title: Consensus-based recommendations for the management of juvenile dermatomyositis.
abstract: In 2012, a European initiative called Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile dermatomyositis (JDM) is a rare disease within the group of paediatric rheumatic diseases (PRDs) and can lead to significant morbidity. Evidence-based guidelines are sparse and management is mostly based on physicians' experience. Consequently, treatment regimens differ throughout Europe.
  
  
  
  To provide recommendations for diagnosis and treatment of JDM.
  
  
  
  Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was constituted, consisting of 19 experienced paediatric rheumatologists and 2 experts in paediatric exercise physiology and physical therapy, mainly from Europe. Recommendations derived from a validated systematic literature review were evaluated by an online survey and subsequently discussed at two consensus meetings using nominal group technique. Recommendations were accepted if >80% agreement was reached.
  
  
  
  In total, 7 overarching principles, 33 recommendations on diagnosis and 19 recommendations on therapy were accepted with >80% agreement among experts. Topics covered include assessment of skin, muscle and major organ involvement and suggested treatment pathways.
  
  
  
  The SHARE initiative aims to identify best practices for treatment of patients suffering from PRD. Within this remit, recommendations for the diagnosis and treatment of JDM have been formulated by an evidence-informed consensus process to produce a standard of care for patients with JDM throughout Europe.
authors: Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.|Division of Allergology, Immunology and Rheumatology, Department of Pediatrics, University Hospital, Lausanne, Switzerland.
authors: Felicitas
authors: F
authors: Bellutti Enders
authors: Department for Immunology, Hematology and Pediatric Rheumatology, Necker Hospital, APHP, Institut IMAGINE, Paris, France.
authors: Brigitte
authors: B
authors: Bader-Meunier
authors: Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
authors: Eileen
authors: E
authors: Baildam
authors: 2nd Department of Pediatrics, Semmelweis Hospital, Budapest, Hungary.
authors: Tamas
authors: T
authors: Constantin
authors: Paediatric Rheumatology Unit, Department of Paediatrics and Adolescent Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic.
authors: Pavla
authors: P
authors: Dolezalova
authors: Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors: Brian M
authors: BM
authors: Feldman
authors: Department of Pediatric Rheumatology, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors: Pekka
authors: P
authors: Lahdenne
authors: Paediatric Rheumatology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm, Sweden.
authors: Bo
authors: B
authors: Magnusson
authors: Centre for Adolescent Rheumatology, Institute of Child Health University College London, London, UK.
authors: Kiran
authors: K
authors: Nistala
authors: Department of Paediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: Seza
authors: S
authors: Ozen
authors: Centre for Adolescent Rheumatology, Institute of Child Health University College London, London, UK.
authors: Clarissa
authors: C
authors: Pilkington
authors: Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy.
authors: Angelo
authors: A
authors: Ravelli
authors: Service of Immunology and Rheumatology, Hospital de Pediatría Garrahan, Buenos Aires, Argentina.
authors: Ricardo
authors: R
authors: Russo
authors: Department of Paediatrics, Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors: Yosef
authors: Y
authors: Uziel
authors: Division of Pediatrics, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Marco
authors: M
authors: van Brussel
authors: Division of Pediatrics, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Janjaap
authors: J
authors: van der Net
authors: Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Sebastiaan
authors: S
authors: Vastert
authors: Centre for Adolescent Rheumatology, Institute of Child Health University College London, London, UK.
authors: Lucy R
authors: LR
authors: Wedderburn
authors: Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Nicolaas
authors: N
authors: Wulffraat
authors: Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
authors: Liza J
authors: LJ
authors: McCann
authors: Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Annet
authors: A
authors: van Royen-Kerkhof
mesh_terms: D016572:Cyclosporine / Q000627:therapeutic use; D003882:Dermatomyositis / Q000175:diagnosis / Q000628:therapy*; D005060:Europe; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000627:therapeutic use; D010348:Patient Care Team / Q000458:organization & administration; D011239:Prednisolone / Q000627:therapeutic use; D000069283:Rituximab / Q000627:therapeutic use; D012955:Societies, Medical; D013473:Sunscreening Agents / Q000627:therapeutic use*
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D013473:Sunscreening Agents; D000069283:Rituximab; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid; D008727:Methotrexate
keywords: Autoimmune Diseases; Dermatomyositis; Treatment