Relapsing Pericarditis: Prediction of Relapses, Risk Scores, and Role of Exercise Restriction

Relapsing pericarditis (RP) is a chronic inflammatory disorder characterized by two or more episodes of acute pericarditis flares after a minimum of a 4-week symptom-free period. Recurrent pericarditis develops in approximately 15% to 30% of patients following an initial episode of acute pericarditis, and nearly half of these individuals experience subsequent recurrences. Although the course is heterogeneous, RP has substantial morbidity and impaired quality of life implications and is associated with pericardial complications, including cardiac tamponade and constrictive pericarditis. This review summarizes current knowledge about clinical perspectives, predictors, and risk stratification tools for relapses in RP and critically appraises the evolving role of exercise restriction as part of RP management. Many adverse prognosticators for RP in clinical, laboratory, multimodality cardiac imaging, and treatment factors have been identified from clinical trials, observational studies, and experiences of managing RP patients. Several risk scores have been recently developed to assist in risk stratification and treatment guidance for RP patients, such as the Athens, Torino, INFLA, and Klein scores. There is also growing evidence for exercise restriction strategies with a focus on practical individualized strategies in the multimodal treatment of RP that have been included in recent pericarditis guidance documents. Multicenter external validation and randomized trials remain necessary to assess the roles and performance of risk scores and exercise restriction in treating RP to improve their clinical outcomes.