Idiopathic pericarditis in 2025: Advances in diagnosis and therapeutic strategies

Idiopathic acute pericarditis is the most frequent form of acute pericarditis in Western countries. Although the short-term course of an uncomplicated first episode is often benign, a substantial proportion of patients progress to complicated forms with recurrences, incessant disease, or chronic constriction, leading to impaired quality of life and challenging management. In 2025, updated American and European guidelines for the diagnosis and management of pericarditis were issued, refining diagnostic criteria-particularly the role of C-reactive protein and multimodality imaging-and integrating targeted therapies such as interleukin-1 (IL-1) inhibitors. A structured assessment of risk factors for complications helps identify patients who require closer monitoring or hospitalization. Initial treatment combines non-steroidal anti-inflammatory drugs or aspirin and colchicine; in case of intolerance or resistance, second-line options include systemic corticosteroids or pharmacological blockade of IL-1. While the long-term prognosis of acute idiopathic pericarditis is generally good in terms of survival and low rates of constrictive pericarditis, recurrent and incessant forms are associated with significant morbidity. Individualized, risk-adapted management and prolonged follow-up are therefore recommended. This review summarizes contemporary data on the pathophysiology, diagnosis, management, and outcomes of idiopathic pericarditis, with a focus on autoinflammatory mechanisms and IL-1-targeted therapies.