POS1565 ACUTE PERICARDITIS WITH PLEUROPULMONARY INVOLVEMENT, FEVER AND ELEVATED C-REACTIVE PROTEIN: A SYSTEMIC AUTOINFLAMMATORY DISEASE? A COHORT STUDY

• Published in: Annals of the rheumatic diseases Vol. 82; no. Suppl 1; pp. 1157 - 1158
• Main Authors: Pisacreta, A M, Mascolo, R, Nivuori, M, Caccia, C, G DI Marco, Carollo, C, Pedroli, A, Casarin, F, Tombetti, E, Brucato, A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2023
• Subjects: C-reactive protein; Cell number; Cohort analysis; Fever; Genotype & phenotype; Inflammation; Inflammatory diseases; Leukocytes (neutrophilic); Lymphocytes; Lymphopenia; Multivariate analysis; Neutrophilia; Neutrophils; Patients; Pericarditis; Pericardium; Peripheral blood; Phenotypes; Pleural effusion
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2023-eular.4755

BackgroundPericardial diseases may involve only the pericardium, or may be part of a systemic condition, with an inflammatory phenotype sharing similarities with autoinflammatory diseases.ObjectivesThis cohort study aims to describe the prevalence and features of systemic phenotype of pericarditis characterized by pleuropulmonary involvement, fever, and elevation of C-reactive protein (CRP), comparing this phenotype with other forms of pericarditis.MethodsAll patients in our center were enrolled in a prospectively maintained registry from 2019 to 2022. 412 patients with idiopathic recurrent pericarditis were analyzed. “Systemic” subset was defined as the presence of all of the following criteria: fever > 38 C°, CRP higher than 2 times normal values, pleural effusion detected with any imaging techniques. The absence of any of the 3 criteria was defined as “isolated” subset.ResultsWe found that 211 (51.2%) of 412 patients presented the systemic subset and the variables significantly associated with this subset in univariate analysis (p<0.001) were: higher mean age of onset 45.5 (±SD 17.2) vs 39.9 (±SD 16.4) years, higher mean CRP values 128.8 (95% CI 117.8-139.8) vs 49.9 (95% CI 41.5-58.3) mg/L, higher proportion of pericardiocentesis 40 (19%) vs 3 (1.5%), higher mean leukocyte count 13143.3 (95% CI 12790.4-13496.2) vs 9910.3 (95% CI 9556.2-10264.4)/mm3, higher mean neutrophils number 10402.5 (95% CI 10082.1-10723) vs 6779.8 (95% CI 6505.2-7054.4)/mm3 and lower mean lymphocyte count 1693.9 (95% CI 1621.9-1765.8) vs 2079.3 (95% CI 1979-2179.6)/mm3. As results the neutrophil-to-lymphocyte ratio was higher in systemic phenotype: 6.6 (95% CI 6.2-6.9) vs 3.4 (95% CI 3.3-3.6). Anti-IL1 therapy was started more frequently in the systemic subgroup (55/211, 26%) than in the isolated subset (15/201, 7.5%) (p < 0.001). On multivariate analysis neutrophil count and lymphopenia, were statistically associated with the systemic subset (p < 0.001).ConclusionThese results demonstrate the clinical relevance of the systemic phenotype in a referral center and confirm its analogy with the autoinflammatory diseases, suggesting a pivotal role of IL1 in the genesis of this subset.References[1]Lopalco G, Rigante D, Cantarini L, et al., The autoinflammatory side of recurrent pericarditis: Enlightening the pathogenesis for a more rational treatment. Trends Cardiovasc Med 2021;31:265-274. doi: 10.1016/j.tcm.2020.04.006.[2]Tombetti E, Casarin F, Bizzi E, et al. Relapsing pericarditis: peripheral blood neutrophilia, lymphopenia and high neutrophil-to-lymphocyte ratio herald acute attacks, high-grade inflammation, multiserosal involvement, and predict multiple recurrences. Int J Rheum Dis. 2022. doi: 10.1111/1756-185X.14523. Online ahead of print.Acknowledgements:NIL.Disclosure of InterestsNone Declared.