[Current perspectives in the management of recurrent pericarditis]

Recurrent pericarditis is the most troublesome problem to tackle in the management of pericardial diseases. Therapeutic modalities usually assume the etiology is autoimmunity, but several cases may be related to infectious etiology or previous inadequate treatments. Therapeutic choices are non-specific and varied. Several small prospective studies have successfully used colchicine to treat and prevent recurrencies after failure of conventional treatment. Although clinical trials were lacking, colchicine has been proposed by expert consensus as first choice drug for recurrent pericarditis in the 2004 guidelines of the European Society of Cardiology. A stronger evidence base for this indication comes from the CORE trial, a prospective, randomized, open label trial, where colchicine as adjunct to conventional treatment significantly decreased symptoms persistence at 72 hours, and halved recurrence rate at 18 months (24.0% vs 50.6%, p=0.022; NNT= 4.0). No serious adverse effects were observed, while corticosteroids were an independent risk factor for further recurrences (OR 2.89).