u/Eustreptospondylus

Recurrence next steps, normal CRP/ESR

For those of you with recurrent pericarditis who had normal or negative inflammatory marker tests during a flare up, what were the next steps you took to achieve a diagnosis and treatment?

I have a post viral acute pericarditis diagnosis 1 year ago, treated with Ibuprofen + Colchicine and subsided despite a few small flares.

4 months ago I had a significant flare of symptoms that felt identical, but my CRP/ESR returned normal, and my echocardiagram showed no effusion or clinical signs. Cardiologist heard my concerns, but due to those test results they felt I did not reach the clinical markers needed for a diagnosis. Despite the lack of diagnosis as recurrent peri, I suffered 2 months of pain and reduced cardiovascular function with a recovery timeline identical to original symptoms. I now have another flare despite remaining on colchicine since my previous flare and appointment, am almost certain this is recurrent pericarditis.

Should I request a cardiac MRI in the hopes of settling the diagnosis? It seems like that would solve the matter and allow my cardiologist to prepare for treatment escalation (possible IL-1 drugs in future).

Thanks for any replies. I've seen several times searching this subreddit people who have accounts of negative inflammatory markers when they had symptoms, but not many follow-up posts from what happened after.

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u/Eustreptospondylus — 4 days ago