Recurrent pericarditis. Relief with colchicine.

Abstract

Recurrence is one of the major complications of pericarditis. Treatment of recurrence is often difficult, and immunosuppressive drugs or surgery may be necessary. We conducted an open-label prospective study of nine patients (seven men and two women; age, 18-64 years; mean age, 41.7 +/- 13.7 years). Patients were treated with colchicine (1 mg/day) to prevent recurrences. All patients had suffered at least three relapses despite treatment with acetylsalicylic acid, indomethacin, prednisone, or a combination. Pericarditis was classified as idiopathic in five patients, postpericardiotomy in two, post-myocardial infarction in one, and associated with disseminated lupus erythematosus in one. For statistical analysis, we conducted a paired comparison design (Student's t test). All patients treated with colchicine responded favorably to therapy. Prednisone was discontinued in all patients after 2-6 weeks (mean, 26.33 +/- 10.9 days), and colchicine alone was continued. After a mean follow-up of 24.3 months (minimum, 10 months; maximum, 54 months), no recurrences were observed in any patient; there was a significant difference between the symptom-free periods before and after treatment with colchicine (p less than 0.002). Our study suggests that colchicine may be useful in avoiding recurrence of pericarditis, although these results need to be confirmed in a larger, double-blind study.

Controversial Issues in the Management of Pericardial Diseases

“…Unsatisfactory results are often reported when NSAIDs are used. 20,21,55 Some of these failures are due to low dosages or courses that are too short, with interruption of the therapy while the disease is still active, as manifested by persistently elevated CRP. Articles often give no details on the specific drug.…”

Relapsing pericarditis

“…This experience is very similar to that of Guindo and colleagues. 17 Clinical manifestations and evolution: key points c Symptoms during recurrences are similar to the index attack, the main manifestation being chest pain of pericardial characteristics c Usually clinical manifestations are more severe in the index attack, while subsequent episodes are milder. Frequently, chest pain is the only manifestation during relapses c Tamponade is infrequent during relapses, especially when not present in the index attack.…”

Colchicine Treatment for Recurrent Pericarditis

“…In a later prospective study, Guindo and colleagues 14 reported on 9 patients (5 idiopathic, 2 post-open heart surgery, 1 with Dressler's syndrome, and 1 with systemic lupus erythematosus) in whom NSAIDs and corticosteroids failed to prevent relapses of pericarditis (mean of 4.3 episodes per patient). All were treated with combined prednisone (20 to 60 mg/d), which was tapered and discontinued within 6 weeks, and colchicine (1 mg/d).…”