Year: 2026
Type: article
Abstract: Pericarditis is the most frequent pericardial syndrome and a common cause of chest pain in emergency and cardiology practice. Over the past 2 decades, its management has moved from largely empirical anti‑inflammatory treatment toward a mechanism‑based, risk‑stratified, and imaging‑supported approach. Diagnosis remains clinical, based on the presence of typical chest pain, pericardial rub, electrocardiographic changes, and pericardial effusion; yet, inflammatory biomarkers and multimodality imaging, especially cardiac magnetic resonance, increasingly support diagnostic confidence, differential diagnosis, and therapeutic decision‑making. For most patients with acute idiopathic or presumed viral pericarditis, aspirin or a nonsteroidal anti‑inflammatory drug combined with colchicine is the first‑line therapy, with exercise restriction recommendations and follow‑up guided by symptoms and C‑reactive protein level. Corticosteroids should be avoided when possible, or used at low‑to‑moderate doses only for selected indications, because they promote chronicity and recurrence in unselected cases. A major recent advance is the recognition of recurrent pericarditis as an autoinflammatory, interleukin (IL)-1-mediated disease in a substantial proportion of patients with an inflammatory phenotype. Data from randomized trials and registries now support IL‑1 inhibition (eg, anakinra or rilonacept) in corticosteroid‑dependent and colchicine‑resistant recurrent pericarditis, as such treatment is associated with rapid symptom control, possibility to withdraw corticosteroids, and marked reduction in recurrences. Remaining challenges include optimal treatment duration, cost of and access to biologics, management of patients without overt systemic inflammation, and personalized strategies for tapering and return to activity.
DOI: 10.20452/pamw.17327
Author: Massimo Imazio
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7166652672
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