Following the approximately 1,200 reports of mild cases of myocarditis and pericarditis potentially linked to COVID-19 vaccinations among younger patients, the CDC has issued new guidance about handling the concerns individuals have regarding cardiac inflammation. In relation to the COVID-19 vaccine, the instances of this inflammation represent an extremely rare side effect, and most individuals who experienced it have fully recovered. While the majority of cases reported have been mild and able to resolve with little to no treatment, pericardial disease itself can be quite serious. Individuals with chronic, recurrent pericarditis cope with debilitating symptoms that can harm their quality of life. If the disease becomes severe enough, it has the potential to lead to abnormal heart rhythm and death. A newly approved therapy is helping overcome the therapeutic challenges of refractory recurrent pericarditis.
Men aged 16 to 65 are more likely to develop pericarditis, though it can affect people of all ages. Among individuals who experience acute pericarditis, nearly 30% may have a subsequent experience, and a small subset of those could develop chronic pericarditis. It is the inflammation of the sac-like structure holding the heart in place that is referred to as pericarditis. When a patient experiences remitting-relapsing inflammation (or symptoms of fluctuating severity) of the pericardium, the condition is referred to as recurrent pericarditis. It is a painful disease and can feel like the pain from a heart attack. This type of symptom may be caused by the inflammation of the pericardium rubbing against the heart itself. There are two serious complications of pericarditis, which are cardiac tamponage and chronic constrictive pericarditis. When excess fluid collects in the pericardium, there is too much pressure placed upon the heart. This, in turn, reduces the heart’s capacity to fill, and therefore less blood exits the heart, resulting in drastically lowered blood pressure. If this is untreated, the condition can be fatal. Chronic constrictive pericarditis occurs after a significant amount of time passes that allows the pericardium to develop scar-like tissue, which causes it to become inflexible and compresses the heart, preventing it from proper functioning. Many patients experience arrhythmias such as atrial fibrillation.
Depending on the etiology of the pericarditis, patients may be able to be effectively treated with over-the-counter NSAIDs, such as aspirin
. More severe cases may require control of inflammation using adjunctive colchicine
. These therapies are often highly effective for symptom control and can help reduce the risk of further complications, including recurrent pericarditis, cardiac tamponade, and constrictive pericarditis. Certain individuals do experience pericarditis that is not controlled by standard-of-care therapies. The recent approval of Arcalyst (rilonacept)
injection is the first approved treatment for recurrent pericarditis in adults and adolescents. The drug became commercially available in April 2021. It is a weekly, subcutaneously-injected, recombinant fusion protein that blocks IL-1α and IL-1β signaling. It disrupts the autoinflammation cycle of recurrent pericarditis. This controlled inhibition can give much more targeted therapy for specific patients, helping to resolve acute episodes and reduce the risk of pericarditis recurrence.