Novel Pathophysiological, Diagnostic and Therapeutic Concepts in Acute and Recurrent Pericarditis

Acute pericarditis is the most frequent pericardial disease characterized by inflammation of layers resulting in pain, dyspnea and fatigue. Often limited to an isolated event, up 30% patients experience one or more recurrences. There knowledge about pathophysiology this disease, possibly due availability animal models. More recently, following seminal clinical trials with colchicine interleukin-1 (IL-1) blockers a novel murine model acute using zymosan A, it has become clear that NLRP3 (NACHT, leucine-rich repeat, pyrin domain-containing protein 3) inflammasome/IL-1β axis plays central role driving sustaining process during Diagnostic management been implemented multimodality imaging including echocardiography, cardiac computed tomography, magnetic resonance. These modalities provide essential diagnostic pathogenetic information, are able characterize inflammation, allowing refine risk stratification personalize treatment. Recent acquisitions yield relevant implications regard therapeutic recurrent pericarditis. Non-steroidal anti-inflammatory drugs (NSAIDs) cornerstone therapies either for However, benefits targeted agents, such as anakinra — recombinant human IL-1 receptor antagonist rilonacept IL-1α/IL-1β trap, being increasingly recognized. To end, phenotyping addressing those presenting auto-inflammatory features (elevated C-reactive protein, sustained systemic multiple recurrences) utmost importance identify who might be likely benefit from pathway blockade.