Childhood Arthritis and Rheumatology Research Alliance Consensus Clinical Treatment Plans for Juvenile Dermatomyositis with Persistent Skin Rash

Adam M Huber^{1

2}, Susan Kim^{3

4}, Ann M Reed^{3

4}, Ruy Carrasco^{3

4}, Brian M Feldman^{3

4}, Sandy D Hong^{3

4}, Philip Kahn^{3

4}, Homaira Rahimi^{3

4}, Angela Byun Robinson^{3

4}, Richard K Vehe^{3

4}, Jennifer E Weiss^{3

4}, Charles Spencer^{3

4}; Juvenile Dermatomyositis Research Committee of the Childhood Arthritis and Rheumatology Research Alliance

Affiliations

¹ From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA. adam.huber@iwk.nshealth.ca.
² A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University. adam.huber@iwk.nshealth.ca.
³ From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
⁴ A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University.

PMID: 27803135
DOI: 10.3899/jrheum.160688

Practice Guideline

Childhood Arthritis and Rheumatology Research Alliance Consensus Clinical Treatment Plans for Juvenile Dermatomyositis with Persistent Skin Rash

Adam M Huber et al. J Rheumatol. 2017 Jan.

. 2017 Jan;44(1):110-116.

doi: 10.3899/jrheum.160688. Epub 2016 Nov 1.

Authors

Affiliations

¹ From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA. adam.huber@iwk.nshealth.ca.
² A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University. adam.huber@iwk.nshealth.ca.
³ From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
⁴ A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University.

PMID: 27803135
DOI: 10.3899/jrheum.160688

Abstract

Objective: Juvenile dermatomyositis (JDM) is the most common form of idiopathic inflammatory myopathy in children. While outcomes are generally thought to be good, persistence of skin rash is a common problem. The goal of this study was to describe the development of clinical treatment plans (CTP) for children with JDM characterized by persistent skin rash despite complete resolution of muscle involvement.

Methods: The Childhood Arthritis and Rheumatology Research Alliance, a North American consortium of pediatric rheumatologists and other healthcare providers, used a combination of Delphi surveys and nominal group consensus meetings to develop CTP that reflected consensus on typical treatments for patients with JDM with persistent skin rash.

Results: Consensus was reached on patient characteristics and outcome assessment. Patients should have previously received corticosteroids and methotrexate (MTX). Three consensus treatment plans were developed. Plan A added intravenous immunoglobulin (IVIG) if it was not already being used. Plan B added mycophenolate mofetil, while Plan C added cyclosporine. Continuation of previous treatments, including corticosteroids, MTX, and IVIG, was permitted in plans B and C.

Conclusion: Three consensus CTP were developed for use in children with JDM and persistent skin rash despite complete resolution of muscle disease. These CTP reflect typical treatment approaches and are not to be considered treatment recommendations or standard of care. Using prospective data collection and statistical methods to account for nonrandom treatment assignment, it is expected that these CTP will be used to allow treatment comparisons, and ultimately determine the best treatment for these patients.

Keywords: CLINICAL TREATMENT PLANS; PEDIATRIC DERMATOMYOSITIS/POLYMYOSITIS; THERAPEUTICS.

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Childhood Arthritis and Rheumatology Research Alliance Consensus Clinical Treatment Plans for Juvenile Dermatomyositis with Persistent Skin Rash

Affiliations

Childhood Arthritis and Rheumatology Research Alliance Consensus Clinical Treatment Plans for Juvenile Dermatomyositis with Persistent Skin Rash

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical