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Objectives: We aimed to estimate what proportion of people with SLE attending UK rheumatology clinics would be categorized as being at high risk from coronavirus disease 2019 (COVID-19) and therefore asked to shield, and explore what implications this has for rheumatology clinical practice., Methods: We used data from the British Society for Rheumatology multicentre audit of SLE, which included a large, representative cross-sectional sample of patients attending UK Rheumatology clinics with SLE. We calculated who would receive shielding advice using the British Society for Rheumatology's risk stratification guidance and accompanying scoring grid, and assessed whether ethnicity and history of nephritis were over-represented in the shielding group., Results: The audit included 1003 patients from 51 centres across all 4 nations of the UK. Overall 344 (34.3%) patients had a shielding score ≥3 and would have been advised to shield. People with previous or current LN were 2.6 (1.9-3.4) times more likely to be in the shielding group than people with no previous LN (P < 0.001). Ethnicity was not evenly distributed between the groups (chi-squared P < 0.001). Compared with White people, people of Black ethnicity were 1.9 (1.3-2.8) and Asian 1.9 (1.3-2.7) times more likely to be in the shielding group. Increased risk persisted after controlling for LN., Conclusion: Our study demonstrates the large number of people with SLE who are likely to be shielding. Implications for clinical practice include considering communication across language and cultural differences, and ways to conduct renal assessment including urinalysis, during telephone and video consultations for patients who are shielding., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To assess the baseline care provided to patients with SLE attending UK Rheumatology units, audited against standards derived from the recently published BSR guideline for the management of adults with SLE, the NICE technology appraisal for belimumab, and NHS England's clinical commissioning policy for rituximab., Methods: SLE cases attending outpatient clinics during any 4-week period between February and June 2018 were retrospectively audited to assess care at the preceding visit. The effect of clinical environment (general vs dedicated CTD/vasculitis clinic and specialized vs non-specialized centre) were tested. Bonferroni's correction was applied to the significance level., Results: Fifty-one units participated. We audited 1021 episodes of care in 1003 patients (median age 48 years, 74% diagnosed >5 years ago). Despite this disease duration, 286 (28.5%) patients had active disease. Overall in 497 (49%) clinic visits, it was recorded that the patient was receiving prednisolone, including in 28.5% of visits where disease was assessed as inactive. Low documented compliance (<60% clinic visits) was identified for audit standards relating to formal disease-activity assessment, reduction of drug-related toxicity and protection against comorbidities and damage. Compared with general clinics, dedicated clinics had higher compliance with standards for appropriate urine protein quantification (85.1% vs 78.1%, P ≤ 0.001). Specialized centres had higher compliance with BILAG Biologics Register recruitment (89.4% vs 44.4%, P ≤ 0.001) and blood pressure recording (95.3% vs 84.1%)., Conclusions: This audit highlights significant unmet need for better disease control and reduction in corticosteroid toxicity and is an opportunity to improve compliance with national guidelines. Higher performance with nephritis screening in dedicated clinics supports wider adoption of this service-delivery model., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Virodhamine is a recently identified novel endocannabinoid. Cannabinoids may evoke vasorelaxation through novel receptors in the vasculature and/or through release of vasodilator peptides from sensory nerve endings. Virodhamine induced endothelium-dependent relaxation in the rat isolated small mesenteric artery mounted in a myograph and precontracted with methoxamine. Desensitization of vanilloid receptors by capsaicin did not affect relaxation responses to virodhamine. The CB(1) receptor antagonist SR 141716A (3 microM), but not the more CB(1)-selective blocker AM 251 (1 microM), attenuated the response, while two CB(2) receptor antagonists, SR 144528 (1 microM) and AM 630 (10 microM), had no effect. The novel antagonist for the putative endothelial 'abnormal-cannabidiol receptor', O-1918 (30 microM), inhibited virodhamine relaxations. Hence virodhamine may activate this novel receptor, which might also recognize SR 141716A. Inhibition of nitric oxide synthase (L-NAME 300 microM) did not affect relaxation to virodhamine but the responses were markedly reduced when tone was induced with 60 mM KCl, suggesting a role for the activation of K(+) channels. The Ca(2+)-activated K(+) channel (K(Ca)) blockers, apamin (50 nM) and charybdotoxin (50 nM), inhibited virodhamine vasorelaxation. Combination of these blockers with SR 141716A (3 microM) caused no further inhibition. It was concluded that virodhamine relaxes the rat small mesenteric artery by endothelium-dependent activation of K(Ca), perhaps via the putative abnormal-cannabidiol receptor.

A patient with sarcoidosis who presented with a granulomatous tattoo reaction is described. Although tattoo granulomata usually represent a local hypersensitivity reaction to tattoo pigments, they can be a manifestation of systemic sarcoidosis. In this case the lesions were confined to the red areas of tattoos suggesting that tattoo sarcoid may be more than just an example of the Koebner response.

Eighteen patients who developed cutaneous reactions to red tattoos were studied to identify the chemicals responsible for the reactions to modern red tattoo pigments. Biopsies from the tattoos were examined histologically and the chemical composition of the red pigments was analysed by X-ray microanalysis. A variety of metallic elements including aluminium, iron, calcium, titanium, silicon, mercury and cadmium were detected. Patch tests were performed to the relevant chemicals in nine cases, and only one patient reacted to mercury. This study demonstrates that although reactions to mercury still occur, other red dyes containing a variety of inorganic pigments may provoke a cutaneous inflammatory response.

The in-situ blood perfused rat superior mesenteric arterial and right iliac arterial preparations were used to investigate the effects of pretreatment for 5 days with either phenobarbitone (80 mg kg-1 daily) or 6-methylprednisolone (17 mg kg-1 daily) on regional vascular resistances. The elevation of the regression of perfusion pressure on perfusion rate in the superior mesenteric arterial bed was significantly decreased by both phenobarbitone and 6-methylprednisolone over the range of flow rates used. Neither phenobarbitone nor 6-methylprednisolone had a significant effect on hepatic portal venous pressure nor was there any significant effect on the regression of perfusion pressure on flow rate in the in-situ iliac arterial bed. It is concluded that pretreatment with either phenobarbitone or 6-methylprednisolone lowers vascular resistance in the superior mesenteric arterial by approximately 9 and 8% respectively but does not affect vascular resistance in the iliac arterial bed.

The cardiovascular effects of intracerebroventricular (i.c.v.) bradykinin and melittin were investigated in the anaesthetized rat. Bradykinin, 30 micrograms, increased mean arterial pressure by 15 mmHg and this was the result of an increase in peripheral resistance; heart rate and cardiac output were unchanged. Tissue blood flow was lower in the skin and spleen in the animals given bradykinin than the controls. Significant increases in tissue vascular resistance occurred in the skin and several organs of the splanchnic region, the spleen, stomach, large intestine and the pancreas/mesentery. Melittin infusion gave a biphasic response in systemic blood pressure in which a depressor response was followed by a pressor phase; the pressor stage was accompanied by an increase in heart rate. Since melittin is a stimulant of membrane bound kallikrein, the results lend limited support to the hypothesis that there is a kallikrein-kinin system endogenous to the central nervous system which is involved in cardiovascular regulation.

The nature of the adrenoceptors and dopamine receptors mediating vascular responses in the in-situ blood perfused superior mesenteric arterial bed of the rat have been studied. alpha 1-Adrenoceptor agonists produced vasoconstriction but alpha 2-agonists had no significant effect on vascular resistance. The vasoconstrictor effects of noradrenaline were antagonized by low doses of prazosin (26 nmol kg-1 i.v.). Isoprenaline and salbutamol produced vasodilation when the vasculature was preconstricted with arginine vasopressin. The responses to isoprenaline were potently antagonized by propranolol (1.69 mumol kg-1 i.v.) and weakly but significantly reduced by practolol (3.75 mumol kg-1 i.v.) whereas the responses to salbutamol were unaffected by the same dose of practolol. After preconstriction of the vasculature and alpha-adrenoceptor blockade, dopamine and apomorphine produced dilator responses with both compounds producing the same maximal response and apomorphine being 1.8 times more potent than dopamine. The dopamine responses were present after the animals had been pithed and were resistant to spiperone (506 nmol kg-1 i.v.) but were antagonized by cis-alpha-flupenthixol (460 nmol kg-1 i.v.). These results suggest that this vascular bed possesses vasoconstrictor alpha 1- but not alpha 2-adrenoceptors, vasodilator beta 1- and beta 2-adrenoceptors and vasodilator dopamine receptors which appear similar to the D1-type found centrally.