Mechanistic Insights and Emerging Therapeutic Strategies in Recurrent Pericarditis

Recurrent pericarditis is a heterogeneous and often debilitating inflammatory disorder characterized by recurrent flares following a symptom-free interval of at least 4 to 6 weeks. Although most cases in developed countries are idiopathic or post-viral, the condition may arise from autoimmune disease, post-cardiac injury syndromes, infection, or systemic inflammatory disorders. Traditional management with nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids has historically provided symptomatic relief but is limited by high recurrence rates, steroid dependence, and substantial morbidity. Over the past decade, growing recognition of the central autoinflammatory mechanisms-particularly NOD-like receptor 3 (NLRP3) inflammasome activation and interleukin (IL-1)-mediated signaling-has transformed the therapeutic approach to this condition. The introduction of IL-1 inhibitors, including anakinra and rilonacept, has reshaped contemporary practice by reducing recurrence rates, minimizing corticosteroid dependence, and establishing a precision-based approach to disease activity-guided therapy. The purpose of this review is to synthesize contemporary evidence surrounding the pathophysiology and evolving treatment paradigms for recurrent pericarditis, with a focus on novel targeted therapies.