Clinical Approach to Recurrent Pericarditis: Challenges and Practical Insights

Abstract

Recurrent pericarditis is a difficult clinical entity whereby patients experience recurrent attacks of pericardial inflammation after an initial acute event. It is associated with the high morbidity rate, high relapses rates, and poor quality of life. This is a narrative review that involves a clinical discussion of recurrent pericarditis, its pathophysiology, diagnostic evaluation and management strategies. The disease is now considered an immune-mediated pathology that combines autoimmune and autoinflammatory pathways and is mainly mediated by the interleukin-1 (IL-1) pathway. Diagnosis is predominantly clinical and laboratory features are C-reactive protein or high-quality imaging, such as cardiac magnetic resonance imaging. Nonsteroidal anti-inflammatory drugs and colchicine are used as the first-line therapy, whereas corticosteroids are used in a few cases. The refractory disease may require immunosuppressive medications or special biologic treatment such as IL-1 inhibitors. Despite any enhancement of therapy regimens, such problems as steroid addiction, treatment resistance, and frequent relapses persist. The long-term management is aimed at preventing recurrence, patient adherence, and periodic follow-up. There are new directions that have the potential to achieve better results, such as individualized medicine and biomarker-driven therapy. This review identifies practical clinical implications to aid in the effective diagnosis and management of recurrent pericarditis.