How would you manage a patient with RA on abatacept now experiencing recurrent pericarditis not responsive to colchicine?

Anakinra or rilonacept (both IL-1 antagonists) have been shown to be effective in idiopathic pericarditis. Their utility in RA-associated pericarditis is unknown. In this particular patient, abatacept has resulted in well-controlled RA but has not prevented pericarditis even with concurrent colchicine. Three strategies are suggested in the absence of RCT data:

1. Add IL-1 antagonism to abatacept, accepting the risk of increased infection reported with this combination in RA
2. Hold abatacept and attempt IL-1 antagonism as monotherapy with hope that it controls the synovial as well as pericardial inflammation
3. Switch abatacept to alternative biologic with the hope for control of synovitis and pericarditis