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Recurrent pericarditis is probably the most common and troublesome complication of pericarditis, affecting around 30% of patients with a first attack of acute pericarditis [1] and up to 50% of patients with a first recurrence [2,3]. Recurrences are often considered as consequences of previous treatment failures and cause readmissions and repetition of diagnostic tests, while affected patients are often worried about possible complications and outcomes, and especially that recurrences may lead to chronicization and constrictive pericarditis [4]. In the last years, improved knowledge on the treatment, prevention and prognosis of this disease has greatly expanded our understanding on how to cope with recurrences.
The aim of this article is to review current and updated knowledge on the management of recurrent pericarditis, with a special focus on more recently published contributions in the last 5 years. A thorough literature review has been performed without language restriction with the MeSH term 'recurrent'(all fields) and ('pericarditis'[MeSH terms] or 'pericarditis'[all fields]). After the initial selection of 483 papers, 52 papers were selected for detailed review, based on novelty or important summarizing data, and were included in the reference list.
Etiopathogenesis
The etiopathogenesis of recurrent pericarditis is poorly understood [4]. Recurrences are often suspected to be an autoimmune phenomenon, although this is generally unproven. Typically, recurrent pericarditis occurs after an episode of idiopathic or presumed viral pericarditis and affects 20-50% of patients [1-3]. Evidence for a possible autoimmune etiopathogenesis include: a latent period of several weeks, the presence of antiheart antibodies, although their role is controversial, the frequent and prompt responsiveness to anti-inflammatory therapies, especially corticosteroids or other immunosuppressive therapy, and the association with other autoimmune processes such as systemic inflammatory diseases [4,5,101].
Serum antiheart, anti-intercalated disk and noncardiac-specific autoantibodies have been detected in idiopathic recurrent pericarditis (25-50% of cases) and correlated with more recurrences and readmissions, supporting the involvement of autoimmunity in the majority of these patients [6,7]. Nonspecific autoantibodies are also common in the setting of recurrent pericarditis. In an Italian study, antinuclear antibodies (ANA) were detected in 44% of patients with idiopathic recurrent pericarditis, and in only 10% of controls (p < 0.001). Low titers (1/40-1/80) were found in the majority of cases, while moderate positivity (1/160-1/320) was more common in patients with a known rheumatic...