From the Guidelines
Corticosteroids are generally not indicated in the treatment of viral pericarditis due to the risk of reactivating viral infections and promoting ongoing inflammation. The use of corticosteroids in viral pericarditis is a topic of debate, but the most recent and highest quality evidence suggests that they should be avoided 1. According to the 2015 ESC guidelines for the diagnosis and management of pericardial diseases, acute viral pericarditis often presents as a self-limiting disease that responds well to a short course of treatment with NSAIDs, with the adjunct of colchicine 1.
The primary concern with using corticosteroids in viral pericarditis is that they can reactivate many virus infections, leading to ongoing inflammation 1. Instead, the focus should be on using NSAIDs, such as ibuprofen or aspirin, in combination with colchicine to reduce symptoms and prevent recurrences. Colchicine has been shown to be effective in modulating inflammatory pathways and reducing the risk of recurrence 1.
In rare cases, where the patient does not respond to standard therapy or has severe inflammation, corticosteroids may be considered, but this should be done with caution and under the guidance of an infectious disease specialist 1. It is essential to rule out active viral infection through appropriate testing before initiating corticosteroids, and patients on steroids require monitoring for side effects, including hyperglycemia, hypertension, weight gain, and mood changes.
Key points to consider in the treatment of viral pericarditis include:
- Avoiding the use of corticosteroids due to the risk of reactivating viral infections
- Using NSAIDs, such as ibuprofen or aspirin, in combination with colchicine as the primary treatment
- Monitoring patients for side effects when using corticosteroids
- Ruling out active viral infection before initiating corticosteroids
- Considering the use of corticosteroids only in rare cases where the patient does not respond to standard therapy or has severe inflammation, and under the guidance of an infectious disease specialist 1.
From the Research
Role of Corticosteroids in Viral Pericarditis
- Corticosteroids are not the first line of treatment for viral pericarditis, and their use should be limited to specific indications 2, 3.
- These specific indications include definite rheumatologic disease, presumed autoimmune etiology, intolerance or contraindications to aspirin or non-steroidal anti-inflammatory drugs, and pregnancy 2.
- The use of corticosteroids is associated with a higher risk of prolonged and chronic course of the disease in idiopathic or viral forms of pericarditis 2, 4.
- Corticosteroid therapy given in the index attack can favor the occurrence of recurrences 4.
Comparison with Other Treatments
- Aspirin and non-steroidal anti-inflammatory drugs (NSAID) are the mainstay of therapy for viral pericarditis, with the possible adjunct of colchicine, especially for recurrences 2, 3.
- Colchicine is effective and safe for the treatment and prevention of recurrent pericarditis, and its use is not contraindicated in the presence of possible COVID-19 infection 4, 5, 6.
- Corticosteroids, colchicine, and anakinra may be considered to treat both pericarditis and COVID-19 infection 5.