Juvenile dermatomyositis (JDM) is associated with high rates of preventable permanent damage, negatively impacting quality of life. Race, genetics, and environment may impact JDM outcomes, so studying diverse populations is critical. There are limited reports on few JDM patients in low and middle-income countries (LMIC) in Africa that found high rates of severe disease. In high-income countries with well-studied populations, outcomes and mortality have improved with early, aggressive treatment. African children with JDM have neither been compared to more-studied populations to identify differences in severity and outcomes nor included in international collaborative efforts to standardize and improve treatment. We aim to compare JDM severity in North American patients (CARRA Registry) vs African patients, focusing on damage measures, calcinosis, interstitial lung disease, and mortality.