Schwier Nicholas C, Coons James C, Rao Shivdev K
Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma; PGY-2 Cardiology Pharmacy Resident, University of Pittsburgh Medical Center, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
Pharmacotherapy. 2015 Jan;35(1):99-111. doi: 10.1002/phar.1527.
Idiopathic (viral) pericarditis is the most common form of pericardial disease in the Western world. Despite the combination of colchicine and nonsteroidal antiinflammatory drugs (NSAIDs) plus aspirin (ASA), considered first-line therapy, the incidence of recurrent pericarditis is ~20-30%. In addition, secondary recurrence without optimal first-line therapy is ~50%. This is due to the many clinical challenges, such as inappropriate NSAID/ASA duration of therapy, the use of corticosteroid therapy, contraindications or intolerances to therapy, adverse effects, and issues related to adherence. This review describes contemporary pharmacotherapeutic management of idiopathic (viral) pericarditis, with a particular emphasis on the role of colchicine. Emerging therapies and management strategies, such as high-sensitivity C-reactive protein-guided therapy and novel immunotherapies, are also reviewed. Ultimately, understanding appropriate treatment will assist the clinician in helping decrease the risk of recurrent, incessant, and refractory pericarditis.
特发性（病毒性）心包炎是西方世界最常见的心包疾病形式。尽管秋水仙碱与非甾体抗炎药（NSAIDs）加阿司匹林（ASA）联合使用被视为一线治疗方案，但复发性心包炎的发生率仍约为20%-30%。此外，未经最佳一线治疗的继发性复发率约为50%。这是由于存在许多临床挑战，如NSAIDs/ASA治疗疗程不当、使用皮质类固醇治疗、治疗的禁忌症或不耐受情况、不良反应以及与依从性相关的问题。本综述描述了特发性（病毒性）心包炎的当代药物治疗管理，特别强调了秋水仙碱的作用。还综述了新兴的治疗方法和管理策略，如高敏C反应蛋白引导治疗和新型免疫疗法。最终，了解适当的治疗方法将有助于临床医生降低复发性、持续性和难治性心包炎的风险。
