Therapy for recurrent acute pericarditis: a rheumatological solution?

  • Brucato A
  • Brambilla G
  • Adler Y
 et al. 
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Abstract

OBJECTIVE: To assess the efficacy of a multidrug protocol in recurrent acute pericarditis. We tried also to assess the specific role of colchicine.

METHODS: We studied 58 patients (34 males) in the largest monocentric observational study. All patients received prolonged courses of non-steroidal anti-inflammatory drugs; generally we do not start a corticosteroid in recurrent acute pericarditis, but if a steroid had already been started, we planned a very slow tapering; if necessary azathioprine, hydroxychloroquine, and other immunosuppressive drugs were used; 44 patients (27 males, 61.4%) were treated also with colchicine and 14 patients (7 males, 50%) were not given this drug.

RESULTS: After starting our protocol recurrences dropped from 0.48 to 0.03 attacks/patient/month (p < 0.00001) within 12 months and remained at the same level till the end of the follow-up (mean 8.1 years) in the whole cohort. In the 44 patients treated with colchicine recurrences dropped from 0.54 to 0.03 attacks/patient/month (p < 0.00001) within 12 months, and in 14 patients not given colchicine recurrences decreased from 0.31 to 0.06 attacks/patient/month (p = 0.002). In patients treated with colchicine the decrease was significantly higher (0.51) than in patients not taking this drug (0.25) (p = 0.006). Colchicine was discontinued by 16.3% of patients because of side effects.

CONCLUSION: A multidrug protocol including non-steroidal anti-inflammatory drugs at high dosage, slow tapering of corticosteroid, colchicine, reassurance and close clinical monitoring is very effective in recurrent pericarditis; this improvement is more dramatic in colchicine treated patients, but also patients who do not tolerate it can achieve good control of the disease.

Author-supplied keywords

  • Acute Disease
  • Adult
  • Azathioprine
  • Azathioprine: therapeutic use
  • Colchicine
  • Colchicine: therapeutic use
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hydroxychloroquine
  • Hydroxychloroquine: therapeutic use
  • Immunosuppressive Agents
  • Immunosuppressive Agents: therapeutic use
  • Male
  • Pericarditis
  • Pericarditis: diagnosis
  • Pericarditis: drug therapy
  • Pericarditis: physiopathology
  • Prednisone
  • Prednisone: therapeutic use
  • Recurrence
  • Recurrence: prevention & control
  • Treatment Outcome

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Authors

  • a Brucato

  • G Brambilla

  • Y Adler

  • D H Spodick

  • B Canesi

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