Acute and recurring pericarditis: More colchicine, less corticosteroids

Abstract

Acute and recurring pericarditis are frequently encountered clinical entities. Given that severe complications such as tamponade and constrictive pericarditis occur rarely, the majority of patients suffering from acute pericarditis will have a benign clinical course. However, pericarditis recurrence, with its painful symptoms, is frequent. In effect, recent studies have demonstrated a beneficial role of colchicine in preventing recurrence, while also suggesting an increase in recurrences with the use of corticosteroids, the traditional first-line agent.

Contemporary management of pericardial diseases

“…However, in this setting colchicine has been proven to be a useful adjunct to conventional anti-inflammatory therapy (aspirin or NSAID). When appropriately used and contraindications have been excluded, oral colchicine is a welltolerated and efficacious treatment and prevention for pericarditis [31][32][33]. At 18 months, the recurrence rate was 24% in the colchicine group and 55% in the placebo group [relative risk reduction (RRR) 0.56, number needed to treat (NNT) 3].…”

Evaluation and management of pericarditis

“…In one study, after adjustment for potential confounders (age, female gender and non-idiopathic origin) only high doses of prednisone were associated with severe side effects, recurrences and hospitalizations (HR: 3.61; 95% CI: 1.96-6.63; p < 0.001) [32]. In a review [33] and in a recently published meta-analysis [34], steroids were associated with a trend toward increased risk of recurrent pericarditis (OR: 7.50). Conversely, low-dose steroids proved superior to high-dose steroids for treatment failure or recurrent pericarditis (OR: 0.29), rehospitalizations (OR: 0.19) and adverse effects (OR: 0.07) [34].…”

Pericarditis: Pathophysiology, Diagnosis, and Management

“…In one study, after adjustment for potential confounders (age, female gender, nonidiopathic origin), only high doses of prednisone were associated with severe side effects, recurrences, and hospitalizations (hazard ratio, 3.61; 95% CI, 1.96-6.63; P<0.001) [40•]. In other studies [41] and in a recently published meta-analysis [42•], steroids were associated with a trend toward increased risk of recurrent pericarditis (OR, 7.50). Conversely, low-dose steroids proved superior to high-dose steroids in cases involving treatment failure or recurrent pericarditis (OR, 0.29), rehospitalization (OR, 0.19), and adverse effects (OR, 0.07) [42•].…”