Background:Comprehensive multisystem clinical assessment using the Birmingham Vasculitis Activity score (BVAS) is widely used in therapeutic studies of systemic vasculitis. Extensive use suggested a need to revise the instrument. The previous version of BVAS has been revised, according to usage and reviewed by an expert committee.Objective:To modify and validate version 3 of the BVAS in patients with systemic vasculitis.Methods:The new version of BVAS was tested in a prospective cross-sectional study of patients with vasculitis.Results:The number of items was reduced from 66 to 56. The subscores for new/worse disease and persistent disease were unified. In 313 patients with systemic vasculitis, BVAS(v.3) correlated with treatment decision (Spearman’s rs = 0.66, 95% CI 0.59 to 0.72), BVAS1 of version 2 (rs = 0.94, 95% CI 0.92 to 0.96), BVAS2 of version 2 in patients with persistent disease (rs = 0.60, 95% CI 0.21 to 0.83), C-reactive protein levels (rs = 0.43, 95% CI 0.31 to 0.54), physician’s global assessment (rs = 0.91, 95% CI 0.89 to 0.93) and vasculitis activity index (rs = 0.88, 95% CI 0.86 to 0.91). The intraclass correlation coefficients for reproducibility and repeatability were 0.96 (95% CI 0.95 to 0.97) and 0.96 (95% CI 0.92 to 0.97), respectively. In 39 patients assessed at diagnosis and again at 3 months, the BVAS(v.3) fell by 17 (95% CI 15 to 19) units (p<0.001, paired t test).Conclusion:BVAS(v.3) demonstrates convergence with BVAS(v.2), treatment decision, physician global assessment of disease activity, vasculitis activity index and C-reactive protein. It is repeatable, reproducible and sensitive to change. The new version of BVAS is validated for assessment of systemic vasculitis.

Objectives:Patients with rheumatoid arthritis (RA) have increased cardiovascular mortality. Tumour necrosis factor α (TNFα)-blocking therapy has been shown to reduce RA disease activity measures and joint damage progression. Some observational studies suggest that TNFα blockade reduces mortality and incidence of first cardiovascular events. The mechanisms contributing to these outcomes are unclear. This study assessed the effects of infliximab treatment on vascular stiffness and structure in patients with RA.Methods:A post hoc analysis of longitudinal data from a randomised placebo controlled study evaluated the effect of infliximab on vascular assessments. 26 patients received intravenous infliximab (3 mg/kg) at weeks 0, 2, 6 and every 8 weeks thereafter to week 54. Patients were followed up to 56 weeks of infliximab therapy with assessments of RA disease activity, cardiovascular risk factors, vascular stiffness (pulse wave velocity (PWV)), carotid intima media thickness (CIMT) and carotid artery plaque (CAP). Univariate analyses of changes over time by repeated measures analysis of variance (ANOVA) were followed by multivariate time-series regression analysis (TSRA) if changes were seen.Results:PWV was significantly lower (better) after 56 weeks of treatment with infliximab (ANOVA p<0.01, TSRA p<0.01). However, CIMT (ANOVA p = 0.50) and CAP (χ2 = 4.13, p = 0.88) did not change over the study period. Multiple cardiovascular risk measures did not change with treatment and did not correlate with changes in measures of vascular structure.Conclusions:Arterial stiffness improves with infliximab treatment in RA. This change may help explain the improved cardiovascular disease survival in patients with RA receiving TNFα-blocking therapy.

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Engagement in creative occupations has been shown to promote well-being for older adults with dementia. Providing access to such occupations is often difficult, as successful participation requires face-time with a person who is knowledgeable in facilitating engagement as well as access to any required resources, such as an arts studio. In response, a computer-based device, the Engaging Platform for Art Development (ePAD), was created to with the aim of enabling more independent access to art creation, ePAD is a an artificially intelligent touch-screen device that estimates a client's level of engagement and provides prompts to encourage engagement if the client becomes disengaged. ePAD is customizable such that an art therapist can choose themes and tools that they feel reflect their client's needs and preferences. This article presents a mixed-methods study that evaluated ePAD's usability by six older adult (with mild-to-moderate dementia) and art therapist dyads. Usability measures suggest that all participants found ePAD engaging but did not find prompts effective. Future development of ePAD includes improving the prompts, implementing the recommendations made by participants in this research, and long-term testing in more naturalistic art therapy contexts.

RÉSUMÉCette étude qualitative canadienne rapporte les résultats de 19 groupes de discussion comprenant 117 participants, incluant des bénéficiaires, des familles et des membres du personnel. Elle avait pour objectifs : 1) d’explorer les soins palliatifs offerts en soins de longue durée (SLD) en vue de faire face aux tensions associées à la prestation de soins aux personnes qui sont encore bien vivantes et celles en fin de vie dans une même communauté de soins et 2) d’identifier des améliorations qui pourraient être apportées aux pratiques en soins palliatifs afin de mieux répondre aux besoins de tous les bénéficiaires en vie ou mourants dans les établissements de SLD, ainsi que celles des familles et du personnel qui leur apportent du soutien. Notre étude a montré que les perspectives liées au confort en fin de vie du personnel en SLD, celles des bénéficiaires et de leurs familles étaient appliquaient à ceux qui se trouvaient en fin de vie ou aux familles qui les soutenaient. Cette compréhension du confort limitait l’intégration des principes de soins palliatifs lors des derniers jours de vie des bénéficiaires. Les résultats de notre étude ont aussi suggéré que le fait de recueillir les perceptions des bénéficiaires liées au confort en fin de vie, de partager l’information à propos de la mort d’un bénéficiaire d’une manière plus personnelle, et de s’assurer que les bénéficiaires, leurs familles et le personnel aient des occasions de participer dans les soins de confort pour les bénéficiaires mourants pouvaient accroître le confort en fin de vie et soutenir une plus grande intégration des principes de soins palliatifs en SLD.

Objective To investigate the effects of intraarticular glucocorticoid treatment on macrophage infiltration, the expression of the chemokines monocyte chemoattractant protein 1 (MCP‐1) and macrophage inflammatory protein 1α (MIP‐1α), and the expression of matrix metalloproteinases 1 and 3 (MMPs 1 and 3) and their inhibitors, the tissue inhibitors of metalloproteinases 1 and 2 (TIMPs 1 and 2), in osteoarthritis (OA) synovial membranes. Methods Forty patients underwent arthroscopic biopsy before and 1 month after intraarticular injection of glucocorticoids. Twenty‐one patients received 120 mg of methylprednisolone acetate (Depo‐Medrol; Upjohn, Kalamazoo, MI), and 20 patients received placebo (1 patient received placebo in 1 knee and methylprednisolone acetate in the other). Immunoperoxidase staining for the expression of CD68, MCP‐1, MIP‐1α, MMP‐1, MMP‐3, TIMP‐1, and TIMP‐2 was performed, and the immunostaining was quantified by color video image analysis. Results CD68, MCP‐1, MIP‐1α, MMP‐1, MMP‐3, TIMP‐1, and TIMP‐2 immunostaining was observed in all synovial membranes. Intraarticular glucocorticoid treatment was associated with a small (30%) but statistically significant (P = 0.048) reduction in CD68+ macrophage staining in the synovial lining layer, but there was no change in the CD68 expression in the synovial sublining layer. No significant differences were observed for MCP‐1, MIP‐1α, MMP‐1, MMP‐3, TIMP‐1, and TIMP‐2 immunostaining in the synovial lining or sublining layers. Conclusion Intraarticular glucocorticoids may reduce CD68+ macrophage infiltration into the synovial lining layer, but not the expression of MCP‐1, MIP‐1α, MMP‐1, MMP‐3, TIMP‐1, and TIMP‐2 in the synovial membrane, in patients with OA.

Autoimmune inflammatory rheumatic diseases (AIIRD), such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis are often complicated by infection, which results in significant morbidity and mortality. The increased risk of infection is probably due to a combination of immunosuppressive effects of the AIIRD, comorbidities and the use of immunosuppressive conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) and more recently, targeted synthetic DMARDs and biologic DMARDs that block specific pro-inflammatory enzymes, cytokines or cell types. The use of these various DMARDs has revolutionised the treatment of AIIRD. This has led to a marked improvement in quality of life for AIIRD patients, who often now travel for prolonged periods. Many infections are preventable with vaccination. However, as protective immune responses induced by vaccination may be impaired by immunosuppression, where possible, vaccination may need to be performed prior to initiation of immunosuppression. Vaccination status should also be reviewed when planning overseas travel. Limited data regarding vaccine efficacy in patients with AIIRD make prescriptive guidelines difficult. However, a vaccination history should be part of the initial work-up in all AIIRD patients. Those caring for AIIRD patients should regularly consider vaccination to prevent infection within the practicalities of routine clinical practice.

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