French protocol for the diagnosis and management of recurrent pericarditis

Recurrent pericarditis is characterised by repeated episodes of pericardial inflammation separated by an asymptomatic interval of at least 4 to 6 weeks. Diagnosis relies on typical clinical features (chest pain, pericardial friction rub), imaging-primarily echocardiography, with MRI when needed-and inflammatory markers, particularly C-reactive protein (CRP). The initial assessment aims to identify an underlying cause, which is most often idiopathic (frequently presumed post-viral) but may be autoimmune, autoinflammatory, or infectious. Management requires close coordination between specialists and reference centres, with the primary goal of preventing recurrence. Colchicine is the cornerstone of therapy and should be prescribed for 3 to 6 months, and often longer. During acute flares, NSAIDs or aspirin are recommended in combination with colchicine. Corticosteroids are no longer indicated, except in highly specific situations. In severe or refractory forms, early use of interleukin-1 inhibitors-particularly anakinra or rilonacept-should be considered. Long-term follow-up includes clinical and laboratory monitoring to ensure symptom resolution and normalisation of CRP levels, as well as regular assessment of quality of life. Treatment withdrawal must be very gradual, over several months or even years, and supported by therapeutic patient education to help patients recognise early warning signs. Coordinated follow-up within structured care networks is essential to ensure optimal access to treatment and advanced therapies. This French Protocol for Diagnosis and Management aims to provide clinicians with clear, harmonised, and up-to-date guidance to improve the diagnosis, treatment, and long-term care of patients with recurrent pericarditis.