From the Guidelines
Myopericarditis is indeed associated with autoimmune conditions, and approximately 5-15% of patients with acute or recurrent pericarditis may have a systemic autoimmune disease. Myopericarditis, which is inflammation of both the heart muscle (myocardium) and the surrounding membrane (pericardium), is frequently associated with several autoimmune disorders, particularly systemic lupus erythematosus, rheumatoid arthritis, and systemic sclerosis, as noted in the 2015 ESC guidelines 1. The connection occurs because autoimmune conditions involve the immune system mistakenly attacking the body's own tissues, including heart tissues.
Key Autoimmune Conditions Associated with Myopericarditis
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Systemic sclerosis
- Sjögren’s syndrome
- Scleroderma
- Systemic vasculitides
- Behçet’s syndrome
- Sarcoidosis
- Inflammatory bowel diseases
In these cases, treatment typically addresses both the underlying autoimmune condition and the cardiac inflammation. Management often includes immunosuppressive medications such as corticosteroids (prednisone at 0.5-1 mg/kg/day), colchicine (0.5-0.6 mg once or twice daily), and sometimes stronger immunomodulators like azathioprine, methotrexate, or mycophenolate mofetil, as suggested by the guidelines 1. NSAIDs may be used for pain and inflammation but should be used cautiously in cardiac patients. The autoimmune-related myopericarditis occurs through mechanisms involving autoantibodies, immune complex deposition, and cytokine-mediated inflammation that directly damage cardiac tissues.
Importance of Early Detection and Treatment
Patients with autoimmune disorders should be monitored regularly for cardiac complications, as early detection and treatment of myopericarditis can significantly improve outcomes and prevent long-term cardiac damage, a principle supported by the more recent recommendations for sport participation in athletes with cardiomyopathies, myocarditis, and pericarditis 1. This highlights the importance of a multidisciplinary approach in managing patients with myopericarditis associated with autoimmune conditions.
From the Research
Association with Autoimmune Conditions
- Myopericarditis can be associated with autoimmune conditions, as it may be related to infectious and inflammatory prodrome 2.
- Pericarditis, which is a component of myopericarditis, can have several different underlying causes, including autoimmune etiologies 3.
- The etiology of pericarditis is varied and includes noninfectious causes such as autoimmune and autoinflammatory diseases 4.
- Recurrent pericarditis, a complication of acute pericarditis, may involve an intricate overlap of autoimmune and autoinflammatory pathways 5.
Treatment and Management
- The treatment of myopericarditis remains without clear direction and focuses on symptom control, with the use of NSAIDs often cautioned due to potential acceleration of the myocarditic process 2.
- Colchicine, a well-established anti-inflammatory agent, may have a role in the management of acute myopericarditis 2.
- Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of therapy in recurrent pericarditis, whereas colchicine is recommended on top of standard anti-inflammatory therapy 5.
- Blockade of IL-1 is a relevant advance in the treatment of recurrent pericarditis refractory to NSAIDs and colchicine, with the IL-1 receptor antagonist anakinra showing a beneficial approach in this disorder 5.