Unifying Concepts

Diagnosis of Autoreactive Pericarditis

Recently, the term “autoreactive pericarditis” has been introduced to describe patients with identification of elements indicative of an autoimmune response who would otherwise be classed as idiopathic.

Diagnosis of Autoreactive Pericarditis
The diagnosis of autoreactive pericarditis is established using the following criteria:

  1. Increased number of lymphocytes and mononuclear cells >5000/mm3 (autoreactive lymphocytic), or the presence of antibodies against heart muscle tissue (antisarcolemmal) in the pericardial fluid (autoreactive antibody-mediated);
  2. Inflammation in epicardial/endomyocardial biopsies by P14 cells/mm2;
  3. Exclusion of active viral infection both in pericardial effusion and endomyocardial/epimyocardial biopsies (no virus isolation, no IgM-titer against cardiotropic viruses in pericardial effusion, and negative PCR for major cardiotropic viruses);
  4. Tuberculosis, Borrelia burgdorferi, Chlamydia pneumoniae, and other bacterial infection excluded by PCR and/or cultures;
  5. Neoplastic infiltration absent in pericardial effusion and biopsy samples;
  6. Exclusion of systemic, metabolic disorders, and uraemia. Intrapericardial treatment with triamcinolone is highly efficient with rare side effects.

Pericarditis occurs in systemic autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus, progressive systemic sclerosis, polymyositis/ dermatomyositis, mixed connective tissue disease, seronegative spondyloarthropathies, systemic and hypersensitivity vasculitides, Behçet syndrome, Wegener granulomatosis, and sarcoidosis. Intensified treatment of the underlying disease and symptomatic management are indicated.



  1. Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmüller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH; Task Force on the Diagnosis and Management of Pricardial Diseases of the European Society of Cardiology. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004 Apr;25(7):587-610. [Medline]
  2. Sagristà Sauleda J1, Permanyer Miralda G, Soler Soler J. Diagnosis and management of acute pericardial syndromes. Rev Esp Cardiol. 2005 Jul;58(7):830-41.[Medline]
  3. LeWinter MM. Clinical practice. Acute pericarditis. N Engl J Med. 2014 Dec 18;371(25):2410-6. [Medline]
  4. Maisch B, Ristic AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy. Eur Heart J. 2002 Oct;23(19):1503-8. [Medline]


Created Mar 16, 2015.

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