despite optimal treatment (2). Idiopathic recurrent pericarditis (IRP) is thought to represent an auto-inflammatory process rather than a reinfection (3). 2015 European Society of Cardiology (ESC) guidelines have outlined treatment of acute episodes and first recurrence with nonsteroidal anti-inflammatory drugs (NSAID), acetyl salicylic acid (ASS) and Colchicine as first line and Glucocorticoids (GC) as second line treatment (3). However GC treatment increases the risk of relapse, dependence and toxicity (2). Interleukin-1 (IL-1) inhibitors have been proposed as possible treatments in IRP (3, 4).Objectives:The aim of this case study is to outline our first experiences treating IRP with the IL-1 inhibitor anakinra in our Rheumatologic clinic.Methods:All patients referred to our department in 2018/2019 with pericarditis were physically seen in our outpatient clinic. All patients were screened for malignancy, infection or rheumatologic disease as possible cause by clinical measures. Following ESC guideline, patients who suffered either the third recurrence under optimal treatment or significant side effects or dependency from GC were considered for anakinra treatment. Daily injection of anakinra (100mg) were given continuously over at least three months with gradual tapering over at least three months afterwards. Physical emergency department contacts, days hospitalized, colchicine- and GC use, the year prior to Anakinra treatment was recorded retrospectively. During follow up the same data was prospectively recorded.Results:Over the course of two years 20 patients were referred to our clinic. All fulfilled ESC diagnostic criteria for pericarditis at index episode. In none of the patients could a rheumatologic, infectious or malignant cause be identified. 16 patients could be treated according to 2015 ESC guidelines with first or second line agents. Four patients were aligned to anakinra-treatment. Prior to referral, duration of symptoms was 5 - 120 months (mean 61 months). Further relevant patient- characteristics are outlined in Table 1.After initiation of anakinra patients were afterwards regularly followed up in scheduled visits every 3 months.Table 1.Characteristics of the four patients aligned to anakinra prior to anakinra-initiation.PatientNumber of recurrencesNumber emergency hospital contacts related to IRP the year prior to nakinraDays hospitalized related to IRP the year prior to anakinraGC dose prior to anakinraotherI2237.5 mgsteroidglaucomaII72410 mgIII472220 mgIV731220 mgFollow-up after start of anakinra was 6-15 months (mean 11.5 months). No patient was admitted to hospital or emergency department in that period. All four patients could taper and stop GC without recurrence. One patient experienced a mild relapse after discontinuing anakinra and was restarted on a low dose with complete remission. No patient had elevated CRP values at the end of follow-up and no patient experienced tamponade or clinical signs of constriction. No significant side effects were noted, no patient had to stop anakinra-treatment during follow up.Conclusion:Implementation of anakinra treatment in cases of complicated IRP was both secure and successful in our rheumatologic outpatient department. In our small sample we could confirm findings from bigger trials regarding effect- and side effect rates of anakinra treating IRP.References:[1]Klein A et al. Cardiol Rev. 2020 Epub ahead of print. PMID: 32956167.[2]Cremer P et al. J Am Coll Cardiol. 2016;68(21):2311-2328[3]Adler Y et alEuropean Heart Journal, 2015;36(42):2873–2885[4]Imazio M et al Eur J Prev Cardiol. 2020;27(9):956-964Disclosure of Interests:None declared

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