Synopsis
Confirm inflammatory relapse, find secondary causes and use slow, steroid-sparing escalation to prevent repeated flares and constriction.
- Recurrent pericarditis is a new episode after a documented first attack and a symptom-free interval, conventionally at least 4-6 weeks.
- Incessant disease continues beyond 4-6 weeks without remission; chronic disease lasts beyond 3 months.
- Do not label every recurrent chest pain inflammatory: document CRP rise, ECG/effusion change or CT/CMR inflammation when criteria are incomplete.
Key red flags
Rising JVP, tachycardia, pulsus paradoxus, hypotension or echo chamber collapse is an emergency irrespective of chronicity.
Investigation priorities
Document inflammation and treatment safety; look for systemic clues.
Management branches
New criteria or objective inflammation after remission.
- Recheck high-risk features and aetiology, adherence, prior dose/duration and whether a rapid taper or steroid exposure preceded relapse.
- Restart aspirin/ibuprofen at full anti-inflammatory dose with gastroprotection and add/continue weight-adjusted colchicine for at least 6 months.
First-line agents unsafe/ineffective and infection excluded.
Key medicines
Ibuprofen600 mg orally three times daily initially, then taper by about 200 mg per dose each week only after symptom and CRP remission; maximum 2400 mg/day.
Colchicine0.5 mg orally once daily at 70 kg or less, or 0.5 mg twice daily if over 70 kg, for at least 6 months in recurrent disease.