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(Circulation. 2008;118:612-613.)
© 2008 American Heart Association, Inc.

Editorial

Corticosteroids for Recurrent Pericarditis

On the Road to Evidence-Based Medicine

Ralph Shabetai, MD

From Cardiology IIIA, Veterans Affairs Health Care System, La Jolla, Calif.

Correspondence to Ralph Shabetai, MD, Cardiology IIIA, Veterans Affairs Health Care System, La Jolla, CA 92161. E-mail rshabetai@ucsd.edu

Key Words: Editorials • corticosteroids • pericarditis • pericardium • therapy

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

We have known for decades that acute pericarditis may recur after apparent cure.¹ In spite of recent advances, recurrence, after an initial attack of acute pericarditis, remains a challenge for many reasons. For example, the exact rate of recurrence is not known because many, if not most, cases go unreported, especially those that have a benign course and respond quickly and completely to a nonsteroidal antiinflammatory agent (NSAID), such as ibuprofen, indomethacin, or aspirin. The evidence that, in most cases, recurrence is an autoimmune response to the initial pericardial insult is compelling,² but we still lack an inexpensive, harmless, readily available test that reliably separates autoimmune reoccurrence from recurrence of another cause, notably infection. The distinction is important, because corticosteroid therapy is required for some of the immunogenic cases of recurrent pericarditis but is contraindicated in cases caused by infection. Reports from tertiary referral centers include a high proportion of patients who did not improve after treatment with prednisone, or had serious steroid-induced side effects.

Article p 667

Pericardial disease is not rare but is far less common and much less likely to be a threat to survival than are, for example, ischemic heart disease, hypertension, valvular heart disease, and the metabolic syndrome. Also, the drugs used to treat it are generic, making it improbable that investigators can find funds for placebo-controlled large trials in a broad spectrum of patients with recurrent pericarditis.

High-dose corticosteroid became the accepted standard treatment for recurrent acute pericarditis long before the concept of evidence-based . . . [Full Text of this Article]