Journals watch: pericarditis, hysterectomy and IUDs

A review of research of interest to GPs, including pericarditis, hysterectomy and IUDs. By Dr Sally Hope

Pericarditis: colchicine reduced the risk of recurrence, researchers found
Pericarditis: colchicine reduced the risk of recurrence, researchers found

 

Colchicine for acute pericarditis

N Engl J Med 2013; 369: 1522-8

Colchicine is apparently an effective treatment for recurrent pericarditis, although no cardiologist has ever recommended it for any of my patients.

In this RCT, patients were randomised to either colchicine 0.5mg twice daily for three months plus NSAIDs, or 'standard therapy' of NSAIDs only (aspirin or ibuprofen).

The patients taking colchicine did much better, with RR reduction of recurrent pericarditis of 0.56, as well as superior symptom reduction at 72 hours. Adverse drug reaction rates did not differ in the two groups.

Further information can be found in the 2004 European Society of Cardiology guidance, Guidelines on the Diagnosis and Management of Pericardial Diseases, which recommends colchicine. This is useful to know because many patients cannot tolerate NSAIDs.

Elective bilateral oophorectomy at the time of hysterectomy

Maturitas 2013; 76(2): 109-10

This is a very helpful review for any GP with patients thinking about the pros and cons of elective oophorectomy when having a hysterectomy.

The review did not consider women with a high risk of breast or ovarian cancer.

Many women fear ovarian cancer (one in 74 women will develop it in their lifetime), but do not consider the common sequelae of early oophorectomy, such as premature death from earlier cardiovascular disease and osteoporosis.

The Women's Health Initiative study showed no adverse effect of oophorectomy on cardiovascular disease, fracture or total mortality, but the follow-up was only 7.6 years.

The Mayo Clinic Cohort Study was a matched cohort group followed for more than 30 years.

Mortality was significantly higher in women with bilateral oophorectomy at <45 years="" of="" age="" hazard="" ratio="" 1="" 67="" p="">

From the Nurses' Health Study cohort, with 28 years of follow-up, women aged under 50 at the time of hysterectomy who opted for oophorectomy had increased mortality if they had never used estrogen replacement therapy, but this was neutralised by estrogen HRT.

If women are under 45 years of age and opt for oophorectomy and hysterectomy for benign disease, they need estrogen replacement therapy to negate the risk of earlier cardiovascular disease.

Risedronate in children with osteogenesis imperfecta

Lancet 2013; 382(9902): 1424-32

Osteogenesis imperfecta (OI) is a genetic disease of varying severity.

In this study, children aged four to 15 years received daily risedronate or placebo for one year, then all received oral risedronate for a further two years.

Bone mineral density increased by 16.3% in the risedronate group versus 7.6% in the placebo group. Clinical fractures occurred in 31% of 94 patients in the risedronate group and 49% of 49 patients in the placebo group (p = 0.0446). Risedronate can reduce fractures in children who have OI.

It is to be hoped the researchers will follow these children to assess the long-term effect of this drug on growth, fertility and morbidity.

Adverse events with IUDs

J Pharmacoepidemiol Drug Safety 2013; 22(s1): 12 (abstr 2), 430 (abstr 855)

These two papers report on real life adverse events in levonorgestrel intra-uterine systems (LNG-IUS) versus copper IUDs (Cu-IUDs).

In this European study of 61,380 women, about 70% had an LNG-IUS and 30%, a Cu-IUD. This was the woman's choice, so the two groups are different: the LNG-IUS group was slightly older (37 versus 33 years).

However, it is reaping useful data. The ectopic pregnancy rate was, as expected, extremely low for the LNG-IUS, at 0.01 per 100 women-years, and higher in the Cu-IUD group, at 0.07 per 100 women-years.

There were 58 uterine perforations, giving an incidence of 0.94 per 1,000 insertions.

The greatest risk factor was breastfeeding. The RR of perforation for women breastfeeding versus not breastfeeding was 6.7, although this is still a very small risk.

  • Dr Hope is a GP in Woodstock, Oxon, and a member of our team who regularly review the journals
CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Give a five-minute presentation on the benefits of colchicine at the next meeting of the practice multidisciplinary team.
  • Audit women under the age of 45 years in your practice who have undergone hysterectomy and bilateral oophorectomy for benign disease, and see how many are not taking their estrogen replacement therapy. Consider inviting them in for a consultation.
  • Review practice protocols on counselling women about the pros and cons of LNG-IUS and Cu-IUDs in the light of these data.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

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