Noninfectious pericarditis: management challenges for cardiologists.

The aim of review is to deal with management challenges related either to diagnosis or therapy of non-infectious pericarditis. In European countries with a low prevalence of tuberculosis, the aetiology search is essentially aimed at the exclusion of most common causes, that may require a specific therapy and are at increased risk of complications: systemic autoimmune or autoinflammatory conditions, post-cardiac injury syndrome (5-20%), neoplastic pericardial involvement (5-10%), tuberculosis (about 5% of cases), and rarely purulent in <5%. In developing countries with a high prevalence of tuberculosis, this is the most common cause of pericardial diseases. The diagnosis is based on clinical criteria (pericarditis chest pain, pericardial rubs) integrated with laboratory (elevation of C-reactive protein), and instrumental findings (ECG, echocardiography and imaging evidence of pericardial inflammation in doubtful cases). Poor prognostic predictors (high fever>38°C, subacute course, large pericardial effusion, cardiac tamponade, and lack of response to empiric anti-inflammatory therapies) identify high-risk patients to be admitted for aetiology search and therapy. The mainstay of medical therapy of non-infectious pericarditis is based on NSAID and colchicine, with the possible adjunct of corticosteroids at low-moderate doses for unresponsive patients. Additional therapies, especially anakinra, have been implemented for those who develop corticosteroid dependence and are colchicine-resistant. The most common and troublesome complication of pericarditis is represented by recurrences, while the risk of developing constriction is related to the aetiology and not to the number of recurrences.