Abstract
Idiopathic recurrent pericarditis(IRP) is characterized by resistant to therapy recurrences. We have studied the effect of chronic treatment with azathioprine and aspirin (A) on 6 patients(pt) 10-15 yr old, with severe (more than 3 relapses per yr) IRP. Antibody studies showed recent infection with Coxsakie B4 in 2 pt. No collagen disorder was found. All pt developed pericardial pain, cardiomegaly, EEG and echocardiographic abnormalities of pericarditis 1 to 3 mo after discontinuation of a 3 to 8 wk treatment with corticosteroids or A (5 pt) and A or indomethacin (1 pt). In two pt reduction of the dose of prednisone below 5 mg × 2/day resulted in recurrence of pericarditis. Administration of azathioprine (1-2 mg/kg/day) (2 pt) or A (starting dose 100 mg/kg/24hr, maintenance 70-80 mg/kg/24hr) for at least 6 mo (4 pt) resulted in disappearance of relapses till today (observation 1-6 yr). The findings indicate that: (1) the recurrences of IRP can be prevented by chronic administration of A; (2) azathioprine may be useful as an alternate drug for pt who may fail on A; (3) corticosteroids suppress the symptoms but even if chronically administerd do not prevent recurrences; and (4) the relapses of IRP result from an autoimmune mechanism, rather than from recurrences of viral infections.
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