Therapy of recurrent pericarditis.
نویسندگان
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.
منابع مشابه
Letter by Chhabra and Spodick regarding article, "Treatment of acute and recurrent idiopathic pericarditis".
To the Editor: We read with great interest the publication by Lilly in a recent issue of Circulation. 1 Lilly has provided a brief yet comprehensive review of the management of acute and recurrent pericarditis. Lilly has recommended that corticosteroids should never be used as a primary line of therapy in acute or recurrent idiopathic pericarditis, unless the disease symptoms are refractory to ...
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BACKGROUND Colchicine seems to be a good drug for treating recurrences of pericarditis after conventional treatment failure, but no clinical trial has tested the effects of colchicine as first-line drug for the treatment of the first recurrence of pericarditis. METHODS A prospective, randomized, open-label design was used to investigate the safety and efficacy of colchicine therapy as adjunct...
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AIMS Effective prevention of recurrent pericarditis remains an important yet elusive goal. Corticosteroid therapy often needs to be continued for a prolonged period and causes severe side effects. We performed a multi-centre all-case analysis to investigate the efficacy of colchicine in preventing subsequent relapses of pericarditis, and addressed the hypothesis that pretreatment with corticost...
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متن کاملIntravenous immunoglobulin therapy for refractory recurrent pericarditis.
Recurrent pericarditis is a troublesome complication of idiopathic acute pericarditis and occurs more frequently in pediatric patients after cardiac surgery (postpericardiotomy syndrome). Conventional treatment with nonsteroidal antiinflammatory drugs, corticosteroids, and colchicine is not always effective or may cause serious adverse effects. There is no consensus, however, on how to proceed ...
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ورودعنوان ژورنال:
- Journal of the American College of Cardiology
دوره 43 11 شماره
صفحات -
تاریخ انتشار 2004