What is the role of prednisone in pericarditis management?

• A. Prednisone is used for severe cases
• B. It is first-line for all patients
• C. It is never used
• D. It is used only with antibiotics

Answer: (A)

In pericarditis, the mainstay of treatment is NSAIDs (to reduce inflammation and pain) often paired with colchicine. Prednisone, a corticosteroid, is not first-line for all patients because while it quickly dampens inflammation, it is associated with a higher risk of recurrence when tapered and can mask infections. Therefore, prednisone is reserved for more severe cases or when NSAIDs (or colchicine) are contraindicated or not tolerated, or when an autoimmune etiology is suspected. If prednisone is used, it’s given at a sufficient dose for a limited duration with a slow taper, and colchicine is often continued to help reduce relapse risk. This makes the use of prednisone specifically in severe cases the best description of its role.