From the Guidelines
The treatment of pericarditis should focus on relieving symptoms and addressing the underlying cause, with first-line therapy including nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, and colchicine as an adjunct to reduce recurrence risk, as recommended by the 2015 ESC guidelines 1. The choice of NSAID should be based on the patient's history, concomitant diseases, and physician expertise, with aspirin or ibuprofen being commonly used options 1.
- Aspirin can be used at a dose of 650-1000mg three times daily for 1-2 weeks, followed by a gradual taper over 2-4 weeks 1.
- Ibuprofen can be used at a dose of 600-800mg three times daily for 1-2 weeks, followed by a gradual taper over 2-4 weeks 1. Colchicine should be added to NSAIDs at a dose of 0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg, for 3 months in acute cases and 6 months for recurrent cases 1. Gastrointestinal protection with a proton pump inhibitor like omeprazole 20mg daily is recommended when using NSAIDs 1. For patients with contraindications to NSAIDs or refractory symptoms, corticosteroids like prednisone may be used, but should be tapered slowly to prevent recurrence, with a dose of 0.25-0.5mg/kg/day being recommended 1. Rest and activity restriction, particularly avoiding competitive sports until resolution of symptoms and normalization of inflammatory markers, is important, with a minimal restriction of 3 months being recommended for athletes 1. Specific causes of pericarditis, such as bacterial or tuberculous infections, require targeted antimicrobial therapy, and pericardiocentesis is indicated for cardiac tamponade or suspected purulent pericarditis 1.
From the Research
Treatment Options for Pericarditis
The treatment for pericarditis typically involves anti-inflammatory therapy, with the goal of reducing symptoms and preventing recurrences. The main treatment options include:
- Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for uncomplicated cases 2, 3, 4
- Colchicine as an adjunct to NSAIDs, especially for recurrences 2, 3, 5
- Corticosteroids as a second-line treatment for difficult cases or specific medical conditions, such as systemic autoimmune diseases or postpericardiotomy syndrome 2, 3, 6
- Interleukin 1 (IL-1) blockers as a potential treatment option for patients with multiple recurrences who do not respond to conventional therapy 3, 5
Treatment Approach
The treatment approach for pericarditis should be individualized, with the goal of providing full daily control of symptoms and achieving remission 2. The treatment should be tapered once symptoms have resolved and C-reactive protein levels have normalized, typically over several weeks 3. For patients with recurrent pericarditis, colchicine should be continued for at least 6 months, and corticosteroids may be used if necessary 3, 6.
Specific Considerations
In certain cases, such as postpericardiotomy syndrome or systemic autoimmune diseases, corticosteroids may be considered as a first-line treatment 2, 6. Additionally, tuberculosis is a common cause of pericarditis in endemic areas and should be treated with antitubercular therapy, with corticosteroids considered for associated constrictive pericarditis 3.