Idiopathic Pericarditis
ICD-10 I30.0 · ICD-11 BB20.Z.2

Recurrent Pericarditis After Acute Pericarditis: What to Do When Glucocorticoid Therapy Fails

Recurrent pericarditis after an initial acute episode affects a meaningful proportion of patients. When a glucocorticoid-based regimen does not achieve prompt control of recurrence symptoms, a defined escalation step exists.

Clinical Scenario

One or more recurrences arise in 15% to 30% of patients after an initial episode of acute pericarditis. A first recurrence typically presents within 18 months, with findings similar to the initial episode — pleuritic chest pain, diffuse ST-segment elevations, a pericardial friction rub, and elevated serum markers of inflammation.

Prior Treatment Did Not Reach Its Target

The preceding treatment step added a glucocorticoid (prednisone) for refractory recurrent pericarditis, with the goal of prompt response of recurrence symptoms. When that target is not met, this protocol is the next step.

Next Treatment Approach (Partial)

For pericarditis refractory to NSAID, colchicine, and glucocorticoid therapies, the protocol involves advanced therapeutic options — including an immunosuppressive agent or a targeted biologic agent — aimed at improvement of symptoms. The complete regimen and decision algorithm are available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/CIRCULATIONAHA.111.066365

One or more recurrences arise in 15% to 30% of patients after an initial episode of acute pericarditis.

A first recurrence typically presents within 18 months, and findings are similar to the initial episode, including pleuritic chest pain, diffuse ST-segment elevations, a pericardial friction rub, and elevated serum markers of inflammation.

For refractory pericarditis despite NSAID, colchicine, and glucocorticoid therapies, improved symptoms have been reported in small numbers of patients with the use of immunosuppressive agents (azathioprine or methotrexate), intravenous immunoglobulin, and the interleukin-1β receptor antagonist anakinra.

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