Dieci quesiti clinici in tema di pericardite ricorrente o incessante [Ten clinical questions about recurrent or incessant pericarditis]

Recurrent pericarditis represents the most challenging complication of acute pericarditis and has a significant impact on patients’ quality of life. It is defined by the occurrence of a new episode after complete remission and should be distinguished from incessant pericarditis, in which symptoms persist without clinical remission. The causes are often idiopathic, likely post-viral or related to autoimmune/autoinflammatory mechanisms, but also include forms secondary to systemic diseases, interventional procedures, or, more rarely, malignancies. The diagnosis is based on the criteria for acute pericarditis applied to a recurrent episode, supported by biomarkers and multimodality imaging. First-line treatment consists of non-steroidal anti-inflammatory drugs or high-dose aspirin combined with colchicine and restriction of physical activity. Corticosteroids are reserved for selected cases and should be used at low doses with very gradual tapering. In refractory or corticosteroid-dependent patients, interleukin-1 inhibitors have revolutionized management, significantly reducing recurrences in forms with an inflammatory phenotype. Prognosis is generally favorable in idiopathic forms but requires structured follow-up and personalized therapeutic strategies. In this article, we address the most common clinical questions regarding recurrent pericarditis, aiming to translate current guideline recommendations into everyday clinical practice.