Clinical management and therapy of idiopathic recurrent pericarditis

Andrea Assolari, Silvia Maestroni, Davide Cumetti, Anna Valenti, Federico Parisi, Antonio Brucato



Recurrent pericarditis is defined when pericarditic chest pain reappears after a symptom-free period of at least 4 to 6 weeks and after completion of full-dose anti-inflammatory therapy. Idiopathic pericarditis is the commonest etiology. The diagnosis of idiopathic cases is essentially an exclusion diagnosis, supported by a typical clinical course. The diagnosis is based on the association of typical symptoms and signs: mainly pericarditic chest pain plus pericardial rubs or electrocardiographic alterations or pericardial effusion. The optimal regimen for recurrences includes combination of non-steroidal anti-inflammatory agents, colchicine, and corticosteroids. In the resistant forms, immunotherapy (azathioprine, intravenous immunoglobulins, and particularly anakinra) has shown to be effective. The long term outcome of idiopathic recurrent pericarditis is good, with no evolution towards constrictive form.


Recurrence; Pericarditis; Anti-Inflammatory Agents, Non-Steroidal; Immunotherapy; Interleukin 1 Receptor Antagonist Protein

Full Text:



  • Adler Y, Charron P, Imazio M, et al. The task force for the diagnosis and management of pericardial diseases of the European society of cardiology (ESC) 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J 2015; 36: 2921-64;
  • Imazio M, Brucato A, Cemin R, et al. Colchicine for recurrent pericarditis (CORP) a randomized trial. Ann Intern Med 2011; 155: 409-14;
  • Imazio M, Belli R, Brucato A, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicenter, double-blind, placebo-controlled, randomized trial. Lancet 2014; 383: 2232-7;
  • Cremer PC, Kumar A, Kontzias A, et al. Complicated Pericarditis: understanding risk factors and pathophysiology to inform imaging and treatment. J Am Coll Cardiol 2016; 68: 2311-28;
  • Imazio M, Gribaudo E, Gaita F. Recurrent pericarditis. Prog Cardiovasc Dis 2017; 59: 360-8;
  • Imazio M, Brucato A, Maestroni S, et al. Prevalence of C-reactive protein elevation and time course of normalization in acute pericarditis: implications for the diagnosis, therapy, and prognosis of pericarditis. Circulation 2011; 123: 1092-7;
  • Imazio M, Gaita F. Diagnosis and treatment of pericarditis. Heart 2015; 101: 1159-68;
  • Imazio M, Spodick DH, Brucato A, et al. Controversial issues in the management of pericardial diseases. Circulation 2010; 121: 916-28;
  • Maggiolini S, De Carlini CC, Ferri LA, et al. The role of early contrast-enhanced chest computer tomography in the etiological diagnosis of patients presenting with cardiac tamponade or large pericardial effusion. Euro Heart J Cardiovasc Imaging 2016; 17: 421-8;
  • Lobert P, Brown RK, Dvorak RA, et al. Spectrum of physiological and pathological cardiac and pericardial uptake of FDG in oncology PET/CT. Clin Radiol 2013; 68: 59-71;
  • Imazio M, Brucato A, Trinchero R, et al. Individualized therapy for pericarditis. Expert Rev Cardiovasc Ther 2009; 7: 965-75;
  • Imazio M, Brucato A, Cemin R, et al. A randomized trial of colchicines for acute pericarditis. N Engl J Med 2013; 369: 1522-8;
  • Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for recurrent pericarditis. High versus low doses: a nonrandomized observation. Circulation 2008; 118: 667-71;
  • Brucato A, Brambilla G, Adler Y, et al. Therapy for recurrent acute pericarditis: a rheumatological solution? Clin Exp Rheumatol 2006; 24: 245-50
  • Vianello F, Cinetto F, Cavraro M, et al. Azathioprine in isolated recurrent pericarditis; a single centre experience. Int J Cardiol 2011; 147: 477-8;
  • Brucato A, Imazio M, Gattorno M, et al. Effect of anakinra on recurrent pericarditis among patients with colchicines resistance and corticosteroid dependence: the AIRTRIP randomized clinical trial. JAMA 2016; 316: 1906-12;
  • Imazio M, Brucato A, Maestroni S, et al. Risk of constrictive pericarditis after acute pericarditis. Circulation 2011; 124: 1270-5;
  • Imazio M, Brucato A, Adler Y, et al. Prognosis of idiopathic recurrent pericarditis as determined from previously published reports. Am J Cardiol 2007; 100: 1026-8;


  • There are currently no refbacks.

© SEEd srl