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meta-analysis by Cabrera et al. on the risk-benefits of using biologic agents to treat JIA, investigators found therapeutic success without serious adverse events is typical with systemic JIA patients.3 Treatment of Pediatric Localized Scleroderma: Results of a Survey of North American Pediatric Rheumatologists SUZANNE C. LI, BRIAN M. FELDMAN, GLORIA C. HIGGINS, KATHLEEN A. HAINES, MARILYNN G. PUNARO, and KATHLEEN M. O’NEIL ABSTRACT. Objective. We surveyed pediatric rheumatologists (PR) in North America to learn how they treat pediatric localized scleroderma (LS), a disease associated with significant morbidity for the growing child. Methods. A Web-based survey was sent to the 195 PR members of the pediatric rheumatology research alliance CARRA (Childhood Arthritis and Rheumatology Research Alliance). Members were asked which medications they use to treat LS and which factors modify their treatment strategies. Clinical vignettes were provided to learn the specific treatment regimens used. Results. A total of 158 PR from over 70 clinical centers in the United States and Canada participated in the survey, representing 81% of the CARRA membership. These PR saw over 650 patients with LS in the prior year. Nearly all respondents treated LS with methotrexate (MTX) and corticosteroids; most of them intensify treatment for lesions located on the face or near a joint, and about half intensify treatment for recent disease onset (< 6 months). Most PR reserve topical medications for limited treatment situations. Clinical vignettes showed that PR use a broad range of treatment doses and durations for MTX and corticosteroids. Conclusion. Most PR in North America treat localized scleroderma with a combination of MTX and corticosteroids. However, there is no consensus on specific treatment regimens. There is a need for controlled treatment trials to better determine optimal therapy for this potentially disabling disease. (First Release Nov 15 2009; J Rheumatol 2010;37:175–81; doi:10.3899/jrheum.090708) Key Indexing Terms: LOCALIZED SCLERODERMA PEDIATRICS DRUG THERAPY SURVEY From the Department of Pediatrics, Division of Pediatric Rheumatology, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, New Jersey, USA. Supported by the Childhood Arthritis and Rheumatology Research Alliance (CARRA). S.C. Li, MD, PhD, Assistant Professor of Pediatrics; K.A. Haines, MD, Associate Professor of Pediatrics, Hackensack University Medical Center; B.M. Feldman, MD, MSc, Professor of Pediatrics, Medicine, Dalla Lana School of Public Health and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; G.C. Higgins, MD, PhD, Associate Professor of Pediatrics, The Ohio State University Nationwide Children’s Hospital, Columbus, Ohio; M.G. Punaro, MD, Professor of Pediatrics, University of Texas Southwestern Medical Center, Director of Arthritis Services, Texas Scottish Rite Hospital, Dallas, Texas; K.M. O’Neil, MD, Associate Professor of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA. Address correspondence to Dr. S. Li, Joseph M. Sanzari Children’s Hospital, HUMC, 30 Prospect Avenue, Imus PC350, Hackensack, NJ 07601, USA. Accepted for publication August 6, 2009. atric patients have extracutaneous morbidity including arthritis, joint contractures, eye disease, and central nervous system involvement1,2. Disability occurs frequently, with 25% of patients with linear scleroderma, the most common childhood LS subtype, reported to have mild or moderate disability at followup3. Despite this potential for severe disease and
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