Treating children with arthritis: towards an evidence-based culture.

We live in a culture of evidence-based medicine. Many areas of medicine have embraced this culture. However, for unusual diseases, like the childhood arthritides, there is little evidence. To provide this evidence a culture change must occur in pediatric rheumatology. The most convincing reason to make this change comes from the field of childhood oncology. Through successive clinical trials, collaborative oncology study groups have discovered cures for many childhood cancers. The most convincing studies are randomized trials; however, these are difficult to do. Collaborative trial groups and innovative designs are needed for an acceptable culture change in childhood arthritis. Recently a number of collaborations have been developed to help further the study of pediatric rheumatology. The best known are the Pediatric Rheumatology Collaborative Study Group in North America, and the Paediatric Rheumatology International Trials Organization in Europe, South America, and Asia. A new North American collaborative study group has formed--the Childhood Arthritis and Rheumatology Research Alliance (CARRA)--to undertake investigator-initiated clinical trials. These groups might potentially lead the way to a new evidence-based culture for childhood arthritis.