This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shabetai, R. Search for Related Content PubMed PubMed Citation Articles by Shabetai, R. Related Collections Pericardial disease Cardiovascular Pharmacology Related Article

(Circulation. 2005;112:1921-1923.)
© 2005 American Heart Association, Inc.

Editorial

Recurrent Pericarditis

Recent Advances and Remaining Questions

Ralph Shabetai, MD

From the University of California, San Diego, and the Veterans Administration Health Care System, La Jolla, Calif.

Correspondence to Ralph Shabetai, MD, VA Medical Center, Cardiology (111A), 3350 La Jolla Dr, La Jolla, CA 92161. E-mail rshabetai@ucsd.edu

Key Words: Editorials • pericarditis • colchicine

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Recurrence is a serious complication of acute pericarditis, characterized by a return of pericardial pain after recovery from an attack of typical acute pericarditis. Some patients experience only a single recurrence, but in many less fortunate, pericardial pain returns unexpectedly at variable intervals during a period that may extend over many years. The pain and any associated fever and leukocytosis disappear within a day or so of high-dose corticosteroid administration (eg, 1 to 1.5 mg/kg per day prednisone in most cases), only to return during tapering to a low dose. Thereafter, the high dose is reinstituted and then maintained for 1 month or 6 weeks, after which prednisone is again slowly tapered during the next several months. This sequence may need to be repeated frequently before it becomes possible to wean the patient from steroidal therapy. This is one of the reasons recurrent pericarditis is so troublesome to patients and treating physicians alike.

See p 2012

Until recently, patients in whom recurrences were frequent and extended for many years often received a massive total dose of a steroid, usually prednisone or prednisolone, with a consequently unacceptable incidence of gastric hemorrhage, aseptic necrosis of the femoral head, and osteoporosis with spinal compression fracture. Seeking a less toxic treatment, physicians began to avoid corticosteroids or limited their use and treated the patients instead with nonsteroidal anti-inflammatory drugs (NSAIDs). The change often was not accomplished easily because patients, and sometimes referring physicians, had been so pleased with the prompt response to high-dose steroid . . . [Full Text of this Article]

Related Article:

Colchicine in Addition to Conventional Therapy for Acute Pericarditis: Results of the COlchicine for acute PEricarditis (COPE) Trial

Massimo Imazio, Marco Bobbio, Enrico Cecchi, Daniela Demarie, Brunella Demichelis, Franco Pomari, Mauro Moratti, Gianni Gaschino, Massimo Giammaria, Aldo Ghisio, Riccardo Belli, and Rita Trinchero
Circulation 2005 112: 2012-2016. [Abstract] [Full Text]

This article has been cited by other articles:

				J. Soler-Soler and J. Sagristà-Sauleda CHAPTER 19 Pericardial Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				M. Imazio, A. Brucato, D. Cumetti, G. Brambilla, B. Demichelis, S. Ferro, S. Maestroni, E. Cecchi, R. Belli, G. Palmieri, et al. Corticosteroids for Recurrent Pericarditis: High Versus Low Doses: A Nonrandomized Observation Circulation, August 5, 2008; 118(6): 667 - 671. [Abstract] [Full Text] [PDF]

				L. G. Futterman and L. Lemberg Pericarditis Am. J. Crit. Care., November 1, 2006; 15(6): 626 - 630. [Full Text] [PDF]

				W. C. Little and G. L. Freeman Pericardial Disease Circulation, March 28, 2006; 113(12): 1622 - 1632. [Full Text] [PDF]