What to know about autoimmune pericarditis

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AP is a form of pericarditis, which is the term doctors use to describe inflammation of the protective sac-like lining around a person’s heart, called the pericardium.

This lining comprises two thin layers of tissue that surround the heart, holding it in place and helping it work. A small amount of fluid between the layers typically keeps them separate, reducing friction as a person’s heart beats.

However, inflammation may cause the layers to rub against a person’s heart. This, in turn, may cause chest pain and other pericarditis symptoms.

A range of conditions can lead to pericarditis. Healthcare professionals often group these causes into either infections or other types of health conditions. However, in potentially up to 90% of cases, doctors cannot establish exactly why pericarditis occurs.

If a person has AP, their own immune system is the cause. It mistakenly attacks their pericardium, causing inflammation. According to 2022 research, about 22% of all pericarditis cases with a known cause are the result of autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus.

According to the United Kingdom’s National Health Service, the principal symptom of pericarditis is chest pain that typically:

• causes a sharp or stabbing sensation
• spreads to a person’s arms, shoulders, or abdomen
• gets better when someone leans forward
• gets worse when someone:
  • swallows
  • coughs
  • breathes deeply
  • lies down, especially on their left side

The American Heart Association (AHA) suggests that this chest pain may feel similar to the pain of a heart attack. A person should call 911 if they are experiencing chest pain with the features listed above, as they may be experiencing a heart attack.

Some other symptoms people may experience include:

• cough
• chills
• fever
• painful joints

Having certain autoimmune disorders may cause a person to develop AP. Some examples of these conditions include:

• systemic lupus erythematosus
• Behçet’s disease
• rheumatoid arthritis
• vasculitis

These disorders may cause a range of symptoms. However, some autoimmune conditions may not cause any symptoms in the early stages. Additionally, some conditions can cause people to have AP that comes and goes over a long period of time.

Pericarditis can affect people at any age. However, males ages 16–65 years old are more likely to develop it.

Research suggests that people with AP tend to be younger. They also often have heart problems as well.

If a person has chest pain, they may have AP. However, the pain may also be a sign of something that requires urgent treatment. Doctors always check for other potentially life threatening causes first, such as aortic dissection and heart attack.

To diagnose AP, doctors also typically review a person’s medical history, including if they have experienced:

• autoimmune conditions
• recent heart attack
• a history of chest trauma, such as surgery or accidents
• tuberculosis (TB)
• recent viral infection
• kidney disease
• recent symptoms, which may include:
  • new rash
  • fever
  • aching joints

A healthcare professional may also ask a person to describe their chest pain. Pericarditis has a specific location and type of pain that doctors look for.

They may also examine a person using a stethoscope. The healthcare professional will listen for a characteristic sound that they may refer to as a “pericardial friction rub.”

Additionally, doctors may also order tests, including:

• chest X-ray
• electrocardiogram
• echocardiogram
• blood test

Finally, a healthcare professional may suggest other types of diagnostic tests to work out whether a person has an underlying autoimmune condition.

Doctors treat different kinds of pericarditis with different methods. They may advise a person rests and treat their pericarditis with:

• anti-inflammatory medication, such as aspirin
• nonsteroidal anti-inflammatory drugs, such as ibuprofen
• colchicine, which is a type of medication for treating inflammation and pain

However, research suggests that people with AP often do not experience a good response to colchicine. They also often need additional immunosuppressive medications, which help prevent a person’s immune system from mistakenly attacking their healthy cells and tissues.

Doctors may also treat pericarditis with a corticosteroid, such as prednisone. Corticosteroids are anti-inflammatory medications that doctors prescribe to treat several conditions.

A healthcare professional may also recommend additional treatments for any underlying autoimmune conditions.

Research indicates that AP may frequently come back.

Studies cited in a 2017 research paper indicate that 15–30% of people with autoimmune conditions may experience a complication that doctors call inflammatory recurrent acute pericarditis. This is when a person has acute pericarditis that keeps coming back.

AP may also cause people to have other complications, including cardiac tamponade and constrictive pericarditis, which refers to permanent scarring and thickening of the pericardium that can interfere with how the heart functions.

However, the AHA advises that while pericarditis complications can be serious or fatal, they are rare. A person should speak with their doctor about how to reduce their risk of experiencing AP complications.

AP is a condition that involves inflammation of the pericardium due to a person’s immune system mistakenly attacking the structure.

People with AP may experience several symptoms, including sharp or stabbing chest pain that may feel similar to a heart attack. If a person has this type of chest pain, they should immediately call 911.

Doctors may use a range of tests to diagnose the condition, including imaging and blood tests. They may also recommend medications to treat the condition, such as anti-inflammatory medications, corticosteroids, and immunosuppressive medications.

People with AP may have recurring symptoms or complications. However, a doctor will advise how someone can manage any underlying autoimmune conditions to help prevent complications.