Recurrent pericarditis: new and emerging therapeutic options

Recurrent pericarditis is the most troublesome complication after an episode of acute pericarditis, and occurs in 20–50% of patients with pericarditisMost cases of recurrent pericarditis are idiopathic, and the pathogenesis is presumed to be immune-mediated or autoinflammatoryThe mainstay of treatment for recurrent pericarditis is high doses of anti-inflammatory therapy—usually aspirin or an NSAID (generally ibuprofen or indomethacin) plus colchicineSecond-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 colchicineTriple combination therapy (aspirin or NSAID plus colchicine and corticosteroid) should be considered for patients with multiple recurrencesAdditional 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