In treating recurrent idiopathic pericarditis with corticosteroid dependency, which medication is best to add?

In the management of recurrent idiopathic pericarditis, particularly in patients who demonstrate corticosteroid dependency, the need for effective anti-inflammatory options that minimize steroid toxicity is critical. Rilonacept, a long-acting interleukin-1 (IL-1) inhibitor, has shown efficacy in treating conditions associated with inflammation, including pericarditis. By adding rilonacept, the anti-inflammatory effects can help control symptoms and reduce reliance on corticosteroids, which are often associated with significant side effects when used long-term.

The rationale for choosing rilonacept stems from its targeted action in modulating the inflammatory response, providing a pathway to effectively manage recurrent pericarditis without the increased risk of complications that comes from prolonged corticosteroid use. This approach not only targets the underlying inflammatory process but may also help in achieving better symptom control and reducing the frequency of episodes.

In contrast, other options, such as changing to ibuprofen, may not adequately address corticosteroid-dependency in this context, and anakinra, while an IL-1 blocker like rilonacept, may have a different dosing regimen and could also come with its own set of challenges. Discontinuing colchicine, meanwhile, could lead to an increase in