Background: Pericarditis is the most common disease affecting the pericardium of the heart. It is inflammation of the fibrous pericardial sac surrounding the heart. Five percent of emergency department visits with chest pain not relating to myocardial infarction are attributed to pericarditis. Evidence shows 80% of cases in developed nations are idiopathic or post-viral in nature. Treatment has consisted of NSAIDS and glucocorticoids as first line therapy. Colchicine is an anti-inflammatory medication that has long been used in the therapy of gout arthritis and other rheumatologic complaints worldwide. It has been proposed that the anti-inflammatory profile occurring within joints can apply to the pericardium of the heart. The purpose of this study is to evaluate how efficacious colchicine is when added to traditional therapy in the treatment of pericarditis.
Methods: An exhaustive search was conducted using Medline-OVID, CINAHL, and Pub-Med using keywords: pericarditis and colchicine. Articles with primary data evaluating the use of colchicine in treating pericarditis were included. These relevant articles were assessed for quality using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)
Results: Three studies met the inclusion criteria for this systematic review. A randomized, double blind, placebo-controlled study investigating colchicine and the treatment of pericarditis demonstrated a reduction in recurrence rate, symptom persistence, and the need for hospitalization. A second randomized, double blind, placebo-controlled study demonstrated a reduction in disease recurrence, symptom persistence, and hospitalization related to the disease. Another randomized, open-label trial evaluating colchicine therapy in treating acute pericarditis demonstrated a decrease in recurrence rate and symptom persistence.
Conclusion: Colchicine when treating pericarditis was demonstrated to reduce disease recurrence, lessen symptom persistence, and limit the need for hospitalization. The safety and efficacy has been evaluated through multiple trials and deemed superior to standard therapy alone. The overall quality of the studies reviewed is moderate based on the GRADE criteria. A weak recommendation for the off-label use of colchicine in the treatment plan of pericarditis can be given at this time based on the available data.
Keywords: Pericarditis, Colchicine
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