For a patient with recurrent idiopathic pericarditis who has not improved on current therapy, what is the best recommendation?

In cases of recurrent idiopathic pericarditis that do not respond adequately to standard treatments such as colchicine or corticosteroids, the addition of anakinra presents a promising option. Anakinra is an interleukin-1 receptor antagonist that has been shown to be effective in some patients with pericarditis, especially those who experience persistent symptoms despite traditional therapy. The rationale behind utilizing anakinra is that it targets the inflammatory processes that underlie pericarditis, thus potentially providing greater relief from symptoms and reducing the frequency of recurrences.

Colchicine and corticosteroids are often the initial treatments for pericarditis, but their efficacy can be limited in some cases. Increasing the dose of prednisone may help in some instances, but it also carries the risk of exacerbating side effects and does not address the underlying inflammatory pathways as effectively as anakinra. Similarly, while aspirin can provide anti-inflammatory benefits, it may not be sufficient for controlling severe or recurrent cases. Discontinuing colchicine, on the other hand, would likely counteract the benefits of treatment, particularly as it is commonly used to manage recurrent episodes.

Thus, the recommendation to add anakinra is indicative of a more aggressive therapeutic approach aimed at managing persistent