PERICARDIAL DISEASE Immunosuppressive Therapy Prevents Recurrent Pericarditis

Objectives. This study reviews the clinical outcome of a series of patients with recurrent pericarditis before and after immunosup-pressive therapy. Background. Despite anti-inflammatory treatment, some pa-tients with acute pericarditis experience repeated relapses of the disease. The use of steroids for the treatment of recurrent pericarditis remains controversial. Methods. Twelve patients (4 women, 8 men; mean [-SD] age 35.9-+ 17.2 years, range 15 to 65) with recurrent pericarditis unrelated to any systemic disease were selected. All 12 patients previously received ineffective short.term courses of low dose steroids and had a total of 39 relapses during a mean follow-up period of 14.2 months (range 4 to 50). A 3-month course of treatment with prednisone, at an immunosuppressive dosage, was started (1 to 1.5 mg/kg body weight per day for 4 weeks, then gradually withdrawn). When prednisone reduction was undertaken, all patients started a 5-month course of treatment with aspirin (1.6 g/day until steroid suspension, then reduced to 0.8 g/day). Results. During a mean follow-up period of 41.6 months (range 7 to I04), immunosuppressive treatment with high dose pred-nisone resulted in stable remission in all except one patient, who experienced one relapse. In this patient, the addition of azathio-prine to prednisone induced a persistent remission, which re-mained after 1.year follow-up. During treatment, three patients had severe steroid-related adverse effects that in two patients required replacement of prednisone with azathioprine and cyclo-phosphamide, respectively. This variation in the immunosuppres-sire regimen did not modify the favorable clinical outcome. Conclusions. The dose and duration of steroid treatment are critical factors in preventing recurrent pericarditis. High dose prednisone with aspirin should be considered in the treatment of recurrent pericarditis resistant to anti-inflammatory therapy. Cyclophosphamide or azathioprine should be reserved for pa-tients who do not respond to high dose prednisone or who experience severe complications related to steroid therapy