title: Recurrent pericarditis: new and emerging therapeutic options.
abstract: 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.
authors.affiliation: Cardiology Department, Maria Vittoria Hospital, and Department of Public Health and Pediatrics, University of Torino, Via Luigi Cibrario 72, 10141 Torino, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Imazio
authors.affiliation: Cardiology Department, University of Athens Medical School, Hippokration General Hospital, 114 Vassilissis Sophias Avenue, Athens 115 27, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Lazaros
authors.affiliation: Internal Medicine, Azienda Ospedaliera, Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Brucato
authors.affiliation: University Division of Cardiology, Department of Medical Science, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use*; D010493:Pericarditis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D053590:Interleukin 1 Receptor Antagonist Protein; D001379:Azathioprine; D001241:Aspirin; D003078:Colchicine