Pericarditis is a human heart disorder in which the lining of the heart becomes inflamed. This lining is called the pericardium. The pericardium performs many important roles that aid to the normal functioning of the heart. It holds the human heart in its appropriate position in the chest; it protects the heart from infection by separating it from the other internal organs and prevents the heart from overfilling with blood. It also lubricates the heart with the pericardial fluid to reduce the friction produced because of the contraction and relaxation of the heart muscles.
Pericarditis can be either acute or chronic in nature. Acute pericarditis develops suddenly and is typically resolved within three weeks with rest and therapy. The patients typically complain of a sharp pain the chest that resembles the pain experienced during a heart attack. This pain is pronounced when the patient inhales and improves when the patient leans forward while sitting up. The patients also experiences low blood pressure, a high temperature (fever), and heart palpitations. In chronic pericarditis, the symptoms develop gradually over a period of many months. It also takes longer to treat the condition and more often than not, the patient develops further complications.
What are the Existing Therapy Options And What Are Their Limitations?
Pericarditis can be treated with a variety of medication. The goal of treatment is to reduce the inflammation of the pericardium. In most clinical settings, this is usually achieved by starting the patient on a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen or aspirin. If the patient does not respond to NSAIDs, corticosteroids are added to the treatment regimen. This is because corticosteroids are associated with a prompt relief of symptoms.
However, recurrence of symptoms is a serious complication associated acute pericarditis. This usually is seen within a few weeks of treatment discontinuation. This incidence of recurrence is noticeable higher in the patients treated with corticosteroids. Some of the clinical studies have demonstrated that addition of corticosteroids to the treatment regime is actually an independent risk factor for developing recurrent pericarditis. Therefore, there is a need for a treatment option that will treat acute pericarditis and at the same time prevent the episodes of recurrence.
What does Colchicine do for Pericarditis?
How does colchicine compare to other treatment options? Colchicine is an anti-inflammatory drug. Mainly it binds to the microtubules in the nucleus of the cell to inhibit mitosis, disrupt polymorphonuclear cell function and interferes with the movement of collagen in cells.
Several investigators have studied colchicine to evaluate its effectiveness in the clinical treatment of pericarditis. The results of these studies indicate that the use of colchicine as an adjuvant treatment of acute pericarditis show considerable merit. The major benefit observed was that the patients treated with colchicine were associated with a lower incidence of recurrence. However, the mechanism by which colchicine treats pericarditis is still not clear.
In one prominent clinical study, patients with acute pericarditis were prescribed either only aspirin or a combination of colchicine and aspirin. The results of this study demonstrated that the patients treated with colchicine had a decrease in their symptoms 72 hours after the first pericarditis episode. After about 18 months, these patients were also seen to have a significantly lower rate of recurrence (decreased by two thirds). In addition, the use of colchicine was not associated with serious adverse events and none of the patients developed any chronic pericarditis complication like constrictive pericarditis or cardiomyopathy. The only adverse event which leads to patient discontinuation was diarrhea.
Thus, the use of colchicine in the treatment of pericarditis looks promising. It is recommended that patients experiencing their first episode of pericarditis should start treatment with an NSAID like aspirin. If that is not effective, then colchicine should be preferred over other conventional corticosteroids. This will aid in reducing the recurrence rate of pericarditis.
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