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Competing Interests: Competing interests: The authors declare no competing interests.

Background: Patients with pericarditis may show elevation of C-reactive protein (CRP) and pericardial effusion at presentation. There are limited data on the prognostic implications of this inflammatory phenotype., Objectives: Aim of the present study is to evaluate the outcome of the inflammatory phenotype in a cohort of patients with acute pericarditis., Methods: Observational cohort study of consecutive adult patients with acute pericarditis in 4 referral centers for pericarditis (Athens, Milan, Turin, Udine)., Results: Our cohort included 918 patients with acute pericarditis (median age of 56, IQR 28 years, 55.6 % females). The etiology of pericarditis was respectively idiopathic in 82.1 %, post-cardiac injury syndrome in 9.3 %, and systemic inflammatory disease in 4.9 % of cases. CRP elevation was detected at presentation in 778 cases (84.7 %), an inflammatory phenotype (CRP elevation and pericardial effusion) was found in 557 patients (60.7 %). Baseline medical therapy included a NSAID in 74.9 %, colchicine 70.9 %, and corticosteroids 25.1 % of cases. After a mean follow-up of 22.5 months, patients with an inflammatory phenotype had a higher recurrence rate at 18 months (respectively 46.0 % vs. 31.0 %; p < 0.0001), and a shorter recurrence-free survival (Log-rank p = 0.0001). In multivariable analysis the inflammatory phenotype presentation was independently associated with an increased risk of recurrences (OR 2.005, 95 % CI 1.454 to 2.765; p < 0.0001)., Conclusions: The inflammatory phenotype of presentation of acute pericarditis is associated with an increased risk of recurrences, highlighting the importance of timely individualized therapy and close follow-up for these patients., Competing Interests: Declaration of competing interest None., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: We aimed to investigate the remission rate and disease duration in idiopathic or post-cardiac injury pericarditis and risk factors for disease duration and anti-interleukin-1 (IL-1) agent discontinuation., Methods: This was a multicenter, longitudinal, observational study including 370 patients (51.4% female). The remission rate was the proportion of patients who stopped all pericarditis-related therapies for at least 6 months without recurrences., Results: The median follow-up was 4.9 (interquartile range [IQR] 2.8-8.4) years, and the median age at the end of follow-up was 49 (IQR 37-60) years. A median of 1.1 (IQR 0.6-1.9) recurrences/year and 0.4 (IQR 0.1-0.9) hospitalizations/year were recorded. The remission rate at follow-up was 34.0%, 7% per year. Disease duration was shorter for patients in remission (3.1 years, IQR 1.6-6.2 years) than for those still receiving treatment (4 years, IQR 2.2-7.8; P = 0.02). Use of "guidelines-based therapy" (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.25-2.73; P = 0.02) and colchicine use at first attack (HR 1.51, 95% CI 1.02-2.23; P = 0.038) were protective factors, whereas steroid use was associated with longer disease duration (HR 0.53, 95% CI 0.35-0.81; P = 0.003). Corticosteroids were used in 77.3% of patients, with a median duration of therapy of 1.1 (IQR 0.4-2.6) years. Anakinra was used in 25.9% with a median duration of therapy of 2.4 (IQR 0.9-5.0) years; only 19.8% were able to stop anakinra at the end of observation period., Conclusion: This study reports the largest and longest follow-up in patients with recurrent pericarditis. Guideline adherence from the first attack is associated with a shorter course. The disease was long and impacting in terms of recurrences and hospitalizations, often requiring a long-term treatment, in particular with anti-IL-1 agents., (© 2025 The Author(s). ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

The knowledge of pericardial diseases has now improved, including prospective and retrospective cohort studies focusing on the pathogenesis, diagnosis, treatment, and outcomes. The complex interplay between genetic predisposition (especially for autoinflammatory conditions), inflammation, and autoimmunity is now known to trigger recurrences of pericarditis. Moreover, diagnostic capabilities have improved with the implementation of multimodality imaging, particularly cardiac magnetic resonance (CMR), to detect and monitor pericardial inflammation, to allow diagnosis in more complicated cases, and tailor the duration of therapy based on objective parameters. A new class of drugs, the anti-IL-1 agents, have been introduced for patients with an inflammatory phenotype of presentation, and not responding to conventional anti-inflammatory therapies, including NSAID, colchicine, and corticosteroids. At present, the clinical management of pericardial diseases is definitely on the road of evidence-based medicine with new ongoing European guidelines focusing on the spectrum of inflammatory myocardial and pericardial syndromes., (Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.)