Recurrent Pericarditis: Modern Approach in 2016.
Recurrent pericarditis is one of the most troublesome complications of pericarditis occurring in about one third of patients with a previous attack of pericarditis. The pathogenesis is presumed to be autoimmune and/or autoinflammatory in most cases. The mainstay of therapy for recurrences is physical restriction and anti-inflammatory therapy based on aspirin or NSAID plus colchicine. Corticosteroids at low to moderate doses (e.g., prednisone 0.2 to 0.5 mg/kg/day) should be considered only after failure of aspirin/NSAID (and more than one of these drugs) or for specific indications (e.g., pregnancy, systemic inflammatory diseases on steroids, renal failure, concomitant oral anticoagulant therapy). One of the most challenging issues is how to cope with patients who have recurrences despite colchicine. A small subset of patients (about 5 %) may develop corticosteroid-dependence and colchicine resistance. Among the emerging treatments, the three most common and evidence-based therapies are based on azathioprine, human intravenous immunoglobulin (IVIG), and anakinra. After failure of all options of medical therapy or for those patients who do not tolerate medical therapy or have serious adverse events related to medical therapy, the last possible option is the surgical removal of the pericardium. Total or radical pericardiectomy is recommended in these cases in experienced centers performing this surgery. A stepwise approach is recommended starting from NSAID and colchicine, corticosteroid and colchicine, a combination of the three options (NSAID, colchicine and corticosteroids), then azathioprine, IVIG, or anakinra as last medical options before pericardiectomy.
Cardiology Department, Maria Vittoria Hospital, Torino, Italy. massimo_imazio@yahoo.it.|Department of Public Health and Pediatrics, University of Torino, Torino, Italy. massimo_imazio@yahoo.it.
Massimo
M
Imazio
Chaim Sheba Medical Center, Tel Hashomer, Israel.|The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.
Yehuda
Y
Adler
Université de Versailles-Saint Quentin, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France.
Philippe
P
Charron
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D010492:Pericardiectomy; D010493:Pericarditis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D001379:Azathioprine; D001241:Aspirin; D003078:Colchicine
Colchicine; Pericarditis; Prognosis; Recurrence; Therapy