title: Consensus treatments for moderate juvenile dermatomyositis: beyond the first two months. Results of the second Childhood Arthritis and Rheumatology Research Alliance consensus conference.
abstract: OBJECTIVE
  To use consensus methods and the considerable expertise contained within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) organization to extend the 3 previously developed treatment plans for moderate juvenile dermatomyositis (DM) to span the full course of treatment.
  
  
  METHODS
  A consensus meeting was held in Chicago on April 23-24, 2010, involving 30 pediatric rheumatologists and 4 lay participants. Nominal group technique was used to achieve consensus on treatment plans that represented typical management of moderate juvenile DM. A preconference survey of CARRA, completed by 151 (56%) of 272 members, was used to provide additional guidance to the discussion.
  
  
  RESULTS
  Consensus was reached on timing and rate of steroid tapering, duration of steroid therapy, and actions to be taken if patients were unchanged, worsening, or experiencing medication side effects or disease complications. Of particular importance, a single consensus steroid taper was developed.
  
  
  CONCLUSIONS
  We were able to develop consensus treatment plans that describe therapy for moderate juvenile DM throughout the treatment course. These treatment plans can now be used clinically, and data collected prospectively regarding treatment effectiveness and toxicity. This will allow comparison of these treatment plans and facilitate the development of evidence-based treatment recommendations for moderate juvenile DM.
authors.affiliation: IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada. adamtheresa@hfx.eastlink.ca
authors.forename: Adam M
authors.initials: AM
authors.lastname: Huber
authors.forename: Angela B
authors.initials: AB
authors.lastname: Robinson
authors.forename: Ann M
authors.initials: AM
authors.lastname: Reed
authors.forename: Leslie
authors.initials: L
authors.lastname: Abramson
authors.forename: Sharon
authors.initials: S
authors.lastname: Bout-Tabaku
authors.forename: Ruy
authors.initials: R
authors.lastname: Carrasco
authors.forename: Megan
authors.initials: M
authors.lastname: Curran
authors.forename: Brian M
authors.initials: BM
authors.lastname: Feldman
authors.forename: Harry
authors.initials: H
authors.lastname: Gewanter
authors.forename: Thomas
authors.initials: T
authors.lastname: Griffin
authors.forename: Kathleen
authors.initials: K
authors.lastname: Haines
authors.forename: Mark F
authors.initials: MF
authors.lastname: Hoeltzel
authors.forename: Josephine
authors.initials: J
authors.lastname: Isgro
authors.forename: Philip
authors.initials: P
authors.lastname: Kahn
authors.forename: Bianca
authors.initials: B
authors.lastname: Lang
authors.forename: Patti
authors.initials: P
authors.lastname: Lawler
authors.forename: Bracha
authors.initials: B
authors.lastname: Shaham
authors.forename: Heinrike
authors.initials: H
authors.lastname: Schmeling
authors.forename: Rosie
authors.initials: R
authors.lastname: Scuccimarri
authors.forename: Michael
authors.initials: M
authors.lastname: Shishov
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stringer
authors.forename: Julie
authors.initials: J
authors.lastname: Wohrley
authors.forename: Norman T
authors.initials: NT
authors.lastname: Ilowite
authors.forename: Carol
authors.initials: C
authors.lastname: Wallace
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003882:Dermatomyositis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D013256:Steroids / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013256:Steroids
references.citation: Arthritis Care Res (Hoboken). 2010 Feb;62(2):219-25
references.pmid: 20191521
references.citation: Ann Intern Med. 2009 Aug 4;151(3):206-9
references.pmid: 19567619
references.citation: Ann Intern Med. 2010 Oct 5;153(7):469-72
references.pmid: 20679544
references.citation: Rheumatology (Oxford). 2003 Dec;42(12):1452-9
references.pmid: 12832713
references.citation: Am Fam Physician. 2004 Feb 1;69(3):548-56
references.pmid: 14971837
references.citation: J Rheumatol. 2003 Mar;30(3):603-17
references.pmid: 12610824
references.citation: Arthritis Rheum. 2004 Jul;50(7):2281-90
references.pmid: 15248228
references.citation: Arthritis Care Res (Hoboken). 2010 Nov;62(11):1533-41
references.pmid: 20583105
references.citation: Rheumatology (Oxford). 2001 Nov;40(11):1262-73
references.pmid: 11709610
references.citation: Arthritis Rheum. 2000 Mar;43(3):541-9
references.pmid: 10728746
references.citation: Stat Med. 2010 Aug 30;29(19):1963-76
references.pmid: 20564311
references.citation: J Rheumatol. 2010 Sep;37(9):1953-61
references.pmid: 20595275
references.citation: Med Care. 2010 Jun;48(6 Suppl):S7-8
references.pmid: 20473202
references.citation: J Pediatr. 1964 Jan;64:101-31
references.pmid: 14100086