The most troublesome complication of acute
pericarditis is recurrent episodes of pericardial
inflammation, which occur in 15-32% of cases. It was recently found that
viral infection has a major role, but in many cases the cause is unknown. The optimal method for prevention has not been fully established; accepted modalities include non-steroidal anti-inflammatory drugs,
corticosteroids,
immunosuppressive agents, and
pericardiectomy. Based on the proven efficacy of
colchicine in
familial Mediterranean fever, several small and large-scale international clinical trials have shown the beneficial effect of
colchicine therapy in preventing recurrent
pericarditis. Indeed,
colchicine-treated patients consistently display significantly fewer recurrences, longer symptom-free periods, and even when attacks occur they are weaker and shorter in nature. It was also found that pretreatment with
corticosteroids substantially attenuates the efficacy of
colchicine, as evidenced by significantly more recurrence episodes and longer
therapy periods.
Colchicine is a safe and effective modality for the treatment and prevention of recurrent
pericarditis, especially as an adjunct to other modalities, since it provides a sustained benefit superior to all current modalities. The safety profile seems superior to other drugs such as
corticosteroids and immunosuppressive drugs.