Table 2.
L | S | Agreement (%) |
|
Systemic corticosteroids may be useful in the active inflammatory phase of JLS. At the same time as starting systemic corticosteroids, MTX or an alternative DMARD should be started. | 2b | C | 100 |
All patients with active, potentially disfiguring or disabling forms of JLS should be treated with oral or subcutaneous methotrexate at 15 mg/m²/week. | 1b | A | 100 |
If acceptable clinical improvement is achieved, methotrexate should be maintained for at least 12 months before tapering. | 3 | C | 100 |
Mycophenolate mofetil may be used to treat severe JLS or MTX-refractory or MTX-intolerant patients. | 2a | B | 100 |
Medium-dose UVA1 phototherapy may be used to improve skin softness in isolated (circumscribed) morphoea lesions. | 1b | A | 100 |
Topical imiquimod may be used to decrease skin thickening of circumscribed morphoea. | 3 | C | 100 |
DMARD, disease-modifying antirheumatic drug; JLS, juvenile localised scleroderma; L, level of evidence; MTX, methotrexate; S, strength of recommendation; UVA1, ultraviolet A1.