Recurrent pericarditis: current challenges and future prospects

Recurrent pericarditis: current challenges and future prospects Claire Dauphin,1 Etienne Merlin,2 Aurélie Chalard,1 Romain Trésorier,1 Jean-René Lusson,1 Martin Soubrier3 1Department of Cardiology and Cardiovascular Diseases, 2Department of Pediatrics, 3Department of Rheumatology, Clermont-Ferrand Hospital, Clermont-Ferrand, France Abstract: Recurrent pericarditis, usually idiopathic, is difficult to treat. Previous etiological studies can eliminate potentially serious causes that require specific treatment. The pathophysiology of “idiopathic” pericarditis involves autoimmunity and autoinflammation in various degrees and is usually caused by a microbacteriological or postinjury trigger. It requires multidisciplinary care to provide individualized treatment to each patient: treatment escalation by increments, then weaning should be guided by clinical examination but also CRP and potential magnetic resonance imaging. The role of immunomodulators, especially anakinra, should be revisited. Their efficacy is remarkable, and they could be considered for second-line treatment, preferably with corticosteroids (at least among certain selected patients), especially after the failure of prolonged and high-dose standard therapy with aspirin/nonsteroidal anti-inflammatory drugs and colchicine. Keywords: recurrent pericarditis, review, pathophysiology, individualized treatment, multidisciplinary care, treatment options