International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences

Lotrionte, Marzia; Biondi‐Zoccai, Giuseppe; Imazio, Massimo; Castagno, Davide; Moretti, Claudio; Abbate, Antonio; Agostoni, Pierfrancesco; Brucato, Antonio; Pasquale, Pietro Di; Raatikka, Marja; Sangiorgi, Giuseppe; Laudito, Antonio; Sheiban, Imad; Gaïta, Fiorenzo

doi:10.1016/j.ahj.2010.06.015

Cited by 123 publications

(79 citation statements)

References 22 publications

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“…Concomitant use of NSAIDs and colchicine has been shown to reduce the risk of treatment failure and recurrence. 7 In addition, glucocorticoids may be considered in cases associated with connective tissue diseases or in those refractory to NSAID therapy. However, their use has been called into question because some studies have shown an increased risk of recurrence with high-dose cortico steroids, although lower-dose cortico steroids may mitigate these risks.…”

Section: Discussionmentioning

confidence: 99%

“…However, their use has been called into question because some studies have shown an increased risk of recurrence with high-dose cortico steroids, although lower-dose cortico steroids may mitigate these risks. 7 Prolonged or repeated cortico steroid courses may also increase osteoporosis risk, and preventive bisphosphonate therapy and/or calcium and vitamin D supplementation should be considered in such cases. Furthermore, high-dose NSAID therapy increases the risk of gastrointestinal complications; thus, consideration should be given to acid suppression therapy for gastroduodenal protection.…”

Section: Discussionmentioning

confidence: 99%

“…12 In recurrent cases, first-line treatment remains NSAIDs, whereas colchicine may be added to reduce the risk of recurrence. 7 …”

Section: Discussionmentioning

confidence: 99%

“…Prednisone is sometimes used as an adjunctive therapy in refractory cases, although it is not recommended as monotherapy because it has been demonstrated to increase the risk of recurrence. 7 Readministering an anti-inflammatory medication, such as methotrexate, for a patient with rheumatoid arthritis and uncontrolled inflammation is appropriate. However, this would not result in immediate, substantial relief and would thus be inadequate monotherapy.…”

mentioning

confidence: 99%

“…Colchicine is an adjunctive treatment that may be added to standard therapy to reduce risk of recurrence but is not recommended as monotherapy. 7 Because this patient was found to have coronary artery disease and underwent stent placement, her anti-inflammatory regimen consisted of aspirin, 650 mg 4 times daily. In addition, the rheumatology department was consulted, and per their recommendations, a 2-week prednisone taper was added (given her untreated rheumatoid arthritis) and her weekly methotrexate was resumed.…”

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confidence: 99%

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84-Year-Old Woman With Chest Pain

Hardegree

Bell

2012

Mayo Clinic Proceedings

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A n 84-year-old woman presented to the emergency department with an 8-hour history of persistent substernal chest pain. The pain intensity was rated a 6 on a scale of 1 to 10, radiated to the shoulder blades, and was worse with deep breathing and lying flat. She denied dyspnea, orthopnea, palpitations, or lower-extremity edema. She had no history of cardiac disease. Her medical history was notable for well-controlled rheumatoid arthritis and hypertension. Her medications included triamterene and hydrochlorothiazide (37.5 and 25 mg/d) for hypertension and methotrexate for rheumatoid arthritis (15 mg/wk), which she had stopped taking 8 weeks earlier after recent hip surgery.Her heart rate was 74 beats/min, blood pressure was 127/72 mm Hg, and respiratory rate was 25/ min. Her temperature was 36.8°C, and oxygen saturation was 97% on ambient air. Initial examination by emergency department staff revealed an alert, well-appearing, white woman in no acute distress. No cardiac murmurs were noted, pulses were equal throughout all extremities, and there was no appreciable jugular venous distention. Pulmonary, abdominal, neurologic, and extremity examination was unrevealing. No lymphadenopathy or rash was noted. A chest radiograph revealed a normal cardiac silhouette and normal-appearing lung fields. An electrocardiogram (ECG) was obtained (Supplemental Figure, available online at http://www.mayoclinicproceedings.org), revealing ST-segment elevation in anterior, inferior, and lateral leads. Given the ST-segment elevation in the context of new-onset chest pain, the institutional ST-segment elevation myocardial infarction (STEMI) protocol was activated; she was given heparin, aspirin, and clopidogrel and taken immediately for coronary angiography.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…12 In recurrent cases, first-line treatment remains NSAIDs, whereas colchicine may be added to reduce the risk of recurrence. 7 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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84-Year-Old Woman With Chest Pain

Hardegree

Bell

2012

Mayo Clinic Proceedings

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Evaluation and Treatment of Pericarditis

Imazio

Gaïta²,

LeWinter

2015

JAMA

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Diagnosis, Risk Stratification, and Treatment of Pericarditis

Cremer,

Klein,

Imazio

2024

JAMA

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ImportancePericarditis accounts for up to 5% of emergency department visits for nonischemic chest pain in North America and Western Europe. With appropriate treatment, 70% to 85% of these patients have a benign course. In acute pericarditis, the development of constrictive pericarditis (&lt;0.5%) and pericardial tamponade (&lt;3%) can be life-threatening.ObservationsAcute pericarditis is diagnosed with presence of 2 or more of the following: sharp, pleuritic chest pain that worsens when supine (≈90%); new widespread electrocardiographic ST-segment elevation and PR depression (≈25%-50%); a new or increased pericardial effusion that is most often small (≈60%); or a pericardial friction rub (&lt;30%). In North America and Western Europe, the most common causes of acute pericarditis are idiopathic or viral, followed by pericarditis after cardiac procedures or operations. Tuberculosis is the most common cause in endemic areas and is treated with antituberculosis therapy, with corticosteroids considered for associated constrictive pericarditis. Treatment of acute idiopathic and pericarditis after cardiac procedures or operations involves use of high-dose nonsteroidal anti-inflammatory drugs (NSAIDs), with doses tapered once chest pain has resolved and C-reactive protein level has normalized, typically over several weeks. These patients should receive a 3-month course of colchicine to relieve symptoms and reduce the risk of recurrence (37.5% vs 16.7%; absolute risk reduction, 20.8%). With a first recurrence of pericarditis, colchicine should be continued for at least 6 months. Corticosteroids are often used if pericarditis does not improve with NSAIDs and colchicine. In certain patients with multiple recurrences, which can occur for several years, interleukin 1 (IL-1) blockers have demonstrated efficacy and may be preferred to corticosteroids.ConclusionsAcute pericarditis is a common cause of nonischemic chest pain. Tuberculosis is the leading cause of pericarditis in endemic areas and is treated with antitubercular therapy. In North America and Western Europe, pericarditis is typically idiopathic, develops after a viral infection, or develops following cardiac procedures or surgery. Treatment with NSAIDs and colchicine leads to a favorable prognosis in most patients, although 15% to 30% of patients develop recurrence. Patients with multiple recurrent pericarditis can have a disease duration of several years or more, are often treated with corticosteroids, and IL-1 blockers may be used for selected patients as steroid-sparing therapy.

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International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences

Cited by 123 publications

References 22 publications

84-Year-Old Woman With Chest Pain

84-Year-Old Woman With Chest Pain

Evaluation and Treatment of Pericarditis

Diagnosis, Risk Stratification, and Treatment of Pericarditis

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