Does Colchicine Substitute Corticosteroids in Treatment of Idiopathic and Viral Pediatric Pericarditis?

Vladislav Vukomanovic,Sasa Popovic,Gordana Petrović,Mila Stajević,Bojko Bjelakovic,Sergej Prijic,Stasa Krasic,Ruzica Borovic,Dejan Nesic,Sanja Ninic

doi:10.3390/medicina55100609

Abstract

Background and Objectives: Recurrence of pericarditis (ROP) is an important complication of the acute pericarditis. The aim of this study was to analyse the influence of aetiology, clinical findings and treatment on the outcome of acute pericarditis. Methods: Data were retrospectively collected from medical records of patients treated from 2011 to 2019 at a tertiary referent heart paediatric center. Results: Our investigation included 56 children with idiopathic and viral pericarditis. Relapse was registered in 8/56 patients, 2/29 (7.41%) treated with nonsteroidal anti-inflammatory drugs (NSAID) and 6/27 (28.57%) treated with corticosteroids (CS) and NSAID. Independent risk factors for ROP were viral pericarditis (p = 0.01, OR 31.46), lack of myocardial affection (p = 0.03, OR 29.15), CS use (p = 0.02, OR 29.02) and ESR ≥ 50 mm/h (p = 0.03, OR 25.23). In 4/8 patients the first recurrence was treated with NSAID and colchicine, while treatment of 4/8 patients included CS. Children with ROP treated with CS had higher median number of recurrence (5, IQR: 2–15) than those treated with colchicine (0, IQR: 0–0.75). Conclusions: Independent risk factors for recurrence are CS treatment, viral aetiology, pericarditis only and ESR ≥ 50 mm/h. Acute pericarditis should be treated with NSAID. Colchicine and NSAID might be recommended in children with the first ROP.

Highlights

Background and ObjectivesRecurrence of pericarditis (ROP) is an important complication of the acute pericarditis
ROP occurred in eight patients with a mean age of 13.44 ± 2.69 years—12 boys (75%) and 4 girls (25%)
Children with ROP treated with CS and nonsteroidal anti-inflammatory drugs (NSAID) had a bigger median number of additional relapses (5, IQR: 2–15) than those treated with colchicine and NSAID (0, IQR: 0–0.75) (p = 0.02)

Summary

Introduction

Recurrence of pericarditis (ROP) is an important complication of the acute pericarditis. Pericarditis is a common disease in children and the cause of 1–5% of chest pain in childhood [1]. Up to 80–90% of cases of pericarditis are either idiopathic or of viral origin [2]. The majority of cases with diagnosed idiopathic acute pericarditis have unrecognized viral or immune aetiology [3,4,5]. Recurrent pericarditis is an important complication of the acute form of the disease. Unlike in adults, there is no consistent data on the incidence and aetiology of both acute and recurrent. The incidence of recurrence is estimated to be 15–30% in adult patients [6]

Objectives

Methods

Results

Discussion

Conclusion