Treatment of recurrent pericarditis with colchicine

Corticosteroid therapy, because of its frequent and severe side effects should be avoided if possible, and colchicine may be an effective substitute in steroid-dependent recurrent pericarditis. The aim of our study was to assess the usefulness of colchicine in recurrent pericarditis before initiating corticosteroid treatment. Nineteen consecutive patients (10 males, nine females, age 46±7 years) with recurrent pericarditis (two episodes or more) were included in this prospective open-label study. Before the study, the patients suffered a total of 57 episodes of pericarditis (mean=3·0 ± 0·5 episodes. patient−1) despite the use of non-steroidal anti-inflammatory drugs. The mean interval time between the episodes was 7·3±5·3 months. Colchicine was given at a loading dose of 3 mg and a maintenance dose of 1 mg daily (for 1 to 27 months (mean=7·7). During the clinical follow-up, the efficacy was estimated by the occurrence of new episodes of pericarditis and by the need for corticosteroid treatment. No recurrence occurred in 14 out of the 19 patients (74%) during a follow-up of 37·4±6·5 months. In four out of the 19 patients (21%), five recurrences occurred, which resolved without corticosteroids. Follow-up at 23·8±12·7 months was free of further recurrence. Only one patient (5%) had several recurrences and required corticosteroids for chronic rheumatism. Tolerance was good except for two cases of diarrhoea, one case of hypothyroidism due to associated long-term antidiarrhoeal therapy (containing iodine), and one case of mild leucopenia. No side effects required interruption of treatment, and the overall duration of recurrence-free follow-up after treatment with colchicine (32·5±6·9 months) was significantly different from the mean interval time between the different episodes before colchicine (P<0·0001). Thus, colchicine offered a very good benefit/risk ratio in our patients with recurrent pericarditis and could avoid the need for corticosteroid treatment.