title: Recurrent pericarditis in children and adolescents: a multicentre cohort study.
abstract: OBJECTIVE
  Limited data are available about recurrent pericarditis in children. We sought to explore contemporary causes, characteristics, therapies and outcomes of recurrent pericarditis in paediatric patients.
  
  
  METHODS
  A multicentre (eight sites) cohort study of 110 consecutive cases of paediatric patients with at least two recurrences of pericarditis over an 11-year period (2000-2010) [median 13 years, interquartile range (IQR) 5, 69 boys].
  
  
  RESULTS
  Recurrences were idiopathic or viral in 89.1% of cases, followed by postpericardiotomy syndrome (9.1%) and familial Mediterranean fever (0.9%). Recurrent pericarditis was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) in 80.9% of cases, corticosteroids in 64.8% and colchicine was added in 61.8%. Immunosuppressive therapies were administered in 15.5% of patients after subsequent recurrences. After a median follow-up of 60th months, 528 subsequent recurrences were recorded (median 3, range 2-25). Corticosteroid-treated patients experienced more recurrences (standardized risk of recurrence per 100 person-years was 93.2 for patients treated with corticosteroids and 45.2 for those without), side effects and disease-related hospitalizations (for all P < 0.05). Adjuvant therapy with colchicine was associated with a decrease in the risk of recurrence from 3.74 per year before initiation of colchicine to 1.37 per year after (P < 0.05). Anakinra therapy (n = 12) was associated with a drop in the number of recurrences from 4.29 per year before to 0.14 per year after (P < 0.05). Transient constrictive pericarditis developed in 2.7% of patients.
  
  
  CONCLUSIONS
  Recurrent pericarditis has an overall favourable prognosis in children, although it may require frequent readmissions and seriously affect the quality of life, especially in patients treated with corticosteroids. Colchicine or anakinra therapies were associated with significant decrease in the risk of recurrence.
authors.affiliation: aCardiology Department, Maria Vittoria Hospital and University of Torino, Torino bInternal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy cMaastricht University, Faculty of Medicine, Maastricht, the Netherlands dPediatrics Department, University of Chieti, Chieti eRheumatology Department, University of Siena, Siena fMeyer Children Hospital, Firenze gUOS Reumatologia Pediatrica - Fondazione IRCCS Ca' Granda Milan, Milan, Italy hDivision of Rheumatology, Department of Paediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome iCardiology Department, Monaldi Hospital, Second University of Naples, Naples jUniversity of Genoa and Pediatria II Istituto Gianna Gaslini, Genova, Italy kDivisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada *Drs. Finkelstein and Martini are cosenior authors.
authors.forename: Massimo
authors.initials: M
authors.lastname: Imazio
authors.forename: Antonio
authors.initials: A
authors.lastname: Brucato
authors.forename: Nikki
authors.initials: N
authors.lastname: Pluymaekers
authors.forename: Luciana
authors.initials: L
authors.lastname: Breda
authors.forename: Giovanni
authors.initials: G
authors.lastname: Calabri
authors.forename: Luca
authors.initials: L
authors.lastname: Cantarini
authors.forename: Rolando
authors.initials: R
authors.lastname: Cimaz
authors.forename: Filomena
authors.initials: F
authors.lastname: Colimodio
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Corona
authors.forename: Davide
authors.initials: D
authors.lastname: Cumetti
authors.forename: Chiara Di Blasi Lo
authors.initials: CD
authors.lastname: Cuccio
authors.forename: Marco
authors.initials: M
authors.lastname: Gattorno
authors.forename: Antonella
authors.initials: A
authors.lastname: Insalaco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Limongelli
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.forename: Anna
authors.initials: A
authors.lastname: Valenti
authors.forename: Yaron
authors.initials: Y
authors.lastname: Finkelstein
authors.forename: Alberto
authors.initials: A
authors.lastname: Martini
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003078:Colchicine / Q000627:therapeutic use; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use; D010493:Pericarditis / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D011379:Prognosis; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D053590:Interleukin 1 Receptor Antagonist Protein; D003078:Colchicine