From the Guidelines
Pericarditis should be treated with aspirin or NSAIDs as first-line therapy, along with colchicine, to reduce the risk of recurrence and improve outcomes, as recommended by the 2015 ESC guidelines 1. The treatment of pericarditis typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 600-800mg three times daily or aspirin 650-1000mg every 8 hours for 1-2 weeks, followed by a gradual taper over 2-4 weeks.
- Colchicine should be added to NSAIDs at a dose of 0.5mg twice daily (or 0.5mg once daily for patients <70kg) for 3 months to reduce recurrence risk, as supported by the guidelines 1.
- For severe or refractory cases, corticosteroids like prednisone 0.25-0.5mg/kg/day may be used, but should be tapered slowly to avoid rebound, as cautioned by the guidelines 1.
- Pain management and rest are important, with activity restriction recommended until symptoms resolve and inflammatory markers normalize, such as CRP, which should be considered to guide the treatment duration and assess the response to therapy 1.
- Patients should avoid strenuous physical activity for at least 3 months after the acute episode, with athletes recommended to return to competitive sports only after symptoms have resolved and diagnostic tests have been normalized, as suggested by the guidelines 1. Pericarditis causes chest pain that typically worsens when lying flat and improves when leaning forward, often accompanied by a friction rub on examination. The condition results from immune-mediated inflammation triggered by viral infections, autoimmune disorders, or cardiac injury, with complications including recurrent pericarditis and, rarely, cardiac tamponade requiring emergency intervention. It is essential to identify high-risk patients who require hospital admission, such as those with high fever, subacute course, large pericardial effusion, cardiac tamponade, or failure to respond to NSAIDs, as highlighted by the guidelines 1.
From the Research
Treatment Options for Pericarditis
- Aspirin and non-steroidal anti-inflammatory drugs (NSAID) are the mainstay of therapy for acute and recurrent pericarditis, with the possible adjunct of colchicine, especially for recurrences 2.
- Corticosteroids are a second choice for difficult cases requiring multi-drug therapies and specific medical conditions, such as systemic autoimmune diseases, postpericardiotomy syndrome, and pregnancy 2.
- Colchicine has been shown to be effective in reducing the number of pericarditis recurrences in patients with recurrent pericarditis or acute pericarditis, and can be used as adjunctive therapy to NSAIDs 3, 4.
Colchicine Therapy
- Colchicine can be used at a dose of 0.5mg twice daily for patients >70kg or once daily for those weighing less, in addition to standard anti-inflammatory therapy, to hasten the response to anti-inflammatory therapy and reduce the subsequent risk of recurrences 3.
- The use of colchicine has been associated with a reduced risk of recurrent pericarditis, with a number needed to treat (NNT) of 4 at 18 months follow-up 4.
- Colchicine has also been shown to lead to a greater chance of symptom relief at 72 hours, although it can cause gastrointestinal side effects, such as abdominal pain and diarrhea 4.
Corticosteroid Therapy
- Corticosteroids, especially at high-dose, have been associated with a higher recurrence rate in patients with pericarditis 5.
- However, a retrospective study found that low-dose corticosteroids did not act as an independent risk factor for recurrences, and may be considered a successful and safe treatment for acute and recurrent idiopathic pericarditis 5.
Pharmacologic Treatment
- A systematic review and meta-analysis of controlled clinical trials found that colchicine is the mainstay of treatment in acute and recurrent pericarditis, while anti-IL1 agents are a valuable option in case of recurrent pericarditis refractory to conventional drugs 6.
- The review also found that colchicine was effective in reducing the risk of recurrent pericarditis, compared with standard treatment, without any differences according to clinical setting 6.