Figure 1.

Management algorithm for the treatment of recurrent pericarditis with first-line agents (non-steroidal anti-inflammatory drugs and colchicine), second-line drugs (low-dose corticosteroids and colchicine), third-line options (anakinra, azathioprine, and intravenous human immunoglobulins), and fourth-line treatment (pericardiectomy) according to the 2015 ESC guidelines.¹⁰ In some institutions (especially in the US), pericardiectomy may be an earlier preferred option instead of taking injection of anti-IL-1 agents, after many failed attempts to be off steroid therapy. Additional clinical trials are warranted to better address this issue.