From the Guidelines
Management of pericarditis involves a stepwise approach focusing on symptom relief and prevention of complications, with first-line treatment consisting of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin (500-1000 mg every 6-8 hours) or ibuprofen, and colchicine (0.5-0.6 mg once or twice daily) for 3 months, as recommended by the most recent guidelines 1. The treatment approach should prioritize symptom relief and prevention of complications, with a focus on minimizing the risk of recurrence.
- Key components of the treatment approach include:
- NSAIDs, such as aspirin or ibuprofen, for 1-2 weeks, followed by gradual tapering over 2-4 weeks
- Colchicine, at a dose of 0.5-0.6 mg once or twice daily, for 3 months in first episodes and 6 months in recurrent cases
- Gastric protection with a proton pump inhibitor, such as pantoprazole 40 mg daily, while on NSAIDs
- Activity restriction, including avoidance of strenuous physical activity, until symptoms resolve and inflammatory markers normalize
- Monitoring with ECGs, echocardiography, and inflammatory markers (CRP) to assess treatment response
- Hospitalization is warranted for high-risk features, including fever >38°C, subacute onset, immunosuppression, trauma, oral anticoagulant therapy, myopericarditis, large pericardial effusion, or cardiac tamponade, as noted in previous guidelines 1. The most recent guidelines 1 provide the most up-to-date recommendations for the management of pericarditis, and should be prioritized in clinical practice.
From the Research
Management of Pericarditis
- The management of pericarditis typically involves the use of anti-inflammatory medications, such as aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), and colchicine 2, 3, 4.
- Corticosteroids may be used as a second-line treatment for patients who do not respond to initial therapy or have recurrent pericarditis 5, 2, 3, 6.
- Immunosuppressive agents, such as azathioprine, methotrexate, and mycophenolate mofetil, may be effective in patients with idiopathic recurrent pericarditis who are unresponsive to corticosteroids or have unacceptable side effects 5.
- Interleukin 1 (IL-1) blockers, such as anakinra and rilonacept, have demonstrated efficacy in reducing recurrences of pericarditis and may be preferred to corticosteroids in certain patients 3, 4.
Treatment Strategies
- The treatment of acute pericarditis typically involves the use of high-dose NSAIDs, with doses tapered once chest pain has resolved and C-reactive protein level has normalized 3.
- Colchicine should be continued for at least 6 months in patients with a first recurrence of pericarditis 3.
- In patients with multiple recurrences, corticosteroids or IL-1 blockers may be used to reduce the risk of further recurrences 3, 4.
- A correct pharmacological management of pericarditis is key to preventing recurrences, and colchicine is the mainstay of treatment in acute and recurrent pericarditis 4.
Special Considerations
- Tuberculosis is the most common cause of pericarditis in endemic areas and is treated with antitubercular therapy, with corticosteroids considered for associated constrictive pericarditis 3.
- Pericarditis after cardiac procedures or operations is typically treated with NSAIDs and colchicine, with corticosteroids used in certain cases 2, 3.
- Pregnancy is a special consideration in the treatment of pericarditis, and corticosteroids may be used in certain cases 2.