Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study.

OBJECTIVE: To investigate limiting factors of American College of Rheumatology (ACR)/EULAR Boolean remission in rheumatoid arthritis (RA), and compare patients who fulfil the criteria to patients who only partly fulfil the criteria, with respect to imaging inflammation and biologic disease modifying anti-rheumatic drug (DMARD) usage. METHODS: Patients with DMARD-naïve RA were treated according to current recommendations in the the ARCTIC trial (Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen). Limiting factors of reaching ACR/EULAR Boolean remission at 2 years were assessed. Imaging inflammation (ultrasound and MRI) in patients in remission was compared with patients failing to fulfil different components of the criteria. The OR of biologic therapy was calculated using logistic regression. RESULTS: Of 203 patients, 112 (55%) reached ACR/EULAR Boolean remission; 49 (24%) fulfilled three of four criteria. The main limiting factors were patient global assessment (PGA) (59%) and tender joints (22%). Imaging inflammation was not significantly different for patients in remission and patients not fulfilling the criteria due to elevated PGA and/or tender joints, but higher odds of using biologics (OR 3.63, 95% CI 1.73 to 7.61) were observed. CONCLUSIONS: PGA and tender joints were the factors most often limiting achievement of ACR/EULAR Boolean remission. The level of imaging inflammation was not elevated in these patients compared with patients in remission, but the odds of using biologic DMARDs were higher.

The effect of training in mindfulness and affect consciousness on the therapeutic environment for patients with psychoses: an explorative intervention study.

RATIONALE: The ward atmosphere and the relationships between patients and staff contribute to the improvement in symptoms and psychiatric patient functioning and satisfaction. The quality of the therapeutic relationship is connected to the degree of self-reflection and self-awareness by the staff. OBJECTIVE: To examine the effect of two different training programmes for healthcare professionals on the ward atmosphere in wards for psychotic patients. DESIGN AND METHODS: Exploratory intervention study with two eight-week interventions of mindfulness training and affect-consciousness training. The outcome was measured on mindfulness and on relevant subscales of the Ward Atmosphere Scale. Data were collected by means of questionnaires and analysed using paired samples t-tests and repeated measures anova. RESULTS: Two groups professionals (n = 27 & n = 23) participated in the study. Improvements indicated that both interventions had a positive impact on the ward atmosphere. STUDY LIMITATIONS: The exploratory design and the small samples size make definitive conclusions difficult. Patient assessment on the ward atmosphere scale would have strengthened the validity of the results. CONCLUSION: The ward atmosphere in two different wards for psychotic patients improved after staff training in mindfulness or affect consciousness. There were differences in change profiles for the groups in accordance with the differences in the two interventions. PRACTICE IMPLICATIONS: We recommend awareness on the quality of the ward atmosphere in wards for psychotic patients. Both training in mindfulness and affect consciousness can support healthcare professionals in their awareness.