Individualized therapy for pericarditis

Abstract

The treatment of pericarditis remains largely empirical owing to a relative lack of randomized, controlled trials; nevertheless, a number of observational studies and the first randomized trials are moving the management of pericardial diseases on the road to evidence-based medicine. Moreover, emerging data suggest that treatment can be tailored to the specific patient and, although the optimal length of treatment is not clearly established, some recommendations can be formulated to guide management and follow-up. Aspirin or a NSAID at medium-to-high dosages are the mainstay of treatment (e.g., aspirin 2–4 g/day, ibuprofen 1200–1800 mg/day, indomethacin 75–150 mg/day). Corticosteroid use should be restricted, and low-to-medium doses (i.e., prednisone 0.2–0.5 mg/kg/day) should be preferred. Colchicine 0.5–1.2 mg/day is effective for reducing recurrences.

Keywords::

• aspirin
• colchicine
• corticosteroid
• pericarditis
• treatment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

Corticosteroid therapy should be restricted to patients with contraindications to aspirin or NSAIDs; after real failure of these drugs and in more severe recurrent cases, consider low-to-medium doses (prednisone 0.2–0.5 mg/kg/day).