What is the treatment for pericarditis?

From the Guidelines

Pericarditis treatment should prioritize a combination of anti-inflammatory medications, including aspirin or NSAIDs, and colchicine, to reduce inflammation and manage pain, as recommended by the 2015 ESC guidelines 1. The treatment approach for pericarditis involves several key components, including:

• The use of aspirin or NSAIDs as the mainstay of therapy, with colchicine added as an adjunct to improve response to medical therapy, improve remission rates, and prevent recurrences 1.
• The recommendation for colchicine use at a dose of 0.5 mg twice daily (or 0.5 mg once daily for patients under 70 kg) for 3 months in acute cases or 6 months for recurrent cases 1.
• The consideration of corticosteroids, such as prednisone, at low to moderate doses (0.2-0.5 mg/kg/day) for patients with contraindications to NSAIDs or incomplete response, but with caution due to the potential for rebound and other complications 1.
• The importance of rest and activity restriction during the acute phase, especially avoiding strenuous physical activity until symptoms resolve and inflammatory markers normalize 1.
• The need for monitoring for complications, such as cardiac tamponade or constrictive pericarditis, and treatment of the underlying cause if pericarditis is secondary to conditions like autoimmune disorders, infections, or malignancy.

Key considerations in the treatment of pericarditis include:

• The use of CRP dosage to guide treatment duration and assess response to therapy 1.
• The recommendation for exercise restriction for non-athletes and athletes with recurrent pericarditis until symptom resolution and CRP normalization 1.
• The consideration of colchicine therapy for longer durations (> 6 months) in some cases, according to clinical response 1.

From the Research

Pericarditis Treatment Overview

• Pericarditis treatment typically involves empiric anti-inflammatory therapy, with aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) being the mainstay of therapy 2, 3, 4, 5.
• Colchicine is often used as an adjunct to NSAIDs, especially for recurrences, and has been shown to reduce the risk of recurrence 3, 6.
• 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, 3.

Treatment Options

• Aspirin and NSAIDs are commonly used to treat acute and recurrent pericarditis, with ibuprofen, indometacin, and ketorolac being relatively well-studied options 4.
• Colchicine is effective in reducing recurrent pericarditis, with a risk reduction of 50% compared to standard treatment 6.
• Anti-interleukin-1 agents, such as anakinra and rilonacept, are a valuable option in case of recurrent pericarditis refractory to conventional drugs 6.

Treatment Considerations

• Treatment should be individualized, with the attack dose given every 8 hours to ensure full daily control of symptoms and till remission and C-reactive protein normalization, and then tapering should be considered 2.
• The choice of NSAID should be dictated by comorbid conditions, tolerability, and adverse effects 4.
• High-sensitivity CRP monitoring, bleeding risk, and contraindications to NSAID therapy should be considered when treating pericarditis 4.