Treatment of pediatric localized scleroderma: results of a survey of North American pediatric rheumatologists.
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.


CONCLUSIONS
Most PR in North America treat localized scleroderma with a combination of MTX 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.
Li
Suzanne C
SC
Sanzari Children's Hospital, HUMC, 30 Prospect Avenue, Imus PC350, Hackensack, NJ 07601, USA.
Feldman
Brian M
BM
Higgins
Gloria C
GC
Haines
Kathleen A
KA
Punaro
Marilynn G
MG
O'Neil
Kathleen M
KM
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012219:Rheumatology / Q000706:statistics & numerical data*; D012594:Scleroderma, Localized / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D008727:Methotrexate