SNOWMASS, COLO. — Avoiding corticosteroids in treating acute pericarditis is the best way to prevent development of chronic relapsing pericarditis, Dr. Rick A. Nishimura said at a conference sponsored by the Society for Cardiovascular Angiography and Interventions.
“[Chronic relapsing pericarditis] is a terrible disease. It's incredibly debilitating and incredibly difficult to treat. The best treatment is to not ever give steroids in the first place for your typical viral pericarditis,” said Dr. Nishimura, professor of medicine at Mayo Medical School, Rochester, Minn.
Chronic relapsing pericarditis most often follows treatment of an episode of acute pericarditis using a several-week burst of prednisone followed by a quick taper. Patients experience multiple recurrences of pericardial pain and an elevated erythrocyte sedimentation rate (ESR) whenever the prednisone dosage drops below, say, 15 mg/day.
Acute pericarditis is an inflammation of the pericardium, typically from an upper respiratory tract infection or other viral infection. A burst of prednisone is a popular therapy because it's the fastest way to get rid of the pericardial pain, but the safest and best therapy is high-dose aspirin or an NSAID for at least a month, followed by a slow taper, he said at the conference cosponsored by the American College of Cardiology.
Treatment options for chronic relapsing pericarditis are limited. The patient can receive high-dose aspirin while a very slow taper off prednisone is attempted. If that's unsuccessful, there is some anecdotal support for off-label use of rituximab (Rituxan), the B-cell-depleting rheumatoid arthritis drug. “The alternative is complete pericardiectomy—that's open-heart surgery for a patient who started out with a simple acute pericarditis.”
Acute pericarditis is diagnosed on the basis of pericardial pain, presence of a precordial friction rub, elevated ESR indicative of acute inflammation, and ECG findings of diffuse ST elevation and PR depression without pathologic Q waves. “You don't need an [ECG] to diagnose pericarditis,” he noted.