Background and objectives: Recurrent pericarditis (RP) guidelines are based on adult studies. We aimed to compare RP in pediatric and adult patients. Methods: This observational longitudinal multicentric cohort study studied 442 patients with idiopathic or post-pericardiotomy RP: 133 pediatric (<18 years) and 309 adult (≥18 years) patients. Results: Children showed a male predominance (90 males, 67.7%). Chest pain was most common in children [129/133 (97%) vs. 217/309 (70.2%) p < 0.001], as fever and pleural effusion [85/133 (63.9%) vs. 136/309 (44%), p < 0.05; 68/133 (51.1%) vs. 106/309 (34.3%), p < 0.001], while pericardial effusion occurred with a similar frequency: 99/133 (74.4%) vs. 249/309 (80.6%). Children exhibited a pronounced inflammatory response, with higher neutrophilia (p = 0.031). The clinical course was more favorable with a lower recurrence rate [median (IQR) 0.5 (0.27 to 0.87) vs. 0.87 (0.43 to 1.56) episodes/year, p < 0.001] and a longer disease-free interval, with a median (IQR) of 20.5 (11 to 30.6) months vs. 12.3 (7.4 to 23.6) months (p < 0.001). Glucocorticoid use was more frequent in adults [231/309 (74.8%) vs. 66/133 (49.6%), p < 0.001], as well as colchicine [306/309 (99%) vs. 120/133 (90%), p < 0.001]. Anakinra was more frequently prescribed in pediatric patients [60/133 (45.1%) vs. 73/309 (23.6%), p < 0.001]. Only 5/60 (8.3%) pediatric subjects were able to stop anakinra. Eleven patients (8.3%) had disease onset before 6 years. Conclusions: Pediatric idiopathic RP exhibits distinct features compared to adult cases, with a more intense inflammatory profile but a more favorable clinical course. IL-1 inhibitors were more commonly used in pediatric subjects.
Mauro, A., Mascolo, R., Bizzi, E., Sandini, M., Collini, V., Caorsi, R., La Torre, F., Celani, C., Cattalini, M., Giani, T., Del Giudice, E., Rigante, D., Maggio, M., Trotta, L., Pancrazi, M., Ceriani, E., Berra, S., Agozzino, F., Mannarino, S., Pasquinucci, M., Insalaco, A., Lubrano, R., Simonini, G., Gattorno, M., Bernardo, L., Imazio, M., Brucato, A., Recurrent pericarditis in children: clinical and therapeutic differences from adults, <<INTERNATIONAL JOURNAL OF CARDIOLOGY>>, 2026; 2026 (459: 134557): 1-7. [doi:10.1016/j.ijcard.2026.134557] [https://hdl.handle.net/10807/337036]
Recurrent pericarditis in children: clinical and therapeutic differences from adults
Rigante, Donato;
2026
Abstract
Background and objectives: Recurrent pericarditis (RP) guidelines are based on adult studies. We aimed to compare RP in pediatric and adult patients. Methods: This observational longitudinal multicentric cohort study studied 442 patients with idiopathic or post-pericardiotomy RP: 133 pediatric (<18 years) and 309 adult (≥18 years) patients. Results: Children showed a male predominance (90 males, 67.7%). Chest pain was most common in children [129/133 (97%) vs. 217/309 (70.2%) p < 0.001], as fever and pleural effusion [85/133 (63.9%) vs. 136/309 (44%), p < 0.05; 68/133 (51.1%) vs. 106/309 (34.3%), p < 0.001], while pericardial effusion occurred with a similar frequency: 99/133 (74.4%) vs. 249/309 (80.6%). Children exhibited a pronounced inflammatory response, with higher neutrophilia (p = 0.031). The clinical course was more favorable with a lower recurrence rate [median (IQR) 0.5 (0.27 to 0.87) vs. 0.87 (0.43 to 1.56) episodes/year, p < 0.001] and a longer disease-free interval, with a median (IQR) of 20.5 (11 to 30.6) months vs. 12.3 (7.4 to 23.6) months (p < 0.001). Glucocorticoid use was more frequent in adults [231/309 (74.8%) vs. 66/133 (49.6%), p < 0.001], as well as colchicine [306/309 (99%) vs. 120/133 (90%), p < 0.001]. Anakinra was more frequently prescribed in pediatric patients [60/133 (45.1%) vs. 73/309 (23.6%), p < 0.001]. Only 5/60 (8.3%) pediatric subjects were able to stop anakinra. Eleven patients (8.3%) had disease onset before 6 years. Conclusions: Pediatric idiopathic RP exhibits distinct features compared to adult cases, with a more intense inflammatory profile but a more favorable clinical course. IL-1 inhibitors were more commonly used in pediatric subjects.
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