Expanding the evidence for effective therapies in recurrent pericarditis

Recurrent pericarditis can be a clinical challenge for the physician and a frustrating experience for the patient. Most physicians will likely remember at least one patient who kept getting readmitted to the hospital every few months with recurrent pericardial effusion and symptoms of pericarditis, despite aggressive therapy with non-steroidal anti-inflammatory drugs (NSAIDs),1 colchicine or steroids. While some patients do not even respond to second line therapy with steroids, others become steroid dependent and develop serious side effects from long-term treatment with this drug class. In addition to unsatisfactory symptom control and side effects, ineffective therapy of pericarditis may also lead to constrictive pericarditis – a severe long-term complication. Constrictive pericarditis is the result of heavy fibrosis of the pericardium, making it thickened and stiff, finally leading to right heart failure. Ultimately, this condition may require pericardiectomy – a procedure that is technically challenging with considerably high operative risk. In that regard, Bertog and colleagues have reported the outcomes of patients undergoing pericardiectomy for constrictive pericarditis (n = 163) over a 24-year period.2 The median follow-up among survivors was 6.9 years (range 0.8–24.5 years), during which 61 deaths (37%) occurred. Perioperative mortality was reported as 6% overall and was found to vary based on etiology. Patients with idiopathic constrictive pericarditis had the best prognosis, with a 7-year survival of 88% (95% confidence interval 76–94%), followed by post-surgical pericarditis reported as 66% (95% confidence interval 52–78%).