From the Guidelines
The treatment for pericarditis typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (600-800 mg every 8 hours) or aspirin (650-1000 mg every 4-6 hours) for 2-4 weeks, as recommended by the European Society of Cardiology (ESC) guidelines [ 1 ].
Key Components of Treatment
- Colchicine (0.5-1.0 mg twice daily) is also recommended as an adjunctive therapy to reduce recurrence rates [ 1 ].
- In cases of severe or recurrent pericarditis, corticosteroids such as prednisone (0.2-0.5 mg/kg/day) may be used, with a gradual tapering of the dose over 2-3 months [ 1 ].
- Exercise restriction should be considered for non-athletes with acute pericarditis until resolution of symptoms and normalization of CRP, ECG, and echocardiogram [ 1 ].
- For athletes, the duration of exercise restriction should be considered until resolution of symptoms and normalization of CRP, ECG, and echocardiogram—at least 3 months is recommended [ 1 ].
- CRP dosage should be considered to guide the treatment duration and assess the response to therapy [ 1 ].
- Gastroprotection should be provided when using NSAIDs [ 1 ].
- Tapering of NSAIDs and colchicine should be considered based on symptoms and CRP levels [ 1 ].
From the Research
Treatment Options for Pericarditis
The treatment for pericarditis typically involves anti-inflammatory therapy, with the goal of reducing inflammation and alleviating symptoms. The main treatment options include:
- Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) as the first line of treatment 2, 3
- Colchicine as an adjunct to conventional therapy, especially for recurrent pericarditis 4, 5, 6
- Corticosteroids as a second-line therapy for difficult cases or specific medical conditions, such as systemic autoimmune diseases or postpericardiotomy syndrome 2, 6
Treatment Approach
The treatment approach for pericarditis should be individualized, with the goal of providing full daily control of symptoms and achieving remission and C-reactive protein normalization 2. The treatment regimen may involve:
- Aspirin or NSAIDs as the initial treatment, with colchicine added as an adjunct for recurrent pericarditis or difficult cases
- Corticosteroids used as a second-line therapy, with careful consideration of the potential risks and benefits
- Alternative medical options, such as azathioprine or intravenous human immunoglobulins, for refractory cases 6
Recurrent Pericarditis
Recurrent pericarditis is a common complication of pericarditis, occurring in 15-30% of cases 6. The treatment for recurrent pericarditis typically involves:
- Aspirin or NSAIDs plus colchicine as the mainstay of medical therapy
- Second-line therapy with low to moderate doses of corticosteroids plus colchicine for difficult cases
- Alternative medical options for refractory cases, with surgical pericardiectomy considered as a last resort in well-experienced centers 6