Acute Pericarditis First-line Treatment — EECC MCQ

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EasyPericardial DiseaseAcute Pericarditis First-line TreatmentEECC

A 45-year-old man presents with chest pain worse on lying down and improved by sitting forward, a pericardial friction rub, and diffuse concave-upward ST elevation with PR depression on ECG. CRP is 85 mg/L. What is the first-line treatment?

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Correct answer: B — High-dose aspirin or NSAID plus colchicine

The 2025 ESC Myocarditis/Pericarditis Guidelines recommend aspirin or NSAIDs (ibuprofen 600 mg TDS is an alternative to aspirin) PLUS colchicine as first-line therapy for acute pericarditis (Class I, LOE A). The COPE and ICAP trials demonstrated that adding colchicine to aspirin/NSAIDs halves the pericarditis recurrence rate (from ~30% to ~15%). Treatment duration: aspirin/NSAIDs for 1-2 weeks (with gradual taper over 2-4 weeks); colchicine for 3 months (acute) or 6 months (recurrent). Corticosteroids are reserved for second/third-line use or specific indications (autoimmune disease, pregnancy, contraindications to aspirin/NSAIDs/colchicine), as they are associated with higher recurrence rates. Activity restriction is recommended until symptom resolution and CRP normalisation.

Reference: ESC (2025): Guidelines for Myocarditis and Pericarditis; COPE/ICAP Trials: https://www.nice.org.uk/guidance/ng222/chapter/recommendations