Побочные эффекты и неэффективность стандартной терапии идиопатического рецидивирующего перикардита: состояние проблемы и описание клинических случаев - Журнал Терапевтический архив №8 Вопросы лечения 2025

Побочные эффекты и неэффективность стандартной терапии идиопатического рецидивирующего перикардита: состояние проблемы и описание клинических случаев

Петрухина А.А., Сафиуллина А.А., Осмоловская Ю.Ф., Жиров И.В., Стукалова О.В., Шитов В.Н., Терещенко С.Н. Побочные эффекты и неэффективность стандартной терапии идиопатического рецидивирующего перикардита: состояние проблемы и описание клинических случаев. Терапевтический архив. 2025;97(8):719–726. DOI: 10.26442/00403660.2025.08.203342

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Petrukhina AA, Safiullina AA, Osmolovskaya YuF, Zhirov IV, Stukalova OV, Shitov VN, Tereshchenko SN. Side effects and ineffectiveness of standard therapy for idiopathic recurrent pericarditis: status of the problem and description of clinical cases. Case report. Terapevticheskii Arkhiv (Ter. Arkh.). 2025;97(8):719–726. DOI: 10.26442/00403660.2025.08.203342

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Аннотация

Идиопатический рецидивирующий перикардит – редкая патология, характеризующаяся рецидивирующим воспалением в полости сердечной сорочки. Лечение рецидивирующего перикардита – эмпирическое, и оно основано на применении препаратов с противовоспалительными свойствами. Препаратами 1-й линии терапии являются нестероидные противовоспалительные препараты и колхицин, 2-й линии – глюкокортикостероиды. Однако их применение сопряжено с развитием нежелательных побочных явлений, что делает невозможным продолжение терапии у ряда пациентов. В статье представлены 2 клинических случая, описывается течение заболевания и развитие осложнений на разных его этапах. Демонстрируется сложность подбора оптимальной терапии в реальной клинической практике.

Ключевые слова: идиопатический рецидивирующий перикардит, перикардит, нестероидный противовоспалительный препарат, глюкокортикостероид, выпот в полости перикарда

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Idiopathic recurrent pericarditis is a rare pathology characterised by recurrent inflammation in the cardiac cavity. Treatment of recurrent pericarditis is empirical and based on the use of drugs with anti-inflammatory properties. First-line drugs are non-steroidal anti-inflammatory drugs and colchicine, second-line drugs are glucocorticosteroids. This is associated with the development of undesirable side effects, which makes it impossible to continue therapy in a number of patients. This article presents two clinical cases, describes the course of the disease and the development of complications at different stages. This article demonstrates the complexity of selecting the optimal therapy in real clinical practice.

Keywords: idiopathic recurrent pericarditis, pericarditis, non-steroidal anti-inflammatory drug, glucocorticosteroid, pericardial effusion

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Список литературы

1. Brucato A, Imazio M, Cremer PC, et al. Recurrent pericarditis: Still idiopathic? The pros and cons of a well-honoured term. Intern Emerg Med. 2018;13(6):839-44. DOI:10.1007/s11739-018-1907-x
2. Imazio M, Belli R, Brucato A, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): A multicentre, double-blind, placebo-controlled, randomised trial. Lancet. 2014;383(9936):2232-7. DOI:10.1016/S0140-6736(13)62709-9
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9. De Nardo D. Toll-like receptors: Activation, signalling and transcriptional modulation. Cytokine. 2015;74(2):181-9. DOI:10.1016/j.cyto.2015.02.025
10. Latz E, Xiao TS, Stutz A. Activation and regulation of the inflammasomes. Nat Rev Immunol. 2013;13(6):397-411. DOI:10.1038/nri3452
11. Rieber N, Gavrilov A, Hofer L, et al. A functional inflammasome activation assay differentiates patients with pathogenic NLRP3 mutations and symptomatic patients with low penetrance variants. Clin Immunol. 2015;157(1):56-64. DOI:10.1016/j.clim.2015.01.003
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13. van Kempen TS, Wenink MH, Leijten EF, et al. Perception of self: Distinguishing autoimmunity from autoinflammation. Nat Rev Rheumatol. 2015;11(8):483-92. DOI:10.1038/nrrheum.2015.60
14. Cavalli G, Colafrancesco S, Emmi G, et al. Interleukin 1α: A comprehensive review on the role of IL-1α in the pathogenesis and treatment of autoimmune and inflammatory diseases. Autoimmun Rev. 2021;20(3):102763. DOI:10.1016/j.autrev.2021.102763
15. Kougkas N, Fanouriakis A, Papalopoulos I, et al. Canakinumab for recurrent rheumatic disease associated-pericarditis: A case series with long-term follow-up. Rheumatology (Oxford). 2018;57(8):1494-5. DOI:10.1093/rheumatology/key077
16. García-García G, Fernández-Auzmendi V, Olgado-Ferrero F, et al. Acute miopericarditis as the presenting feature of adult-onset Still’s disease. Reumatología Clínica (English Edition). 2012;8(1):31-3 (in Spanish). DOI:10.1016/j.reumae.2011.03.002
17. Мячикова В.Ю., Маслянский А.Л., Гайдукова И.З., и др. Трудности диагностики и лечения болезни Стилла взрослых, протекавшей с экссудативным перикардитом в качестве ведущего клинического проявления. Современная ревматология. 2016;10(1):31-6 [Myachikova VYu, Maslyansky AL, Gaydukova IZ, et al. Difficulties in diagnosis and treatment of adult-onset Still’s disease concurrent with pericardial effusion as a leading clinical manifestation. Sovremennaya Revmatologia = Modern Rheumatology Journal. 2016;10(1):31-6 (in Russian)]. DOI:10.14412/1996-7012-2016-1-31-36
18. Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for Recurrent pericaditis: High versus Low doses: A nonrandomized observation. Circulation. 2008;118(6):667-71. DOI:10.1161/CIRCULATIONAHA.107.761064
19. Cantarini L, Lucherini OM, Frediani B, et al. Bridging the gap between the clinician and the patient with cryopyrin-associated periodic syndromes. Int J Immunopathol Pharmacol. 2011;24(4):827-36. DOI:10.1177/039463201102400402
20. Lucas GNC, Leitao ACC, Alencar RL, et al. Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs. J Bras Nefrol. 2019;41(1):124-30. DOI:10.1590/2175-8239-JBN-2028-0107
21. Ziya Şener Y, Okşul M. Effects of NSAIDs on kidney functions and cardiovascular system. J Clin Hypertens (Greenwich). 2020;22(2):302. DOI:10.1111/jch.13769
22. Pivonello R, Isidori AM, De Martino MC, et al. Complications of Cushing's syndrome: Current state. Lancet Diabetes Endocrinol. 2016;4(7):611-29. DOI:10.1016/S2213-8587(16)00086-3
23. Reinke M. Myopathy associated with Cushing's syndrome: It's time for a change. Endocrinol Metab (Seoul). 2021;36(3):564-71. DOI:10.3803/EnM.2021.1069
24. O'Brien CA, Jia D, Plotkin LI, et al. Glucocorticoids act directly on osteoblasts and osteocytes, causing their apoptosis and reducing bone formation and strength. Endocrinology. 2004;145(4):1835-41. DOI:10.1210/en.2003-0990
25. Lane NE, Yao W, Balooch M, et al. In mice treated with glucocorticoid therapy, local changes in the properties of trabecular bone material and the size of osteocyte lacunae were observed, which were not observed in mice treated with placebo or deficient in estrogen. J Bone Miner Res. 2006;21(3):466-76. DOI:10.1359/JBMR.051103
26. Canalis E, Delany AM. Mechanisms of action of glucocorticoids in bones. Ann NY Acad Sci. 2002;966:73-81. DOI:10.1111/j.1749-6632.2002.tb04204.x
27. Каратеев А.Е., Насонов Е.Л., Яхно Н.Н., и др. Клинические рекомендации «Рациональное применение нестероидных противовоспалительных препаратов (НПВС) в клинической практике». Современная ревматология. 2015;9(1):4-23 [Karateev AE, Nasonov EL, Yakhno NN, et al. Clinical recommendations "Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice". Modern Rheumatology. 2015;9(1):4-23 (in Russian)]. DOI:10.14412/1996-7012- 2015-1-4-23
28. Moskowitz RW, Abramson SB, Berenbaum F, et al. Coxibs and NSAIDs – is the air any clearer? Perspectives from the OARSI/International COX-2 Study Group Workshop 2007. Osteoarthritis Cartilage. 2007;15(8):849-56. DOI:10.1016/j.joca.2007.06.012
29. Каратеев А.Е., Мороз Е.В. Влияют ли глюкокортикоиды на развитие язв и эрозий верхних отделов желудочно-кишечного тракта у больных, принимающих НПВС? Терапевтический архив. 2018;90(5):50-4 [Karateev AE, Moroz EV. Do glucocorticoids affect the development of ulcers and erosions of the upper gastrointestinal tract in patients taking NSAIDs? Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(5):50-4 (in Russian)]. DOI:10.26442/ terarkh201890550-54
30. Deftereos S, Giannopoulos G, Papoutsidakis N, et al. Colchicine and the heart: Going beyond the limits. J Am Coll Cardiol. 2013;62(20):1817-25. DOI:10.1016/j.jacc.2013.08.726
31. Leung YY, Yao Hui LL, Kraus VB. Colchicine – Updated information on the mechanisms of action and therapeutic use. Semin Arthritis Rheum. 2015;45(3):341-50. DOI:10.1016/J.semarthrit.2015.06.013
32. Stewart S, Yang KCK, Atkins K, et al. Side effects of oral colchicine: A systematic review and meta-analysis of randomized controlled trials. Arthritis Res Ther. 2020;22(1):28. DOI:10.1186/s13075-020-2120-7
33. Tardif JC, Bouabdallaoui N, L'Allier PL, et al. Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial. Lancet Respir Med. 2021;9(8):924-32. DOI:10.1016/S2213-2600(21)00222-8

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1. Brucato A, Imazio M, Cremer PC, et al. Recurrent pericarditis: Still idiopathic? The pros and cons of a well-honoured term. Intern Emerg Med. 2018;13(6):839-44. DOI:10.1007/s11739-018-1907-x
2. Imazio M, Belli R, Brucato A, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): A multicentre, double-blind, placebo-controlled, randomised trial. Lancet. 2014;383(9936):2232-7. DOI:10.1016/S0140-6736(13)62709-9
3. Myachikova VYu, Maslyansky AL, Moiseeva OM. Is idiopathic recurrent pericarditis a new orphan autoinflammatory disease? A retrospective analysis of cases of idiopathic recurrent pericarditis and a plan for a randomized, placebo-controlled trial to evaluate the therapeutic efficacy and safety of an IL-1 blocker (RPH-104). Cardiology. 2021;61(1):72-7 (in Russian). DOI:10.18087/cardio.2021.1.n1475
4. Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of acute and recurrent pericarditis: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(1):76-92. DOI:10.1016/j.jacc.2019.11.021
5. Imazio M, Gaita F. Diagnosis and treatment of pericarditis. Heart. 2015;101(14):1159-68. DOI:10.1136/heartjnl-2014-306362
6. Zipes D, Libby P, Bonow R, et al. Braunwald's heart disease: A textbook of cardiovascular medicine. 2-Volume Set, 11th Ed. Philadelphia: Elsevier, 2019.
7. Moiseev S, Rameev V. Differential diagnosis of systemic autoinflammatory diseases. Klinicheskaya farmakologiya i terapiya = Clin Pharmacol Ther. 2022;31(2):5-13 (in Russian). DOI:10.32756/0869-5490-2022-2-5-132
8. Lazaros G, Antonatou K, Vassilopoulos D. The therapeutic role of interleukin-1 inhibition in idiopathic recurrent pericarditis: Current evidence and future challenges. Front Med (Lausanne). 2017;4:78. DOI:10.3389/fmed.2017.00078
9. De Nardo D. Toll-like receptors: Activation, signalling and transcriptional modulation. Cytokine. 2015;74(2):181-9. DOI:10.1016/j.cyto.2015.02.025
10. Latz E, Xiao TS, Stutz A. Activation and regulation of the inflammasomes. Nat Rev Immunol. 2013;13(6):397-411. DOI:10.1038/nri3452
11. Rieber N, Gavrilov A, Hofer L, et al. A functional inflammasome activation assay differentiates patients with pathogenic NLRP3 mutations and symptomatic patients with low penetrance variants. Clin Immunol. 2015;157(1):56-64. DOI:10.1016/j.clim.2015.01.003
12. Swanson KV, Deng M, Ting JP. The NLRP3 inflammasome: molecular activation and regulation to therapeutics. Nat Rev Immunol. 2019;19(8):477-89. DOI:10.18087/cardio.2021.1.n1475
13. van Kempen TS, Wenink MH, Leijten EF, et al. Perception of self: Distinguishing autoimmunity from autoinflammation. Nat Rev Rheumatol. 2015;11(8):483-92. DOI:10.1038/nrrheum.2015.60
14. Cavalli G, Colafrancesco S, Emmi G, et al. Interleukin 1α: A comprehensive review on the role of IL-1α in the pathogenesis and treatment of autoimmune and inflammatory diseases. Autoimmun Rev. 2021;20(3):102763. DOI:10.1016/j.autrev.2021.102763
15. Kougkas N, Fanouriakis A, Papalopoulos I, et al. Canakinumab for recurrent rheumatic disease associated-pericarditis: A case series with long-term follow-up. Rheumatology (Oxford). 2018;57(8):1494-5. DOI:10.1093/rheumatology/key077
16. García-García G, Fernández-Auzmendi V, Olgado-Ferrero F, et al. Acute miopericarditis as the presenting feature of adult-onset Still’s disease. Reumatología Clínica (English Edition). 2012;8(1):31-3 (in Spanish). DOI:10.1016/j.reumae.2011.03.002
17. Myachikova VYu, Maslyansky AL, Gaydukova IZ, et al. Difficulties in diagnosis and treatment of adult-onset Still’s disease concurrent with pericardial effusion as a leading clinical manifestation. Sovremennaya Revmatologia = Modern Rheumatology Journal. 2016;10(1):31-6 (in Russian). DOI:10.14412/1996-7012-2016-1-31-36
18. Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for Recurrent pericaditis: High versus Low doses: A nonrandomized observation. Circulation. 2008;118(6):667-71. DOI:10.1161/CIRCULATIONAHA.107.761064
19. Cantarini L, Lucherini OM, Frediani B, et al. Bridging the gap between the clinician and the patient with cryopyrin-associated periodic syndromes. Int J Immunopathol Pharmacol. 2011;24(4):827-36. DOI:10.1177/039463201102400402
20. Lucas GNC, Leitao ACC, Alencar RL, et al. Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs. J Bras Nefrol. 2019;41(1):124-30. DOI:10.1590/2175-8239-JBN-2028-0107
21. Ziya Şener Y, Okşul M. Effects of NSAIDs on kidney functions and cardiovascular system. J Clin Hypertens (Greenwich). 2020;22(2):302. DOI:10.1111/jch.13769
22. Pivonello R, Isidori AM, De Martino MC, et al. Complications of Cushing's syndrome: Current state. Lancet Diabetes Endocrinol. 2016;4(7):611-29. DOI:10.1016/S2213-8587(16)00086-3
23. Reinke M. Myopathy associated with Cushing's syndrome: It's time for a change. Endocrinol Metab (Seoul). 2021;36(3):564-71. DOI:10.3803/EnM.2021.1069
24. O'Brien CA, Jia D, Plotkin LI, et al. Glucocorticoids act directly on osteoblasts and osteocytes, causing their apoptosis and reducing bone formation and strength. Endocrinology. 2004;145(4):1835-41. DOI:10.1210/en.2003-0990
25. Lane NE, Yao W, Balooch M, et al. In mice treated with glucocorticoid therapy, local changes in the properties of trabecular bone material and the size of osteocyte lacunae were observed, which were not observed in mice treated with placebo or deficient in estrogen. J Bone Miner Res. 2006;21(3):466-76. DOI:10.1359/JBMR.051103
26. Canalis E, Delany AM. Mechanisms of action of glucocorticoids in bones. Ann NY Acad Sci. 2002;966:73-81. DOI:10.1111/j.1749-6632.2002.tb04204.x
27. Karateev AE, Nasonov EL, Yakhno NN, et al. Clinical recommendations "Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice". Modern Rheumatology. 2015;9(1):4-23 (in Russian). DOI:10.14412/1996-7012- 2015-1-4-23
28. Moskowitz RW, Abramson SB, Berenbaum F, et al. Coxibs and NSAIDs – is the air any clearer? Perspectives from the OARSI/International COX-2 Study Group Workshop 2007. Osteoarthritis Cartilage. 2007;15(8):849-56. DOI:10.1016/j.joca.2007.06.012
29. Karateev AE, Moroz EV. Do glucocorticoids affect the development of ulcers and erosions of the upper gastrointestinal tract in patients taking NSAIDs? Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(5):50-4 (in Russian). DOI:10.26442/ terarkh201890550-54
30. Deftereos S, Giannopoulos G, Papoutsidakis N, et al. Colchicine and the heart: Going beyond the limits. J Am Coll Cardiol. 2013;62(20):1817-25. DOI:10.1016/j.jacc.2013.08.726
31. Leung YY, Yao Hui LL, Kraus VB. Colchicine – Updated information on the mechanisms of action and therapeutic use. Semin Arthritis Rheum. 2015;45(3):341-50. DOI:10.1016/J.semarthrit.2015.06.013
32. Stewart S, Yang KCK, Atkins K, et al. Side effects of oral colchicine: A systematic review and meta-analysis of randomized controlled trials. Arthritis Res Ther. 2020;22(1):28. DOI:10.1186/s13075-020-2120-7
33. Tardif JC, Bouabdallaoui N, L'Allier PL, et al. Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial. Lancet Respir Med. 2021;9(8):924-32. DOI:10.1016/S2213-2600(21)00222-8

Авторы

А.А. Петрухина¹, А.А. Сафиуллина*¹, Ю.Ф. Осмоловская¹, И.В. Жиров^1,2, О.В. Стукалова¹, В.Н. Шитов¹, С.Н. Терещенко^1,2

¹ФГБУ «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Россия;
²ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*a_safiulina@mail.ru

________________________________________________

Angelina A. Petrukhina¹, Alfiya А. Safiullina*¹, Yulia F. Osmolovskaya¹, Igor V. Zhirov^1,2, Olga V. Stukalova¹, Victor N. Shitov¹, Sergey N. Tereshchenko^1,2

¹Chazov National Medical Research Center of Cardiology, Moscow, Russia;
²Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*a_safiulina@mail.ru

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