Correspondence Article Type Response to Letter Regarding Article “Treatment of Acute and Recurrent Pericarditis”
management of pericarditis during pregnancy, as reported in a small number of patients.4
I appreciate the comments of Drs Chhabra and Spodick regarding the April 23, 2013 clinician update Treatment of Acute and Recurrent Idiopathic Pericarditis.1 The focus of that article is the contemporary therapy of postviral/idiopathic pericarditis, the foundation of which is nonsteroidal anti-inflammatory therapy and colchicine while reserving glucocorticoids for refractory cases. Chhabra and Spodick rightly indicate that, in the case of certain other causes of pericarditis, including collagen vascular diseases, glucocorticoid therapy has a more primary role in the management of the underlying systemic disorder and the pericardial inflammatory component. As indicated by Chhabra and Spodick, the treatment of pericarditis during pregnancy poses a unique challenge. Aspirin at anti-inflammatory dosage and other nonselective cyclooxygenase inhibitors are not known to be teratogenic in humans and can be prescribed during the first and second trimesters. However, they should not be prescribed after gestational week 20 to avoid premature constriction of the ductus arteriosus.2 Colchicine has been continued successfully during pregnancy in some patients with familial Mediterranean fever.3 However, colchicine crosses the placental barrier and has been associated with teratogenicity in animals, such that it is generally avoided during pregnancy in the management of pericarditis. Conversely, prednisone at a dosage of ≤25 mg daily appears to be safe and has been prescribed effectively in the
Disclosures None. Leonard S. Lilly, MD Cardiovascular Division Brigham and Women’s Hospital Boston, MA
References 1. Lilly LS. Treatment of acute and recurrent idiopathic pericarditis. Circulation. 2013;127:1723–1726. 2. Østensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, Doria A, Rai R, Meroni P, Cetin I, Derksen R, Branch W, Motta M, Gordon C, Ruiz-Irastorza G, Spinillo A, Friedman D, Cimaz R, Czeizel A, Piette JC, Cervera R, Levy RA, Clementi M, De Carolis S, Petri M, Shoenfeld Y, Faden D, Valesini G, Tincani A. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther. 2006;8:209. 3. Ben-Chetrit E, Ben-Chetrit A, Berkun Y, Ben-Chetrit E. Pregnancy outcomes in women with familial Mediterranean fever receiving colchicine: is amniocentesis justified? Arthritis Care Res (Hoboken). 2010;62:143–148. 4. Brucato A, Imazio M, Curri S, Palmieri G, Trinchero R. Medical treatment of pericarditis during pregnancy. Int J Cardiol. 2010;144:413–414.
(Circulation. 2013;128:e392.) © 2013 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.113.005506
e392
management of pericarditis during pregnancy, as reported in a small number of patients.4
I appreciate the comments of Drs Chhabra and Spodick regarding the April 23, 2013 clinician update Treatment of Acute and Recurrent Idiopathic Pericarditis.1 The focus of that article is the contemporary therapy of postviral/idiopathic pericarditis, the foundation of which is nonsteroidal anti-inflammatory therapy and colchicine while reserving glucocorticoids for refractory cases. Chhabra and Spodick rightly indicate that, in the case of certain other causes of pericarditis, including collagen vascular diseases, glucocorticoid therapy has a more primary role in the management of the underlying systemic disorder and the pericardial inflammatory component. As indicated by Chhabra and Spodick, the treatment of pericarditis during pregnancy poses a unique challenge. Aspirin at anti-inflammatory dosage and other nonselective cyclooxygenase inhibitors are not known to be teratogenic in humans and can be prescribed during the first and second trimesters. However, they should not be prescribed after gestational week 20 to avoid premature constriction of the ductus arteriosus.2 Colchicine has been continued successfully during pregnancy in some patients with familial Mediterranean fever.3 However, colchicine crosses the placental barrier and has been associated with teratogenicity in animals, such that it is generally avoided during pregnancy in the management of pericarditis. Conversely, prednisone at a dosage of ≤25 mg daily appears to be safe and has been prescribed effectively in the
Disclosures None. Leonard S. Lilly, MD Cardiovascular Division Brigham and Women’s Hospital Boston, MA
References 1. Lilly LS. Treatment of acute and recurrent idiopathic pericarditis. Circulation. 2013;127:1723–1726. 2. Østensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, Doria A, Rai R, Meroni P, Cetin I, Derksen R, Branch W, Motta M, Gordon C, Ruiz-Irastorza G, Spinillo A, Friedman D, Cimaz R, Czeizel A, Piette JC, Cervera R, Levy RA, Clementi M, De Carolis S, Petri M, Shoenfeld Y, Faden D, Valesini G, Tincani A. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther. 2006;8:209. 3. Ben-Chetrit E, Ben-Chetrit A, Berkun Y, Ben-Chetrit E. Pregnancy outcomes in women with familial Mediterranean fever receiving colchicine: is amniocentesis justified? Arthritis Care Res (Hoboken). 2010;62:143–148. 4. Brucato A, Imazio M, Curri S, Palmieri G, Trinchero R. Medical treatment of pericarditis during pregnancy. Int J Cardiol. 2010;144:413–414.
(Circulation. 2013;128:e392.) © 2013 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.113.005506
e392
