From the Guidelines
Pericarditis treatment should primarily involve a combination of anti-inflammatory medications, with aspirin or NSAIDs as the mainstay of therapy, and colchicine added to reduce recurrence rates, as recommended by the 2015 ESC guidelines 1. The treatment approach for pericarditis is focused on reducing inflammation, relieving symptoms, and preventing complications.
- The first-line treatment consists of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin for 1-2 weeks, followed by a gradual taper over 2-4 weeks.
- Colchicine (0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg) should be added to NSAIDs for 3 months in acute cases and 6 months for recurrent cases, as it significantly reduces recurrence rates, as supported by the guidelines 1.
- For pain relief, acetaminophen or opioids may be used if NSAIDs are contraindicated.
- In severe or refractory cases, corticosteroids like prednisone might be necessary but should be used cautiously due to potential side effects and risk of recurrence, as noted in the guidelines 1.
- Rest and activity restriction, particularly avoiding strenuous physical activity for about 3 months, are important to prevent complications, with a minimal restriction of 3 months recommended for athletes 1. Key considerations in the management of pericarditis include:
- Identifying and treating the underlying cause, if possible
- Monitoring response to treatment and adjusting medications as needed
- Regular follow-up to prevent complications and recurrence, with serum CRP levels considered to guide treatment duration and assess response to therapy 1.
From the Research
Pericarditis Treatment Overview
- Pericarditis is typically treated with anti-inflammatory medications, with the goal of relieving symptoms and preventing recurrences 2, 3, 4, 5, 6.
- The mainstay of therapy for acute and recurrent pericarditis includes high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine 2, 3, 4, 6.
Medications Used in Pericarditis Treatment
- Aspirin and NSAIDs are commonly used to treat pericarditis, with colchicine often added to reduce the risk of recurrences 2, 3, 4, 6.
- Corticosteroids, such as prednisone, may be used in certain cases, including those with autoimmune disorders or recurrent pericarditis that does not respond to NSAIDs and colchicine 2, 3, 4, 5.
- Interleukin-1 blockers, such as anakinra and rilonacept, may be used as a third-line option in patients who cannot come off glucocorticoids or as second-line therapy after NSAIDs and colchicine in patients with contraindications to glucocorticoids 3, 6.
Treatment Strategies
- Treatment of acute pericarditis typically involves the use of high-dose NSAIDs, which are tapered once symptoms are controlled, and colchicine, which is continued for at least 3-6 months 3, 4, 6.
- In cases of recurrent pericarditis, colchicine should be continued for at least 6 months, and corticosteroids may be used if NSAIDs and colchicine are not effective 3, 4, 5.
- A systematic review and meta-analysis of controlled clinical trials found that colchicine and anti-interleukin-1 agents were effective in reducing the risk of recurrent pericarditis 6.