Recurrent pericarditis is the most troublesome complication after an episode of acute pericarditis, and occurs in 20–50% of patients with pericarditis
Most cases of recurrent pericarditis are idiopathic, and the pathogenesis is presumed to be immune-mediated or autoinflammatory
The mainstay of treatment for recurrent pericarditis is high doses of anti-inflammatory therapy—usually aspirin or an NSAID (generally ibuprofen or indomethacin) plus colchicine
Second-line drugs are corticosteroids, to be used at low-to-moderate doses (such as prednisone 0.2–0.5 mg/kg per day or equivalent), plus colchicine
Triple combination therapy (aspirin or NSAID plus colchicine and corticosteroid) should be considered for patients with multiple recurrences
Additional options for patients with multiple (three or more) failures of conventional anti-inflammatory therapies include azathioprine, intravenous immunoglobulins, and anakinra, with pericardiectomy being a last resort
Recurrent pericarditis is one of the most common and troublesome complications after an episode of pericarditis, and affects 20–50% of patients treated for pericarditis. In most of these patients, the pericarditis remains idiopathic, although an immune-mediated (either autoimmune or autoinflammatory) pathogenesis is often presumed. The mainstay of therapy for recurrences is aspirin or NSAIDs, with the adjunct of colchicine. Corticosteroids are a second-line option to be considered for specific indications, such as connective tissue disease or pregnancy; contraindications or intolerance to aspirin, NSAIDs, and/or colchicine; or insufficient response to these medications. Furthermore, corticosteroids can be added to NSAIDs and colchicine in patients with persistent symptoms. In patients who do not respond adequately to any of these conventional therapies, alternative treatment options include azathioprine, intravenous human immunoglobulins, and anakinra. An improved understanding of how recurrent pericarditis develops after an initiating event is critical to prevent this complication, and further research is needed into the pathogenesis of recurrences. We discuss the aetiology and diagnosis of recurrent pericarditis, and extensively review the treatment options for this condition.
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The authors declare no competing financial interests.
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Imazio, M., Lazaros, G., Brucato, A. et al. Recurrent pericarditis: new and emerging therapeutic options. Nat Rev Cardiol 13, 99–105 (2016). https://doi.org/10.1038/nrcardio.2015.115
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