title: Consensus treatment plans for new-onset systemic juvenile idiopathic arthritis.
abstract: OBJECTIVE
  There is wide variation in therapeutic approaches to systemic juvenile idiopathic arthritis (JIA) among North American rheumatologists. Understanding the comparative effectiveness of the diverse therapeutic options available for treatment of systemic JIA can result in better health outcomes. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans and standardized assessment schedules for use in clinical practice to facilitate such studies.
  
  
  METHODS
  Case-based surveys were administered to CARRA members to identify prevailing treatments for new-onset systemic JIA. A 2-day consensus conference in April 2010 employed modified nominal group technique to formulate preliminary treatment plans and determine important data elements for collection. Followup surveys were employed to refine the plans and assess clinical acceptability.
  
  
  RESULTS
  The initial case-based survey identified significant variability among current treatment approaches for new-onset systemic JIA, underscoring the utility of standardized plans to evaluate comparative effectiveness. We developed 4 consensus treatment plans for the first 9 months of therapy, as well as case definitions and clinical and laboratory monitoring schedules. The 4 treatment regimens included glucocorticoids only, or therapy with methotrexate, anakinra, or tocilizumab, with or without glucocorticoids. This approach was approved by >78% of the CARRA membership.
  
  
  CONCLUSIONS
  Four standardized treatment plans were developed for new-onset systemic JIA. Coupled with data collection at defined intervals, use of these treatment plans will create the opportunity to evaluate comparative effectiveness in an observational setting to optimize initial management of systemic JIA.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Esi Morgan
authors.initials: EM
authors.lastname: DeWitt
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kimura
authors.forename: Timothy
authors.initials: T
authors.lastname: Beukelman
authors.forename: Peter A
authors.initials: PA
authors.lastname: Nigrovic
authors.forename: Karen
authors.initials: K
authors.lastname: Onel
authors.forename: Sampath
authors.initials: S
authors.lastname: Prahalad
authors.forename: Rayfel
authors.initials: R
authors.lastname: Schneider
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Stoll
authors.forename: Sheila
authors.initials: S
authors.lastname: Angeles-Han
authors.forename: Diana
authors.initials: D
authors.lastname: Milojevic
authors.forename: Kenneth N
authors.initials: KN
authors.lastname: Schikler
authors.forename: Richard K
authors.initials: RK
authors.lastname: Vehe
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Weiss
authors.forename: Pamela
authors.initials: P
authors.lastname: Weiss
authors.forename: Norman T
authors.initials: NT
authors.lastname: Ilowite
authors.forename: Carol A
authors.initials: CA
authors.lastname: Wallace
mesh_terms: D000293:Adolescent; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards*; D003625:Data Collection; D019468:Disease Management; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D009656:North America
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D053590:Interleukin 1 Receptor Antagonist Protein; C502936:tocilizumab; D008727:Methotrexate