Pathogenesis, management, and prevention of recurrent pericarditis

Recurrent pericarditis is one of the most troublesome complications of acute pericarditis and, despite recent advances, remains one of the most challenging problems in pericardial diseases. The exact recurrence rate is unknown, but a reasonable estimate is 30%. The diagnosis is based on clinical criteria, and only routine laboratory testing is required. In many, probably most cases, this is an autoimmune disease, but sometimes it is caused by reactivation of viral pericarditis, an unrelated infection, or is provoked by corticosteroid therapy. Therapeutic modalities are non-specific and varied, and usually the etiology is autoimmunity. Non-steroidal anti-inflammatory drugs with the possible addition of colchicine are the best first-choice treatment, before steroid therapy is tried. Corticosteroid therapy is an independent risk factor for recurrences. In order to provide an evidence-based clinical approach to management, we performed a systematic review of all publications on acute and recurrent pericarditis focusing on recent clinical trials.