Long-term echocardiographic findings in patients with idiopathic recurrent pericarditis treated with anakinra.

aimIdiopathic recurrent pericarditis (IRP) is considered an autoinflammatory disease, and interleukin 1 inhibitors, such as anakinra, are used to treat resistant cases. Constrictive pericarditis, a feared complication, continues to be a critical concern. In the biologic era, evidence on long-term transthoracic echocardiographic (TTE) findings following anakinra treatment remains limited.

methodsWe conducted a cross-sectional study that included 18 patients with IRP treated with anakinra who had been attack-free for at least 3 months. TTE was performed on all patients and 21 healthy controls, and findings were compared between the groups.

resultsPericardial thickness was significantly increased in patients compared with controls (3.1 mm (interquartile range (IQR): 3.0-3.4) vs 2.1 mm (IQR: 1.9-2.4), P < 0.001). None of the patients exhibited echocardiographic signs of constrictive pericarditis. Mild pericardial effusion was present in nine patients (50%) despite being attack-free. Pericardial hyperechogenicity was observed in 61.1% of the patient group and 23.8% of the control group (P = 0.018). In the subgroup analysis of patients receiving ongoing anakinra treatment and those who had discontinued, there were no significant differences in pericardial thickness (P = 0.573), pericardial effusion (P = 0.637) or pericardial hyperechogenicity (P = 0.066).

conclusionIn conclusion, despite the refractory course of the disease, no cases of constrictive pericarditis were identified. TTE evaluation revealed increased pericardial thickness in patients who received anakinra compared with healthy controls, despite being attack-free. Further studies are needed to clarify whether the presence of pericardial thickening or ongoing pericardial effusion should influence treatment planning.