Colchicine Treatment for Recurrent Pericarditis

Abstract

Background-The most troublesome complication of acute pericarditis is recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases. The cause of the recurrence is usually unknown, although in some cases it may be traced to viral infection or may be a consequence of coronary artery bypass grafting. The optimal method for prevention has not been fully established; accepted modalities include nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressive agents, and pericardiectomy. Methods and Results-Based on the proven efficacy of colchicine therapy for familial Mediterranean fever (recurrent polyserositis), several small studies have used colchicine successfully to prevent recurrence of acute pericarditis after failure of conventional treatment. Recently, we reported the results from the largest multicenter international study on 51 patients who were treated with colchicine to prevent further relapses and who were followed up for Յ10 years. Conclusions-In light of new trial data that have accumulated in the past decade, we review the evidence for the efficacy and safety of colchicine for the prevention of recurrent episodes of pericarditis. Clinical and personal experience shows that colchicine may be an extremely promising adjunct to conventional treatment and may ultimately serve as the initial mode of treatment, especially in idiopathic cases. (Circulation. 1998;97:2183-2185.)

Pericardiectomy vs Medical Management in Patients With Relapsing Pericarditis

“…4 First-line medical treatment for symptom relief has included NSAIDs 4 and colchicine, which has also been effective in preventing recurrences. 5,8,10 Corticosteroid use has been controversial and has been recommended only when first-line treatment has failed. However, 60% to FIGURE 2.…”

“…[4][5][6][7][8][9][10][11] Immunosuppressive therapy has generally been used when the underlying cause of pericarditis is autoimmune or rheumatologic in origin. 6 The question that clinicians have in these cases of refractory relapsing pericarditis is what to do next when medical therapy has failed.…”

“…In our study, only 25 surgical patients (43.1%) and 23 medical patients (18.2%) were treated with colchicine at the time of the index visit. In addition, numerous studies have linked corticosteroid treatment with a higher rate of relapse, [4][5][6][7][8][9][10][11] and the current literature recommends limited use of corticosteroids in relapsing pericarditis. Yet, 41 patients (70.7%) in the surgical group and 53 (42.1%) in the medical group were treated with corticosteroids at the index visit.…”

“…Current recommendations on the management of relapsing pericarditis include treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine for the initial relapse, 5 corticosteroids for patients in whom initial medical therapy has failed, and possibly immunosuppressive agents for patients in whom an autoimmune or inflammatory disease is the underlying cause. 3,6 Although the use of corticosteroids for relapsing pericarditis can provide relatively rapid relief of symptoms, multiple studies have suggested that corticosteroid administration may favor relapses [4][5][6][7][8][9][10][11] and also predisposes the patient to multiple adverse events.…”

Anesthesia and the patient with pericardial disease

“…49 Colchicine 0.6 mg bid has also been used alone or in combination with other anti-inflammatory therapies. 50,51 For most patients with pericarditis, symptoms usually improve within two weeks, but if persistent, a change in NSAID type or the addition of colchicine may be indicated. Steroids may also be added as secondary therapy, but in studies that have used glucocorticoids as first-line therapy, the incidence of recurrence appears to be greater, [52][53][54] making routine steroids inadvisable.…”