Idiopathic Pericarditis Refractory to or Intolerant of NSAID Plus Colchicine
Standard first-line management of idiopathic pericarditis centres on an NSAID plus colchicine. When that regimen fails to resolve symptoms and normalise inflammatory markers — or cannot be tolerated — a structured next step is required.
First-line therapy consisted of rest, physical activity restriction, an NSAID plus colchicine (with gastric protection). The goals of that regimen were resolution of symptoms and improvement of acutely elevated serum inflammatory markers — C-reactive protein and erythrocyte sedimentation rate — after an initial 7 to 14 days.
Escalation to the present protocol is indicated when those goals are not achieved, or when the first-line regimen cannot be tolerated.
For patients who are refractory to, or intolerant of, NSAID plus colchicine, the next therapeutic step involves the addition of a glucocorticoid. Additional protective measures are also factored into prolonged management.
Full regimen details — including phased management, dosing considerations, and tapering guidance — are available in the complete protocol below.
Prompt symptomatic relief.
References
DOI: 10.1161/CIRCULATIONAHA.111.066365
- As a result, and owing to the side effects associated with long-term steroid therapy, glucocorticoids should only be prescribed to patients with idiopathic pericarditis who are refractory to treatment with, or intolerant of, an NSAID plus colchicine.
- A lower dosage (0.25–0.50 mg·kg−1·d−1) for 2 to 4 weeks, followed by slow tapering is effective and is associated with fewer relapses than the higher dosage.
- With prolonged corticosteroid use, osteoporosis prevention (eg, calcium, vitamin D, and bisphosphonates) should be considered.
- Steroid therapy has long been used to treat pericarditis because it induces prompt symptomatic relief; however, glucocorticoids should not be used as primary therapy in uncomplicated acute idiopathic pericarditis because of a high rate of relapse when the steroid is tapered or stopped.