29 A Toolkit for Health Care Professionals Recurrent Pericarditis Top Takeaways Careful clinical evaluation is essential to confirm the diagnosis of recurrent pericarditis. Further evaluation for alternative nonpericardial causes of chest pain should be performed where patients present with acute chest pain without coexistent elevated inflammatory markers (CRP). Beware of mimickers including particularly musculoskeletal chest pain, gastroesophageal reflux disease and fibromyalgia. The mainstay of therapy for an initial acute pericarditis episode is aspirin/NSAIDs plus colchicine and exercise restriction. Low-dose corticosteroids should be reserved for patients who cannot tolerate first-line therapies or as add-on to first-line therapies in recurrent pericarditis if aspirin/NSAIDs and colchicine fails. Anakinra and rilonacept are IL-1 blocking agents that are recommended in patients who have had multiple recurrences. IL-1 receptor blocker discontinuation is associated with a high incidence of pericarditis recurrence. Radical surgical pericardiectomy, performed at the hands of experienced pericardial surgeons at expert pericardial centers, should be considered in patients with refractory disease or where long-term medical therapy cannot be withdrawn or is contraindicated. 1 2 3 4 5 6 Notes:
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