Treatment Plan Summaries
Systemic Juvenile Idiopathic Arthritis: The JIA committee chose to focus their first consensus treatment plan on systemic JIA. Making up just about 5 to 15 percent of all cases of JIA, systemic JIA may also be the most variable subset of JIA, which makes it all the more difficult to standardize its treatment. The consensus treatment plan presents four treatments: corticosteroids only, methotrexate, anakinra (Kineret) and tocillizumab (Actemra), all with or without corticosteroids.
Lupus Nephritis: The SLE group focused their consensus treatment plan specifically on the induction phase – or the first six months of treatment – of lupus nephritis, which is seen in about 80 percent of all children with SLE. The consensus plans present immunosuppressive therapy options of either daily oral mycophenolic acid (CellCept) or monthly intravenous cyclophosphamide (Cytoxan), as well as three options for use of corticosteroids.
Juvenile Dermatomyositis: The JDM committee provided three plans for the treatment of moderate juvenile dermatomyositis: IV methylprednisolone, methotrexate and predisone; IV methylprednisolone, methotrexate, prednisone and IV immunoglobulin; and finally, methotrexate and prednisone.
Juvenile Localized Scleroderma: The SVRD committee developed consensus treatment plans focusing on the first year of treatment of juvenile localized scleroderma. The plans include methotrexate alone; methotrexate and IV corticosteroids; and methotrexate plus a combination of oral and IV corticosteroids.
As a patient or a parent of a patient, you may never know that you are part of one of these treatment plans, and that is the point. If your pediatric rheumatologist thinks your child is a candidate for one of the protocols, they will likely follow it, but CARRA recognizes the many variables in pediatric rheumatic diseases and that sometimes circumstances dictate that your doctor follows another course of treatment.
“We’re not trying to take judgment away from physicians. We are trying to standardize treatments so they can be compared,” explains Dr. Wallace.
While the primary goal is to develop standards of care, an added benefit is that publication of these treatment plans may also reach doctors who see JA patients but aren’t pediatric rheumatologists and may not be sure of the most current treatments.
CARRA sees these consensus treatment plans as works in progress. As new treatments are introduced and evidence is collected, these plans will change and improve. The data collection on these treatment plans “will inform not only which treatment protocol is best, but which is safest and with the least side effects,” says Dr. Wallace.
“With time, our goal is to have the best treatment for each patient -- personalized care, which is where they are with childhood cancer,” she says. “Eventually, we will achieve that.”