Recent months have brought two major updates to clinical guidance for pericarditis management: the European Society of Cardiology (ESC) guidelines on myocarditis and pericarditis and the French Protocol for the Diagnosis and Management of recurrent pericarditis (PNDS). Both documents introduce substantive conceptual, diagnostic, and therapeutic changes.

Inflammatory Myopericardial Syndrome (IMPS) Framework

The ESC guidelines formalize the concept of IMPS as a unifying framework. The spectrum includes pericarditis and myocarditis, along with mixed presentations such as myopericarditis and perimyocarditis in acute (< 1 month), subacute (1-3 months), and chronic (> 3 months) phases.

“This generic term, used during the initial diagnostic process until a definitive diagnosis is established, reflects the possible overlap between myocarditis and pericarditis, with the aim of improving recognition of the disease spectrum and enabling faster diagnosis and better management,” experts noted.

Diagnostic Shift

The ESC guidelines established a central role for cardiac MRI in diagnosis. Clinical history, physical examination, chest radiography, biomarkers, electrocardiography, and echocardiography are recommended in patients with suspected myocarditis or pericarditis.

Cardiac MRI supports diagnostic confirmation by noninvasively finding edema, inflammation, and fibrosis, thereby minimizing the need for endomyocardial biopsy.

Treatment Updates

Treatment recommendations now incorporate interleukin-1 (IL-1) inhibitors into the therapeutic strategy.

• First-line treatment includes aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) combined with colchicine to reduce the risk for recurrence.
• Corticosteroids are positioned as second-line therapy (0.2-0.5 mg/kg/d prednisone equivalent) in cases of contraindication or failure of first-line therapy and should be used in combination with colchicine.
• IL-1 inhibitors, including anakinra and rilonacept, are recommended for recurrent pericarditis that does not respond to prior treatment. These agents appear particularly relevant in inflammatory phenotypes, including presentations with fever, elevated C-reactive protein, or pleural effusion, as well as suspected autoinflammatory diseases with a genetic component.

Recurrent Disease

The guidance published in late 2025 defines recurrent pericarditis as repeated episodes of pericardial inflammation that are recurrent (a new flare after at least 4-6 weeks without symptoms). Diagnosis relies on typical clinical features, such as chest pain and pericardial friction rub, imaging findings — primarily on echocardiography — and elevated levels of inflammatory markers.

Colchicine is the cornerstone of treatment and should be prescribed for 3-6 months, with a longer duration in selected cases. It is combined with NSAIDs or aspirin during inflammatory flare-ups.

The protocol discourages the use of corticosteroids, except at low-to-moderate doses in specific cases, such as connective tissue disease, because of adverse effects and “possibly a higher risk for recurrence.” It also confirms the role of IL-1-targeted biologic therapy as a last resort in refractory forms of the disease.

Care Coordination

The PNDS emphasized the significant role of the primary care physician in the management of the disease. Monitoring should enable early detection of recurrence. Physicians should advise modifying their lifestyle, including strict limitation of physical activity until complete clinical and biologic remission is achieved.

ESC recommendations state that patients should wait at least 1 month after an episode before resuming physical activity. Fixed timelines are no longer recommended. Decisions should be individualized and based on confirmed remission, including resolution of symptoms and normalization of inflammatory markers.

Primary care physicians play a central role in the care pathways for these patients. This includes coordinating multidisciplinary follow-up with cardiologists and referring patients to expert centers when needed, particularly in recurrent or complex cases. Patient education remains essential to support treatment adherence and early recognition of recurrence.

Clinicians should also assess the psychosocial impact of the condition, including anxiety related to recurrence and limitations in daily activities. Addressing these factors supports recovery and helps maintain quality of life.

This story was translated from Univadis France, part of the Medscape Professional Network.