Colchicine Treatment and Prevention of Recurrent Pericarditis

Abstract

Accessible online at: www.karger.com/hed The efficacy of colchicine for familial Mediterranean fever (FMF) suggested its use in acute and recurrent pericarditis [1]. This remarkable agent has since entered the therapy of pericarditis of many kinds, but particularly stubborn recurrent cases and especially for patients ‘hooked’ on a corticosteroid [2]. Colchicine has been known for centuries as an effective agent for gout, but more recently its many remarkable actions have become apparent, including tubulin binding; inhibiting mitoses in the cell nucleus; inhibiting various polymorphonuclear leukocyte functions; stabilizing the cytoskeleton and cell membranes, and interfering with transcellular movement of collagen [3]. In these roles, colchicine may reduce or block immunologic triggering mechanisms when given early enough and probably has antifibroblastic and immunosuppressant properties when used early or late [3]. Tenenbaum et al. [4, this issue] with an international consortium contributing patient data have now demonstrated that colchicine appeared to prevent new relapses in patients with recurrent pericarditis related to postcardiac injury syndromes both during active therapy and subsequently. Because of the stubbornness of many forms of recurrent pericarditis (including incessant pericarditis [3]), this is a solid achievement, since most patients tolerate colchicine well with acute or chronic administration [2–4]. Moreover, colchicine tablets are convenient to take and inexpensive. Out of 21 patients who qualified for the investigation of Tenenbaum et al., 13 (62%) remained free of recurrences over a mean follow-up of 32 months, and retreatment has aided the others. It is significant that colchicine in this investigation may have been acting in several of its roles noted above, one of which may be as an immunosuppressant, since the postcardiac injury syndromes are considered to be immunopathic, In brief, colchicine appears to have been successful with patients acting as their own controls. However, as Tenenbaum et al. emphasize: as with nearly every treatment, this must remain sub judice pending an appropriately designed, prospective, randomized, double-blind controlled trial.