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Recurrent pericarditis in children: Clinical and therapeutic differences from adults

A Mauro1, R Mascolo2, E Bizzi3

  • 1Pediatric Rheumatology Unit, Department of Childhood and Adolescent Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy.

International Journal of Cardiology
|May 27, 2026
PubMed

Insights

Pediatric recurrent pericarditis (RP) shows a stronger inflammatory response but fewer recurrences than adult RP. Interleukin-1 (IL-1) inhibitors were more frequently used in children.

Area of Science:

  • Cardiology
  • Pediatric Rheumatology
  • Internal Medicine

Background:

  • Current recurrent pericarditis (RP) guidelines are primarily derived from adult studies.
  • Significant differences in RP presentation and management between pediatric and adult populations are suspected but not well-characterized.

Purpose of the Study:

  • To compare the clinical features, management, and outcomes of recurrent pericarditis in pediatric versus adult patients.
  • To inform guideline development for pediatric recurrent pericarditis.

Main Methods:

  • An observational, longitudinal, multicenter cohort study.
  • Inclusion of 442 patients with idiopathic or post-pericardiotomy recurrent pericarditis (133 pediatric, 309 adult).
  • Comparison of demographic data, clinical presentation, inflammatory markers, treatment strategies, and recurrence rates.

Main Results:

  • Pediatric patients presented with more frequent chest pain, fever, and pleural effusion, alongside higher neutrophilia.
  • Despite a more intense inflammatory profile, children experienced a more favorable clinical course with lower recurrence rates and longer disease-free intervals.
  • Glucocorticoid and colchicine use was more common in adults, while Interleukin-1 (IL-1) inhibitors like anakinra were more frequently prescribed in pediatric patients.

Conclusions:

  • Pediatric idiopathic recurrent pericarditis has distinct characteristics compared to adult cases, including a more pronounced inflammatory response but a better prognosis.
  • Treatment strategies differ, with a higher utilization of IL-1 inhibitors in the pediatric cohort.
  • Further research is needed to optimize management guidelines for pediatric recurrent pericarditis.
Abstract

Keywords:
AnakinraAutoflammatoryChildrenRecurrent pericarditis

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