TY - JOUR
T1 - Treatment approaches to juvenile dermatomyositis (JDM) across North America
T2 - The Childhood Arthritis and Rheumatology Research Alliance (CARRA) JDM treatment survey
AU - Stringer, Elizabeth
AU - Bohnsack, John
AU - Bowyer, Suzanne L.
AU - Griffin, Thomas A.
AU - Huber, Adam M.
AU - Lang, Bianca
AU - Lindsley, Carol B.
AU - Ota, Sylvia
AU - Pilkington, Clarissa
AU - Reed, Ann M.
AU - Scuccimarri, Rosie
AU - Feldman, Brian M.
PY - 2010/9
Y1 - 2010/9
N2 - Objective. There are a number of different approaches to the initial treatment of juvenile dermatomyositis (JDM). We assessed the therapeutic approaches of North American pediatric rheumatologists to inform future studies of therapy in JDM. Methods. A survey describing clinical cases of JDM was sent to pediatric rheumatologists. The cases described children with varying severity of typical disease, disease with atypical features, or refractory disease. Three open-ended questions were asked following each case: (1) What additional investigations would you order; (2) What medicine(s) would you start (dose, route, frequency, adjustment over time); and (3) What nonmedication treatment(s) would you start. Results. The response rate was 84% (141/167). For typical cases of JDM, regardless of severity, almost all respondents used corticosteroids and another medication, methotrexate (MTX) being the most commonly used. The route and pattern of corticosteroid administration was variable. Intravenous immunoglobulin (IVIG) was used more frequently for more severe disease, for refractory disease, and for prominent cutaneous disease. Hydroxychloroquine was often used in milder cases and cases principally characterized by rash. Cyclophosphamide was reserved for ulcerative disease and JDM complicated by lung disease. Conclusion. For the majority of North American pediatric rheumatologists, corticosteroids and MTX appear to be the standard of care for typical cases of JDM. There is variability, however, in the route of administration of corticosteroids and use of IVIG and hydroxychloroquine. The Journal of Rheumatology
AB - Objective. There are a number of different approaches to the initial treatment of juvenile dermatomyositis (JDM). We assessed the therapeutic approaches of North American pediatric rheumatologists to inform future studies of therapy in JDM. Methods. A survey describing clinical cases of JDM was sent to pediatric rheumatologists. The cases described children with varying severity of typical disease, disease with atypical features, or refractory disease. Three open-ended questions were asked following each case: (1) What additional investigations would you order; (2) What medicine(s) would you start (dose, route, frequency, adjustment over time); and (3) What nonmedication treatment(s) would you start. Results. The response rate was 84% (141/167). For typical cases of JDM, regardless of severity, almost all respondents used corticosteroids and another medication, methotrexate (MTX) being the most commonly used. The route and pattern of corticosteroid administration was variable. Intravenous immunoglobulin (IVIG) was used more frequently for more severe disease, for refractory disease, and for prominent cutaneous disease. Hydroxychloroquine was often used in milder cases and cases principally characterized by rash. Cyclophosphamide was reserved for ulcerative disease and JDM complicated by lung disease. Conclusion. For the majority of North American pediatric rheumatologists, corticosteroids and MTX appear to be the standard of care for typical cases of JDM. There is variability, however, in the route of administration of corticosteroids and use of IVIG and hydroxychloroquine. The Journal of Rheumatology
KW - Juvenile dermatomyositis
KW - Myositis
KW - Pediatric rheumatology
KW - Treatment
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U2 - 10.3899/jrheum.090953
DO - 10.3899/jrheum.090953
M3 - Article
C2 - 20595275
AN - SCOPUS:77956453825
SN - 0315-162X
VL - 37
SP - 1953
EP - 1961
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 9
ER -