Objective Vaccination against preventable infections is widely recommended for patients with systemic rheumatic disease. The coronavirus disease 2019 (COVID‐19) pandemic has highlighted variability in attitudes toward vaccination, particularly with the use of novel vaccine platforms. We studied attitudes toward vaccination against COVID‐19 and other preventable infections among patients with systemic rheumatic disease and compared these against the general population. Methods We surveyed patients treated at Brigham and Women’s Hospital for systemic rheumatic disease using a secure web‐based survey or paper survey in English or Spanish, from December 2020 to April 2021. We included survey questions used in the nationwide Harris Poll (October 2020 and February 2021), allowing the comparison of responses with those from the general population. Response frequencies were estimated and compared using descriptive statistics. Results Of 243 participants (25% response rate), the mean age was 56 years, 82% were women, and 33% were nonwhite. Rheumatoid arthritis (50%) and systemic lupus erythematosus (28%) were the most common diagnoses. Thirty percent had been hospitalized previously for any infection. Seventy‐six percent worried a lot or somewhat about contracting COVID‐19. Attitudes toward vaccination were very favorable, with 92% having received a flu shot in the past year and 84% desiring a COVID‐19 vaccine as soon as possible compared with 30% to 40% of Harris Poll respondents ( P < 0.001). Physician recommendation to receive a vaccine and desire to avoid infection were the most common reasons for desiring vaccinations. Conclusion Vaccine acceptability, including toward COVID‐19 vaccines, was high among this population of patients with systemic rheumatic disease seen at an academic medical center cohort. Physician recommendation is a key factor for vaccine uptake.

ObjectiveRecent large-scale randomised trials demonstrate that immunomodulators reduce cardiovascular (CV) events among the general population. However, it is uncertain whether these effects apply to rheumatoid arthritis (RA) and if certain treatment strategies in RA reduce CV risk to a greater extent.MethodsPatients with active RA despite use of methotrexate were randomly assigned to addition of a tumour necrosis factor (TNF) inhibitor (TNFi) or addition of sulfasalazine and hydroxychloroquine (triple therapy) for 24 weeks. Baseline and follow-up18F-fluorodeoxyglucose-positron emission tomography/CT scans were assessed for change in arterial inflammation, an index of CV risk, measured as an arterial target-to-background ratio (TBR) in the carotid arteries and aorta.Results115 patients completed the protocol. The two treatment groups were well balanced with a median age of 58 years, 71% women, 57% seropositive and a baseline disease activity score in 28 joints of 4.8 (IQR 4.0, 5.6). Baseline TBR was similar across the two groups. Significant TBR reductions were observed in both groups—ΔTNFi: −0.24 (SD=0.51), Δtriple therapy: −0.19 (SD=0.51)—without difference between groups (difference in Δs: −0.02, 95% CI −0.19 to 0.15, p=0.79). While disease activity was significantly reduced across both treatment groups, there was no association with change in TBR (β=0.04, 95% CI −0.03 to 0.10).ConclusionWe found that addition of either a TNFi or triple therapy resulted in clinically important improvements in vascular inflammation. However, the addition of a TNFi did not reduce arterial inflammation more than triple therapy.Trial registration numberNCT02374021.

IMPORTANCEWomen in midlife often develop chronic conditions and experience declines in physical health and function. Identifying factors associated with declines in physical health and function among these women may allow for targeted interventions. OBJECTIVE To examine the factors associated with clinically important 10-year declines in the physical component summary score (PCS) of the Short Form 36 (SF-36), a widely used patientreported outcome measure, in women in midlife. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study collected data from geographically dispersed sites in the US. Participants were part of the Study of Women's Health Across the Nation (SWAN), a racially and ethnically diverse cohort of women enrolled at or immediately before the menopause transition. Women have been followed for up to 21 years, between 1996 and 2016, with annual visits. Data were analyzed from October 2020 to March 2021. EXPOSURES Demographic indicators, health status measures, and laboratory and imaging assessments. MAIN OUTCOMES AND MEASURESThe main outcome was a clinically important decline (Ն8 points) on the PCS, based on the 10-year difference in scores between ages 55 and 65 years. RESULTSFrom the SWAN cohort of 3302 women, 1091 women (median [IQR] age, years; 264 [24.2%] Black women; 126 [11.6%] Chinese women; 135 [12.4%] Japanese women; 566 [51.9%] White women) were eligible for analyses based on duration of follow-up and availability of SF-36 data. At age 55, women had a median (IQR) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 27.0 (23.2-32.6), a median (IQR) baseline PCS of 53.1 (46.8-56.7), 108 women (9.9%) were current smokers, and 938 women (86.3%) had at least 1 comorbidity. Between ages 55 and 65 years, the median (IQR) change in PCS was −1.02 (−6.11 to 2.53) points with 206 women (18.9%) experiencing declines of 8 points or more. In multivariable models, factors associated with clinically important decline included higher baseline PCS (odds ratio [OR],

Objective. Many patients with rheumatoid arthritis (RA) have difficulty finding clinicians to treat them because of workforce shortages. We developed an app to address this problem by improving care efficiency. The app collects patient-reported outcomes (PROs) and can be used to inform visit timing, potentially reducing the volume of low-value visits. We describe the development process, intervention design, and planned study for testing the app.Methods. We employed user-centered design, interviewing patients and clinicians, to develop the app. To improve visit efficiency, symptom tracking logic alerts clinicians to PRO trends: worsening PROs generate alerts suggesting an earlier visit, and stable or improving PROs generate notifications that scheduled visits could be delayed. An interrupted time-series analysis with a nonrandomized control population will allow assessment of the impact of the app on visit frequency.Results. Patient interviews identified several of the following needs for effective app and intervention design: the importance of a simple user interface facilitating rapid answering of PROs, the availability of condensed summary information with links to more in-depth answers to common questions regarding RA, and the need for clinicians to discuss the PRO data during visits with patients. Clinician interviews identified the following user needs: PRO data must be easy to view and use during the clinical workflow, and there should be reduced interval visits when PROs are trending worse. Some clinicians believed visits could be delayed for patients with stable PROs, whereas others raised concerns.Conclusion. PRO apps may improve care efficiency in rheumatology. Formal evaluation of an integrated PRO RA app is forthcoming.