Consensus treatments for moderate juvenile dermatomyositis: Beyond the first two months. Results of the Second Childhood Arthritis and Rheumatology Research Alliance Consensus Conference

Abstract

Objectives To use consensus methods and the considerable expertise contained within the Children’s Arthritis and Rheumatology Research Alliance (CARRA) organization, to extend the 3 previously developed treatment plans for moderate juvenile dermatomyositis (JDM) to span the full course of treatment. Methods A consensus meeting was held in Chicago on April 23–24, 2010 involving 30 pediatric rheumatologists and 4 lay participants. Nominal group technique was used to achieve consensus on treatment plans which represented typical management of moderate JDM. A pre-conference survey of CARRA, completed by 151/272 (56%) members, was used to provide additional guidance to discussion. Results Consensus was reached on timing and rate of steroid tapering, duration of steroid therapy, and actions to be taken if patients were unchanged, worsening, experiencing medication side effects or disease complications. Of particular importance, a single, consensus steroid taper was developed. Conclusions We were able to develop consensus treatment plans which describe therapy for moderate JDM throughout the treatment course. These treatment plans can now be used clinically, and data collected prospectively regarding treatment effectiveness and toxicity. This will allow comparison of these treatment plans and facilitate the development of evidence-based treatment recommendations for moderate JDM.

Treatment of Juvenile Dermatomyositis: An Update

“…IVIG is usually given as a dose of 2 g/kg (maximum dose 70 g), administered as a single dose or divided over two days. Two different regimes have been proposed [89][90][91]. IVIG is either given every two weeks, initially for three doses, and is then generally administered monthly for up to two years or it is given in monthly infusions starting from the first dose.…”

Idiopathic Inflammatory Myopathies: an Update on Classification and Treatment with Special Focus on Juvenile Forms

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Improving care delivery and outcomes in pediatric rheumatic diseases

“…The initial treatment of moderately severe JDM was the first CTP published by CARRA in 2010, which was prompted after a collaborative survey reported considerable treatment variation [49,50]. A subsequent CTP developed protocols for the entire JDM treatment course [51]. CTPs for induction therapy of newly diagnosed proliferative lupus nephritis in cSLE were published in 2012 [52].…”