Managing Recurrent Pericarditis: Insights and Treatment Options

Patients at higher risk for recurrent pericarditis can be identified by certain risk factors, including high initial levels of C-reactive protein (CRP), failure to normalize CRP levels within a week, prolonged symptoms, and the presence of fever. Recurrence is defined as the onset of symptoms more than four to six weeks after initial treatment has resolved acute pericarditis symptoms. The management typically involves utilizing nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine, with an emphasis on prolonging colchicine therapy—often extending its use to six months or longer for recurrences. Interleukin-1 blockers represent a promising new therapeutic option for patients resistant to colchicine treatment or experiencing corticosteroid-dependent symptoms. These blockers help manage the inappropriate activation of the innate immune response commonly seen in recurrent pericarditis, particularly following cardiac injury. Randomized trials support their efficacy, particularly in cases marked by elevated systemic inflammation, as indicated by CRP levels. It is crucial to diagnose and evaluate pericarditis in the correct clinical context, including CRP assessment which informs both diagnosis and treatment implications. Using corticosteroids, particularly high doses of prednisone, for initial treatment increases the risk of recurrence and should be avoided. Effective management requires careful consideration of the patient's history, appropriate treatment duration, and avoidance of ineffective therapies.