The Childhood Arthritis and Rheumatology Research Alliance (CARRA) is developing consensus treatment plans for childhood rheumatic diseases.
CARRA was established in 2002 to create a network of pediatric rheumatologists across North America, providing infrastructure to collaborate more easily in large, multicenter studies, increasing the number of participants in studies and reducing the time it takes to achieve results. Today, the majority of all pediatric rheumatologists in the United States and Canada count themselves as members of CARRA, representing more than 92 institutions.
The Arthritis Foundation has supported CARRA from the start, providing funding for its development and ongoing funding for its administrative core and support for the CARRA registry.
What Are Consensus: 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.
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.
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.