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Recurrent pericarditis
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Recurrent pericarditis

I've had 7 pericarditis recurrences in the last year and a half. I was treated immediately with corticosteroids and NSAIDs, and have had steroids restarted everytime it relapsed and then slowly tapered down. About 8 months ago the doctors thought i should try Colchicine, and I've been taking it ever since. I've had one recurrence during this period, when i caught a cold. I need an advice, is there anything I can do to help prevent these recurrences, beside trying to avoid getting ill? The pericarditis itself isn't so dangerous, the layering between the membranes was about 7mm top, but the inflammation is always strong, the CRP was once 220. And I only feel strong pain and sometimes fever. Were the doctors wrong for giving me high dosages of steroids? And it takes only a small amount, 5 mg of corticosteroids to keep everything OK. And I do not respond well to NSAIDs, it has almost no effect, except for the small, current pain relief. I'm 18 years old, please, any help? Will it stop someday, how long can I continue to take Colchicine?
Avatar_n_tn
Hi Milan94,

Without being able to review your entire history it will not be possible to give you an exact answer, so I will speak generally based on the patients we see with pericarditis.  Generally, we will begin with high doses of NSAIDS (up to 800mg three times a day) as well as colchicine and then very slowly taper them over time.  For those who have continued inflammation despite treatment or who have frequent relapses, we will consider corticosteroids in addition to the NSAIDS and colchicine.  The type of corticosteroid taper we use is a VERY slow one, usually 6 months or more.  We taper until the patient is on the lowest possible dose with the hope of eventually getting the patient off the corticosteroid.    

We usually then continue the NSAIDS and colchicine and then slowly taper off of those.  The reason for this is you need something to curb the inflammation after you're off the steroids so that you are not quickly cut off from any antiinflammatory agents.  Based on the regimens we commonly use and what you are describing, your doctors are using the correct agents to treat you.  The taper of corticosteroids may just need to be slower so that you are not going back on huge doses of steroids with every relapse.  

I would discuss the length of time of colchicine with your doctor, but if you do not have a recurrence in the next several months, then you could consider tapering off of it.  Given you have had a number of recurrences in the last year and a half, and the colchicine seems to be helping, I wouldn't be in a rush to stop it for the time being.  We have patients who are on colchicine for very long periods of time.  As long as your doctors are monitoring your liver function and your kidney function is normal, you should be able to continue to tolerate the colchicine.

As to what you can do to prevent the attacks, there is unfortunately no good way to predict when they are going to come on.  Most studies suggest that eventually pericarditis resolves, although it may take a long period of time to do so.  You are right that the pericarditis itself is not dangerous.  What we worry about is the thickening of the lining of the heart (pericardium), and it sounds like your doctors are monitoring that closely.

Hope this helps!
CCFHEARTMD20
4 Comments
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Avatar_m_tn
Thank you very much. The problem is that 4 days ago it happened again, after a sore throat. The doctors prescribed the treatment from last time (corticosteroids 20mg for 5 days, 10mg for 7 days, 5mg for 7 days), and it's effective, after a few days it's all right.

Even while on Colchicine it relapses everytime I catch a cold. Should I increase the dosage when I catch a cold next time? Were the doctors wrong for giving me Colchicine so late, on my 5th recurrence?

I really appreciate your help.
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Avatar_m_tn
I mean should I increase the dosage of Colchicine the next time I catch a cold to prevent it from relapsing after the cold? Or anything else while I have the cold, because it usually happens a few days after. Thank you.
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Avatar_n_tn
Hi Milan94,

That's a difficult question to answer without seeing you.  Normally, when patients have recurrent pericarditis, we do further evaluation to determine treatment  and how to go about managing "flares".  We'll often get further laboratory testing and an MRI to better analyze the lining (pericardium) to better determine how inflamed the pericardium is.  

There are several specialized centers in the country with cardiologists that focus specifically on pericarditis.  You could consider researching some of these places in order to get a second opinion.  I would not try to self-medicate during your flares.  Rather, I would look into the possibility of being seen by a cardiologist that routinely sees cases like yours.  

Hope this helps!
CCFHeartMD20
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