What Are Consensus Treatment Plans?
The consensus treatment plans are a ground-breaking effort, says Dr. Wallace. “It’s a huge change, a big shift in how we’ve done things to date in pediatric rheumatology.”
How things have been done to date is based on habit or each doctor’s individual experience, as no studies exist that have determined the best treatment for pediatric rheumatic diseases. Most doctors agree on the basics of treatment, for example, the use of corticosteroids and methotrexate as a first course of action for some types of rheumatic disease, but that is where consensus ends. How much? How often? What route? For how long? When to taper off? These are questions that could have a hundred different answers.
The consensus plans offer a limited number of treatments to choose from that have been developed by input from CARRA members through a rigorous consensus processes. Pediatric rheumatologists agree to choose the treatment plan most closely resembles what they would do and what they feel would be best for a specific patient. The clinician then follows the plan and collects data about how the patient responds and if there are problems with the treatment.
“By having pediatric rheumatologists utilize one of the consensus treatment plans for their patients, we can then compare the relative outcomes for three or four different treatment approaches instead of literally hundreds of different approaches, most with only minor differences from each other,” says Tim Beukelman, MD, associate professor of pediatrics in the Division of Pediatric Rheumatology at the University of Alabama at Birmingham School of Medicine, and vice chair of the CARRA Juvenile Idiopathic Arthritis (JIA) Committee.
“If we’re ever going to learn about the best way to treat any disease, we must standardize treatments and collect the information about the patients on these treatments,” says Yukiko Kimura, MD, a pediatric rheumatologist at Joseph M. Sanzari Children’s Hospital in Hackensack, N.J., and chair of the CARRA JIA committee and incoming vice chair of the CARRA Steering Committee.
Dr. Kimura points to the pediatric oncology community as a model, which has significantly increased survival rates of children with cancer by developing treatment standards, continually updating and retesting them.
“They standardized their treatments and got all the pediatric oncologists to use these treatments and collected the information,” she explains. “And gradually, they were able to understand how to fine tune the treatments and find the best treatments that result in the best outcomes for these kids. This is what’s needed in pediatric rheumatology.”
Right now, CARRA has published four groups of consensus treatment plans, one from each of its disease-specific committees.