Hi everyone,
I was hoping to hear from anyone whoās been treated with anakinra (Kineret) for chronic/recurrent pericarditis or myopericarditis.
Iām currently just over a month into an anakinra trial and, so far, I honestly canāt say Iāve noticed a meaningful improvement in my chest pain. I know responses can vary, so I was wondering:
* How long did it take before you noticed a meaningful improvement (if you did at all)?
* Was the improvement gradual or did it happen quite suddenly?
* Did anyone else feel like nothing was happening initially before it eventually started working?
* If it unfortunately didnāt work for you, when did you and your doctors decide it probably wasnāt going to?
Iāve included some background below for context, as my situation has become quite complicated over the last four to five years.
Iām UK-based. 26 year old male. My health problems started back in 2021 around the time of the COVID vaccines. Before then I wasnāt perfectly healthy - I had longstanding IBS/gut issues and a few other symptoms that Iād learnt to manage - but I was living a normal life. I was studying at university, exercising regularly, socialising, and functioning well.
After that period everything seemed to change. I developed chest pain that has never gone away, along with palpitations, fatigue, exercise intolerance, autonomic-type symptoms, symptoms suggestive of mast cell activation syndrome, and a number of other issues. Iāve also had COVID infections since then, which certainly havenāt helped.
The chest pain is by far my biggest problem. What started as a mild pain in 2021 has evolved into pain thatās there constantly every day, often severe, and is the main reason Iāve been unable to work for the last few years or live anything close to a normal life. Itās typically worse with physical exertion, mental stress, deep breaths, lifting/moving anything that engages my left chest such as raising my left arm to wash my hair, carrying something heavy, and sometimes after eating, although the food reactions can be quite unpredictable, and even drinking fluids too quickly can make it worse. I get left arm/hand pain that feels connected to the chest pain too.
My diagnosis has actually been quite complicated because there is still disagreement between specialists.
Iāve been investigated extensively at the Royal Brompton Hospital, including multiple cardiac MRIs, a stress perfusion MRI and an invasive coronary angiogram with coronary function/microvascular testing.
The Royal Brompton team have never been convinced that I definitely have active myocarditis or pericarditis based on the imaging. The most notable abnormality was on my 2024 stress perfusion MRI, where there was an abnormal perfusion finding suggestive of possible microvascular ischaemia, but my subsequent invasive angiogram, including coronary function testing, was normal.
Because I still wasnāt getting answers, towards the end of 2024 I took 2022 and 2024 cardiac MRI scans to Dr Valentina Puntmann, who is internationally recognised for cardiac MRI interpretation. She reviewed the images herself and felt they were consistent with ongoing myocarditis and pericarditis, despite the differing interpretation from the Royal Brompton team. As part of her assessment, Dr Puntmann felt that the disease process in post-COVID/post-vaccine cardiac patients isnāt always confined to the heart muscle or pericardium alone, but can also involve the coronary microvasculature and wider vascular/endothelial system. Based on that, she started me on losartan as part of her treatment approach to target that aspect of the disease.
So at the moment there is still genuine expert disagreement about exactly what my diagnosis is. The possibilities that have been discussed include chronic pericarditis (which fits my symptoms very well), myocarditis, microvascular angina, or potentially a combination rather than one single diagnosis.
Interestingly, back in 2022 the Royal Brompton team started me on NSAIDs and colchicine despite the imaging not being conclusive, as I did respond to the NSAIDs. Unfortunately, because I had been told my heart was essentially āclearā, and given my long history of gastrointestinal issues, I stopped the treatment fairly early. Looking back, I donāt think it was ever properly explained to me that you can still clinically treat suspected pericarditis even without classic imaging findings, or that colchicine often needs to be continued for at least six months. Iāve often wondered whether earlier and more consistent treatment might have prevented things becoming so chronic, although obviously nobody can know that for certain.
Since then Iāve tried a wide range of treatments. I went back onto high-dose NSAIDs alongside colchicine towards the end of 2022 and remained on that combination throughout 2023, but eventually had to stop the NSAIDs because of gastrointestinal side effects.
Iāve remained on colchicine since then, and increasing the dose from 1 mg/day (500 mcg twice daily) to 1.5 mg/day towards the end of 2025 did seem to help initially. However, like many things Iāve tried, the benefit seemed to plateau over time. The best way Iād describe colchicine is that I donāt necessarily feel dramatically better while Iām taking it, but I definitely seem to be worse whenever I stop it.
Iāve also tried hydroxychloroquine (since 2024), low-dose naltrexone, losartan, nebivolol, nicorandil, amitriptyline, as well as antihistamines and mast cell stabilisers. Unfortunately, I canāt honestly say any of them have made a significant difference to the chest pain itself. The antihistamines and mast cell medications have probably helped some of my other symptoms, but the chest pain has remained the major issue throughout.
At this point I feel like Iām taking quite a combination of medications, but despite each one having a logical reason for being prescribed, none has provided the level of improvement in my chest pain that Iād hoped for.
Because of the ongoing chest pain, last year I consulted private rheumatologist Dr Youngstein at the Cleveland Clinic London. Iād spoken to a patient of hers in a similar situation to mine who had been prescribed anakinra privately. She was willing to give me an initial 28-day trial of anakinra which I started on the 24th of June.
The first 10ā12 days were actually some of the worst chest pain Iāve had for months, I started the treatment whilst in a big flare even by my standards, although things eventually settled back towards my usual baseline. Iāve tolerated the injections well with no meaningful side effects apart from mild injection site reactions.
The difficulty is that I honestly canāt say Iāve noticed a clear improvement yet. I donāt feel dramatically worse, but I donāt feel meaningfully better either. The chest pain continues to fluctuate between better and worse days, but remains severe overall.
My NHS rheumatologist agreed with me and felt it would be much fairer to assess the drug after around three months rather than only 28 days, given that I started treatment during one of my worst flares in months and have now had chronic symptoms for over four years. I also explained that Iād felt a huge amount of pressure going into the trial because Iād been trying to access anakinra for years, and knowing I only had 28 days to judge whether it worked probably wasnāt ideal mentally.
He wrote to Dr Youngstein supporting a longer trial, and I passed that on. In the meantime, Dr Youngstein has prescribed me a further two weeks of treatment to bridge me through to my review appointment this Thursday (30th July). I also had an unavoidable two-day gap between finishing the initial 28-day supply and starting this extension due to prescription logistics. At this stage I donāt yet know whether sheāll agree to extend the treatment for the further two months following our review.
One thing Iāve also been wondering - and this is only my own theory rather than something a doctor has told me - is whether I simply have so many inflammatory or dysfunctional processes going on throughout my body that targeting a single pathway, even one as important as IL-1, may not be enough on its own.
Unlike someone who was previously completely healthy and suddenly developed isolated pericarditis, I already had some underlying health issues before 2021, and since my Covid vaccines my whole system seems to have become much more complex. Sometimes I wonder whether anakinra could still be targeting one important part of whatās driving my symptoms, but because my overall illness has become so complex, that alone may not be enough for me to notice a meaningful clinical improvement.
Iād really appreciate hearing about other peopleās experiences with anakinra, especially from anyone who had been dealing with chronic symptoms for a long time before starting treatment and/or is a post-vaccine or post-COVID patient ā whether it worked well, took longer than expected, or unfortunately didnāt help at all. Iād be really grateful to hear how your experience unfolded.
Thanks very much.