Therapy for recurrent acute pericarditis: A rheumatological solution?

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  • G. B
  • Y. A
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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
  • Colchicine
  • Combination
  • Dose-Response Relationship
  • Drug
  • Drug Therapy
  • Female
  • Humans
  • Hydroxychloroquine
  • Immunosuppressive Agents
  • Italy
  • Male
  • Pericarditis
  • Prednisone
  • Secondary Prevention
  • Treatment Outcome
  • acetylsalicylic acid
  • aged
  • article
  • aspirin
  • azathioprine
  • clinical feature
  • cohort analysis
  • colchicine
  • controlled study
  • corticosteroid
  • cyclosporin
  • diagnosis
  • diarrhea
  • disease control
  • drug dose reduction
  • drug efficacy
  • drug eruption
  • drug megadose
  • drug therapy
  • echocardiography
  • electrocardiogram
  • female
  • follow up
  • gastrointestinal toxicity
  • human
  • hydroxychloroquine
  • ibuprofen
  • immunosuppressive agent
  • immunosuppressive treatment
  • indometacin
  • long term care
  • major clinical study
  • male
  • methotrexate
  • nonsteroid antiinflammatory agent
  • observational study
  • patient monitoring
  • pericarditis
  • physiopathology
  • prednisone
  • priority journal
  • recurrent disease
  • therapeutic use
  • treatment outcome
  • treatment response

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  • Brucato A.

  • Brambilla G.

  • Adler Y.

  • Spodick D.H.

  • Canesi B.

  • A Brucato

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