We congratulate Imazio et al1 for their excellent article on colchicine treatment for recurrent pericarditis. We also strongly agree that colchicine is useful for this condition,2 even in difficult patients.3 We have also used the half dose of 0.5 mg, in some conditions, to improve compliance.
On the other hand, in clinical practice many physicians do not believe colchicine works, perhaps because they still see recurrences after starting treatment with this drug. In our opinion, there are several explanations for this. First, colchicine is clearly useful for acute pericarditis but not for other types of pericardial diseases that are often erroneously labeled as “pericarditis”; for instance, it is not useful for painless chronic pericardial effusions with a normal C-reactive protein level. Second, some physicians discontinue treatment with corticosteroids and nonsteroidal anti-inflammatory drugs and add de novo colchicine, but treatment with only colchicine will probably lead to another failure. Finally, in complicated patients with a long history of recurrences at each corticosteroid withdrawal, adding colchicine treatment will give a good chance of controlling the disease only if the corticosteroid is tapered extremely slowly over months; in these difficult corticosteroid-dependent patients it is crucial to switch from rapid steroid-tapering to very gradual tapering to obtain a good control of the disease. Even if colchicine is not a magic bullet that alone will cure all the pericardial diseases and all the most complicated cases of recurrent acute pericarditis, the important article by Imazio et al1 should convince even the more skeptical cardiologists that colchicine really works when used correctly in the proper setting.
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