This review emphasizes individualized, multidisciplinary care for recurrent pericarditis and highlights the potential of anakinra as a second-line treatment option after failure of standard therapy.
Multidisciplinary stepwise therapy may aid recurrent pericarditis management; leaves open optimal protocols pending prospective trials.
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.
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Dauphin et al. (2016) studied this question.