This protocol addresses idiopathic pericarditis presenting as recurrent pericarditis following an initial episode of acute pericarditis. One or more recurrences arise in 15% to 30% of patients after an initial acute episode. A first recurrence typically presents within 18 months, with findings similar to the initial episode — including pleuritic chest pain, a pericardial friction rub, diffuse ST-segment elevations, and elevated serum markers of inflammation.
Initial management of the recurrent episode with aspirin or another NSAID plus colchicine did not achieve improvement and resolution of symptoms (pleuritic chest pain, pericardial friction rub) or normalization of elevated serum markers of inflammation.
This protocol defines the next step for that refractory situation.
For recurrent pericarditis refractory to initial therapy, the approach involves adding a glucocorticoid — the complete protocol specifies the agent, regimen, taper strategy, and considerations that accompany its use.
The primary clinical goal is prompt response of recurrence symptoms.
Full dosing, sequencing, and monitoring details are available in the structured protocol below.
DOI: 10.1161/CIRCULATIONAHA.111.066365
One or more recurrences arise in 15% to 30% of patients after an initial episode of acute pericarditis.
A first recurrence typically presents within 18 months, and findings are similar to the initial episode, including pleuritic chest pain, diffuse ST-segment elevations, a pericardial friction rub, and elevated serum markers of inflammation.
Therefore, the consensus is to initially treat recurrent episodes of pericarditis with an NSAID plus colchicine and to prescribe glucocorticoids only for refractory cases.
Thus, a now common approach to the use of steroids in patients with recurrent pericarditis whose symptoms are refractory to an NSAID plus colchicine is the lower-dose prednisone regimen listed in the Table.
With prolonged corticosteroid use, osteoporosis prevention (eg, calcium, vitamin D, and bisphosphonates) should be considered.
Symptoms of pericarditis recurrence respond promptly to glucocorticoid therapy.
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