Current Approach to Acute Pericarditis: Treatment Strategies

• DOI: https://doi.org/10.22533/at.ed.15953225221012

• Palavras-chave: Acute Pericarditis; Treatment; Recurrent Pericarditis.

• Keywords: Acute Pericarditis; Treatment; Recurrent Pericarditis.

• Abstract:

  Acute pericarditis is the most common condition affecting the pericardium, predominantly idiopathic or viral in etiology, whose diagnosis is established clinically by the presence of at least two of four classic criteria. Although most cases have a benign course, the main complication is the high recurrence rate, which significantly impacts patients' quality of life. This narrative review addresses current management strategies, highlighting first-line therapy based on the combination of nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine, which is essential for reducing the risk of recurrence. The role of corticosteroids as second-line therapy is discussed, whose use is limited by the increased risk of recurrence. For refractory and recurrent cases, understanding the autoinflammatory pathophysiology mediated by interleukin-1 has paved the way for targeted biological therapies, such as IL-1 receptor antagonists (anakinra, rilonacept), which have proven to be highly effective. Risk stratification, identifying the "inflammatory phenotype" (elevated CRP and pericardial effusion), is crucial for individualizing treatment and predicting outcomes. In extreme cases that progress to constrictive pericarditis, surgical pericardiectomy remains the only curative option.