Therapy of recurrent pericarditis.

نویسندگان

  • Antonio Brucato
  • Giovanni Brambilla
  • Yehuda Adler
چکیده

e read with interest the paper by Raatikka et al. (1) that gives us useful piece of information regarding pericarditis in children. he data are relevant, particularly regarding the good long-term utcome, with no instance of constriction, in agreement with our xperience in adults. We would like to comment on some tatements regarding therapy. The authors in fact conclude that orticosteroids, methotrexate, azathioprine, cyclosporine, and colhicine did not prevent recurrences. Should we conclude that no rug is effective, so that no drug should be employed? We have ublished case reports describing different experiences. A 14.5ear-old boy (2) previously treated with high-dose steroids, intraenous immunoglobulin, and indomethacin experienced an excelent response when colchicine 1 mg was added, while slowly apering steroids and continuing indomethacin. In another 12ear-old boy (3) who did not respond well to nonsteroidal nti-inflammatory drugs (NSAIDs) and prednisone, the introducion of colchicine proved beneficial; thereafter, the patient preented with six relapses, each occurring 1 to 4 weeks after the iscontinuation of colchicine on his own initiative. The excellent tudy by Raatikka et al. (1), in our opinion, was not designed to ssess the problem of therapy, with the interactions between ifferent drugs, dosages, and combinations: we have to wait for ore definitive studies specifically addressing therapy. Moreover, e have to evaluate if efficacy of a drug means that it must work fter discontinuing all the previous therapies (e.g., to stop steroids nd NSAIDs and add de novo colchicine) or, probably more isely, if a drug’s efficacy means that it works when added to a revious active therapy (e.g., to add colchicine to steroids and SAIDs). In the meantime, even if it will be proved true that recurrent ericarditis has a chronic course irrespective of the therapy given, nd that the activity of the disease gradually “burns out” spontaeously, it remains necessary to use some drugs, the less toxic ones, uring the acute phases. In our opinion, this is best accomplished m ith a multidrug therapy including: 1) a very slow tapering of teroids (months), similar to what is often done in many rheumaologic conditions; 2) NSAIDs used at the recommended dosages; nd 3) introduction of colchicine, if tolerated. In our experience, his therapy greatly ameliorates the quality of life of these patients, nd possibly may reduce the number of recurrences. We acknowldge that it will be difficult to formally prove the efficacy of this herapy in the framework of a randomized, controlled trial.

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منابع مشابه

Letter by Chhabra and Spodick regarding article, "Treatment of acute and recurrent idiopathic pericarditis".

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عنوان ژورنال:
  • Journal of the American College of Cardiology

دوره 43 11  شماره 

صفحات  -

تاریخ انتشار 2004