Recurrent pericarditis in children: Clinical and therapeutic differences from adults

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.