Pericardite acuta recidivante: Diagnosi e terapia

Introduction: Recurrent acute idiopathic pericarditis is an immunomediated process, and therapy is controversial. Steroids are effective in blunting the acute attack, but relapses are common. Nonsteroidal antiinflammatory drugs (NSAIDs) are often considered less effective, even if rarely used at optimal dosage. Recently colchicine was found to be useful in preventing recurrences. Methods: 25 patients (7 females and 18 males, mean age: 48 yrs) were studied; average follow up lasted 82.1 months (range 19-312). All were treated with NSAIDs and colchicine; steroids, previously administered in 22 pts, were tapered very slowly. Two patients discontinued colchicine for gastrointestinal intolerance and 1 for failure some months after starting the therapy. Results: Recurrences were 0.54/month before introduction of colchicine, and dropped to 0.04/month during colchicine (p >0.001, two-tailed t test for paired samples; 99% confidence limits: 0.26-0.74). The intensity of the pain (visual analogic scale from 1 to 10) during the attacks in the 7 patients who had recurrences also on colchicine was 7.19 on average before and 6.71 during colchicine. In 3 cases hydroxychloroquine, azathioprine or cyclosporine were added. Conclusions: Multidrug therapy including FANS plus colchicine is effective in reducing the frequency and the intensity of the recurrences in idiopathic pericarditis. When colchicine is not tolerated or ineffective, other immunosoppressive drugs may be used.