From the Guidelines
Management of pericarditis should prioritize treating the underlying cause, relieving symptoms, and preventing complications, with first-line treatment including high-dose aspirin (500-1000 mg every 6-8 hours) and colchicine (0.5-0.6 mg once or twice daily for 3 months) 1. The therapeutic approach targets inflammation reduction in the pericardium, which alleviates pain and prevents fibrosis that could lead to constrictive pericarditis.
- Key considerations in pericarditis management include:
- Treating the underlying cause
- Relieving symptoms
- Preventing complications
- Using NSAIDs such as ibuprofen or indomethacin for 1-2 weeks, then tapering over 1-2 additional weeks
- Adding colchicine (0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg) for 3-6 months to reduce recurrence risk
- Reserving corticosteroids like prednisone (0.25-0.5mg/kg/day) for refractory cases, autoimmune causes, or contraindications to NSAIDs, and tapering slowly
- Recommending rest and activity restriction until symptoms resolve and inflammatory markers normalize
- Considering immunomodulators like azathioprine, IVIG, or anakinra for recurrent pericarditis
- Using pericardiectomy as a last resort for constrictive pericarditis Treatment efficacy is monitored through symptom improvement, normalization of inflammatory markers (CRP, ESR), and resolution of ECG changes, as recommended by the most recent guidelines 1.
From the Research
Pericarditis Management Overview
- Pericarditis is typically managed with empiric anti-inflammatory therapy, including aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine 2.
- The choice of treatment depends on the underlying etiology and the presence of specific medical conditions, such as systemic autoimmune diseases or postpericardiotomy syndrome 2.
First-Line Treatment
- Aspirin and NSAIDs are the mainstay of therapy for acute and recurrent pericarditis, with colchicine often added as an adjunct to reduce the risk of recurrences 2, 3, 4.
- Colchicine is continued for at least 3-6 months to reduce the rate of recurrences 3.
Second-Line Treatment
- Corticosteroids are reserved for patients with a first recurrence who have failed NSAIDs and colchicine, or for those with autoimmune disorders 5, 3.
- Immunosuppressive agents, such as azathioprine, methotrexate, and mycophenolate mofetil, may be effective in patients with idiopathic recurrent pericarditis who are unresponsive to corticosteroids or have unacceptable side effects 5.
Third-Line Treatment
- Interleukin-1 blockers, such as anakinra, rilonacept, and goflikicept, 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 or high-risk features 3.
- Anti-interleukin-1 agents have been shown to be effective in reducing recurrences in patients with recurrent pericarditis refractory to conventional drugs 4.
Treatment Considerations
- Medical therapy for pericarditis should be individualized, with the goal of providing full daily control of symptoms and normalization of C-reactive protein levels 2.
- Treatment should be tapered slowly to minimize the risk of recurrence, and patients should be monitored closely for signs of recurrence or treatment failure 2, 3.