RT Journal Article
SR Electronic
T1 Treatment Approaches to Juvenile Dermatomyositis (JDM) Across North America: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) JDM Treatment Survey
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1953
OP 1961
DO 10.3899/jrheum.090953
VO 37
IS 9
A1 ELIZABETH STRINGER
A1 JOHN BOHNSACK
A1 SUZANNE L. BOWYER
A1 THOMAS A. GRIFFIN
A1 ADAM M. HUBER
A1 BIANCA LANG
A1 CAROL B. LINDSLEY
A1 SYLVIA OTA
A1 CLARISSA PILKINGTON
A1 ANN M. REED
A1 ROSIE SCUCCIMARRI
A1 BRIAN M. FELDMAN
YR 2010
UL http://www.jrheum.org/content/37/9/1953.abstract
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.