What is the role of steroids in the treatment of pericardial effusion?

Updated: Nov 28, 2018
  • Author: William J Strimel, DO, FACP; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Steroid administration early in the course of acute pericarditis appears to be associated with an increased incidence of relapse after the steroids are tapered. In the COPE trial, steroid use was an independent risk factor for recurrence. Also, an observational study strongly suggested that the use of steroids increases the probability of relapse in patients treated with colchicine. [30]

Systemic steroids should be considered only in patients with recurrent pericarditis that is unresponsive to NSAIDs and colchicine or as needed for treatment of an underlying inflammatory disease. If steroids are to be used, an effective dose (1-1.5 mg/kg of prednisone) should be given, and it should be continued for at least 1 month before slow tapering. The European Society of Cardiology recommends that systemic corticosteroid therapy be restricted to connective-tissue diseases, autoreactive pericarditis, or uremic pericarditis. [28]

The intrapericardial administration of steroids has been reported to be effective in acute pericarditis without producing the frequent reoccurrence of pericarditis that complicates the use of systemic steroids, [32] but the invasive nature of this procedure limits its use.


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