From the Guidelines
Treatment for mild pericarditis typically involves rest, pain management, and anti-inflammatory medications, with the first-line treatment being nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin, and colchicine added to reduce recurrence risk, as recommended by the 2015 ESC guidelines 1.
Key Components of Treatment
- NSAIDs, such as ibuprofen (600-800 mg three times daily) or aspirin (750-1000 mg three to four times daily), are used for 1-2 weeks, followed by a gradual taper over 2-4 weeks 1.
- Colchicine is added to the regimen (0.5 mg twice daily for patients >70 kg or 0.5 mg once daily for patients <70 kg) for 3 months to reduce recurrence risk, as supported by the guidelines 1.
- Patients should restrict physical activity beyond light daily tasks until symptoms resolve and inflammatory markers normalize, typically 2-4 weeks, and monitoring for symptom improvement is essential, with follow-up evaluation recommended after 1-2 weeks of treatment 1.
Considerations for Treatment
- Corticosteroids may be used in cases of incomplete response to aspirin/NSAIDs and colchicine, but they should be added at low to moderate doses to aspirin/NSAIDs and colchicine as triple therapy, not replace these drugs, as recommended by the guidelines 1.
- The treatment approach should be guided by the patient's symptoms, CRP levels, and other clinical factors, with the goal of reducing inflammation and preventing recurrence, as emphasized by the guidelines 1.
Important Considerations
- Adequate hydration and avoiding alcohol while taking these medications is also important to prevent complications, and patients should be closely monitored for potential side effects and recurrence of symptoms 1.
- The guidelines recommend a gradual tapering of NSAIDs and colchicine to minimize the risk of recurrence and side effects, and to ensure a smooth transition to maintenance therapy 1.
From the Research
Treatment for Mild Pericarditis
The treatment for mild pericarditis typically involves anti-inflammatory therapy. The mainstay of therapy includes:
- Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3, 4, 5
- Colchicine, especially for recurrences 2, 3, 4, 5
- Corticosteroids are considered a second choice for difficult cases or specific medical conditions, such as systemic autoimmune diseases, postpericardiotomy syndrome, and pregnancy 2, 3, 4, 6
Treatment Approach
The treatment approach for mild 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 should be tapered once chest pain has resolved and C-reactive protein level has normalized, typically over several weeks 3.
Recurrence Prevention
To prevent recurrences, a 3-month course of colchicine is recommended, with continuation for at least 6 months in cases of recurrence 3. In patients with multiple recurrences, interleukin 1 (IL-1) blockers may be considered as an alternative to corticosteroids 3.
Corticosteroids Use
Corticosteroids should be used with caution, as they may be associated with a higher recurrence rate, especially at high doses 6. However, low-dose corticosteroids may be considered a successful and safe treatment for acute and recurrent idiopathic pericarditis, with a favorable course and no serious side effects 6.