Idiopathic recurrent pericarditis in children and adults:clinical and diagnostic differences

Background Current guidelines for diagnosis and treatment of recurrent pericarditis are based on adult populations. Aims Due to limited pediatric data, this study aims to highlight clinical, laboratory, and therapeutic differences between idiopathic recurrent pericarditis in children and adults to optimize pediatric disease management. Methods and Results This retrospective multicentric cohort study analyzed data from patients with recurrent pericarditis (idiopathic or post-cardiac injury). Clinical, laboratory, and outcome data were compared between pediatric (<18 years) and adult (>18 years) patients. A total of 61 children and 289 adults were included. Follow-up was significantly longer in children (8 vs. 4 years, p < 0.001). Males were predominantly affected in pediatric patient’s cohort (30.3% female vs 69.7% male), while gender distribution was similar in adults (51.6% female vs. 48.4% male). Children were hospitalized more frequently than adult (81.8% vs. 58.5%, p < 0.05). From the clinical point of view, chest pain was the most common symptom in both group (100% vs. 57.1%), whereas dyspnea was exclusive to adults (31.5%, p < 0.05). Pericardial effusion was less common in children (63.6% vs. 80.6%, p < 0.05) and no pediatric patients developed constrictive pericarditis requiring pericardiectomy. Pediatric patient’s cohort had a higher incidence of ST-segment elevation on ECG (64.7% vs. 32.4%, p < 0.01) and a higher relative lymphocyte count (p < 0.05) with a lower neutrophil-to-lymphocyte ratio (3.65 vs. 4.71, p < 0.05). Although the difference is not statistically significant, the troponin levels were found to be lower in children compared with adults (29 ng/L vs 72.6 ng/L, p=0.294). Recurrence of pericarditis was more frequent in adults (9.59 vs. 4.4 episodes/10 years, p < 0.001), but children had significantly longer relapse-free periods (68.31 vs. 31.72 months, p < 0.001). There were no significant differences observed in the treatment between the two groups. A total of 48 children (78.8%) and 237 adults (82.0%) were treated with NSAIDs. Colchicine was prescribed to 22 children (36.4%) and 136 adults (47.1%), while 15 children (24.2%) and 73 adults (25.3%) received Anakinra. The only notable difference was in the dosage of prednisone, with children receiving significantly higher doses compared to adults (37.25 mg vs. 25 mg, p = 0.023). Conclusions Recurrent pericarditis in children follows a different course than in adults, with fewer recurrences, prolonged symptom-free periods, and typical ECG abnormalities. The higher corticosteroid use in children raises some concerns because of its potential side effects, including growth impairment and osteoporosis. IL-1 inhibitors should be considered to minimize corticosteroid administration. These findings emphasize the importance of developing a pediatric age-specific guideline.