RT Journal Article
SR Electronic
T1 Treatment of Pediatric Localized Scleroderma: Results of a Survey of North American Pediatric Rheumatologists
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.090708
DO 10.3899/jrheum.090708
A1 Suzanne C. Li
A1 Brian M. Feldman
A1 Gloria C. Higgins
A1 Kathleen A. Haines
A1 Marilynn G. Punaro
A1 Kathleen M. O'Neil
YR 2009
UL http://www.jrheum.org/content/early/2009/11/16/jrheum.090708.abstract
AB Objective We surveyed pediatric rheumatologists (PR) in North America to learn how they treat pediatric localized scleroderma (LS), a disease associated with significant morbidity for the growing child. Methods A Web-based survey was sent to the 195 PR members of the pediatric rheumatology research alliance CARRA (Childhood Arthritis and Rheumatology Research Alliance). Members were asked which medications they use to treat LS and which factors modify their treatment strategies. Clinical vignettes were provided to learn the specific treatment regimens used. Results A total of 158 PR from over 70 clinical centers in the United States and Canada participated in the survey, representing 81% of the CARRA membership. These PR saw over 650 patients with LS in the prior year. Nearly all respondents treated LS with methotrexate (MTX) and corticosteroids; most of them intensify treatment for lesions located on the face or near a joint, and about half intensify treatment for recent disease onset (< 6 months). Most PR reserve topical medications for limited treatment situations. Clinical vignettes showed that PR use a broad range of treatment doses and durations for MTX and corticosteroids. Conclusion Most PR in North America treat localized scleroderma with a combination ofMTX and corticosteroids. However, there is no consensus on specific treatment regimens. There is a need for controlled treatment trials to better determine optimal therapy for this potentially disabling disease.