Clinical Rheumatology

, Volume 38, Issue 2, pp 563–575 | Cite as

Juvenile arthritis management in less resourced countries (JAMLess): consensus recommendations from the Cradle of Humankind

  • Christiaan ScottEmail author
  • Mercedes Chan
  • Waheba Slamang
  • Lawrence Okong’o
  • Ross Petty
  • Ronald M. Laxer
  • María-Martha Katsicas
  • Francis Fredrick
  • James Chipeta
  • Gail Faller
  • Gecilmara Pileggi
  • Claudia Saad-Magalhaes
  • Carine Wouters
  • Helen E. Foster
  • Raju Kubchandani
  • Nicolino Ruperto
  • Ricardo Russo
Original Article


Juvenile idiopathic arthritis (JIA) is the most prevalent chronic rheumatic disease in children and young people (CYP) and a major cause of pain and disability. The vast majority of the world’s children and their families live in less resourced countries (LRCs) and face significant socioeconomic and healthcare challenges. Current recommendations for standards of care and treatment for children with JIA do not consider children living in less resourced countries. In order to develop appropriate recommendations for the care of CYP with JIA in less resourced countries a meeting of experienced pediatric rheumatologists from less resourced countries was convened with additional input from a steering group of international pediatric rheumatologists with experience in developing recommendations and standards of care for JIA. Following a needs assessment survey of healthcare workers caring for CYP with JIA in LRC, a literature review was carried out and management recommendations formulated using Delphi technique and a final consensus conference. Responses from the needs assessment were received from 121/483 (25%) practitioners from 25/49 (51%) less resourced countries. From these responses, the initial 84 recommendations were refined and expanded through a series of 3 online Delphi rounds. A final list of 90 recommendations was proposed for evaluation. Evidence for each statement was reviewed, graded, and presented to the consensus group. The degree of consensus, level of agreement, and level of evidence for these recommendations are reported. Recommendations arrived at by consensus for CYP with JIA in less resourced countries cover 5 themes: (1) diagnosis, (2) referral and monitoring, (3) education and training, (4) advocacy and networks, and (5) research. Thirty-five statements were drafted. All but one statement achieved 100% consensus. The body of published evidence was small and the quality of evidence available for critical appraisal was low. Our recommendations offer novel insights and present consensus-based strategies for the management of JIA in less resourced countries. The emphasis on communicable and endemic diseases influencing the diagnosis and treatment of JIA serves as a valuable addition to existing JIA guidelines. With increasing globalization, these recommendations as a whole provide educational and clinical utility for clinicians worldwide. The low evidence base for our recommendations reflects a shortage of research specific to less resourced countries and serves as an impetus for further inquiry towards optimizing care for children with JIA around the world.


Developing world Juvenile idiopathic arthritis Management Recommendations 


Funding information

The research was conducted using funding from an International Leagues of Associations for Rheumatology (ILAR) Grant.

Compliance with ethical standards




  1. 1.
    Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P, International League of Associations for Rheumatology (2004) International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31(2):390–392Google Scholar
  2. 2.
    Crisp N (2011) Global health capacity and workforce development: turning the world upside down. Infect Dis Clin N Am 25(2):359–367CrossRefGoogle Scholar
  3. 3.
    (2017) Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet;390(10100):1151–210Google Scholar
  4. 4.
    Denno D (2011) Global child health. Pediatr Rev 32(2):e25–e38CrossRefGoogle Scholar
  5. 5.
    Henrickson M (2011) Policy challenges for the pediatric rheumatology workforce: Part III the international situation. Pediatr Rheumatol Online J 9:26CrossRefGoogle Scholar
  6. 6.
    Manners PJ, Bower C (2002) Worldwide prevalence of juvenile arthritis why does it vary so much? J Rheumatol 29(7):1520–1530Google Scholar
  7. 7.
    Manners PJ, Diepeveen DA (1996) Prevalence of juvenile chronic arthritis in a population of 12-year-old children in urban Australia. Pediatrics 98(1):84–90Google Scholar
  8. 8.
    United Nations Chidlrens Fund (UNICEF) 2017 State of the World’s Children Report: [Available from:
  9. 9.
    Arkachaisri T, Tang SP, Daengsuwan T, Phongsamart G, Vilaiyuk S, Charuvanij S, Hoh SF, Tan JH, Das L, Ang E, Lim W, Chan YH, Bernal CB, Asia Pacific Pediatric Rheumatology Education and Research Network (2017) Paediatric rheumatology clinic population in Southeast Asia: are we different? Rheumatology (Oxford) 56(3):390–398Google Scholar
  10. 10.
    Gibson T (2015) Rheumatology in India and Pakistan today. Rheumatology (Oxford) 54(5):753–754CrossRefGoogle Scholar
  11. 11.
    Scott C, Webb K (2014) Paediatric rheumatology in sub-Saharan Africa. Rheumatology (Oxford) 53(8):1357–1358CrossRefGoogle Scholar
  12. 12.
    Ruperto N, Martini A (2011) Networking in paediatrics: the example of the Paediatric rheumatology international trials organisation (PRINTO). Arch Dis Child 96(6):596–601CrossRefGoogle Scholar
  13. 13.
    Consolaro A, Dolezalova P, Panaviene V, Christensen AE, Merino R, Constantin T, Martini A, Ravelli A, EPOCA study group (2014) A multinational study of the epidemiology, treatment and outcome of childhood arthritis (epoca study): preliminary data from 6,940 patients. Pediatr Rheumatol 12(1):O8CrossRefGoogle Scholar
  14. 14.
    Consolaro A, Ruperto N, Filocamo G, Lanni S, Bracciolini G, Garrone M, Scala S, Villa L, Silvestri G, Tani D, Zolesi A, Martini A, Ravelli A, for the Pediatric Rheumatology International Trials Organization (PRINTO) (2012) Seeking insights into the EPidemiology, treatment and outcome of childhood arthritis through a multinational collaborative effort: introduction of the EPOCA study. Pediatr Rheumatol Online J 10(1):39CrossRefGoogle Scholar
  15. 15.
    Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM et al (2011) 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken) 63(4):465–482CrossRefGoogle Scholar
  16. 16.
    Davies K, Cleary G, Foster H, Hutchinson E, Baildam E (2010) BSPAR standards of care for children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 49(7):1406–1408CrossRefGoogle Scholar
  17. 17.
    Munro J, Murray K, Boros C, Chaitow J, Allen RC, Akikusa J, Adib N, Piper SE, Singh-Grewal D, Australian Paediatric Rheumatology Group (2014) Australian Paediatric rheumatology group standards of care for the management of juvenile idiopathic arthritis. J Paediatr Child Health 50(9):663–666CrossRefGoogle Scholar
  18. 18.
    Cellucci T, Guzman J, Petty RE, Batthish M, Benseler SM, Ellsworth JE et al (2016) Management of Juvenile Idiopathic Arthritis 2015: a position statement from the pediatric Committee of the Canadian Rheumatology Association. J Rheumatol 43(10):1773–1776CrossRefGoogle Scholar
  19. 19.
    Constantin T, Foeldvari I, Anton J, de Boer J, Czitrom-Guillaume S, Edelsten C et al (2018) Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann Rheum Dis:annrheumdis-2018-213131Google Scholar
  20. 20.
    Ravelli A, Consolaro A, Horneff G, Laxer RM, Lovell DJ, Wulffraat NM, Akikusa JD, al-Mayouf SM, Antón J, Avcin T, Berard RA, Beresford MW, Burgos-Vargas R, Cimaz R, de Benedetti F, Demirkaya E, Foell D, Itoh Y, Lahdenne P, Morgan EM, Quartier P, Ruperto N, Russo R, Saad-Magalhães C, Sawhney S, Scott C, Shenoi S, Swart JF, Uziel Y, Vastert SJ, Smolen JS (2018) Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Ann Rheum Dis 77(6):819–828Google Scholar
  21. 21.
    Giannini EH, Brewer EJ, Kuzmina N, Shaikov A, Maximov A, Vorontsov I, Fink CW, Newman AJ, Cassidy JT, Zemel LS (1992) Methotrexate in resistant juvenile rheumatoid arthritis. Results of the U.S.a.-U.S.S.R. double-blind, placebo-controlled trial. The pediatric rheumatology collaborative study group and the cooperative Children's study group. N Engl J Med 326(16):1043–1049CrossRefGoogle Scholar
  22. 22.
    Ruperto N, Murray KJ, Gerloni V, Wulffraat N, de Oliveira SK, Falcini F et al (2004) A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. Arthritis Rheum 50(7):2191–2201CrossRefGoogle Scholar
  23. 23.
    Foell D, Wulffraat N, Wedderburn LR, Wittkowski H, Frosch M, Gerss J, Stanevicha V, Mihaylova D, Ferriani V, Tsakalidou FK, Foeldvari I, Cuttica R, Gonzalez B, Ravelli A, Khubchandani R, Oliveira S, Armbrust W, Garay S, Vojinovic J, Norambuena X, Gamir ML, García-Consuegra J, Lepore L, Susic G, Corona F, Dolezalova P, Pistorio A, Martini A, Ruperto N, Roth J, Paediatric Rheumatology International Trials Organization (PRINTO) (2010) Methotrexate withdrawal at 6 vs 12 months in juvenile idiopathic arthritis in remission: a randomized clinical trial. JAMA 303(13):1266–1273CrossRefGoogle Scholar
  24. 24.
    Ruperto N, Lovell DJ, Quartier P, Paz E, Rubio-Perez N, Silva CA et al (2010) Long-term safety and efficacy of abatacept in children with juvenile idiopathic arthritis. Arthritis Rheum 62(6):1792–1802CrossRefGoogle Scholar
  25. 25.
    De Benedetti F, Brunner HI, Ruperto N, Kenwright A, Wright S, Calvo I et al (2012) Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Engl J Med 367(25):2385–2395CrossRefGoogle Scholar
  26. 26.
    Ruperto N, Brunner HI, Quartier P, Constantin T, Wulffraat N, Horneff G, Brik R, McCann L, Kasapcopur O, Rutkowska-Sak L, Schneider R, Berkun Y, Calvo I, Erguven M, Goffin L, Hofer M, Kallinich T, Oliveira SK, Uziel Y, Viola S, Nistala K, Wouters C, Cimaz R, Ferrandiz MA, Flato B, Gamir ML, Kone-Paut I, Grom A, Magnusson B, Ozen S, Sztajnbok F, Lheritier K, Abrams K, Kim D, Martini A, Lovell DJ, PRINTO, PRCSG (2012) Two randomized trials of canakinumab in systemic juvenile idiopathic arthritis. N Engl J Med 367(25):2396–2406CrossRefGoogle Scholar
  27. 27.
    Brunner HI, Ruperto N, Zuber Z, Keane C, Harari O, Kenwright A, Lu P, Cuttica R, Keltsev V, Xavier RM, Calvo I, Nikishina I, Rubio-Pérez N, Alexeeva E, Chasnyk V, Horneff G, Opoka-Winiarska V, Quartier P, Silva CA, Silverman E, Spindler A, Baildam E, Gámir ML, Martin A, Rietschel C, Siri D, Smolewska E, Lovell D, Martini A, de Benedetti F, Paediatric Rheumatology International Trials Organisation PRINTO, Pediatric Rheumatology Collaborative Study Group (PRCSG) (2015) Efficacy and safety of tocilizumab in patients with polyarticular-course juvenile idiopathic arthritis: results from a phase 3, randomised, double-blind withdrawal trial. Ann Rheum Dis 74(6):1110–1117CrossRefGoogle Scholar
  28. 28.
    Brunner HI, Ruperto N, Tzaribachev N, Horneff G, Chasnyk VG, Panaviene V, Abud-Mendoza C, Reiff A, Alexeeva E, Rubio-Pérez N, Keltsev V, Kingsbury DJ, del Rocio Maldonado Velázquez M, Nikishina I, Silverman ED, Joos R, Smolewska E, Bandeira M, Minden K, van Royen-Kerkhof A, Emminger W, Foeldvari I, Lauwerys BR, Sztajnbok F, Gilmer KE, Xu Z, Leu JH, Kim L, Lamberth SL, Loza MJ, Lovell DJ, Martini A, Paediatric Rheumatology International Trials Organisation (PRINTO) and the Pediatric Rheumatology Collaborative Study Group (PRCSG) (2018) Subcutaneous golimumab for children with active polyarticular-course juvenile idiopathic arthritis: results of a multicentre, double-blind, randomised-withdrawal trial. Ann Rheum Dis 77(1):21–29CrossRefGoogle Scholar
  29. 29.
    El Zorkany B, Alwahshi HA, Hammoudeh M, Al Emadi S, Benitha R, Al Awadhi A et al (2013) Suboptimal management of rheumatoid arthritis in the Middle East and Africa: could the EULAR recommendations be the start of a solution? Clin Rheumatol 32(2):151–159CrossRefGoogle Scholar
  30. 30.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381CrossRefGoogle Scholar
  31. 31.
    Delbecq AL Van de Ven AH, Gustafson DH. (1975) Group Techniques for Program Planning: A guide to nominal group and Delphi processes,. 1 ed: Foresman and companyGoogle Scholar
  32. 32.
    World Health Organisation(WHO) (2018) Climate Change And Infectious Diseases: [Available from:
  33. 33.
    Held MFG, Hoppe S, Laubscher M, Mears S, Dix-Peek S, Zar HJ, Dunn RN (2017) Epidemiology of musculoskeletal tuberculosis in an area with high disease prevalence. Asian Spine J 11(3):405–411CrossRefGoogle Scholar
  34. 34.
    Sharma A, Pinto B, Dogra S, Sharma K, Goyal P, Sagar V, Dhir V, Sharma S, Singh S (2016) A case series and review of Poncet's disease, and the utility of current diagnostic criteria. Int J Rheum Dis 19(10):1010–1017CrossRefGoogle Scholar
  35. 35.
    Chinniah K, Mody GM, Bhimma R, Adhikari M (2005) Arthritis in association with human immunodeficiency virus infection in black African children: causal or coincidental? Rheumatology (Oxford) 44(7):915–920CrossRefGoogle Scholar
  36. 36.
    UNAIDS (2016) People Living with HIV [Available from:
  37. 37.
    Childhood Tuberculosis: World Health Organisation(WHO) 2017 [Available from:
  38. 38.
    Arevalo-Herrera M, Lopez-Perez M, Medina L, Moreno A, Gutierrez JB, Herrera S (2015) Clinical profile of plasmodium falciparum and plasmodium vivax infections in low and unstable malaria transmission settings of Colombia. Malar J 14:154CrossRefGoogle Scholar
  39. 39.
    Murray CJ, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA et al (2014) Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384(9947):1005–1070CrossRefGoogle Scholar
  40. 40.
    Samra JA, Hagood NL, Summer A, Medina MT, Holden KR (2017) Clinical features and neurologic complications of children hospitalized with chikungunya virus in Honduras. J Child Neurol 32(8):712–716CrossRefGoogle Scholar
  41. 41.
    Kumar A, Best C, Benskin G (2017) Epidemiology, clinical and laboratory features and course of chikungunya among a cohort of children during the first Caribbean epidemic. J Trop Pediatr 63(1):43–49CrossRefGoogle Scholar
  42. 42.
    Kajeguka DC, Kaaya RD, Mwakalinga S, Ndossi R, Ndaro A, Chilongola JO, Mosha FW, Schiøler KL, Kavishe RA, Alifrangis M (2016) Prevalence of dengue and chikungunya virus infections in North-Eastern Tanzania: a cross sectional study among participants presenting with malaria-like symptoms. BMC Infect Dis 16:183CrossRefGoogle Scholar
  43. 43.
    Vanderhave KL, Perkins CA, Scannell B, Brighton BK (2018) Orthopaedic manifestations of sickle cell disease. J Am Acad Orthop Surg 26(3):94–101CrossRefGoogle Scholar
  44. 44.
    Vaishya R, Agarwal AK, Edomwonyi EO, Vijay V (2015) Musculoskeletal manifestations of sickle cell disease: a review. Cureus 7(10):e358Google Scholar
  45. 45.
    Zuhlke LJ, Beaton A, Engel ME, Hugo-Hamman CT, Karthikeyan G, Katzenellenbogen JM et al (2017) Group a Streptococcus, acute rheumatic fever and rheumatic heart disease: epidemiology and clinical considerations. Curr Treat Options Cardiovasc Med 19(2):15CrossRefGoogle Scholar
  46. 46.
    Karwowski MP, Nelson JM, Staples JE, Fischer M, Fleming-Dutra KE, Villanueva J, Powers AM, Mead P, Honein MA, Moore CA, Rasmussen SA (2016) Zika virus disease: a CDC update for pediatric health care providers. Pediatrics 137(5):e20160621CrossRefGoogle Scholar
  47. 47.
    Rassi A Jr, Rassi A, Marcondes de Rezende J (2012) American trypanosomiasis (Chagas disease). Infect Dis Clin N Am 26(2):275–291CrossRefGoogle Scholar
  48. 48.
    Groot N, Heijstek MW, Wulffraat NM (2015) Vaccinations in paediatric rheumatology: an update on current developments. Curr Rheumatol Rep 17(7):46CrossRefGoogle Scholar
  49. 49.
    Heijstek MW, Ott de Bruin LM, Bijl M, Borrow R, van der Klis F, Kone-Paut I et al (2011) EULAR recommendations for vaccination in paediatric patients with rheumatic diseases. Ann Rheum Dis 70(10):1704–1712CrossRefGoogle Scholar
  50. 50.
    Kobayashi I, Mori M, Yamaguchi K, Ito S, Iwata N, Masunaga K, Shimojo N, Ariga T, Okada K, Takei S (2015) Pediatric rheumatology Association of Japan recommendation for vaccination in pediatric rheumatic diseases. Mod Rheumatol 25(3):335–343CrossRefGoogle Scholar
  51. 51.
    United Nations Childrens Fund(UNICEF)/World Health Organisation(WHO) (2016) 1 in 10 infants worldwide did not receive any vaccinations in 2016: [Available from:
  52. 52.
    Anelli CG, Amorim ALM, Osaku FM, Terreri MT, Len CA, Reiff A (2017) Challenges in transitioning adolescents and young adults with rheumatologic diseases to adult Care in a Developing Country - the Brazilian experience. Pediatr Rheumatol Online J 15(1):47CrossRefGoogle Scholar
  53. 53.
    Cooley WC, Sagerman PJ (2011) Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics 128(1):182–200CrossRefGoogle Scholar
  54. 54.
    Foster HE, Minden K, Clemente D, Leon L, McDonagh JE, Kamphuis S et al (2017) EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases. Ann Rheum Dis 76(4):639–646CrossRefGoogle Scholar
  55. 55.
    Robertson L (2006) When should young people with chronic rheumatic disease move from paediatric to adult-centred care? Best Pract Res Clin Rheumatol 20(2):387–397CrossRefGoogle Scholar
  56. 56.
    Foster HE, Eltringham MS, Kay LJ, Friswell M, Abinun M, Myers A (2007) Delay in access to appropriate care for children presenting with musculoskeletal symptoms and ultimately diagnosed with juvenile idiopathic arthritis. Arthritis Rheum 57(6):921–927CrossRefGoogle Scholar
  57. 57.
    Foster H, Rapley T, May C (2010) Juvenile idiopathic arthritis: improved outcome requires improved access to care. Rheumatology (Oxford) 49(3):401–403CrossRefGoogle Scholar
  58. 58.
    Tzaribachev N, Benseler SM, Tyrrell PN, Meyer A, Kuemmerle-Deschner JB (2009) Predictors of delayed referral to a pediatric rheumatology center. Arthritis Rheum 61(10):1367–1372CrossRefGoogle Scholar
  59. 59.
    Aoust L, Rossi-Semerano L, Kone-Paut I, Dusser P (2017) Time to diagnosis in juvenile idiopathic arthritis: a french perspective. Orphanet J Rare Dis 12(1):43CrossRefGoogle Scholar
  60. 60.
    Albers HM, Wessels JA, van der Straaten RJ, Brinkman DM, Suijlekom-Smit LW, Kamphuis SS, Girschick HJ, Wouters C, Schilham MW, le Cessie S, Huizinga TW, ten Cate R, Guchelaar HJ (2009) Time to treatment as an important factor for the response to methotrexate in juvenile idiopathic arthritis. Arthritis Rheum 61(1):46–51CrossRefGoogle Scholar
  61. 61.
    Anesi SD, Foster CS (2012) Importance of recognizing and preventing blindness from juvenile idiopathic arthritis-associated uveitis. Arthritis Care Res (Hoboken). 64(5):653–657CrossRefGoogle Scholar
  62. 62.
    Bou R, Adan A, Borras F, Bravo B, Calvo I, De Inocencio J et al (2015) Clinical management algorithm of uveitis associated with juvenile idiopathic arthritis: interdisciplinary panel consensus. Rheumatol Int 35(5):777–785CrossRefGoogle Scholar
  63. 63.
    Edelsten C, Lee V, Bentley CR, Kanski JJ, Graham EM (2002) An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood. Br J Ophthalmol 86(1):51–56CrossRefGoogle Scholar
  64. 64.
    Gregory AC, 2nd, Kempen JH, Daniel E, Kacmaz RO, Foster CS, Jabs DA, et al. Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the systemic immunosuppressive therapy for eye diseases study. Ophthalmology 2013;120(1):186–192Google Scholar
  65. 65.
    Heiligenhaus A, Niewerth M, Ganser G, Heinz C, Minden K (2007) Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology (Oxford) 46(6):1015–1019CrossRefGoogle Scholar
  66. 66.
    Saurenmann RK, Levin AV, Feldman BM, Laxer RM, Schneider R, Silverman ED (2010) Risk factors for development of uveitis differ between girls and boys with juvenile idiopathic arthritis. Arthritis Rheum 62(6):1824–1828CrossRefGoogle Scholar
  67. 67.
    Saurenmann RK, Levin AV, Feldman BM, Rose JB, Laxer RM, Schneider R, Silverman ED (2007) Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term followup study. Arthritis Rheum 56(2):647–657CrossRefGoogle Scholar
  68. 68.
    Jandial S, Stewart J, Foster HE (2015) What do they need to know: achieving consensus on paediatric musculoskeletal content for medical students. BMC Med Educ 15:171CrossRefGoogle Scholar
  69. 69.
    Wadey VM, Tang ET, Abelseth G, Dev P, Olshen RA, Walker D (2007) Canadian multidisciplinary core curriculum for musculoskeletal health. J Rheumatol 34(3):567–580Google Scholar
  70. 70.
    Woolf AD, Walsh NE, Akesson K (2004) Global core recommendations for a musculoskeletal undergraduate curriculum. Ann Rheum Dis 63(5):517–524CrossRefGoogle Scholar
  71. 71.
    Tong A, Jones J, Speerin R, Filocamo K, Chaitow J, Singh-Grewal D (2013) Consumer perspectives on pediatric rheumatology care and service delivery: a qualitative study. J Clin Rheumatol 19(5):234–240CrossRefGoogle Scholar
  72. 72.
    Stinson J, Ahola Kohut S, Forgeron P, Amaria K, Bell M, Kaufman M, Luca N, Luca S, Harris L, Victor C, Spiegel L (2016) The iPeer2Peer program: a pilot randomized controlled trial in adolescents with juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 14(1):48CrossRefGoogle Scholar
  73. 73.
    Chipeta J, Njobvu P, McGill PE, Bucala R (2014) Progress made towards enhancement of rheumatology education and practice in Zambia: review of an ILAR-supported project. Clin Rheumatol 33(10):1367–1372CrossRefGoogle Scholar
  74. 74.
    Colmegna I, Bartlett SJ, Oyoo OG (2011) The ILAR-East Africa initiative: current needs and progress in the globalization of rheumatology. Clin Rheumatol 30(2):251–253CrossRefGoogle Scholar
  75. 75.
    Ruperto N, Vesely R, Saint-Raymond A, Martini A (2013) Paediatric rheumatology international trials O. impact of the European paediatric legislation in paediatric rheumatology: past, present and future. Ann Rheum Dis 72(12):1893–1896CrossRefGoogle Scholar
  76. 76.
    Lau CS, Feng PH (2007) Rheumatology without borders. Nat Clin Pract Rheumatol 3(6):305CrossRefGoogle Scholar
  77. 77.
    2018 Recommended Immunizations For Infants and Children (Birth through 6 Years): Centers for Disease Control and Prevention; 2018 [Available from:
  78. 78.
    Summary of WHO Position Papers - Recommended Routine Immunizations for Children: World Health Organisation(WHO); 2018 [Available from:
  79. 79.
    Moore DL (2018) Immunization of the immunocompromised child: key principles. Paediatr Child Health 23(3):203–205CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Christiaan Scott
    • 1
    Email author
  • Mercedes Chan
    • 2
  • Waheba Slamang
    • 1
  • Lawrence Okong’o
    • 3
  • Ross Petty
    • 4
  • Ronald M. Laxer
    • 5
  • María-Martha Katsicas
    • 6
  • Francis Fredrick
    • 7
  • James Chipeta
    • 8
  • Gail Faller
    • 9
  • Gecilmara Pileggi
    • 10
  • Claudia Saad-Magalhaes
    • 11
  • Carine Wouters
    • 12
  • Helen E. Foster
    • 13
  • Raju Kubchandani
    • 14
  • Nicolino Ruperto
    • 15
  • Ricardo Russo
    • 16
  1. 1.Department of Pediatrics and Child Health, Room 515, ICH building, Red Cross War Memorial Children’s HospitalUniversity of Cape TownCape TownSouth Africa
  2. 2.Department of Pediatrics, BC Children’s HospitalUniversity of British ColumbiaVancouverCanada
  3. 3.University of NairobiNairobiKenya
  4. 4.Department of PediatricsUniversity of British ColumbiaVancouverCanada
  5. 5.The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  6. 6.Hospital de Pediatría GarrahanBuenos AiresArgentina
  7. 7.School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
  8. 8.Department of Paediatrics and Child HealthUniversity of Zambia School of MedicineLusakaZambia
  9. 9.Wits Donald Gordon Medical CentreUniversity of the WitwatersrandJohannesburgSouth Africa
  10. 10.Clinical Research Center of Ribeirão Preto Medical SchoolUniversity of Sao PauloSao PauloBrazil
  11. 11.Division of Pediatric RheumatologySao Paulo State UniversitySao PauloBrazil
  12. 12.Department of Microbiology and Immunology and Pediatric RheumatologyUniversity Hospitals LeuvenLeuvenBelgium
  13. 13.Great North Children’s HospitalNewcastle UniversityNewcastleUK
  14. 14.Department of PediatricsJaslok HospitalMumbaiIndia
  15. 15.Istituto Giannina Gaslini, Clinica Pediatrica e ReumatologiaPRINTOGenoaItaly
  16. 16.Hospital de Pediatría GarrahanBuenos AiresArgentina

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