Pediatric recurrent pericarditis exhibits distinct features compared to adult cases, with a more intense inflammatory profile but a more favorable clinical course, and IL-1 inhibitors were more commonly used in pediatric subjects.
Children with recurrent pericarditis showed a strong male predominance.
Chest pain was significantly more common in children than adults with recurrent pericarditis.
Fever was significantly more frequent in pediatric patients than in adults.
Pleural effusion was significantly more common in children than adults.
Pericardial effusion occurred at a similar frequency in both pediatric and adult patients.
Children exhibited a more pronounced inflammatory response, with higher neutrophilia compared to adults.
The recurrence rate was significantly lower in children than in adults.
Children had a significantly longer disease-free interval compared to adults.
Glucocorticoid use was significantly more frequent in adult patients than in children.
Colchicine use was significantly more common in adults than in pediatric patients.
Anakinra (an IL-1 inhibitor) was prescribed significantly more frequently in pediatric patients than in adults.
A subset of pediatric patients had very early disease onset, before 6 years of age.
This research suggests that recurrent pericarditis — a condition where the sac surrounding the heart becomes repeatedly inflamed — looks and behaves quite differently in children compared to adults. In a study of 442 patients across multiple centers, children were much more likely to experience chest pain, fever, and fluid around the lungs than adults. They also showed stronger markers of inflammation in their blood. Despite this more intense inflammatory response, children actually had a better overall disease course: they experienced fewer relapses per year and went longer between episodes without symptoms. The study also found notable differences in how children and adults were treated. Adults were more commonly given glucocorticoids (steroids) and colchicine, which are the standard treatments recommended by current guidelines. Children, on the other hand, were much more frequently treated with anakinra, a medication that blocks a specific inflammatory signal called interleukin-1 (IL-1). Notably, very few children who started anakinra were able to stop taking it, suggesting that this drug may need to be continued long-term in pediatric patients. This research matters because current clinical guidelines for recurrent pericarditis are largely based on studies of adults, yet this work demonstrates that the disease presents and responds to treatment differently in children. The findings highlight a need for pediatric-specific research and potentially separate treatment guidelines for children, particularly regarding when and how to use IL-1 blocking medications.
Mauro A, Mascolo R, Bizzi E, Sandini M, Collini V, Caorsi R, et al.. (2026). Recurrent pericarditis in children: Clinical and therapeutic differences from adults.. International journal of cardiology. https://doi.org/10.1016/j.ijcard.2026.134557