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Autoimmunity and autoinflammation as the yin and yang of idiopathic recurrent acute pericarditis.
[familial mediterranean fever]
Autoimmunity
and
autoinflammation
are
generally
considered
as
mutually
exclusive
mechanisms
of
diseases
but
may
concur
to
specific
syndromes
.
Idiopathic
recurrent
acute
pericarditis
(
IRAP
)
is
defined
as
the
recurrence
of
pericardial
symptoms
at
any
point
following
the
prior
cessation
of
acute
pericarditis
,
and
the
latency
is
generally
6
weeks
.
Manifestations
of
pericarditis
such
as
pericardial
friction
rub
,
electrocardiographic
changes
,
and
pericardial
effusion
are
less
frequent
in
the
subsequent
episodes
compared
to
the
index
attack
,
and
in
some
cases
the
only
clinical
sign
is
represented
by
a
suggestive
chest
pain
.
Several
autoimmune
diseases
may
manifest
with
pericarditis
which
is
often
related
to
viral
infections
,
while
postviral
pericarditis
may
in
turn
display
a
nonspecific
autoimmune
background
.
Similarly
,
autoinflammatory
syndromes
such
as
familial
Mediterranean
fever
and
tumor
necrosis
factor
receptor-associated
periodic
syndrome
are
characterized
by
self-limiting
pericardial
symptoms
.
Corticosteroids
are
generally
effective
,
thus
supporting
the
autoimmune
nature
of
IRAP
,
but
dramatic
results
are
obtained
with
interleukin-
1
blocking
agents
in
corticosteroid-dependent
cases
,
pointing
to
a
pathogenic
role
for
the
inflammasome
.
Based
on
these
observations
,
we
submit
that
IRAP
represents
a
paradigmatic
example
of
the
putative
coexistence
of
autoimmunity
and
autoinflammation
:
the
main
aim
of
this
review
is
to
critically
discuss
the
hypothesis
as
well
as
the
current
understanding
of
this
enigmatic
clinical
condition
.
Diseases
Validation
Diseases presenting
"pericardial effusion"
symptom
acute rheumatic fever
cushing syndrome
erdheim-chester disease
familial mediterranean fever
primary effusion lymphoma
pyomyositis
systemic capillary leak syndrome
This symptom has already been validated