Pericarditis in adults: systematic review of epidemiology, etiologies, diagnosis and management – 2025 update

Abstract

Pericarditis is the most common cause of pericardial inflammation in adults and presents a broad clinical spectrum, ranging from self-limited episodes to severe forms associated with cardiac tamponade or constrictive pericarditis. This systematic review synthesizes recent evidence on the epidemiology, etiologies, diagnosis and management of pericarditis in adults, focusing on publications from 2018 to 2025. Searches were conducted in PubMed/MEDLINE, Embase, Scopus and the Cochrane Library, including clinical trials, observational studies, meta-analyses and international guidelines. Of 3,106 initially identified studies, 156 met eligibility criteria. Findings indicate that most cases are idiopathic or viral with excellent prognosis, although high-risk features require hospitalization and expanded evaluation. Cardiac magnetic resonance has become central for detecting active inflammation, while biomarkers such as C-reactive protein and troponin aid in risk stratification. Treatment with non-steroidal anti-inflammatory drugs, colchicine and selected use of corticosteroids or immunosuppressants has reduced recurrence and complications. Advances in understanding inflammation have modernized therapeutic strategies and improved outcomes.