title: Childhood Arthritis and Rheumatology Research Alliance consensus clinical treatment plans for juvenile dermatomyositis with skin predominant disease.
abstract: BACKGROUND
  Juvenile dermatomyositis (JDM) is the most common form of the idiopathic inflammatory myopathies in children. A subset of children have the rash of JDM without significant weakness, and the optimal treatments for these children are unknown. The goal of this study was to describe the development of consensus clinical treatment plans (CTPs) for children with JDM who have active skin rashes, without significant muscle involvement, referred to as skin predominant JDM in this manuscript.
  
  
  METHODS
  The Children's Arthritis and Rheumatology Research Alliance (CARRA) is a North American consortium of pediatric rheumatology health care providers. CARRA members collaborated to determine consensus on typical treatments for JDM patients with skin findings without significant weakness, to develop CTPs for this subgroup of patients. We used a combination of Delphi surveys and nominal group consensus meetings to develop these CTPs.
  
  
  RESULTS
  Consensus was reached on patient characteristics and outcome assessment, and CTPs were developed and finalized for patients with skin predominant JDM. Treatment option A included hydroxychloroquine alone, Treatment option B included hydroxychloroquine and methotrexate, and Treatment option C included hydroxychloroquine, methotrexate and corticosteroids.
  
  
  CONCLUSIONS
  Three CTPs were developed for use in children with skin predominant JDM, which reflect typical treatment approaches. These are not considered to be specific recommendations or standard of care. Using the CARRA network and prospective data collection, we will be able to apply statistical methods in the future to allow comparisons of JDM patients following these consensus treatment plans.
authors.affiliation: Division of Pediatric Rheumatology, Benioff Children's Hospital, University of California at San Francisco, 550 16th St, San Francisco, CA, USA. Susan.kim@ucsf.edu.
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0003-2159-8059
authors.initials: S
authors.lastname: Kim
authors.affiliation: Division of Pediatric Rheumatology, New York University Langone Medical Center, 550 First Avenue, New York, NY, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Kahn
authors.affiliation: Pediatric Rheumatology, Rainbow Babies and Children's Hospital, 11100 Euclid Ave MS6008B, Cleveland, OH, USA.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Robinson
authors.affiliation: Department of Pediatrics, IWK Health Centre and Dalhousie University, 5980 University Ave, Halifax, NS, Canada.
authors.forename: Bianca
authors.initials: B
authors.lastname: Lang
authors.affiliation: Pediatric Rheumatology, Children's Hospital of Orange County, 1201 W La Veta Ave, Irvine, CA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Shulman
authors.affiliation: Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Oberle
authors.affiliation: Divisions of Adolescent Medicine and Pediatric Rheumatology, Department of Pediatrics, University of Louisville School of Medicine, 571 South Floyd St, Louisville, KY, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Schikler
authors.affiliation: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, USA.
authors.forename: Megan Lea
authors.initials: ML
authors.lastname: Curran
authors.affiliation: Department of Pediatrics, Rheumatology, Albany Medical Center, 43 New Scotland Ave, Albany, NY, USA.
authors.forename: Lilliana
authors.initials: L
authors.lastname: Barillas-Arias
authors.affiliation: Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Spencer
authors.affiliation: Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Rider
authors.affiliation: Department of Pediatrics, IWK Health Centre and Dalhousie University, 5980 University Ave, Halifax, NS, Canada.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Huber
mesh_terms: D000293:Adolescent; D035843:Biomedical Research; D002648:Child; D032921:Consensus; D003245:Consensus Statements as Topic; D003882:Dermatomyositis / Q000628:therapy*; D006801:Humans; D010347:Patient Care Planning; D010641:Phenotype; D012042:Registries; D012955:Societies, Medical
keywords: Adolescent; Amyopathic; Child; Dermatomyositis, Childhood Type; Therapeutics