Management of pericarditis: recent advances

Area of Science:

• Cardiology
• Internal Medicine
• Rheumatology

Background:

• Pericarditis is a frequent cause of chest pain, with management shifting towards targeted therapies.
• Diagnosis relies on clinical findings, supported by inflammatory biomarkers and advanced imaging like cardiac MRI.
• Traditional treatment involves NSAIDs and colchicine, with corticosteroids reserved for specific cases.

Purpose of the Study:

• To review the evolving management strategies for pericarditis.
• To highlight the role of imaging and biomarkers in diagnosis and treatment decisions.
• To discuss the emerging role of interleukin-1 inhibition in recurrent pericarditis.

Main Methods:

• Clinical diagnosis based on chest pain, pericardial rub, ECG, and effusion.
• Use of inflammatory biomarkers (e.g., C-reactive protein) and multimodality imaging (especially cardiac MRI).
• First-line therapy with aspirin/NSAIDs plus colchicine; selective use of corticosteroids.
• Evaluation of IL-1 inhibitors for refractory recurrent pericarditis.

Main Results:

• A mechanism-based, risk-stratified, and imaging-supported approach is now standard.
• IL-1 inhibition demonstrates efficacy in corticosteroid-dependent, colchicine-resistant recurrent pericarditis.
• Biologics facilitate corticosteroid withdrawal and reduce recurrence rates.

Conclusions:

• Recurrent pericarditis is increasingly recognized as an IL-1-mediated autoinflammatory condition.
• IL-1 inhibitors represent a significant advance for specific patient subgroups.
• Further research is needed on optimal treatment duration, cost-effectiveness, and personalized care.