From Hippocrates to Biologics, The Evolving History of Pericarditis: A Review

Pericarditis remains a common and clinically relevant cardiovascular condition whose diagnosis and management have evolved substantially over time. Understanding this historical progression provides important context for contemporary practice and emerging therapeutic strategies. Early descriptions, dating back to Hippocrates, framed pericarditis as a clinical observation, with more precise diagnostic characterization emerging in the 19th century through the work of Laennec and later refined by clinicians such as Spodick and Hatle. Initial treatment approaches were largely symptomatic or surgical, including pericardiectomy for advanced constrictive disease. The mid-twentieth century marked a shift toward medical therapy with the introduction of nonsteroidal anti-inflammatory drugs and corticosteroids, which improved symptom control but were limited by high recurrence rates. The advent of echocardiography transformed pericardial disease evaluation by enabling noninvasive diagnosis, hemodynamic assessment, and safer pericardiocentesis. More recently, cardiac magnetic resonance imaging has further advanced care by allowing detailed tissue characterization and improved risk stratification. Randomized trials established colchicine as a cornerstone therapy for both acute and recurrent pericarditis. A major paradigm shift has occurred with the recognition of autoinflammatory mechanisms underlying recurrent disease and the introduction of targeted interleukin-1 inhibition, including anakinra and rilonacept, particularly for refractory cases. Together, these advances reflect a transition from empirical management toward mechanism-based, personalized care. Ongoing progress in imaging, biomarker integration, and targeted immunomodulation is expected to further refine diagnosis, treatment, and long-term outcomes for patients with pericardial disease.