- CEREMAIA
- Jun 30
- 2 min read
Updated: 2 days ago
First author: Yvan Jamilloux
Country of study: France
CEREMAIA Tenon author: Sophie Georgin-Lavialle
Reference: Jamilloux Y, André M, Maillard H, Baudet M, Beauvais F, Boursier G, Buschiazzo A, Donal E, Flecher E, Georgin-Lavialle S, Gerfaud-Valentin M, Kone-Paut I, Labombarda F, Piriou N, Saadoun D, Aouba A, and collaborators. French protocol for the diagnosis and management of recurrent pericarditis / Protocole national de diagnostic et de soins – Péricardites récidivantes. La Revue de médecine interne. 2026;47:127–146.
DOI: https://doi.org/10.1016/j.revmed.2026.02.002
5 key points
Recurrent pericarditis means repeated episodes of inflammation of the pericardium, separated by a symptom-free period of at least 4 to 6 weeks.
Diagnosis is based on symptoms, clinical examination, electrocardiogram, echocardiography, sometimes cardiac MRI, and inflammation markers such as CRP.
Colchicine is the cornerstone treatment to reduce the risk of recurrence and is often combined with anti-inflammatory drugs during flares.
Corticosteroids should be avoided as much as possible, except in specific situations, because they may promote treatment dependence and recurrences.
In severe or resistant forms, treatments targeting interleukin-1, such as anakinra, may be discussed with expert centres.
Introduction
Pericarditis is inflammation of the pericardium, the thin sac surrounding the heart. When it comes back several times after a first episode, it is called recurrent pericarditis. This condition can cause significant chest pain, anxiety, emergency visits and difficulties in family, social or professional life.
Methods
This article is a French national protocol for diagnosis and care. It brings together expert recommendations to help physicians diagnose, treat and follow people with recurrent pericarditis, including adults, children and specific situations such as pregnancy.
Results
Diagnosis relies on several elements: typical chest pain, a pericardial rub heard during examination, electrocardiogram changes, fluid around the heart on echocardiography, and blood signs of inflammation, especially CRP. Cardiac MRI can help in difficult cases. Most cases are called idiopathic, often presumed to follow a viral infection, but some may be linked to autoimmune, autoinflammatory or infectious diseases, or to inflammation after cardiac surgery or procedures. Serious complications, such as cardiac tamponade or constrictive pericarditis, are rare but must be recognized quickly.
Discussion
Treatment aims to control inflammation, relieve pain and, above all, prevent recurrences. Colchicine is central and often needs to be continued for several months. During flares, anti-inflammatory drugs or aspirin may be used together with colchicine. Corticosteroids are no longer recommended except in specific cases. In severe, resistant or corticosteroid-dependent forms, interleukin-1 inhibitors, particularly anakinra, can improve symptoms and quality of life. Follow-up should also include rest, gradual return to physical activity, patient education and attention to psychological impact.
Conclusion
Recurrent pericarditis requires coordinated care involving cardiologists, internal medicine specialists, general practitioners and expert centres. Accurate diagnosis, appropriate treatment and very gradual treatment withdrawal can reduce relapses and improve quality of life.
