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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EKey success features for pediatric rheumatology have included an improvement in the pipeline of talent and the development of a research network to improve the care of children with rheumatic disease. This article discusses threats to the survival of the field of pediatric rheumatology in North America, the response to those threats, and future directions.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArthritis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELupus\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArthritis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELupus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EKey success features for pediatric rheumatology have included an improvement in the pipeline of talent and the development of a research network to improve the care of children with rheumatic disease. Christy Sandborg, MD, Stanford University, Palo Alto, California, USA, discussed threats to the survival of the field of pediatric rheumatology in North America, the response to those threats, and future directions.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe American Board of Pediatrics (ABP) had considered dropping pediatric rheumatology subspecialty certification in the late 1990s owing to a lack of infrastructure and compromises in academic productivity as a result of burgeoning clinical loads, which had the additional effect of distracting from research. Interventions were subsequently instituted to enhance the training of pediatric rheumatology fellows, culminating in the ABP accrediting \u0026gt;25 fellowship programs. As a result, there are currently 312 board-certified pediatric rheumatologists, compared with 92 in 1992 (the year of the first certification examination), and \u223c90 fellows in training, with \u0026gt;25 graduating per year. Given the prevalence of pediatric rheumatic diseases (estimated at 200 to 300 per 100,000 children), a \u0026gt;75% increase in the number of pediatric rheumatologists is required to provide adequate clinical care for children with rheumatic disease, said Dr. Sandborg. As of 2012, ten states did not have any boarded pediatric rheumatologists.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe Childhood Arthritis and Rheumatology Research Alliance (CARRA) is a multicenter investigator-driven research network that was established and designed to take advantage of collaboration to conduct efficient, results-oriented clinical research and treatment trials. CARRA includes the vast majority of practicing pediatric rheumatologists and trainees in the United States and Canada, with \u0026gt;390 members and 107 institutions.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe Arthritis Foundation has provided core infrastructure support for 13 years. Its efforts have led to federal funding of the CARRA registry, creating a platform to learn from every patient, said Dr. Sandborg. The registry is compiled from data gathered at CARRA sites about pediatric rheumatology patients, their disease, and their treatments, resulting in a unified infrastructure through which researchers can readily gather information. There are currently \u0026gt;9000 patients in the CARRA registry, 71% of whom have juvenile idiopathic arthritis (JIA), 12% systemic lupus erythematosus (SLE), 7% juvenile dermatomyositis, 4% localized scleroderma, and 6% other rheumatic conditions.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EOne goal of the CARRA network was to provide access to participation in one or more clinical studies for all children with rheumatic diseases in the United States and Canada by 2012. At the time of this presentation in November 2013, there were 35 research studies and 4 major clinical trials that had been supported by CARRA. The clinical trials include the Atherosclerosis Prevention in Pediatric Lupus Erythematosus [APPLE; Schanberg LE et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2012]; Trial of Early Aggressive Treatment of Polyarticular JIA [TREAT JIA; Wallace CA et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2012]; Randomized Placebo Phase Study of Rilonacept in the Treatment of Systemic JIA [RAPPORT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00534495\u0026amp;atom=%2Fspmdc%2F13%2F18%2F35.atom\u0022\u003ENCT00534495\u003C\/a\u003E], and Rituximab in Myositis [RIM; Oddis CV et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2013]. The CARRA registry can also serve as a foundation for long-term safety studies; for example, understanding the safety of biologic agents and new drugs in the context of disease and multiple exposures.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ECARRA has also engaged experts to develop consensus treatment plans for juvenile localized scleroderma [Li SC et al. \u003Cem\u003EArthritis Care Res\u003C\/em\u003E 2012], newly diagnosed proliferative lupus nephritis in juvenile SLE [Mina R et al. \u003Cem\u003EArthritis Care Res\u003C\/em\u003E 2012], and moderate juvenile dermatomyositis [Huber AM et al. \u003Cem\u003EArthritis Care Res\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/18\/35\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the American College of Rheumatology 77th Annual Scientific Meeting presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2128059385\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the American College of Rheumatology 77th Annual Scientific Meeting presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/18\/35\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/18\/35\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/18\/35\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13778\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the American College of Rheumatology 77th Annual Scientific Meeting presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/18\/35.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzo6ze\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo6ze\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}