Recurrent pericarditis in children and adolescents: report of 15 cases.
OBJECTIVE
The aim of this study was to analyze the clinical findings, course, and treatment of recurrent pericarditis (RP) in patients with onset in childhood and adolescence.


BACKGROUND
Recurrent pericarditis is a chronic condition that has presented problems in management. Knowledge about this disease is based on observations in adults, and no series of children has previously been published.


METHODS
Fifteen children (nine males, six females) in whom pericarditis had recurred at least twice were encountered in the period 1985 to 1998. Their age at onset was 6.5 to 16.8 years (mean 11.6 years), and the follow-up was 4.0 to 16.2 years (mean 8.0 years).


RESULTS
Recurrent pericarditis was preceded by open-heart surgery by 1 month to 5 years earlier in 7 of 15 patients. The six children with an atrial septal defect (ASD) had an operation at an older age (mean 9.9 years) than usual (mean 4.8 years). The risk of RP in children operated on for ASD at the age of six years or later was 5%. An initial attack of pericarditis was associated with pleuritis and/or pneumonia in 10 of 15 patients and with colitis in 2 of 15 patients During follow-up, the patients had 2 to 30 recurrences (mean 9.9). Later attacks tended to be milder. At the end of follow-up, 7 patients had been without attacks for >or=4 years, whereas after 4 to 16 years, the remaining patients still had active disease. No instance of constriction was found. Altogether, 11 of 15 patients were treated with corticosteroids. However, corticosteroids, whether alone or with methotrexate (n = 5), azathioprine (n = 1), cyclosporine (n = 1), or colchicine (n = 4) did not prevent recurrences.


CONCLUSIONS
The most frequent background for RP in children was the closure of ASD after the age of six years. Its course was unpredictable and often chronic, irrespective of the underlying cause or the therapy given. Colchicine did not prevent relapses.
Raatikka
Marja
M
Department of Pediatrics, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
Pelkonen
Pirkko M
PM
Karjalainen
Jouko
J
Jokinen
Eero V
EV
D000293:Adolescent; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002908:Chronic Disease; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology / Q000628:therapy; D010493:Pericarditis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D013256:Steroids
D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D013256:Steroids