September 12, 2011Open Access

Recurrent acute idiopathic pericarditis: rheumatologic therapy, autoantibodies and long term outcome

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Recurrent acute idiopathic pericarditis (n=46). Intervention: Rheumatologic protocol (high-dose NSAIDs, slow corticosteroid tapering, colchicine) vs. Baseline (pre-protocol). Primary outcome: Recurrence rate (attacks/patient/month) at 12 months (p=<0.00001).

Key Result

A rheumatologic protocol including high-dose NSAIDs, slow corticosteroid tapering, and colchicine significantly reduced the recurrence rate of acute idiopathic pericarditis from 0.46 to 0.03 attacks/patient/month.

Study Design

Type

Observational (n=46)

Multicenter

Structured PICO

Does a rheumatologic protocol including high-dose NSAIDs, slow corticosteroid tapering, and colchicine reduce recurrences in patients with recurrent acute idiopathic pericarditis?

Population

46 patients with recurrent acute idiopathic pericarditis treated with a rheumatologic protocol and followed for a mean of 8 years.

Intervention

Rheumatologic protocol consisting of high-dose NSAIDs for months until normalization of inflammatory markers, very slow tapering of corticosteroids, colchicine (1 mg/day) for 1-2 years if tolerated, and strict clinical monitoring.

Comparator

Historical baseline (attack rate before protocol) and retrospective comparison between patients who received colchicine (n=37) and those who did not (n=9).

Outcome

Recurrence rate (attacks/patient/month) at 12 months and at the end of follow-up.hard clinical

A rheumatologic approach using high-dose NSAIDs, slow corticosteroid tapering, and colchicine significantly reduces the recurrence rate of acute idiopathic pericarditis.

Main Result

Absolute Event Rate: 0.03% vs 0.46%

p-value: p=<0.00001

Limitations

Retrospective analysis
Lack of randomization
No intention-to-treat analysis
Single-center study
Small sample size for the non-colchicine group

Abstract

OBJECTIVE: To evaluate therapy and rheumatologic aspects of recurrent acute idiopathic pericarditis (RAIP). METHODS: We studied 46 patients. We used non-steroidal anti-inflammatory drugs (NSAIDs) at high dosage. We did not start corticosteroid: if already started, we planned a very slow tapering; 37 patients (80.4%) were treated with colchicine. We also assessed the frequency of ANA, anti-SSA and Rheumatoid factor. RESULTS: With our protocol recurrences dropped from 0.46 to 0.03 attacks/patient/month (p1/80, in 7 (15.2%) >1/160. Rheumatoid factor was positive in 7 (15.2%) and anti-SSA in 4 (8.7%). During the follow-up 4 (8.7%) new diagnosis of Sjogren and 1 (2.2%) of Rheumatoid Arthritis were made. CONCLUSION: NSAIDs at high dosage, slow tapering of corticosteroid and colchicine are very effective in RAIP. The improvement is more dramatic in colchicine treated patients, but also other patients can achieve good control of the disease. The finding of ANA, anti-SSA and the new rheumatological diagnoses support the involvement of autoimmunity.

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Cite This Study

Brambilla et al. (Mon,) conducted a observational in Recurrent acute idiopathic pericarditis (n=46). Rheumatologic protocol (high-dose NSAIDs, slow corticosteroid tapering, colchicine) vs. Baseline (pre-protocol) was evaluated on Recurrence rate (attacks/patient/month) at 12 months (p=<0.00001). A rheumatologic protocol including high-dose NSAIDs, slow corticosteroid tapering, and colchicine significantly reduced the recurrence rate of acute idiopathic pericarditis from 0.46 to 0.03 attacks/patient/month.

synapsesocial.com/papers/6a1f0d5d9bbe36aec96b73ab https://doi.org/https://doi.org/10.4081/reumatismo.2007.25

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