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Research priorities in pediatric rheumatology: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus

Sylvia Ota1, Randy Q Cron2, Laura E Schanberg3, Kathleen O'Neil4, Elizabeth D Mellins5, Robert C Fuhlbrigge6 and Brian M Feldman110789*

Author Affiliations

1 Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada

2 Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, USA

3 Department of Pediatrics, Duke University Medical Center, North Carolina, USA

4 Division of Pediatric Rheumatology, University of Oklahoma Health Sciences Center, Oklahoma City, USA

5 Department of Pediatrics, Stanford University, Stanford, USA

6 Division of Immunology, Children's Hospital-Boston, Boston, USA

7 Department of Pediatrics, University of Toronto, Toronto, Canada

8 Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

9 Department of Public Health Sciences, University of Toronto, Toronto, Canada

10 Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada

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Pediatric Rheumatology 2008, 6:5  doi:10.1186/1546-0096-6-5

Published: 1 April 2008



North American pediatric rheumatologists have created an investigator-initiated research network (the Childhood Arthritis and Rheumatology Research Alliance – CARRA) to facilitate multi-centre studies. One of the first projects undertaken by this network was to define, by consensus, research priorities for the group, and if possible a first group-sponsored clinical trial in which all members could participate.


We determined consensus using the Delphi approach. This approach has been used extensively in health research to reach consensus in large groups. It uses several successive iterations of surveys eliciting ideas and opinions from specialists in the field. Three surveys were designed based on this method and were distributed to members of CARRA to elicit and rank-order research priorities.


A response rate of 87.6% was achieved in the final survey. The most highly ranked research suggestion was to study infliximab treatment of uveitis unresponsive to methotrexate. Other highly ranked suggestions were to study i) the treatment of systemic arthritis with anakinra and ii) the treatment of pediatric systemic lupus erythematosus with mycophenolate mofetil.


The Delphi approach was an effective and practical method to define research priorities in this group. Ongoing discussion and cooperation among pediatric rheumatologists in CARRA and others world-wide will help in developing further research priorities and to facilitate the execution of clinical trials in the future.