REMEDY annual report 2024

REMEDY 2024

CENTER FOR TREATMENT OF RHEUMATIC AND MUSCULOSKELETAL DISEASES

REMEDY – Center for Treatment of Rheumatic and Musculoskeletal Diseases is a “Center for Clinical Treatment Research”. It was established in 2022 with funding from the Research Council of Norway (128 million NOK) as a targeted, long-term investment to strengthen and further develop outstanding research and innovation environments to improve treatment. In addition, REMEDY is supported by a generous grant from the Olav Thon Foundation (32 million NOK).

Our aim is to evolve patient care in the field of rheumatology and musculoskeletal diseases, with significant impact on individuals and society. We seek to develop novel therapies and excellent treatment strategies by adopting a comprehensive research approach to the field. We strive to conduct clinical studies that have the potential to change clinical practice.

DESIGN: Anagram Design

PHOTOS: Nicolas Tourrenc/Diakonhjemmet Hospital, unless otherwise credited

PRINT: Konsis

01 Introduction

Rheumatic and musculoskeletal diseases affect one in four people and are associated with morbidity, reduced quality of life, increased mortality, and severe long-term pain and disability. The large individual and societal impact of these conditions underlines the need for comprehensive and coordinated actions to improve patient outcomes.

Directors’ Comments

We are proud to present the third annual report of REMEDY – Center for Treatment of Rheumatic and Musculoskeletal Diseases. The establishment of REMEDY would not have been possible without the generous support of the Research Council of Norway and the Olav Thon Foundation.

In 2024, we honored the memory of Olav Thon, a visionary entrepreneur, philanthro pist, and steadfast supporter of musculoskeletal research, who passed away at the remarkable age of 101. His legacy continues to inspire researchers to improve the lives of patients with rheumatic and musculoskeletal diseases.

Internatio nal collaboration remains central to our activities, through e.g. Scandinavian research programs, a novel EU Horizon Europe project, as well as the continuation of long­standing partnerships. A major achievement has been the launch of the RA­DRUM trial, a REMEDY­ led multi center initiative exemplifying cross­border European collaboration to advance treatments for our patients.

This year, REMEDY celebrated a record of 12 successful PhD dissertations, high­

lighting the talent, dedication, and innovation of our young researchers. The establishment of REMEDY has provided significant additions to the academic environment for early­career researchers, and the center has focused on the importance of mentoring the next generation of scientists.

Our visiting professors have continued to enhance REMEDY academically. We are particularly grateful to Professor Daniel H. Solomon, who completed his final year in 2024. His experience and excellence in clinical research, mentorship, and collaboration have left a lasting impact, and we thank him for his participation in numerous activities, for interesting discussions, and for being a great inspiration to all of us.

Infrastructure development has also been a highlight. The establishment of

“This year, REMEDY celebrated a record of 12 successful PhD dissertations, highlighting the talent, dedication, and innovation of our young researchers”

a state­of­the­art biobank facility marks a significant step forward, enabling cutting­edge research on biomarkers and personalized treatment strategies. Additionally, upgrades to the research laboratory at the host institution and expanded office and meeting spaces facilitate daily collaboration and innovation.

Both our host institution and partner organizations continue to play pivotal roles in advancing clinical research. REMEDY has further solidified its position as

Espen A. Haavardsholm

Professor, MD

PhD

Centre Director

a leading center for multi disciplinary research on rheumatic and musculoskeletal diseases, both nationally and internationally. This year’s accomplishments include a successful annual research seminar, several large research grants, numerous publications in highimpact journals, and active dissemination of findings through public and media outreach.

We are very grateful to everyone who has contributed to REMEDY’s successes in 2024 – researchers, clinical personnel,

Anne Therese Tveter

Professor, PT

PhD

Vice Director

administrative staff, patient partners, and funding bodies. The results, leading to improved patient care, would not have been possible without your efforts.

Looking ahead, REMEDY remains committed to pushing the boundaries of clinical research, strengthening international collaborations, and translating discoveries into better patient outcomes. We thank you for your continued support as we embark on our next year.

Sincerely,

Ida K. Bos­Haugen Senior Researcher, MD PhD Vice Director

Senior

Siri Lillegraven

Researcher, MD PhD MPH

Vice Director

Vision and Goals

Research Area

REMEDY is a Norwegian Center for Clinical Treatment Research focusing on rheumatic and musculoskeletal diseases. These diseases constitute a heterogeneous group of diseases associated with significant morbidity, reduced quality of life, and increased mortality. The conditions have major consequences for society and the individual.

Vision

Our vision is to be a world ­ leading center developing state ­ of­ the ­ art treatment and management strategies across rheumatic and musculoskeletal diseases, to benefit the individual and society.

Aims of the Center

The overarching aim of the REMEDY center is to improve treatment of rheumatic and musculoskeletal diseases by randomized clinical trials assessing novel treatment and treatment strategies, in combination with research and innovation to untangle the causes and characteristics of these diseases. The seven work packages approach the knowledge gaps within the field from different angles, ensuring that the research results will benefit patients in all stages of the diseases.

Impact of the REMEDY Center

Ground-breaking research that will change national and international treatment recommendations

For Patients

• Increased quality of life

• Work participation

• Improved physical function

• Personalized treatment strategies

• User involvement in research

• Patient empowerment

For Healthcare Systems

• Improved treatment

• Fast-track from research to implementation

• Decision support tools and digitalization

• Remote healthcare

• Education of highly qualified researchers and healthcare personnel

For Industry

• Implementation of digital platforms

• One-stop shop for pharmaceutical trials

• Innovative technologies

• Performing phase II-IV trials

• Collaboration

For Society

• Considerable gains for large patient groups

• Rapid implementation of results

• Sustainable healthcare

• Utilization of registry data

• Translational value for other chronic diseases

Organization

Diakonhjemmet Hospital is the host institution for REMEDY, in partnership with Oslo University Hospital, the Institute of Clinical Medicine at the University of Oslo, the MAGIC Evidence Ecosystem Foundation and the Norwegian Rheumatism Association. All partnering institutions engage in the organization, management and research activities conducted within the framework of the center, as well as dissemination and implementation both nationally and internationally.

Host Institution

Partners

Organization Structure

The center is organized to have a clear governance and advisory structure, with active involvement from the host institution, the partner institutions, international collaborators and users, to ensure oversight and optimal performance of the center.

Host Institution

Diakonhjemmet Hospital

Center Leadership

Scientific Advisory Board

Patient Advisory Board

Mobility and International Network

Center Board

Center Executive Committee

Center Management Committee

Partners

• Oslo University Hospital

• MAGIC

• The Norwegian Rheumatism Association

• Institute of Clinical Medicine (University of Oslo)

Young Researcher Program

Work Packages

WP1 Optimized Medical Interventions

WP2 Phenotyping for Personalized Medicine

WP3 Pain Mechanisms and Management

WP4 Managing Comorbidities

WP5 Innovative Approaches to Remote Care

WP6 Deciphering Long­term Outcomes

WP7 Empowering the Individual

Implementation

Clinical Trial Unit

National Clinical Consortium

Center Board

The Center Board consists of one member from each of the partnering institutions and is led by the Chief Executive Officer (CEO) at Diakonhjemmet Hospital. The board will assist the center directors in overseeing the operations of the center in an advisory capacity. The board is responsible for the approval of the annual work plan, financial year­end statements, and the annual report. The board held two meetings in 2024.

Center Leadership

The REMEDY center is led by Professor Espen A. Haavardsholm together with the vice directors, senior researcher Siri Lillegraven (on maternity leave from September 2024), Professor Anne Therese Tveter, senior researcher Ida K. Bos­Haugen (replacing Siri Lillegraven during her maternity leave) and administrative manager Eline Lundgaard. The center leadership is responsible for overseeing and coordinating activities in the center and the center committees, as well as reporting to the Research Council of Norway. The leadership group had weekly meetings throughout 2024.

Center Executive Committee

The Center Executive Committee (CEC) consists of the center directors, the work package leaders, the leader of the Patient Advisory Board, the leaders of the Young Researcher Program and key senior scientific staff members from the partnering institutions. The CEC is responsible for the development and maintenance of the long­term strategic plan for the center. The CEC held five meetings in 2024.

Center Management Committee

The Center Management Committee (CMC) consists of the center directors, the leaders and co­leaders of the individual work packages, the leaders of the National Clinical Consortium and the leader of the Clinical Trial Unit. The CMC is responsible for the ongoing day­to­day implementation of the long­term center strategy. The CMC had seven meetings in 2024.

Jan Frich Chair of the Board, CEO of Diakonhjemmet Hospital

Shuo-Wang Qiao Board Member, Deputy Head, Institute of Clinical Medicine, The University of Oslo

Center Board Center Leadership

Espen A. Haavardsholm

Center Director, Professor, MD, PhD

Siri Lillegraven Vice Director, Senior Researcher, MD, MPH, PhD

Kjetil Bergsmark Board Member, Head of Division of Rheumatology and Research, Diakonhjemmet Hospital

Bo Gleditsch Board Member, General Secretary, The Norwegian Rheumatism Association

John-Anker Zwart Board Member, Head of Research, Division of Clinical Neurology, Oslo University Hospital

Per Olav Vandvik Board Member, CEO, MAGIC Evidence Ecosystem Foundation

Anne Therese Tveter Vice Director, Professor, Physical Therapist, PhD

Ida K. Bos-Haugen Vice Director, Senior Researcher, MD, PhD

Eline Lundgaard Administrative Manager

User Involvement in Research

2024 has been marked by the continued development and strengthening of patient involvement in research within the center. Building on established collaborations and new initiatives, we have observed increasing awareness and interest in the value of collaborative partnerships among researchers, PhD candidates and institutions. The structured collaboration with user representatives in the different research projects aims to ensure that the results are relevant and valuable to end-users.

Main Activities

Courses and Training

In 2024, we took part in the implementation of a credit­awarding course on Patient and Public Involvement (PPI) in Medical and Health Research in collabo ration with the University of Bergen. Neuro­SysMed, CCBIO, NorHead, MATRIX, NorCrin, FORMI, and the Nor wegian Health Association are also partners in this collaboration, and the course is funded by the DAM Foundation, as well as collaborating institutions.

The course brought 88 researchers, PhD candidates, and user representatives together in April, fostering a deeper understanding of the complexities and opportunities of collaboration in research. Participants in the course reported improved understanding and skills related to PPI and increased knowledge and

experience among researchers and user representatives to realize the potential of such collaboration.

Advisory and Mentoring Services

The advisor in user involvement in research has provided guidance for researchers, PhD candidates, and patient research partners on collaboration in research projects. This included developing collaboration agreements and clarifying roles and expectations.

Collaboration and Network Building

Further development of the collaboration within the REMEDY Patient Advisory Board was a priority in 2024, ensuring relevance and quality in research projects. Five advisory board meetings were held, focusing on sharing experiences from project collaborations, role clarifica­

tion, and awareness of roles, processes, and expectations for partnerships.

The advisor in user involvement in research has continued the effort to enhance PPI competence among everyone involved in the REMEDY center.

All members were invited to the 2024 REMEDY annual retreat, among others including a plenary session with Maarten de Wit from European Alliance of Associations for Rheumatology (EULAR) and a workshop on PPI in research projects.

With the establishment and coordination of a nationwide advisory network for advisors in PPI in research, our aim is to provide support, experience­sharing and facilitate greater exchange of experiences between different professional environments.

Dialogue Seminar

The Dialogue Seminar is a collaborative initiative between the Norwegian Rheumatism Association and REMEDY, providing a platform for patients, researchers and clinicians to exchange knowledge and experiences. The theme of the 2024 autumns seminar, A Rheumatic Disease Rarely Comes Alone, focused on comorbidities in rheumatic conditions.

The event began with a plenary session offering an overview of common comorbidities and challenges related to medication, followed by parallel sessions addressing cardiovascular disease, pain, and fatigue. Approximately 200 participants attended, actively engaging in discussions with speakers and expert patient partners.

Facts and Figures

64.7 million NOK 68.3 million NOK

Own financing

Other financing

RCN grant (Research Council of Norway)

South-Eastern Norway Regional Health Authority

Other national funding

Other international funding

REMEDY Funding 2024 Obtained Grants 2024

This figure shows the total costs for 2024 and how these costs are funded. Total costs for 2024 are 64.7 MNOK. Own financing includes funds provided by the host institution and partners. Other financing includes financing secured before 2022 from public funding schemes, mainly from the regional health authorities, interregional authorities, the DAM Foundation and other publicly available grants.

REMEDY researchers have obtained a number of grants during 2024 for projects in the coming years. The total amount obtained is 68.3 MNOK. This is mainly financing from the South­Eastern Norway Regional Health Authority, as well as other national grants such as the DAM Foundation and international funding, including Horizon Europe funding for the MDR­RA project.

Climate and Sustainability

Climate change threatens to undo decades of progress in global health and widen existing health inequalities. The healthcare sector is a major contributor to global greenhouse gas emissions, accounting for approximately 5% – more than aviation and shipping combined. Scientific research also has a significant carbon footprint. REMEDY is committed to facilitating a transition toward sustainable research and clinical practice.

REMEDY actively takes steps to mitigate climate change by reducing the carbon footprint of our research activities and conducting studies aimed at shifting clinical practice toward low ­ carbon solutions. For example, our remote care projects seek to minimize emissions associated with hospital visits.

Green Congress

In June 2024, REMEDY co­organized the Green Congress (Grønn Kongress), an annual national conference for the Norwegian rheumatology community.

The conference summarizes and disseminates international research while reducing carbon emissions linked to travel for international congresses.

Each year, we invite a climate scientist to provide a state­of­the­art lecture. In 2024, the speaker was biologist and researcher Bob van Oort from CICERO. His talk concerned foot, climate, and sustainability.

We actively work to minimize the carbon footprint of the congress itself, implementing sustainable measures where possible. In 2022, 2023 and 2024 the event was certified as an environmentally approved event by the Foundation for Environmental Education.

The hybrid format has been highly successful, with more than 400 attendees in 2024 providing excellent feedback.

Bob van Oort

International Initiative to Fight Climate Change

Over the past year, researchers at REMEDY, in collaboration with The Clinical Effectiveness Group at the University of Oslo and Oslo University Hospital, have initiated a project to incorporate environmental endpoints into clinical trials. This includes conducting life cycle assessments to quantify and compare the carbon footprint of the trial interventions. These efforts aim to guide clinicians, regulators, and policymakers in selecting the best clinical practices with the lowest possible environmental harm. We outlined this concept in a commentary published in New England Journal of Medicine in May 2024.

Espen A. Haavardsholm, Lena Nordberg, Siri Lillegraven and Michael Bretthauer.

Lectures on Climate Change

In 2024, REMEDY researchers also delivered invited lectures on climate change and sustainable healthcare at Ullevål, Rikshospitalet, Diakonhjemmet and Akershus Hospital, and in a health leadership course organized by the University of Oslo.

Lena Bugge Nordberg

02 Center Highlights

Timeline 2024

Highlights 2024

The REMEDY center has had a remarkable third year. In this section, we highlight key achievements from 2024, including awards, national and inter national collaborations, secured funding, and vari ous center and network activities.

We also introduce the 12 PhD candidates who defended their dissertations this year, showcase major clinical and innovative studies conducted at the center, present our scientific advisory board, and share updates from initiatives such as the RECONNECT network and our annual retreat.

JANUARY EULAR Recommendations

for the Non-Pharmacological Core Management of Hip and Knee Osteoarthritis

The updated EULAR recommendations are based on new research and were led by Professor Nina Østerås and Associate Professor Tuva Moseng.

JANUARY

ExeHeart – Best Abstract in Trondheim

Kristine Røren Nordén received the prize for best abstract on behalf of co­authors in one of the sub­studies of Exeheart at the Forum for Clinical Physiology congress in Trondheim.

MARCH BRIDGE –Closing Meeting

The BRIDGE study provided unique insights into healthcare personnel’s perspectives on the delivery of interdisciplinary rehabilitation services, as well as patients’ perspectives on challenges related to health­promoting change processes.

MARCH

REMEDY Annual Research Retreat

The retreat was held at Sanner Hotel, bringing together more than 100 researchers, clinicians, and patient research partners.

FEBRUARY Dissertation

PhD candidate Marthe Gløersen defended her thesis Pain and Pain Sensitization in People with Hand Osteoarthritis

FEBRUARY Dissertation

PhD candidate Maria Dehli Vigeland defended her thesis, Gene Expression Analyses in Subphenotypes of Chronic Low Back Pain.

APRIL

Young Researcher Seminar

The seminar was held at Leangkollen Hotel, bringing together around 60 participants. Guest Professor Désirée van der Heijde and Professor Robert Landewé delivered several insightful presentations.

APRIL

Patient and Public Involvement

Credit­awarded course on Patient and Public Involvement in Medical and Health Research was organized in collaboration with the University of Bergen. A total of 88 researchers, PhD candidates, and user representatives participated.

MAY

Collective Choice in the Treatment of Arthritis

APRIL

APRIL

The HIFSAT Study

The randomized controlled multicenter study HIFSAT started inclusion. The study is led from REMEDY and compares two surgical methods for the implantation of a hemiarthroplasty in hip fracture patients.

OARSI Congress

Professor Nina Østerås gave an abstract presentation about the SAMBA study’s eight­year linkage to the prosthesis register.

With modern treatment, around two out of three people with rheumatoid arthritis avoid impaired functional capacity. A research article from the ARCTIC REWIND trial published in The Lancet Rheumatology provides new insights into different treatment strategies.

MAY Dissertation

PhD candidate Nina Martine Krafft Sande at Institute of Clinical Medicine defended her thesis, Evaluation of Ultrasound in Juvenile Idiopathic Arthritis

APRIL Dissertation

PhD candidate Marthe Kirkesæther Brun defended her thesis, Infliximab Therapy in Immune ­ Mediated Inflammatory Diseases: Immunogenicity and Proactive Therapeutic Drug Monitoring.

MAY

Dissertation

PhD candidate Ingrid Jyssum defended her thesis, Immunogenicity of Therapeutics in Inflammatory Joint and Bowel Diseases

MAY

Norwegian Initiative to Fight Climate Change

REMEDY researchers published a commentary proposing to calculate the climate footprint of medical interventions as a secondary outcome in clinical trials. The goal is to provide healthcare services that benefit both the patient and the planet. These ambitions were published in the world’s highest­ranked medical journal, The New England Journal of Medicine.

MAY

Classification Criteria for Hand Osteoarthritis

New classification criteria for hand osteoarthritis were developed with the support of EULAR, with Ida K. Bos­Haugen, Merete Hermann­Eriksen, and Rikke H. Moe playing central roles. The new criteria combine self­reported data with radiological findings, and represent a significant advancement for all research within hand osteoarthritis.

MAY

Award at EFORT Congress

Alexander Nilsskog Fraser received a prestigious award at the European EFORT congress. The five­year results from the DelPhi study will be able to influence future guidelines.

JUNE Dissertation

PhD candidate Henriette Didriksen defended her thesis, Biomarkers Associated with Severe Systemic Sclerosis Organ Complications.

JUNE

Green Congress

The fourth Green Congress for Rheumatology summarized key insights from EULAR 2024, attracting 150 in­person attendees at Deichman Library, Oslo, along with virtual participants – bringing the total to over 400.

JUNE

New EULAR Vice President

Rikke H. Moe from REMEDY was appointed as the new Vice­President HPR of EULAR.

SEPTEMBER Dialogue Seminar

Diakonhjemmet Hospital, REMEDY, and the Norwegian Rheumatism Association invited researchers, clinicians, and patients to the annual Dialogue Seminar. The main theme for 2024 was comorbidity.

JULY

EU Funding

The MDR­RA consortium, comprising 23 partners, including Diakonhjemmet Hospital, received EU funding through Horizon Europe to study multi­drug resistance and difficult­to­treat rheumatoid arthritis.

AUGUST

Arendalsuka: Debate Hosted by RECONNECT

Digital patient treatment – The key to the Future of Healthcare? The interesting conversation highlighted both major challenges and great opportunities.

AUGUST

New Textbook in Rheumatology

The textbook Revmatologi was launched, with Professor Espen A. Haavardsholm and Professor Øyvind Molberg as two of the editors. Several REMEDY researchers contributed as authors.

SEPTEMBER Dissertation

PhD candidate Ingrid Egeland Christensen defended her thesis, Serious Infections in Patients with Inflammatory Joint Diseases

OCTOBER

Meeting with the Minister of Health

Jan Christian Vestre visited Diakonhjemmet Hospital, where he was briefed on the oppor tunities and challenges of developing patient apps.

OCTOBER

BMJ Rapid Recommendations with MAGIC Based on the NOR-DRUM Study

Clinical practice guidelines on proactive therapeutic drug monitoring of biologic drugs in adults with inflammatory bowel disease, inflammatory arthritis, or psoriasis were published.

OCTOBER MUSS Conference

REMEDY partnered with the Norwegian Musculoskeletal Research Network (MUSS) to co­fund the annual research conference. Several REMEDY researchers presented their work.

OCTOBER

Dissertation

Foundation

OCTOBER Funding from the DAM

Ida K. Bos­Haugen and Anne Grete P. Semb received funding from the DAM Foundation.

OCTOBER MOVE-JIA Trial

Initiation and inclusion of the first patient in the multicenter trial

NOVEMBER RECONNECT Network

Seminar

The seminar attracted 70 participants, focusing on How to Avoid the Pilot Graveyard when developing apps to improve patient care and enhance health literacy.

PhD candidate Kristine Røren Nordén defended her thesis, Cardiorespiratory Fitness in Patients with Inflammatory Joint Disease: Associations, Validity of Assessment, and Effects of an Exercise Intervention.

NOVEMBER New Biobank Facilities

Equipped with high capacity and an advanced tracking system, our state­of­the­art biobank is now ready for use, enabling advanced studies on biological materials.

NOVEMBER ACR Conference

REMEDY’s two Guest Professors, Daniel H. Solomon and Désirée van der Heijde, received prestigious awards of distinction.

DECEMBER

DECEMBER Dissertation

PhD candidate Elisabeth Mulrooney defended her thesis, Hand Osteoarthritis Pain in a Biopsychosocial Framework

Funding by the South Eastern Norway Health Authority

Eight REMEDY research projects received 42 million NOK, including major initiatives like the pivotal Nor­CAR study, which will establish Norway’s first CD19 CAR T­cell manufacturing facility.

DECEMBER

New Modular Building for Research

Researchers at Diakonhjemmet Hospital gained access to 400 m² of modern office facilities and meeting rooms.

DECEMBER “All

About Clinical Trials” Course at Diakonhjemmet Hospital

In collaboration with the European Society of Cardiology, REMEDY organized the AACT course, providing insights into methodological issues related to study design and trial execution.

NOVEMBER

Dissertation

PhD candidate Sigrid Reppe Moe defended her thesis, Outcome and Identification of Early Risk Factors in a PopulationBased Systemic Lupus Erythematosus Cohort in Norway

DECEMBER Dissertation

PhD candidate Joachim Sagen defended his thesis, Patient Engagement in the Development and Delivery of Healthcare Services

Elizabeth Mulrooney

PhD degree: Institute of Health and Society, University of Oslo

REMEDY affiliation: WP3 – Pain mechanisms and treatment

1st opponent: Lisa Carlesso, McMaster University, Canada

2nd opponent: Martin van der Esch, Amsterdam University of Applied Sciences, the Netherlands PhD dissertations

PhD dissertation

Employed: Division of Rheumatology and Research, Diakonhjemmet Hospital

Main supervisor: Ida K. Bos­Haugen

Co­supervisors: Tore K. Kvien, Karin Magnusson, Hilde B. Hammer, Hanne Dagfinrud

Exploring Pain in Hand Osteoarthritis: A Biopsychosocial Perspective

Elisabeth Mulrooney, a physical therapist and PhD candidate at Diakonhjemmet Hospital, has advanced the understanding of pain in people with hand osteoarthritis through her research. Her PhD thesis, Pain in Hand Osteoarthritis in a Biopsychosocial Framework shed light on the relationship between biological, psychological and social factors and the pain experience in people with hand osteoarthritis.

A Complex Condition with Limited Treatment Options

Hand osteoarthritis is a common condition characterized by joint pain, stiffness, and disability. The treatment options remain limited, and there is an unmet need for more research to understand how pain can be most effectively managed.

“Pain is the most dominant symptom of osteoarthritis and affects quality of life,” Mulrooney explains. “Yet, we poorly understand how biopsychosocial factors affect pain”.

The Role of Biopsychosocial Factors

Mulrooney’s research highlights the interplay between mind, body, and environment with regards to people´s pain experiences. Her findings revealed that individuals with hand osteoarthritis who exhibited higher levels of anxiety, depressive symptoms, and catastrophic thinking

reported greater pain compared to those with lower levels of these psychological factors. Those with a greater burden of comorbidities in addition to hand osteoarthritis also experienced more pain.

Notably, Mulrooney identified five distinct patient subgroups based on their biological, psychological, and social characteristics. “Individuals with hand osteoarthritis experiencing higher levels of anxiety, depression, pain sensitivity, comorbidities, poor coping skills, and disrupted sleep, reported greater pain compared to those primarily burdened by joint damage,” she notes.

Personalized Pain Management

While the study could not determine whether these factors are the cause or the result of pain, the findings emphasize the need for a broader approach to treatment.

“We need to move beyond a one­sizefits­all approach. Identifying modifiable

risk factors and addressing them can help to reduce pain,” Mulrooney explains.

This individualized perspective is relevant for the management of pain in people with hand osteoarthritis, paving the way for more effective, tailored treatments.

Insights from the Nor­Hand Study Mulrooney’s research is part of the Nor­Hand study, an extensive observational cohort study following people with hand osteoarthritis since 2016 at Diakonhjemmet Hospital. The study has gathered a comprehensive amount of data with a particular focus on pain.

“This research underscores how multifaceted the hand osteoarthritis condition is,” Mulrooney concludes.

Her work enhances the understanding of pain in hand OA and provides critical insights for future studies and clinical care.

Henriette Didriksen

PhD dissertation

PhD degree: Institute of Clinical Medicine, University of Oslo

Employed: Department of Rheumatology, Oslo University Hospital, Rikshospitalet

REMEDY affiliation: WP4 –Managing comorbidities

Main supervisor: Øyvind Molberg

Co­supervisors: Anna­Maria Hoffmann­Vold, Guttorm Haraldsen

1st opponent: Kristofer Andréasson, Lund

University, Sweden

2nd opponent: Gro Østli Eilertsen, UiT – The Arctic University of Norway, Norway

Gut Bacteria and Biomarkers: A New Frontier in Treating Systemic Sclerosis

Henriette Didriksen has shed new light on severe organ complications in people with systemic sclerosis through her doctoral research. Her thesis, Biomarkers Associated with Severe Systemic Sclerosis Organ Complications may lead to earlier diagnosis and improved treatment for patients with this complex disease.

A Disease with Potentially Severe Complications

Systemic sclerosis is an autoimmune disease where the immune system attacks its own tissue, causing stiffness and scarring of the skin and internal organs. It can also cause serious complications such as pulmonary arterial hypertension, a condition caused by damage to the blood vessels in the lungs, which can lead to heart failure if left untreated. Additionally, many patients struggle with gastrointestinal issues often difficult to manage.

Biomarkers Could Save Lives

Early detection is crucial for effective treatment, but reliable tools for diagnosing the disease at an early stage are lacking.

“There is a significant need to identify biomarkers that can signal the risk of severe complications,” Didriksen says. Biomarkers are molecules from the body that can indicate the presence of a disease. She has focused her research on how specific biomarkers are linked to the

development of pulmonary arterial hypertension and gastrointestinal problems.

Biomarkers That Reveal Risk

Didriksen and her team analyzed blood samples from patients with systemic sclerosis in Oslo, Zurich, and Los Angeles. They discovered that two molecules (VEGF­C and CCL21) involved in processes associated with the development of pulmonary arterial hypertension were dysregulated in patients with systemic sclerosis, compared to healthy individuals.

“With these new biomarkers, it might be possible to detect the risk of pulmonary arterial hypertension through a blood test before serious symptoms appear,” Didriksen says.

How Gut Bacteria Can Help Patients with Systemic Sclerosis

The researchers also examined tissue samples from the intestines of patients who had undergone fecal microbiota transplantation.

Gut bacteria play a crucial role in regulating the immune system and inflammation, which are key factors in systemic sclerosis. Fecal microbiota transplantation introduces healthy gut bacteria that may help rebalance these processes.

The study showed that fecal microbiota transplantation could improve gastrointestinal symptoms. “After treatment, we observed changes in how genes in the intestinal cells influenced inflammation. These results suggest that fecal microbiota transplantation might not only improve symptoms but also address the underlying biological processes contributing to inflammation,” Didriksen explains.

Hope for More Effective Treatment

Didriksen’s research provides new hope for patients with systemic sclerosis. “If we know which biomarkers to look for in blood tests, we can diagnose the disease earlier, allowing more effective treatment to prevent severe complications,” she explains.

Henriette Schermacher Marstein

PhD dissertation

PhD degree: Institute of Clinical Medicine, University of Oslo

Employed: Institute for Experimental Medical Research, Oslo University Hospital, Ullevaal

REMEDY affiliation: WP4 –Managing comorbidities

Main supervisor: Helga Sanner

Co­supervisor: Ivar Sjaastad

1st opponent: Annet van RoyenKerkhof, University Medical Center

Utrecht, The Netherlands

2nd opponent: Jan Kristian Damås, – Norwegian University of Science and Technology, Norway

Uncovering the Long-Term Impact of Juvenile Dermatomyositis to Improve Outcomes

Henriette Schermacher Marstein has advanced our understanding of juvenile dermatomyositis through her PhD thesis, Associations between Inflammatory Markers and Organ Involvement in Long-Term Juvenile Dermatomyositis

Juvenile dermatomyositis is a rare autoimmune condition with childhood onset, characterized by a distinctive skin rash and weakened muscles. To gain deeper insight into the relationships between inflammatory modulators and long­term outcomes related to body composition, heart, and lung health, Marstein conducted a study comparing 59 patients with juvenile dermatomyositis to healthy matched controls. She also examined differences between patients with active and inactive disease.

Inflammatory Modulators

Marstein explored the role of specific inflammatory modulators, such as cytokines, and their links to organ outcomes. Cytokines are small proteins that act as messengers between cells, regulating the body’s response to disease or injury.

She identified higher levels of certain cytokines that are known to be produced in fat, in patients compared to controls. In addition, she discovered differences

in cytokine levels between patients with active and inactive disease.

Abdominal fat increases Risk of Cardiovascular Disease

Marstein also investigated how fat is distributed and associated with health risks, such as cardiovascular disease and metabolic syndrome.

“Our findings showed that patients had significantly more abdominal fat than controls and that imbalances in cytokines derived from fatty tissue negatively affected heart function. These issues were most evident in patients with active disease. Subclinical reduced heart function was three times more common in the patients, especially in those with more abdominal fat”, she says.

Lung Function and Associations with Cytokines

When examining lung outcomes and associations with cytokines, reduced oxygen uptake among patients with active disease

was discovered. Additionally, she found differences in cytokine levels between patients with active and inactive disease, which had not been explored previously.

“Our findings revealed that specific cytokines play a significant role in the observed measures of both lung and heart function in patients versus controls and in active versus inactive disease.” Marstein explains. “Interestingly, a distinct set of cytokines was linked to lung outcomes in patients with inactive disease. This underscores the importance for clinicians to recognize that even patients in remission may still harbor underlying, ongoing inflammation that affects the lungs”, she adds.

“Treating this disease is a comprehensive process and should be tailored to each individual child. Our findings improve the understanding of the molecular influence on vital organs after long­term disease and pave the way for the development of more individual and targeted treatment”, Marstein concludes.

Ingrid Egeland Christensen PhD dissertation

PhD degree: Institute of Clinical Medicine, University of Oslo Employed: Division of Rheumatology and Research, Diakonhjemmet Hospital

REMEDY affiliation: WP6 –Dechiphering long­term outcomes

Main supervisor: Sella Provan Co­supervisors: Siri Lillegraven, Tore K. Kvien, Till Uhlig

1st opponent: Kevin Winthrop, Oregon Health and Science University, United States

2nd opponent: Mari Hoff, Norwegian University of Science and Technology, Norway

Increased Risk of Serious Infections in Inflammatory Joint Diseases

Patients with inflammatory joint diseases undergoing treatment with biological drugs face a significantly higher risk of serious infections than the general population.

Dr. Ingrid Egeland Christensen’s PhD thesis, Serious Infections in Patients with Inflammatory Joint Diseases, explores the increased risk of infections in patients treated with biologic therapies.

Biological drugs are key in treating inflammatory diseases of the joints and intestines. However, these medications suppress the immune system, increasing the likelihood that a common infection could become severe.

“Patients who initiate biological treatment are explicitly informed that they must pause their medication if they develop an infection,” Christensen says.

Higher Risk Than the General Population

Christensen´s research shows that the risk of serious infections is twice as high in patients on biological treatment in comparison with the general population.

Patients with rheumatoid arthritis also have a greater risk of infections compared to those with psoriatic arthritis or spondyloarthritis.

Research Influences

Clinical Practice

Christensen’s findings have already impacted the treatment of patients with inflammatory joint diseases at Diakonhjemmet Hospital.

Increased awareness of infection risks has emphasized the importance of vaccination for patients receiving biological treatment to prevent them from getting severe infections.

COVID ­ 19 and Vaccination Response

During the COVID­19 pandemic, Christensen participated in a study examining how patients with inflammatory diseases responded to coronavirus vaccination.

The study demonstrated that these patients exhibited a weaker antibody response to coronavirus vaccination and lost their antibodies faster than healthy individuals.

“These findings have been important in the development of vaccine recommendations for this patient group”, Ingrid Egeland Christensen concludes.

Ingrid Jyssum

PhD dissertation

PhD degree: Institute of Clinical Medicine, University of Oslo

Employed: Division of Rheumatology and Research, Diakonhjemmet Hospital

REMEDY affiliation: WP1 –Optimized medical interventions

Main supervisor: Guro Løvik Goll Co­supervisors: Silje Watterdal Syversen, Nils Bolstad, Espen A. Haavardsholm

Personalizing Treatment for Inflammatory Diseases

1st opponent: Gert­Jan Wolbink, Amsterdam University Medical Centre, Free University Amsterdam, the Netherlands

2nd opponent: Inger Gjertsson, Göteborg Universitet, Sverige

Dr. Ingrid Jyssum’s doctoral research has deepened our understanding of how patients’ immune responses influence the efficacy of treatments for inflammatory joint- and bowel diseases.

In her dissertation, Immunogenicity of Therapeutics in Inflammatory Joint- and Bowel Diseases, Dr. Jyssum and her team identified key insights into the immune system’s impact on treatment outcomes. Patients with these conditions often require long­term immunosuppressive medications, and the immune system’s response plays a crucial role in the success of both treatments and vaccines.

Informing COVID ­ 19 Vaccine Recommendations

Ingrid Jyssum’s research revealed that patients with inflammatory diseases require additional COVID ­19 vaccine doses to achieve protection comparable to healthy individuals. These results informed public health vaccine recommendations during the pandemic.

“By studying a large patient cohort, we demonstrated how certain biological drugs can impair vaccine response, even with repeated doses. These findings

enabled health authorities to provide targeted vaccine guidelines for patients using immunosuppressive medications,” Jyssum explains.

The study included data from 2,300 patients, comprising individuals treated for inflammatory joint diseases at Diakonhjemmet Hospital and inflammatory bowel diseases at Akershus University Hospital.

Enhancing the Effectiveness of Biological Drugs

Another focus of Jyssum’s research was adalimumab, the world’s most prescribed biological drug for inflammatory joint diseases. Despite its widespread use, the drug is currently dosed uniformly across patients, without considering individual factors such as weight or metabolism.

“We discovered that 10% of patients developed antibodies against adalimumab within three months, reducing its effective­

ness. Additionally, adalimumab drug levels in the blood were closely linked to treatment outcomes. This underscores the importance of tailoring dosing to individual patient needs,” Jyssum says.

Bridging Research and Clinical Practice

The research highlights the potential for more personalized approaches to biological treatments, optimizing therapeutic outcomes by aligning dosages with patients’ unique response patterns.

Dr. Jyssum’s work underscores the need to monitor and adapt how biological drugs are administered. Her findings represent an important step toward individualized treatment strategies for severe inflammatory diseases.

“Our research emphasizes the critical role of tailoring therapies to improve patient outcomes and ensure the most effective use of biological medications,” Ingrid Jyssum concludes.

Joachim Sagen

PhD dissertation

PhD degree: Faculty of Health Sciences, Oslo Metropolitan University

Employed: Division of Rheumatology and Research, Diakonhjemmet Hospital

REMEDY affiliation: WP7 –Empowering the individual

Main supervisor: Rikke Helene Moe

Co­supervisors: Ingvild Kjeken, Hanne Dagfinrud

1st opponent: Julia Abelson, McMaster University, Canada

2nd opponent: Jonathan Quetzal

Tritter, Nord University, Norway

How Patient Engagement Drives Better Healthcare Outcomes

Can patients contribute to improving healthcare? Joachim Sagen’s PhD provides a clear answer: Yes! When patients participate, treatment becomes more effective and meaningful.

Hearing the Patient’s Voice

Joachim Sagen defended his thesis, Patient Engagement in the Development and Delivery of Healthcare Services where he focused on the involvement of patients in own treatment decisions as well as involvement of patient representatives at the system level. To find answers, he combined several methods:

Scoping Review: Sagen analyzed 37 studies from 2005 to 2022, and found that patient engagement is most effective when patient representatives, healthcare professionals, and leaders collaborate. Dialogue, training, and clarity on roles are essential for success.

Measurement Tools: A Canadian questionnaire was adapted to Norwegian conditions to measure patient engagement at a system level. The Canadian Public and Patient Engagement Evaluation Tool evaluates culture, policy and practices, and collaboration, and can also track progress over time.

Patient representatives’ insight: Sagen interviewed 47 patient representatives, and found that the majority believed that involvement strengthened their institutions, but many representatives experienced minor influence.

Rehabilitation in Practice: The RehabNytte study followed more than 2,000 patients in rehabilitation institutions. Patients who were involved in the planning of their treatment achieved their goals and improved their function more frequently than their counterparts. The goals reflected patients’ own priorities, such as climbing stairs or returning to work.

Patient Engagement in Practice

The REMEDY center has established platforms to amplify patient voices, and patient engagement is integrated from the planning to the implementation of research.

Challenges

Patient engagement faces barriers such as time constraints, lack of resources, and the healthcare system’s focus on standardization. Sagen emphasizes that patient engagement must be tailored to the context and secured through adequate time and resources.

A Vision for the Future

The research points toward establishing better systems for using patients’ experiences in decision­making. When the contributions are valued, the engagement increases.

From Research to Practice

As Head of Research at the Norwegian Rheumatism Association, one of REMEDY’s partners, Sagen strengthens patient engagement in research. He advocates for healthcare services that are not only efficient but also reflect patients’ genuine needs and preferences.

Kristine Røren Norén

PhD

dissertation

PhD degree: Institute of Health and Society, University of Oslo

Employed: Division of Rheumatology and Research, Diakonhjemmet Hospital

REMEDY affiliation: WP4 –Managing comorbidities

Main supervisor: Anne Therese Tveter

Co­supervisors: Hanne Dagfinrud, Anne Grete Semb, Jonny Hisdal

1st opponent: Inger­Lise Aamodt Aksetøy, Norwegian University of Science and Technology, Norway

2nd opponent: Martin van der Esch, Amsterdam University of Applied Sciences, the Netherlands

Aerobic Capacity in Patients with Inflammatory Joint Diseases

People with inflammatory joint diseases face a higher risk of cardiovascular disease. Kristine Røren Nordén examined how personalized high-intensity training can improve aerobic capacity, a vital marker of cardiovascular and overall health in the thesis, Cardiorespiratory Fitness in Patients with Inflammatory Joint Disease: Associations, Validity of Assessment, and Effects of an Exercise Intervention

Aerobic Capacity and Cardiovascular Health

The body’s ability to use oxygen during physical activity, known as aerobic capacity, is strongly linked to the risk of cardiovascular disease. Nordén studied ways to measure and improve this in patients with inflammatory joint diseases.

“Aerobic capacity is generally lower in this patient group compared to the general population, but targeted exercise can confer significant health benefits,” Nordén says.

Higher level of aerobic capacity in patients with inflammatory joint disease was linked to a better health profile including higher levels of the “good” cholesterol, better exercise self­efficacy, as well as lower levels of triglycerides, body fat, and resting heart rate.

Personalized and Effective Exercise

In the ExeHeart randomized controlled trial, patients completed a 12 ­ week high­intensity interval training (HIIT) program, supervised by physical therapists in primary care. The program included three weekly sessions: two with HIIT training and one session at moderate intensity. This led to a significant increase in aerobic capacity after three months, and this improvement was maintained at six months, demonstrating a long­lasting effect of the intervention.

“HIIT was well tolerated and did not worsen disease activity, thereby showcasing its benefits and safety in this patient group”, Nordén explains.

Fitness Calculators: Use with Caution

The team also explored whether fitness calculators could effectively estimate

aerobic capacity and monitor changes over time. “These calculators are moderately accurate at group level, but they tend to overestimate aerobic capacity and show significant individual measurement errors. Therefore, caution is advised when using them for individual patients,” Nordén explains.

Implications for Clinical Practice

Nordén’s work shows how structured HIIT can be a valuable part of physical therapy management and highlights the importance of incorporating exercise in treatment plans.

“Exercise is indeed medicine and should be an integrated part of a comprehensive treatment plan,” she concludes.

Maria Dehli Vigeland

PhD dissertation

PhD degree: Institute of Clinical Medicine, University of Oslo

Employed: The Department of Medical Genetics, University of Oslo

REMEDY affiliation: WP2 – Phenotyping for personalized medicine

Main supervisor: Benedicte Alexandra Lie Co­supervisor: Linda M. Pedersen

1st opponent: Anne Barton, University of Manchester, United Kingdom

2nd opponent: Vibeke Videm, Norwegian University of Science and Technology

New Insights into Gene Expression and Chronic Low Back Pain

Maria Dehli Vigeland (PhD) has been studying chronic low back pain, a common issue affecting millions worldwide. Her PhD thesis, Gene Expression Analyses in Subphenotypes of Chronic Low Back Pain examines why some people develop this condition and how their bodies respond.

A Global Health Challenge

Chronic low back pain is a leading cause of disability and absence from work, while its causes are often unclear and treatments frequently fail. Vigeland’s research focuses on patients with Modic changes, which are small spinal abnormalities visible on MRI scans. While longterm antibiotics have been suggested as a treatment, evidence remains uncertain.

Examining Modic Changes and Gene Expression

Vigeland studied three groups of patients with Modic changes: Those with severe MRI­detected changes, those reporting higher pain or disability, and those treated with long­term antibiotics. Blood samples revealed insights at the molecular level of this condition.

Key Findings: Genes, Inflam ­

mation, and

Long ­Term Effects of Antibiotics

“We found that people with more severe Modic changes exhibited increased act ivity in specific genes related to immune function and energy production,” Vigeland explains.

She also found that pain and disability were connected to molecular changes, and that these changes mostly occurred differently in men and women.

Vigeland observed a concerning trend among patients who had used antibiotics with persistent long­term changes in genetic activity even nine months post­treatment. “This raises questions about the long­term effects of antibiotic use in these patients,” she says.

Inflammation’s Role in Back Pain

The findings show that inflammation and immune responses are central to this pain. Gender differences also influence pain experiences, highlighting the need for tailored treatment approaches. “These findings suggest exercising caution when prescribing long­term antibiotic use for these patients,” she explains.

Toward Better Treatments

“Understanding the biology of this pain is crucial for developing more effective treatments,” Vigeland says. Her research marks an important step toward uncovering the causes of chronic low back pain and improving care.

Marte Gløersen

PhD dissertation

PhD degree: Institute of Clinical Medicine, University of Oslo

Employed: Diakonhjemmet Hospital, Division of Rheumatology and Research

REMEDY affiliation: WP3 – Pain mechanisms and treatment

Main supervisor: Ida K. Bos­Haugen Co­supervisor: Hilde B. Hammer

Understanding Pain in Hand Osteo arthritis

1st opponent: David Walsh, University of Nottingham, United Kingdom

2nd opponent: Jérémie Sellam, Sorbonne University, France

Marthe Gløersen’s PhD research illuminates the connection between overweight and pain among people with hand osteoarthritis, and the role of sensitization. Her findings pave the way for better understanding and treatment of this understudied condition. Her thesis was titled, Pain and Pain Sensitization in People with Hand Osteoarthritis.

Chronic Pain Has Complex Causes

Hand osteoarthritis can cause significant pain and lead to difficulties with activities of daily living. Despite mild joint changes, many patients report severe pain, indicating other contributing factors.

“Our research project started with one question: Why do some people with hand osteoarthritis experience severe pain despite limited joint damage?” Gløersen explains.

Her research focused on overweight and pain sensitization – an increased sensitivity to pain – to find answers to this question.

Key Findings on BMI and Pain

In the Nor­Hand study, comprising 300 participants with hand osteoarthritis, Gløersen found that higher body weight was associated with more severe pain,

even in non­weight­bearing joints like the hands. People with higher weight had also greater pain sensitization.

“This indicates that joint pain is not purely due to mechanical loading, and that systemic factors may also play a role. In our study, the hormone leptin seemed to partly explain the higher levels of hand pain in persons with overweight,” she notes.

The Role of Pain Sensitization

Gløersen also linked greater pain sensitization to worse symptoms, such as widespread pain and reduced function.

“These findings highlight that pain sensitization may play a role in the hand osteoarthritis experience. Pain sensitization can possibly explain why some patients have severe symptoms despite limited structural damage in their joints” she says.

From Research to Better Care

Personalized approaches that target different contributors to pain could improve outcomes. Overweight may be a modifiable factor that affects pain in hand osteoarthritis.

By uncovering the mechanisms of pain, Gløersen’s work is a first step towards development of more effective treatments.

“Improving care for patients with hand osteoarthritis starts with understanding the causes of pain. Uncovering why pain happens may eventually lead to ways to relieve it, making daily life easier for those affected,” she concludes.

Marte

Kirkesæther Brun

PhD dissertation

PhD degree: Institute of Clinical Medicine, University of Oslo

Employed: Division of Rheumatology and Research, Diakonhjemmet Hospital

REMEDY affiliation: WP1 –Optimized medical interventions

Main supervisor: Silje Watterdal Syversen

Co­supervisors: Guro L. Goll, Espen A. Haavardsholm, Johanna

E. Gehin, Kristin K. Jørgensen

1st opponent: Carl Turesson, Lund University, Sweden

2nd opponent: Diane van der Woude, Leiden University Medical Center, the Netherlands

Drug Monitoring Improves Personalized Treatment for Chronic Inflammatory Diseases

Marthe K. Brun’s PhD research has paved the way for better outcomes in patients with chronic inflammatory diseases, such as rheumatoid arthritis, by tailoring treatment to the individual. Her findings emphasize the importance of therapeutic drug monitoring for optimizing the dosage of infliximab, a commonly used biologic medication. Her thesis was titled, Infliximab Therapy in Immune-Mediated Inflammatory Diseases: Immunogenicity and Proactive Therapeutic Drug Monitoring

Chronic Diseases with Significant Impact

Inflammatory joint diseases like rheumatoid arthritis are lifelong conditions that can cause pain, joint damage, and reduced quality of life. Biologic medications, including infliximab, have revolutionized treatment of these diseases, with two­thirds of patients achieving remission. However, for the remaining third, treatment may be ineffective or lose its effect over time.

“Understanding why some patients do not respond to infliximab and finding ways to address these challenges was the driving force behind my research,” Brun explains.

Personalized Dosing for Better Outcomes

Brun’s research focused on why infliximab works well for some patients but fails for others. A key finding was the role of antibodies produced by the im­

mune system against the drug. These antibodies can bind to infliximab and block its effects. Brun found that treatment outcomes were poorer for people who developed antibodies. By monitoring infliximab levels in the blood and thereby detecting antibody formation early, Brun demonstrated that treatment could be adjusted to prevent treatment failure.

“Therapeutic drug monitoring allows us to tailor treatment for each patient, helping them to achieve better disease control,” she says.

Risk factors

Brun identified several risk factors for developing antibodies against infliximab, including high disease activity, smoking, and long intervals between drug infusions. Her work also uncovered a genetic factor—HLA­DQ2—that increased the likelihood of antibody formation.

“Patients with these risk factors particularly benefit from regular monitoring to adjust their treatment and detect antibodies early,” Brun notes.

From Research to Clinical Practice

At Diakonhjemmet Hospital, therapeutic drug monitoring is part of clinical routine for patients receiving infliximab. Brun’s research has also influenced national treatment guidelines, ensuring that more patients across Norway can benefit from personalized treatment strategies.

“Seeing our research being implemented in clinical practice and improving patient care is incredibly rewarding,” Brun concludes. Her work highlights how personalized medicine can transform outcomes for patients with chronic diseases, reaffirming the importance of research in driving better patient care.

Nina Martine Krafft Sande

PhD

dissertation

PhD degree: Institute of Clinical Medicine, University of Oslo

Employed: Department of Rheumatology, Oslo University Hospital, Rikshospitalet

REMEDY affiliation: WP1 –Optimized medical interventions

Main supervisor: Pernille Bøyesen

Co­supervisors: Berit Flatø, Vibke Lilleby

1st opponent: Athimalaipet Ramanan, University of Bristol, United Kingdom

2nd opponent: Daniel Windschall, St. Josef­Stift Sendenhorst, Germany

Improved Diagnostic Tools Enhance Treatment for Juvenile Idiopathic Arthritis

Nina Martine Krafft Sande, through her PhD research, has contributed to improving imaging diagnostics for juvenile idiopathic arthritis, which is the most common rheumatic disease in children. Accurate diagnosis is essential for effective treatment. Her thesis was titled, Evaluation of Ultrasound in Juvenile Idiopathic Arthritis.

Approximately 140 New Cases Annually

Juvenile idiopathic arthritis is a chronic joint disease affecting children under the age of 16. It is characterized by joint inflammation (synovitis). Without proper treatment, the disease can lead to serious consequences, including permanent joint damage, growth disturbances, and reduced quality of life.

“It is important to detect synovitis early and to understand the severity of the synovitis. This enables healthcare workers to provide the right treatment and help the patient in the best way possible,” Krafft Sande explains.

Ultrasound is a safe, simple, and painless imaging procedure. This imaging technology is increasingly used to examine joint inflammation in children. However, using ultrasound in children can be challenging due to their growing skeleton, which makes image interpretation more complex.

A More Precise Method

To address these challenges, Krafft Sande and her team developed a standardized ultrasound method to examine various joints. They also created a system to assess the severity of inflammation in individual joints. Additionally, they developed sets of ultrasound images for four age groups, showing the different severity of inflammation in each joint.

The team further explored the use of Doppler ultrasound to evaluate blood flow in inflamed joints. This is particularly challenging in children due to physiological variations in blood flow during growth.

Key Findings

One of the most important outcomes of Krafft Sande’s research was the development of highly reliable tools to assess synovitis in children with juvenile idiopathic arthritis. Additionally, Doppler ultrasound findings (blood flow) in inflamed joints were associated with other indicators of joint inflammation.

“Our tools provide a structured approach to make ultrasound examinations of joints more accurate and consistent,” she adds.

Implications for Research and Treatment

The standardized tools developed in her research not only improve the reliability of synovitis assessment but also facilitate better disease monitoring and treatment for children with juvenile idiopathic arthritis.

“By providing methods tailored specifically for children, our research provides a basis for more precise assessments of disease activity and more targeted treatments,” she concludes.

The standardized tools are already used in clinical practice across all health regions in Norway and in the MyJIA trial, a national multicenter clinical study.

Sigrid Elise Reppe Moe

PhD

dissertation

PhD degree: Institute of Clinical Medicine, University of Oslo

Employed: Department of Rheumatology, Oslo University Hospital, Rikshospitalet

REMEDY affiliation: WP6 –Deciphering long­term outcomes

Main supervisors: Karoline Lerang

Co­supervisor: Øyvind Molberg

1st opponent: Elisabet Svenungsson, Karolinska Institutet, Sweden

2nd opponent: Anne Troldborg, Aarhus University, Denmark

Exploring Risk Factors and Outcomes in Systemic Lupus Erythematosus

Systemic lupus erythematosus is a complex autoimmune disease that can affect multiple organs and lead to severe complications. Sigrid Elise Reppe Moe, MD, recently defended her PhD thesis, Outcome and Identification of Early Risk Factors in a Population-Based Systemic Lupus Erythematosus Cohort Set in Norway, shedding light on factors that influence disease progression and patient outcomes.

Systemic Lupus Erythematosus and Its Challenges

The disease places a heavy burden on those affected, with symptoms ranging from mild to life­threatening. Despite its impact, knowledge about disease outcomes on a population level has been limited. Reppe Moe aimed to bridge this gap by establishing a population­based cohort in South Eastern Norway. The study rigorously confirmed diagnoses of systemic lupus erythematosus and provided robust data on disease progression and risk factors.

One key objective was to assess the reliability of using International Classification of Diseases (ICD ­ 10) codes from health administrative databases to identify disease cases, a method increasingly used in research.

Key Findings

Reppe Moe’s research revealed important limitations in relying solely on ICD10 codes for identifying patients with systemic lupus erythematosus. “Given the varied symptoms and overlap with other conditions, relying solely on administrative data often overestimates disease cases, particularly in older age groups,” she explains.

The study also identified a high risk of thromboembolic events around the time of diagnosis, which may have implications for preventive treatment strategies. While short­term survival among patients with systemic lupus erythematosus is good, long­term outcomes remain concerning. The findings show that patients with systemic lupus erythematosus have more than double the risk of death compared to the general population, with the highest mortality risk in those diagnosed before

the age of 16 years. “This highlights the need for continued focus on long­term disease management and prevention,” Reppe Moe says.

Implications for Research and Treatment

The thesis underscores the importance of accurate disease identification in research and clinical practice. It also calls for careful interpretation of administrative health data to avoid misclassification of cases with systemic lupus erythematosus.

“By providing robust population­based data, this research can contribute to better disease management and guide future studies,” Reppe Moe concludes.

RA-DRUM

Advancing Personalized Medicine in Rheumatology

The randomized Rheumatoid Arthritis therapeutic DRUg Monitoring (RA-DRUM) trial aims to evaluate whether personalized drug dosing, guided by therapeutic drug monitoring (TDM), can optimize the effectiveness of adalimumab – the world’s most widely used biological therapy.

Tumor necrosis factor alpha (TNF) inhibitors, such as adalimumab, remain a cornerstone in the treatment of rheumatoid arthritis. There is a strong need to ensure that these drugs are used in a way that maximizes their clinical benefit. TDM, which involves tailoring drug doses based on measurements of drug levels in the blood, has been proposed as a promising strategy to fully harness the potential of TNF inhibitors. The RA­DRUM trial addresses a critical knowledge gap, aiming to improve the management of this common and potentially disabling condition. In addition, the trial will explore genetic and other novel biomarkers to advance algorithms for personalized TNF inhibitor therapy.

STUDY TEAM

This multicenter, randomized controlled trial is led by Diakonhjemmet Hospital in collaboration with Oslo University Hospital. It is conducted as a part of the multinational EU funded SQUEEZE consortium aiming to maximizing the effect of prescription drugs in rheumatoid arthritis. All 16 Norwegian rheumatology departments and additionally 5 European rheumatology departments are participating as study centers and collaborators (see Map). The trial compares TDM to standard therapy with adalimumab with regards to sustain disease control and prevent flare. With a target enrolment of 350 participants, recruitment began in August 2024 and is ongoing.

Assoc. Prof. Silje W. Syversen MD PhD Coordinating Investigator, Prof. Espen A. Haavardsholm MD PhD Sponsor representative, Nils Bolstad MD PhD Laboratory lead, Assoc. Prof. Guro Løvik Goll MD PhD Medical lead, Ingrid Jyssum MD PhD National Coordinating Investigator Norway, Camilla S. Mørstad MsC Study coordinator, Johanna E. Gehin MD PhD Laboratory Coordinating Investigator, Siri Lillegraven MD MPH PhD Trial methodologist, Joe Sexton PhD Trial statistician, Camilla Stabell User representative.

The study is led by Associate Professor Silje Watterdal Syversen, postdoc Ingrid Jyssum is national coordinating investigator in Norway, and postdoc Johanna Gehin is laboratory coordinating investigator. Conduction of this complex multinational trial would not have been feasible without support from the CTU and study coordinator Camilla S. Mørstad in particular.

The Oslo TDM collaboration is currently at the forefront of clinical TDM research in international rheumatology and aims to continue to fill knowledge gaps within this field by the RA­DRUM trial.

FUNDING

The trial has received funding through an EU grant (HorizonHLTH-2022) to the SQUEEZE consortium “Maximising Impact of Prescription Drugs in Rheumatoid Arthritis”. The trial has also received funding for a postdoc through the South-Eastern Norway Regional Health Authority.

Tromsø

Bodø

Mo i Rana

Trondheim

Ålesund

Lillehammer

Førde

Bærum

Bergen

Drammen

Haugesund

Stavanger

Kristiansand

Skien

Moss

Oslo

Centers involved

Stockholm

Gothenburg

Vienna

London High drug level Reduce dose Within therapeutic range Continue dose

Low drug level, ADAb­ Increase dose

Low drug level, ADAb+ Switch drug

Algorithm for proactive therapeutic drug monitoring

Bucuresti

SPARK

The SPARK (SPondyloARtritt Kondis) trial introduces and assesses a digital exercise program that provides a personalised, long­term, sustainable and decentralised follow­up of patients with spondyloarthritis.

Exercise as treatment

Exercise is a cornerstone in spondyloarthritis treatment, often combined with medication. Exercise has a dose­dependent effect on health outcomes, with highintensity interval training (HIIT) being the most effective method for improving cardiorespiratory fitness. Previous publications from Diakonhjemmet Hospital have shown that supervised HIIT at healthcare facilities significantly reduces disease activity in spondyloarthritis, measured by the Ankylosing Spondylotis Disease Activity Score (ASDAS). However, longterm adherence to exercise is crucial for sustaining its benefits, making feasibility a key factor in managing disease activity.

The SPARK approach

The remote nature of SPARK includes a digital weekly follow­up by physical therapists, and exercise programs and educational videos in­app. The digital platform alleviates geographical, social and work­related constraints for both

patients and healthcare professionals during follow­up. Goal setting, measures of progression, support and health literacy are important factors for longterm adherence included in the SPARK trial. The SPARK application is delivered by the health­tech company Abel Health with specific SPARK modifications regarding data security and content.

Complex intervention

In the development of SPARK, a pilot study has been crucial. Thirteen patients with spondyloarthritis participated in miniSPARK, conducting a 3­week SPARK intervention program. The pilot study included evaluation of patient acceptability and perceived benefit through selfreported questionnaires and qualitative

interviews. The SPARK research group received important feedback on trial logist ics. “This strategy alongside a workshop and close collaboration with our user representatives has contributed to significant improvements in the SPARK trial regarding follow ­ up and data collection”, Camilla Fongen states.

The SPARK trial is led by Sella Aarrestad Provan, rheumatologist, senior researcher, and leader of work package 6 (Longterm outcomes) in REMEDY, together with Birgitte Nellemann, rheumatologist and postdoc on the SPARK trial, both clinicians at Diakonhjemmet hospital. Camila Fongen is a physical therapist specialised on spondyloarthritis and PhD fellow on SPARK. “The next stage for SPARK in 2025 is the establishment of collaborating centers, emphasizing the decentralized structure”, Provan says.

Funding

The SPARK trial is funded by the SouthEastern Norway Health Region (several grants: 11 million NOK), the DAM Foundation (STREV project), and smaller grants from the Grete Harbitz Scholarship, the Norwegian Research Council, and Diakonhjemmet Hospital for the feasibility study and innovative preparations.

Where Are We Now?

In 2024, the three researchers and their research partners have performed the data collection for a systematic review on digital exercise program in arthritic diseases, completed the pilot study, collected data for a validation study of cardio­pulmonary exercise testing and started on the inclusion of patients in the SPARK trial. Our goal for 2025 is to continue including patients in the SPARK trial while working on the publications from the completed studies.

RESEARCH QUESTIONS

• Can the SPARK approach improve disease activity in patients with spondyloarthritis, compared to treatment as usual?

• What are the facilitators and barriers for exercise delivered digitally in patients with spondyloarthritis?

• Is it safe to initiate HIIT for the newly diagnosed patients with spondyloarthritis?

• Does the SPARK approach cause improved physical fitness and other health-related outcome measures such as fat mass, weight, overall activity level, and sleep?

• Does it affect empowerment and health literacy for the participants?

Camilla Fongen, Birgitte Nellemann and Sella Arrestad Provan.

The ReMonit Study : Remote Monitoring for Axial Spondyloarthritis

Can patients with axial spondyloarthritis with low disease activity be followed by remote monitoring or patient-initiated care?

The ReMonit Trial

Follow­up of chronic inflammatory joint diseases is time­consuming for patients and resource­demanding for the healthcare services. Novel follow­up, such as remote monitoring or patient­initiated care, offer alternative follow­up strategies that could enable more targeted and efficient use of healthcare resources.

The ReMonit trial evaluated whether patients with axial spondyloarthritis could maintain low disease activity through remote monitoring or patient­initiated care, compared to traditional follow­up with pre­scheduled face­to­face consultations at the outpatient clinic.

Axial Spondyloarthritis

Axial spondyloarthritis is an inflammatory joint disease affecting the spine and sacroiliac joints leading to back pain and stiffness. It usually debuts in the third decade of life, affecting many individuals who are part of the workforce. Over the past two

decades, the medical treatment of axial spondyloarthritis has been revolutionised after the introduction of treatment with tumor necrosis factor (TNF) inhibitors, allowing a substantial part of the patients to reach inactive disease or low disease activity.

Follow­up of axial spondyloarthritis patients in specialist healthcare is usually offered as regular, usually biannual, pre­scheduled face­to­face visits at the outpatient clinic. However, this follow­up is time consuming for patients and resource demanding for the healthcare services.

ReMonit

In the ReMonit trial we investigated alternative follow­up strategies of patient with axial spondyloarthritis in low disease activity treated with TNF inhibitors. The primary objective of the study was to compare the effectiveness of these strategies in maintaining low disease activity.

Inger Jorid Berg

A total of 243 patients were randomly assigned to either Remote Monitoring, Patient­initiated Care, or Control Group, with a follow­up period of 18 months. In the Remote Monitoring group, the patients reported their symptoms monthly via an app. If the disease activity was high, a

study nurse contacted the patient and evaluated the need for a consultation at the outpatient clinic. In the Patient­initiated Care group, there were no pre­scheduled consultations during the study; the patients reached out to the outpatient clinic if they experienced significant worsening of their condition. The Control Group received traditional follow­up with pre­scheduled face­to­face consultations at the outpatient clinic. Across all three groups, patients could request additional consultations if needed.

Results

In 2024, physical therapist and PhD candidate Emil E.K. Thomassen published a paper from the ReMonit study, demonstrating that patients were willing to use remote care and adhered to reporting patient reported outcomes for remote monitoring throughout the study.

Preliminary results from the main study analyses were presented as a late breaking abstract in a podium presentation at the EULAR congress in June 2024. The results showed that alternative follow­up strategies with Remote Monitoring or Patient­initiated Care both were non­inferior to traditional follow­up in maintaining low disease activity. Healthcare providers’ resource­use was lowest in Patient­initiated Care group. These findings suggested that patients with axial spondyloarthritis can be effectively followed by either remote monitoring or patient­initiated care. Following the presentation at the EULAR Congress the audience characterised these findings as game­changing.

Funding

The ReMonit study is funded from The South­Eastern Norway Regional Health Authority with a grant of 9 million NOK.

Above: ReMonit study group: Espen A. Haavardsholm, Inger Jorid Berg, Anne Therese Tveter, Nina Østerås, Sella Provan, Eirik Kristianslund and Ellen Moholt.

Publications in 2024:

1. Thomassen EEK, Berg IJ, Kristianslund EK, et al. Patients with axial spondyloarthritis reported willingness to use remote care and showed high adherence to electronic patient­reported outcome measures: an 18­month observational study. Rheumatol Int 2024;44(10):2089­98.

2. Berg IJ, Sexton J, Kristianslund E, et al. LBA0004 Remote monitoring and patient­initiated care compared to regular face­to­face outpatient visits in axial spondyloarthritis: results from a randomized controlled non­inferiority trial. Ann Rheum Dis 2024;83(Suppl 1):234­35.

REMEDY Advisory Board

Scientific

In 2024, REMEDY successfully established its Scientific Advisory Board (SAB), comprising three internationally recognized experts to provide strategic guidance and evaluation of REMEDY’s scientific progress. The Center Executive Committee selected and appointed the SAB members to cover the center’s range of activities and decided that one member should be a national researcher with extensive knowledge of the Norwegian research system. It was set as a requirement that SAB members should have no ongoing or planned scientific collaborations with center researchers.

THE REMEDY SCIENTIFIC ADVISORY BOARD

George Peat, PhD MCSP

Head and Director of Institute of Cancer Research at Oslo University Hospital and Professor at Institute for Clinical Medicine, University of Oslo

Director of Experimental Medicine, Professor of Rheumatology, and Honorary Consultant Rheumatologist at the University of Manchester

Director of Centre for Applied Health & Social Care Research (CARe) and Professor of Clinical Epidemiology at the Sheffield Hallam University

Kjetil Tasken, MD PhD

Maja Buch, MD PhD FRCP

Site Visit

The first SAB meeting was held as a site visit in Oslo on October 21­22, 2024. During this comprehensive lunchto­lunch meeting, the SAB engaged with key stakeholders within REMEDY. Highlights from the agenda included presentations and Q&A sessions with the center leadership and each of REMEDY’s work packages and main activities, detailing scientific achievements and future plans, as well as tours of the clinical facilities at Diakonhjemmet Hospital.

SAB Evaluation and Feedback

Following their visit, the SAB conveyed their findings through a report consisting of an executive summary for the Center Board, as well as more detailed feedback to the Center leadership with succinct sections dedicated to each work package and main activity.

The board was impressed by REMEDY’s substantial progress and stellar accomplish ments since its inception. They commended the center’s leadership and its wider team for their exemplary performance, and recognized REMEDY for establishing a robust governance structure and demonstrating impressive outputs in clinical research and trials. They highlighted the positive work culture and collaborative ethos evident within the center.

Key recommendations from the SAB included enhanced integration and coordination across work packages and fostering strategic partnerships to expand expertise and interdisciplinary opportunities. They also emphasized the importance of addressing clinical space constraints, particularly for the Clinical Trial Unit, to ensure continued growth and effectiveness in clinical trials.

The SAB’s feedback underscores the center’s strong performance and sets a strategic pathway as REMEDY continues its journey towards the mid­term review by the Norwegian Research Council.

Overall, the establishment of the SAB marks a pivotal step in ensuring REMEDY’s research excellence and strategic growth, with the board’s insights serving as a valuable asset for future achievements.

RECONNECT

The Regional Research Network on Decentralized Clinical Studies (RECONNECT) aims to enhance knowledge and collaboration in clinical studies incorporating decentralized elements. The network has three specific focus areas which includes digital data collection, issues regarding medical devices, and drug management in decentralized clinical studies. Additionally, knowledge sharing is a central aspect.

2024 marked the inaugural year of RECONNECT’s activities. During this period, the work packages held their initial meetings, identified bottlenecks, and leveraged their experiences to develop tools that facilitate the implementation of decentralized elements in clinical studies.

In August 2024, RECONNECT organized a debate at Arendalsuka titled Digitalization in Healthcare: A Debate on Research and Future (Health) Services (Digitalisering i helsevesenet: En debatt om forskning og fremtidige tjenester). The debate garnered significant attention, with a robust physical attendance and over 150 viewers on the live stream.

The network’s website (www.reconnectnettwork.no) went live in October. It offers valuable resources, including information on digital data collection tools for research and lists of relevant standards and guidelines for the development of medical devices.

A successful first seminar was held in November, themed How to Avoid the Pilot Graveyard (Hvordan unngå pilotkirkegården). The seminar featured presentations on:

• Medical Device Regulation

• Experiences with app development

• The South­Eastern Norway Regional Health Authorities’ innovation strategy

• Market placement of devices and software developed by hospitals

The RECONNECT network aims to foster increased collaboration across medical disciplines, technological expertise, and patient groups. By including user representatives who share their experiences with decentralized elements, the network provides valuable insights that enhance research quality.

In its first year, RECONNECT has made significant strides in promoting decentralized clinical studies. Through continued collaboration and innovation, the network is poised to make lasting contributions to the field.

Anne Therese Tveter, Tuva Moseng, Marie Skovli Pettersen and Nina Østerås.

These Hospitals / Health Trusts are Participating:

Innlandet Hospital, Tynset

Oslo University Hospital

Akershus University Hospital

Østfold Hospital Trust

Diakonhjemmet Hospital

Vestre Viken Hospital Trust

Sørlandet Hospital Trust

The seven hospitals in the network represent different diagnostic groups and have experience with different decentralized elements in various types of clinical studies.

The panel at Arendalsuka.

REMEDY

Annual Retreat

The REMEDY Annual Retreat 2024 was a great success, bringing together over 100 participants at Sanner Hotel on March 12­13. The event serves as an arena for fostering collaboration, exchanging knowledge, and inspiring future research endeavors. With the overarching theme, Developing Excellent Research for the Future, the retreat reinforced REMEDY’s commitment to advancing high­quality, impactful research.

On the first day, four state­of­the­art lectures were given, followed by discussions in thematic workshops. Our prominent Guest Professor Daniel H. Solomon from Harvard Medical School and Brigham and Women’s Hospital (Boston, USA) presented on how to perform pragmatic trials with clinical impact, while Professor Maarten de Wit, who is the chair of EULAR Study Group for Collaborative Research, shared his knowledge regarding involvement of patient research partners. Professor Saedis Saevardsdóttir from the University of Iceland increased our understanding of

how human genetics can evolve medical care in rheumatic and musculoskeletal diseases, and Professor Andrew Garman from Rush University (Chicago, USA) gave a virtual presentation on sustainable healthcare.

In the afternoon, participants joined various networking activities, such as cross­country skiing or cultural sightseeing at the two medieval churches nearby. The day was concluded with presentations from the three recipients of the Young Researcher Program’s grant (Marthe Mæhlen, Eirik Ikdahl, and Fatima Heinicke) before Associate Professor in rhetorics Kristian Bjørkdahl engaged the audience with an inspiring talk about the art of storytelling.

The second day began with an update from leaders and co­leaders from REMEDY work packages, followed by insightful and inspiring presentations from Professor Daniel H. Solomon about artificial intelligence in manuscript preparations, and

guidance and advice about how to succeed as a project leader. The rest of the day was dedicated to individual project discussions, where new project ideas were presented and discussed. These project discussions have been a tradition in our research environment for several years, and many of the project ideas discussed in workshops like this have later emerged as clinical trials and major studies receiving substantial funding.

Scientific retreats such as this play a pivotal role in advancing research by fostering interdisciplinary dialogue and strengthening collaborative networks. They provide an essential platform for mentorship, knowledge dissemination, and the development of innovative research initiatives. The REMEDY Annual Retreat remains an important arena for generating high­impact research that translates into improved patient care and medical advancements.

Scientific sessions, workshops and networking at the Annual retreat at Sanner Hotel.

03 Work Packages

The seven work packages in REMEDY have a broad interdisciplinary focus on all aspects of rheumatic and musculoskeletal diseases – from epidemiology, pathogenesis and disease mechanisms to factors that promote health and wellbeing.

Overview of Work Packages

Work Packages

The overarching aim of the REMEDY center is to improve treatment of rheumatic and musculoskeletal diseases (RMDs) by randomized clinical trials assessing novel treatment and treatment strategies, in combination with research and innovation to untangle the causes and characteristics of RMDs.

The seven work packages approach the knowledge needs within RMD treatment from different angles, ensuring that the research results will benefit patients in all stages of the diseases. This multifaceted construct will result in high quality in all aspects of comprehensive treatment courses.

We will conduct clinical trials to test new therapies and treatment strategies.

Translational research activities will improve understanding of disease mechanisms and identify potential novel targets for treatment of diseases and pain.

Development of precision medicine means that the patient will receive the correct treatment earlier in the disease course, optimizing the chance of treatment response and reducing irreversible damage.

Increased knowledge about how to identify and treat co­morbid conditions is expected to have direct consequences for mortality and morbidity.

Use of remote monitoring, supported by artificial intelligence (e.g., through machine learning), will provide more flexible care for the patients, while detecting important changes of disease activity with less use of healthcare resources.

Health registries are national assets, giving a unique opportunity for real

world data and linkage of health information, and may be used to improve long­term outcomes in patients with RMDs.

The development of empowermentoriented self­management interventions may contribute to reduce variability and ensure health equity for people with RMDs.

WP7

To empower patients and enhance their ability and self­efficacy to deal with medical, role and emotional management.

WP1

To develop, assess and implement innovative interventions and treatment strategies to optimize patient outcomes in RMDs.

WP2

To improve precise diagnosis, characterize and stratify RMDs into clinically relevant subgroups and to develop the necessary tools to offer personalized treatment.

WP6

To disentangle the longitudinal disease course of RMDs in order to understand the disease and treatment associated outcomes, including work ability and health economics.

WP5

To develop, assess and implement feasible, effective and cost­effective approaches to remote monitoring and follow­up, tailored to the individual patient.

WP4

WP3

To better understand underlying pain mechanisms in order to optimize pain management.

To reduce the burden of comorbidities in people with RMDs with a special focus on cardiovascular diseases.

WP1: Optimized Medical Interventions

Optimized Medical Interventions Work Package 1

Leader

Silje W. Syversen, Associate Professor, MD PhD

Leader

Siri Lillegraven, Senior Researcher, MD MPH PhD (Maternity leave from Sept.)

Co­Leader

Anna­Birgitte Aga, Senior Researcher, MD PhD

Viewpoint

Randomized controlled trials (RCTs) are crucial for informing sustainable evidence­based medical practices. In REMEDY, work package 1 focuses on academic clinical trials with potential to optimizing existing treatments, exploring novel strategies and improving patient care. Ongoing trials assess a broad range of interventions such as drugs, surgical techniques, approaches to organization of healthcare, diet, physical exercise and decision support tools for treatment allocation. Examples of the latter include imaging­informed treatment algorithms and algorithms based on therapeutic drug monitoring.

A main focus in 2024 has been the initiation and patient recruitment in several new large randomized clinical trials (RCTs). This include the EU­funded multinational RA­DRUM trial, assessing therapeutic drug monitoring of adalimumab, the national multicenter HIFSAT trial, comparing two surgical approaches for hemiprosthesis in hip fractures and the MOVEJIA trial, evaluating tapering of medication in juvenile idiopathic arthritis. Another focus is patient recruitment and initiation of more sites in ongoing clinical trials, such as NOR­CACTUS (carpal tunnel syndrome), PICASSO / MERINO (both hand osteoarthritis) and NOR­SPRINT

(psoriatic arthritis). Overall, all these studies engage a large number of study sites within rheumatology and orthopedic surgery.

These randomized clinical trials are made possible through a continuous partnership between clinicians, researchers, and patient partners, and by collaboration across partner institutions, and study centers in multicenter trials. This collaboration is also key to ensure that novel knowledge is disseminated to clinical personnel and patients in an effective manner. Work package 1 work closely with the Clinical trial unit to expand knowledge­sharing across studies, e.g. regarding the new CTIS system for European approval of clinical trials.

Studies conducted within the work package (NOR­DRUM, NORD­STAR and ARCTIC REWIND) have gained international attention i.e. in review sessions at the European rheumatology congress EULAR, – and have led to development of new guidelines, nationally and internationally.

We were especially proud of a new initiative to include climate footprint as an outcome measure in clinical trials, this proposal was launched through a perspective paper in NEJM, with international attention.

Highlights of the Year

Start of new study: The large RA­DRUM, HIFSAT and MOVE­JIA trials have been initiated across Norway, and have started recruitment.

Results: Main results from ARCTIC ­REWIND (assessing tapering of disease­modifying anti­rheumatic drugs in rheumatoid arthritis) and novel results from the NOR­DRUM (therapeutic drug monitoring) and NORD ­STAR (comparison of disease­modifying anti­rheumatic drugs in early rheumatoid arthritis) trials have been published.

International attention: A new initiative to include climate footprint as an outcome measure in clinical trials has received wide national and international attention.

Key Publications

Nordberg, L. B., et al. “Carbon­Footprint Analyses in Rcts ­ toward Sustainable Clinical Practice.” N Engl J Med 390.24 (2024): 2234­36.

Kjorholt, K. E., et al. “Effects of Tapering Conventional Synthetic Disease­Modifying Antirheumatic Drugs to Drug­Free Remission Versus Stable Treatment in Rheumatoid Arthritis (Arctic Rewind): 3­Year Results from an Open ­ Label, Randomised Controlled, Non­Inferiority Trial.” Lancet Rheumatol 6.5 (2024): e268­e78.

Brun, M. K., et al. “Clinical Consequences of Infliximab Immunogenicity and the Effect of Proactive Therapeutic Drug Monitoring: Exploratory Analyses of the Randomised, Controlled nor­Drum Trials.” Lancet Rheumatol 6.4 (2024): e226­e36.

Aim

The main aim of work package 1 is to develop, assess and implement innovative interventions to optimize patient outcomes in rheumatic and musculoskeletal diseases. This includes investigation of personalized treatment strategies, novel drugs, surgical procedures, imaging guided interventions, and non­pharmacological therapies.

WP2: Phenotyping for Personalized Medicin

Phenotyping for Personalized Medicine Work Package 2

Leader

Hilde Berner Hammer, Professor, MD PhD

Co­leader

Guro Løvik Goll, Associate Professor, MD PhD

Co­leader

Benedicte Lie, Professor, PhD

Viewpoint

Phenotyping and stratifying rheumatic diseases are necessary to personalize treatment and to understand disease processes. Work package 2 promotes collaboration between clinicians, clinical scientists, and laboratory researchers. We facilitate the exchange of results and ideas between translational science and clinicians to benefit all of REMEDY.

The clinical studies within REMEDY provide samples of blood and tissue, crucial for addressing key questions within rheumatic and musculoskeletal diseases to achieve our key aim of personalized treatment. In 2024, we established facilities to isolate and store leukocytes (PBMC). Further, a new biobank facility for the storage of cells, blood samples, joint fluid, and synovial biopsies was opened at Diakonhjemmet Hospital.

Synovial biopsies are central to several national partners and international collaborations in the next few years. We have a strong collaborative network within the Oslo area combining expertise in rheumatology, immunology, genomics, and single­cell and spatial biology for in­depth studies of the underlying pathological processes, uncovering biomarkers, predicting

treatment outcomes, and finding new treatment targets. Working with world­leading research groups, we have planned for ambitious projects assessing the fine molecular characteristics of arthritis subgroups.

We included the first patient in the study “Early STratification of patients with acute ARThritis” (START). The primary aim is to identify markers in early inflammatory arthritis to ensure timely diagnosis and correct initial treatment. The study involves collaboration across several disciplines, and includes a broad assessment of laboratory variables, immune cell characterizations, and genetics to identify potential markers in joint fluid and biopsies.

Single­cell RNA sequencing and spatial transcriptomics of synovial fluid or synovial tissue from 46 patients with juvenile idiopathic arthritis were completed, and analyses are ongoing.

In the Nor­VaC project, we assessed the course of COVID ­ 19 among patients with immune­mediated diseases and the need for COVID vaccine booster doses.

Work package 2 organised a fall seminar with international leaders in the field of personalized medicine, resulting in extended participation

in international studies. The contact between basic­, translational­ and clinical researchers has thus been proven valuable and resulted in several new emerging projects in 2024.

Highlights of the Year

Seminar: Work package 2 organized two scientific seminars with international leaders in the field of personalized medicine. In February, professor Vibeke Videm (NTNU, Norway) talked about physical activity in people with rheumatoid arthritis, while professor Anne Barton (UK) discussed precision medicine in rheumatoid arthritis. In May, professor Gertjan Wolbink (the Netherlands) presented the Dutch experience with therapeutic drug monitoring.

Funding: The European multicenter study “Defining Clinical and Molecular Phenotypes of Multi­Drug Resistance in difficult­to­treat Rheumatoid Arthritis” (the MDR­RA study) received the highest possible score and was funded by the EU (Horizon Europe). Diakonhjemmet Hospital is one of the partners in the consortium.

Biobank: Establishment of a new biobank and a cell laboratory at Diakonhjemmet Hospital.

Key Publications

Ørbo, H. S., et al. “Humoral and Cellular Responses to a Fifth Bivalent Sars­Cov­2 Vaccine Dose in Patients with Immune­Mediated Inflammatory Diseases on Tumour Necrosis Factor Inhibitors: A Prospective Cohort Study.” Lancet Reg Health Eur 48 (2025): 101121.

Gjefsen, E., et al. “Efficacy of a Tumor Necrosis Factor Inhibitor in Chronic Low­Back Pain with Modic Type 1 Changes: A Randomized Controlled Trial.” Arthritis Rheumatol (2024).

Ørbo, H. S., et al. “Incidence and Outcome of Covid­19 Following Vaccine and Hybrid Immunity in Patients on Immunosuppressive Therapy: Identification of Protective Post­Immunisation Anti­Rbd Antibody Levels in a Prospective Cohort Study.” RMD Open 10.2 (2024).

Aim

The main aim of work package 2 is to identify novel biomarkers for diagnosis, disease severity, and treatment responses, which can be used for the characterization and stratification of early rheumatic and musculoskeletal diseases, as well as for improvement of treatment response.

WP3: Pain Mechanisms and Management

Pain Mechanisms and Management Work Package 3

Leader

Ida K. Bos­Haugen, Senior Researcher, MD, PhD

Co­leader

Kaja Selmer, Senior Researcher, MD, PhD

Viewpoint

Better understanding of the pain etiology is needed for personalized pain management and better care for patients with chronic pain. We want to identify factors outside the joint that clinicians should have in mind when treating patients with pain due to musculoskeletal and rheumatic diseases. Identifying important biopsychosocial factors, such as altered pain modulation in the central nervous system, emotional factors, cognitive functioning, and genetic factors, that contribute to pain is of importance. Additionally, the work package will focus on classification of people into different pain phenotypes and endotypes, as these may require different management.

In 2024, we continued our work looking at factors outside the joint that could explain part of the pain experience in people with hand osteoarthritis. Two PhD candidates affiliated with work package 3 defended their theses for the degree of PhD, using the rich data collection of the Nor­Hand study. In February, Marthe Gløersen (MD) successfully defended her thesis, Pain and pain sensitization in people with hand osteoarthritis, while Elisabeth Mulrooney (physical therapist) defended her thesis, Pain in hand osteoarthritis in a biopsychosocial

framework in December. A key publication on hand osteoarthritis phenotypes within the Nor­Hand study was published in Osteoarthritis and Cartilage with Elisabeth Mulrooney as first author. Interesting results regarding the strong associations between sleep problems and pain in people with hand osteoarthritis were presented by PhD candidateDaniel Huseby Bordvik at the OARSI and EULAR conferences.

The Nor­Pain study NOR­PAIN was approved by the regional ethical committee. Patients with systemic inflammatory joint diseases who are included in the Nor­DMARD register will be invited to participate in this study on pain sensitization and cognitive factors, and how these factors affect response to biological treatment. The data collection will begin in 2025.

A paper on patient involvement in the rehabilitation process was published from the RehabNytte study, showing that 92% of the specialized rehabilitation population reported long­term pain (> 3 months) prior to rehabilitation admission. The project on a Cognitive Behavioural Therapy Intervention for long­term pain in people with rheumatic and musculoskeletal diseases is still recruiting, and the Avoidance­Endurance fast screening (AE­FS)

was translated to Norwegian and validated for use in this project. Within a study population with fibromyalgia, weak correlations were found between the degree of pain hypersensitivity by quantitative sensory testing and disease severity, pointing to the multifactorial nature of fibromyalgia symptoms.

In January 2024, Mari Spildrejorde (MSc, PhD) started as a postdoc in work package 3. She is working with multi­omics datasets (genetics and epigenetics) to identify molecular associations with pain or pain intensity in patients with distal peripheral neuropathy. She had an oral presentation of her preliminary results at a workshop organized by PAINSTORM, a European consortium working with neuropathic pain, in London in June.

Highlights of the Year

New insight: Analyses of the follow­up data of the Nor­Hand study continued, focusing on the consequences and potential risk factors for pain and pain sensitization in people with hand osteoarthritis.

New funding: Two postdoc projects using data from the PICASSO trial received funding from the Dam foundation and the South­Eastern

Health Authority. These projects will focus on the safety and efficacy of corticosteroid injections, saline injections, and a multimodal occupational therapy intervention as well as clinically relevant changes and acceptable symptom state in people with osteoarthritis in their thumb base joint.

Outreach: Kaja K. Selmer and Mari Spildrejorde presented the research in work package 3 in a webinar arranged by Norwegian Rheumatism Association in November.

Key Publications

Mulrooney, E., et al. “Hand Osteoarthritis Phenotypes Based on a Biopsychosocial Approach, and Their Associations with Cross ­ Sectional and Longitudinal Pain.” Osteoarthritis Cartilage 32.8 (2024): 963­71.

Pettersen, P. S., et al. “Pain Sensitization in Fibromyalgia. Cross­Sectional Associations between Quantitative Sensory Testing of Pain Sensitization and Fibromyalgia Disease Burden.” Eur J Pain 29.1 (2025): e4771.

Aim

The primary aim of work package 3 is to increase the understanding of the complexity of pain and the variety of different factors that can contribute to pain. Additionally, we aim to identify subgroups of patients with similar characteristics and clinical outcomes.

WP4: Managing Comorbidities

Managing Comorbidities Work Package 4

Leader

Anna­Maria

Hoffmann­Vold, Professor, MD PhD

Co­leader

Eirik Ikdahl, Postdoc researcher MD PhD

Viewpoint

Patients with inflammatory rheumatic diseases have an increased risk of comorbidities and organ manifestations. Despite advancements in treatment, significant knowledge gaps persist in effectively managing these complex conditions, highlighting the need for ongoing research and innovation to optimize patient outcomes and improve overall care.

In 2024, a new leadership was established, broadening the research scope of the work package. While maintaining a strong focus on cardiovascular conditions, the work package also expanded to explore the impact of rheumatic diseases on pulmonary conditions and other organ systems. This strategic shift aims to provide a more holistic understanding of the various organ manifestations and associated comorbidities, such as osteoporosis, infectious diseases, and diabetes.

Two manuscripts were published, utilizing data from the comprehensive nationwide Norwegian Cardio­Rheuma register. The first explored the risk of ischemic stroke in patients with rheumatoid arthritis, while the second examined the impact of stable anti­rheumatic therapy on the

risk of cardiovascular disease in these patients. In October 2024, Kristine Røren Norden defended her thesis entitled Cardiorespiratory fitness in patients with inflammatory joint disease: Associations, validity of assessment and effects of an exercise intervention with data from the ExeHeart trial, a randomized controlled trial on high­intensity training. The manuscript on the main effect of this trial was published in RMD Open in January 2024, gaining a lot of publicity in the mass media.

Work package 4 is involved in several collaborative networks, including the Better Diet study, a Scandinavian multicenter randomized controlled trial comparing the effects of brief versus extended information on heart­friendly diets on lipids, dietary changes, and carbon footprint. Funding for a PhD candidate in this study was secured from the Dam Foundation. The SURF­SLE project, led by work package 4, is another comprehensive international consortium dedicated to systematically recording cardiovascular risk factors and examining preventive treatments in 3,401 patients with systemic lupus erythematosus across 27 centers in 24 countries. The collaboration culminated in 2024 in a publication of the findings in Lancet Rheumatology.

Highlights of the Year

Leadership Transition: Anne Grete Semb stepped down as the leader of the work package, and we welcomed professor Anna­Maria Hoffmann­Vold, who specializes in pulmonary manifestations of inflammatory rheumatic conditions, as the new work package leader. Eirik Ikdahl continues as the co­leader.

Positions: Eirik Ikdahl started as a postdoc in September 2024.

Completed study inclusion: Patient recruitment to the Better Diet trial in Norway was completed, with more than 100 participants enrolled, and we are well on our way to reach our goal of enrolling the last patient in the study by the end of August 2025.

All About Clinical Trials: A course covering all aspects of conducting clinical trials, took place at Diakonhjemmet Hospital in December 2024. This event was a collaboration with several cardiovascular societies and the REMEDY center.

Key Publications

Bolla, E., et al. “Prevalence and Target Attainment of Traditional Cardiovascular Risk Factors in Patients with Systemic Lupus Erythematosus: A Cross­Sectional Study Including 3401 Individuals from 24 Countries.” Lancet Rheumatol 6.7 (2024): e447­e59.

Kerola, A. M., et al. “Rheumatoid Arthritis and the Risk of Ischaemic Stroke after Diagnosis of Atrial Fibrillation: A Norwegian Nationwide Register Study.” Rheumatology (Oxford) 63.11 (2024): 2997­3005

Vrints, C., et al. “2024 ESC Guidelines for the Management of Chronic Coronary Syndromes.” Eur Heart J 45.36 (2024): 3415­537.

Participants of the AACT course, Diakonhjemmet Hospital, Oslo 2024

Aim

The main aim of work package 4 is to develop and evaluate strategies for optimal management of comorbidities and organ manifestations in patients with rheumatic and musculoskeletal diseases, including the prevention of cardiovascular disease and identification and management of other important comorbidities and organ manifestations such as lung diseases and diabetes mellitus.

WP5: Innovative Approaches to Remote Care

Innovative Approaches to Remote Care Work Package 5

Leader Nina Østerås, Professor, Physical Therapist, PhD

Co­leader

Anne Therese Tveter, Professor, Physical Therapist, PhD

Viewpoint

Demographic shifts and an anticipated shortage of healthcare personnel necessitate smarter work strategies within the healthcare sector. Prioritizing digitalization, technology, and remote care may be essential for achieving sustainability. Regional Health Trusts are directing the specialist healthcare to adopt remote care strategies for personalized patient follow­up. However, further research is needed to establish the efficacy and safety of these strategies. Included in work package 5 are four randomized controlled trials (ReMonit, NOR­Flare, ReMonit Gout, OA­AID) and one qualitative study (RemoteUX) as primary initiatives, alongside three additional associated randomized controlled trials.

Key findings from the ReMonit study, which involved 243 patients with axial spondyloarthritis, were presented as a late­breaking abstract at the EULAR Congress. This study compared remote monitoring and patientinitiated care with conventional prescheduled face­to­face consultations. Our postdoctoral researcher has conducted interviews with healthcare professionals from the ReMonit and NOR­Flare (remote monitoring in rheumatoid arthritis) studies as part of the RemoteUX

study. Published findings from the ReMonit study revealed high patient willingness to utilize remote care and high adherence to digital reporting of health­related information on a regular basis. These findings have attracted nationwide attention, receiving coverage from major communication platforms such as Dagens Medisin, Forskning.no, and Health Talk. Additionally, a systematic review of 40 randomized controlled trials on the costeffectiveness of remote care was submitted for publication in 2024.

The ReMonit Gout feasibility study tested Urika, a self­management app for people with gout, with 21 participants and three months follow­up. In October, a postdoctoral fellow joined the project team. The OA­AID feasibility study has begun recruiting participants to assess the Genus app among people referred for specialist healthcare consultations due to knee osteoarthritis, enrolling eligible individuals via telephone. Oslo Metropolitan University has secured funding for a new PhD candidate in the OA­AID study, starting in February 2025.

A senior advisor/coordinator of the regional network for decentralized clinical studies, RECONNECT, commenced in June. Sub­

sequently, the RECONNECT webpage was launched, and meetings for the entire network, as well as for individual work packages, have taken place. During Arendalsuka 2024, a well­attended debate on the implementation and research needs of remote care pathways was held, attracting over 70 in­person attendees and more than 200 viewers via digital streaming. RECONNECT arranged their first network conference in November, focusing on strategies to prevent studies from ending up in the “pilot cemetery”.

Highlights of the Year

New funding: The Remote Monitoring and personalised patient pathways in young adults with Juvenile Idiopathic Arthritis (ReMonit JIA) clinical trial received funding from South­Eastern Norway Regional Authority (9 million NOK).

New achievement: Approvals for two studies (The ReMonit Gout and the OA­AID) with patient apps applied under the EU regulation for medical devices were obtained from the Norwegian Medicine Agency and the Regional committees for medical and health research ethics (REK KULMU).

Completed patient recruitment or data collection: The NOR­Flare study testing remote monitoring completed recruitment of 260 patient participants with rheumatoid arthritis. The ReMonit Gout feasibility trial of the patient app, Urika, completed its three months follow­up data collection.

Key Publications:

Martinsen, L., et al. “Usage, Attitudes, Facilitators, and Barriers toward Digital Health Technologies in Musculoskeletal Care: Survey among Primary Care Physiotherapists in Norway.” JMIR Rehabil Assist Technol 11 (2024): e54116.

Thomassen, E. E. K., et al. “Patients with Axial Spondyloarthritis Reported Willingness to Use Remote Care and Showed High Adherence to Electronic Patient­Reported Outcome Measures: An 18­Month Observational Study.” Rheumatol Int 44.10 (2024): 2089­98.

Berg, I. J., et al. “Remote Monitoring and Patient­Initiated Care Compared to Regular Face­to­Face Outpatient Visits in Axial Spondyloarthritis: Results from a Randomized Non­Inferiority Trial.” Ann Rheum Dis 83.Suppl 1 (2024): 234­35.

Aim

The main aim of work package 5 is to determine the feasibility, efficacy, safety, user satisfaction, and cost­effectiveness of remote care.

WP6: Deciphering Long-term Outcomes

Deciphering Long-term Outcomes Work Package 6

Leader

Sella Provan, Professor, MD, PhD

Co­Leader Till Uhlig, Professor, MD, PhD

Viewpoint

To achieve our aims we have chosen to focus our work in three key areas.

Epidemiological Data

The epidemiological studies of work package 6 utilize data from several cohorts owned by members of the REMEDY center, both at Diakonhjemmet Hospital and Oslo University Hospital, together with data from collaborating centers in Norway and abroad. The largest cohorts are the NOR­DMARD, NOR­GOUT, and RehabNytte. In NOR­DMARD, we have continued to share data with Nordic and European partners, including one EU project, resulting in several publications. We have also had success in renewing our linkages to national Norwegian registries. Three PhD candidates and one postdoctoral researcher are currently working on NOR­DMARD data, while Ingrid Egeland Christensen successfully defended her PhD thesis in September 2024. NOR­GOUT has completed the 5­year followup of patients with gout who are “treated to target” and the data collection is coming to an end. Eleven papers have been published

from NOR­GOUT, and there are still two more papers in the pipeline. In RehabNytte, patients who have participated in national rehabilitation programs have been linked to the National Welfare Agency (NAV) register. A PhD candidate is currently exploring work productivity and welfare benefit expenditure in response to rehabilitation with her team of supervisors.

Health Economic Evaluations

Within health economics, work package 6 has delivered assistance to several projects that wish to include health economic outcomes and analyses. Four master students from the health economic studies at the Department of Health Management and Health Economics at the University of Oslo have worked on data from this work package, solidifying our collaborations with the University of Oslo and preparing the ground for new publications.

Novel Trial Design and Big Data

We collaborate with the Department of Research Support for Clinical Trials at Oslo University Hospital in comparing the efficacy of biological disease­modifying anti­rheumatic

drugs in a target trial emulation. We also have an ongoing collaboration with SINTEF for the analyses of big data from our many cohorts. Lastly, work package 6 is pleased to have received funding for a postdoctoral researcher on the TODAY trial. This randomized controlled trial is embedded in the NOR­DMARD cohort, and will hopefully pave the way for exciting new opportunities.

Highlights of the Year

Dissertation

Ingrid Egeland Christensen successfully defended her thesis titled Serious Infections in patient with inflammatory joint diseases Sigrid Reppe Moe successfully defended her thesis Outcome and identification of early risk factors in a population­based Systemic Lupus Erythematosus cohort set in Norway.

Funding

The TODAY study received funding.

Key Publications

Provan, S. A., et al. “Interstitial Lung Disease in Patients with Rheumatoid Arthritis or Psoriatic Arthritis Initiating Biologics and Controls: Data from 5 Nordic Registries.” J Rheumatol 51.11 (2024): 1111­18.

Uhlig, T., et al. “Non­Adherence to Urate Lowering Therapy in Gout after 5 Years Is Related to Poor Outcomes­Results from the Nor­Gout Study.” Rheumatology (Oxford) (2024).

Moe, S. R., et al. “Persisting Mortality Gap in Systemic Lupus Erythematosus; a Population­Based Study on Juvenile­ and Adult­Onset SLE in Norway 1999­2022.” Rheumatology (Oxford) 63.8 (2024): 2109­17.

Aim

The aim of work package 6 is to examine the longterm efficacy, safety, work participation, and health economic consequences associated with novel drugs and treatment strategies through linkage to national and international registry data.

Empowering the Individual Work Package 7

Leader

Ingvild Kjeken, Professor, Occupational Therapist, PhD

Co­leader

Anne Therese Tveter, Professor, Physical Therapist, PhD

Viewpoint

Empowerment and self­management are central in all activities in the work package, rooted in an understanding that the origins of good health are not necessarily the same as the origins of poor health. Effective health promotion interventions therefore need to build on patients’ strengths and resources and be adapted to their level of self­efficacy and health literacy, and their social, economical and cultural context.

A total of 13 studies are primarily affiliated to this work package, among them six studies aimed at developing effective interventions and ensuring high quality in the care for people with osteoarthritis, three studies focusing on improved quality and coordination in rehabilitation, and one study exploring the involvement of patients in the development and delivery of healthcare services. The development of innovative eHealth interventions such as apps and web­based programs is a common focus across studies. With a steadily increasing immigrant population, we have a particular focus on how to improve communication between immigrant patients with rheumatic diseases, health professionals, and employees in the Norwegian Labor and Welfare

Service, to improve treatment outcomes for these patient groups. The work package also hosts the REMEDY Patient Advisory Board. The patient research partners are involved in all new projects from the initial phase, when research questions are developed, to the implementation of results and interventions in clinical practice. The output in 2024 included 12 scientific articles, two master theses, one PhD thesis, two articles in mass media, two in Norwegian journals, 16 presentations at international and national conferences, and the Dialogue seminar in collaboration with the Norwegian Rheumatism Association. Through these efforts, we built important expertise to meet future needs for flexible, sustainable, and cost­effective healthcare services.

Highlights of the Year

Thesis Completed: PhD candidate Joachim Sagen defended his thesis, Patient engagement in the development and delivery of healthcare services

New Funding: The DRIVE study, piloting a new collaborative model including digital support and a tailored rehabilitation application, and the Diagnostic puzzle, a digital

tool for improved health competence and illness perception, received funding from the DAM Foundation.

Patient Involvement in Research: The creditawarded course on Patient and Public Involvement in Medical and Health Research was arranged in collaboration with the University of Bergen, the Norwegian Health Association, and five other centers/networks.

Three Completed Studies: The study on Patient engagement in healthcare services, which is part of the RehabNytte study, resulted in four publications (one published in 2024) and a PhD thesis.

The BRIDGE trial was a collaboration between six rehabilitation centers, aiming for improved quality, professional practice, and cost­effective utilization of healthcare resources. One postdoc and one postdoctoral student have published six articles in rehabilitation journals (of which three were published in 2024).

In the third study (the CMC1 study), involving three hospitals, the main aim was to evaluate if occupational therapy in the waiting period before surgical consultation may reduce or

delay the need for surgery in carpometacarpal osteoarthritis. One PhD candidate and one postdoc candidate have published a total of eight articles based on study results (of which one article published in 2024).

In the two last studies, all participants have received a summary in lay language of the main results.

Key Publications

Tveter, A. T., et al. “Development of the Happy Hands Self­Management App for People with Hand Osteoarthritis: Feasibility Study.” JMIR Form Res 8 (2024): e59016.

Berdal, G., et al. “Does Follow ­ up Really Matter? A Convergent Mixed Methods Study Exploring Follow­up across Levels of Care in Rehabilitation of Patients with Rheumatic and Musculoskeletal Diseases.” Disabil Rehabil 46.23 (2024): 5531­44.

Zink, S., et al. “Who Does What in Hand Osteoarthritis Care? A Qualitative Study of Boundary Work between Rheumatologists and Occupational Therapists in Norway.” J Multidiscip Healthc 17 (2024): 3995­4009.

Aim

The primary aim of work package 7 is to empower patients and enhance their ability and selfefficacy to deal with medical, role and emotional management of their disease.

Clinical Trial Unit

Viewpoint

Clinical Trials Units are specialized units that provide expert methodologi cal advice and coordination required to undertake successful clinical trials, both investigator­initiated and industryfunded trials.

The Clinical Trial Unit was established at Diakonhjemmet Hospital in 2023 and encompasses a heterogeneous group of statisticians/data managers, research coordinators, research advisors, biobank coordinators and study nurses. In 2024, the unit has supported the initiation of new clinical trials and numerous ongoing studies, provided expert trial advice and statistical, epidemiological and methodological support to projects.

An important milestone was reached in 2024 regarding the development of research biobank and laboratory infrastructure at Diakonhjemmet Hospital. The infrastructure was developed by the Clinical Trial Unit in close collaboration with the management at Diakonhjemmet Hospital, and will increase opportunities and facilitate collaboration in national and international research projects.

Established and regularly updated standard operating procedures are essential for conducting high­quality clinical trials and represent a continuous responsibility for the Clinical Trial Unit. Well­functioning routines for pharmacological trials involving the Norwegian and European Medical Agency and relevant ethical committees have resulted in numerous approvals across 2024, including a large international pharmacological study led by Diakonhjemmet Hospital and REMEDY.

Statistical knowledge is vital for interpreting clinical trials. The statisticians in the Clinical Trial Unit are an important part of REMEDY’s research environment. Throughout 2024, they have provided significant support in large­scale data management, data interpretation, study design, and analysis. In addition, by offering statistical guidance across the entire center, they contribute to developing research capabilities across professions.

Collaboration with our external network, including national and international collaborating research environments, South­Eastern Health Regional Clinical Trial Unit, NorTrials, NorCRIN, Inven2, and Biobank Norway, is important for operation and has been prioritized in 2024. Furthermore, internal development and capacity building of Clinical Trial Unit personnel has been a continuous focus area with a vast participation in courses and congresses in areas relating to clinical trials, statistics, privacy regulations and translational medicine and biobank.

Highlights of the Year

Organization: New colleagues have successfully been recruited and onboarded.

Procedures and Guides: The clinical trial unit has developed procedures and guides for working with pharmacological trials and has supported two new multicenter applications and two transition applications in the application system CTIS managed by the European Medical Agency (EMA).

Data Management: Expert statistical advice and guidance have been provided to researchers across REMEDY projects.

Biobank and Research Lab: Major upgrades such as a modern biobank storage facility was built, the research laboratory was upgraded and a sample management inventory solution was obtained.

Orange in the background: Cell counter. Purple box: Freezing box used for controlled freezing of living cells.

Biobank and Research Lab

State­of­the­art Biobank Facility: Diakonhjemmet Hospital opened a state­of­theart biobank facility in 2024. The modern premise holds advanced monitoring, security and ventilation systems and meets regulations and best practice recommendations set by Biobank Norway. The development of this premise increases storage capacity substantially, improves quality, expands types of material that can be utlized and facilitates collaboration in national and international research projects.

“Through REMEDY, we will continue to actively utilize the biobank in future research, particularly to identify biomarkers and develop algorithms for predictive treatment outcomes”, Espen A. Haavardssholm explains.

Research Lab: The research lab at Diakonhjemmet Hospital was expanded and upgraded during 2024 for quality optimization and to ensure various current and future methods can be applied. The upgrade includes new equipment to optimize the processing of biobank samples, increase types of material that can be isolated and expand applicable methods to strengthen opportunities today and in the future.

“These upgrades increase our opportunities and reflect our commitment to research in the field of personalized medicine”, Silje W. Syversen states, leader of work package 1 and project manager of RA­DRUM and START.

Sample Management Inventory Solution: A sample management inventory solution that provides biobank sample tracking and overview was obtained at

Diakonhjemmet Hospital in 2024. This quality system enables a systematic overview of the entire biobank and will increase the use of samples in the future.

Biobank coordinator, Julie Røkke Osen, is processing biobank samples.

Julie Røkke Osen is working with samples in a LAF cabinet.

The National Clinical Consortium

Leader Rheumatology

Marte Schrumpf Heiberg, Senior Researcher, MD, PhD

Leader Rehabilitation

Rikke Helene Moe, Senior Researcher, Physical Therapist, PhD

Viewpoint

Over the past years, cross­regional collaboration within rheumatic and musculoskeletal disease research has been strengthened. With REMEDY, the national collaboration has been extended and formalized by the establishment of a national clinical consortium. All rheumatology hospital departments as well as rheumatologists in private practice and several rehabilitation institutions representing all Norwegian Health Regions are represented in the consortium.

Our digital communication platform enables consortium members to identify potential research partners, exchange project ideas and share information about future and ongoing research, meetings, and webinars.

The Green Congress was arranged in Oslo on June 21, reviewing the latest news within international rheumatic and musculoskeletal disease research. This annual congress has a green profile and a strong focus on climate and sustainability. The Green Congress in 2024 was a great success with more than 400 on­site and virtual attendees.

A digital consortium meeting was held on November 28. An updated status from REMEDY was presented as well as several new research projects, inviting consortium members to participate in planned multicenter studies.

Aim

The aim of the National clinical consortium is to promote and facilitate national multicenter trials, thereby securing equal opportunities for healthcare providers and patients in Norway to participate in clinical trials.

Highlights of the Year

• Green congress was arranged June 21.

• The annual meeting in the National Clinical Consortium was held November 28.

• Results from several multicenter clinical trials conducted within the National Clinical Consortium was presented at international congresses, along with publications in major medical journals.

Specialist Healthcare

• Stavanger University Hospital

• Haukeland University Hospital

• Førde Hospital

• Haugesund Rheumatism Hospital

Rehabilitation Institutions

• Haugland Rehabilitation Center

• Åstveit Rehabilitation Center

• Ravneberg Rehabilitation Center

Specialist Healthcare

• The University Hospital of North Norway HF

• Finnmark Hospital Hammerfest

• Helgeland Hospital Trust

• Nordland Hospital Bodø

Rehabilitation Institutions

• Helsepartner Rehabilitation Center

Specialist Healthcare

• St. Olavs Hospital

• Ålesund Hospital

• Nord­Trøndelag Hospital Trust

Rehabilitation Institutions

• Selli Rehabilitation Center

• Muritunet

• Meråker Kurbad

Specialist Healthcare

• Diakonhjemmet Hospital

• Oslo University Hospital, Rikshospitalet

• Oslo University Hospital, Ullevål

• Martina Hansens Hospital

• Betanien Hospital

• Lillehammer Rheumatism Hospital

• Østfold Hospital

• Sørlandet Hospital, Kristiansand

• Drammen Hospital

• Akershus University Hospital

• Kongsvinger Hospital

• Oslo Rheumatology Practice

• Humana Helse

• The Rheumatologists in Tollbodgata

Rehabilitation Institutions

• Skogli Health and Rehabilitation Center

• Unicare Norway

• Unicare Jeløy

• Unicare Landaasen

• Unicare Hokksund

• Unicare Friskvern

• Vikersund Rehabilitation Center

• The Hernes Occupational Rehabilitation Center

• CatoSenteret Rehabilitation Center

Young Researcher Program

Viewpoint

Leader

Alexander Mathiessen, Postdoc, MD PhD

Leader

Tuva Moseng Postdoc, Physical Therapist PhD

This year, REMEDY has continued its work with its ambitious career development and training program targeting early career researchers.

In April 2024, the annual two­day seminar for early career researchers was successfully arranged with 50 participants. The heading of this year’s seminar was Developing research for the future. Guest Professor Désirée van der Heijde and Professor Robert Landewé participated in the seminar. They shared insights from the development of their own careers, focusing on the importance of choosing career paths you enjoy. Their other presentations, focusing on subjects such as methodology, how to write your first paper and how to recognize fraud in science were greatly appreciated. Other program highlights ranged from topics such as mobility, international collaboration and practical tips for everyday life. Many of the participants presented their work in short flash talks.

The mentoring program for early­career researchers continued in 2024, and the three researchers in the program regularly met with their mentors. The meetings provided personalized guidance and support and gave the researchers unique opportunities to benefit from the mentors’ extensive professional network and experience.

REMEDY also continued to fund young researchers at critical stages of their careers. In 2024 three research projects received grants. This funding aims to foster innovative and impactful research that can contribute significantly to their respective fields.

As a new initiative, an All About Clinical Trials course was arranged in December as a collaboration between REMEDY and The European Society of Cardiology. The comprehensive program of the course provided an insight into methodological issues regarding study design and trial conduction, as well as the interpretation of trial results, newly proposed clinical trial methodologies, and regulatory requirements.

In 2024, three research projects were awarded grants ranging from 155,000 to 190,000 NOK each. These funds aim to support innovative and impactful research with the potential to make significant contributions to their respective fields.

GRANT RECIPIENTS

Lene Bugge Nordberg

Diakonhjemmet Hospital

Carbon Footprint Analyses in Clinical Trials

– 190,000 NOK

Abel M. Tesfaye

Oslo University Hospital

Immune Cells in the Synovial Tissue in Juvenile Idiopathic Arthritis

– 155,000 NOK

University of Oslo

Stratification of Inflammatory Arthritis Using Immunophenotyping

– 155,000 NOK

Øyvind Bakke

Highlights from the YRP seminar at Leangkollen, with Professor Désirée van der Heijde and Professor Robert Landewé.

International Collaboration

REMEDY is involved in numerous large international collaborations. A few key projects are highlighted here.

MDR ­ RA

The MDR­RA consortium, focusing on multidrug resistance in patients with rheumatoid arthritis, received funding from the European Union’s Horizon Europe research and innovation program in 2024. Diakonhjemmet Hospital is one of 23 partners in the project, which will get started in 2025.

SQUEEZE

The SQUEEZE project, funded by the European Union’s Horizon Europe research and innovation programme, addresses three critical unmet needs in rheumatoid arthritis treatment: (a) guidance on selecting the most effective drug; (b) optimization of dosage or administration route; and (c) development of care settings and digital support tools to maximize drug benefits.

The project’s conceptual approach combines large­scale data analysis and clinical trials to predict drug response. This includes translational studies and innovative biomarker platform validation, complemented by behavioral research and design thinking for real­life implementation. REMEDY plays an active role in SQUEEZE, contributing to all clinical trials and several other initiatives.

ScandRA

ScandRA is a European Research Area PerMed partnership built on successful international collaborations among academia, healthcare, patients, industry, and SMEs in biomarker technologies, data interoperability, and e­health. Scandinavian partners, including REMEDY, have amassed extensive longitudinal data from rheumatoid arthritis patients through registries and biobanks.

The project utilizes unique cohorts with detailed clinical information on disease activity, treatment, and lifestyle, paired with novel genomic and biomarker data from blood samples. ScandRA focuses on integrating these findings into clinical practice, advancing personalized care for rheumatoid arthritis patients.

Hand Osteoarthritis

Classifi cation Criteria

The paper on EULAR hand osteoarthritis classification criteria was published in Annals of Rheumatic Diseases in 2024. This international collaboration was led by senior researcher Ida K. Bos­Haugen from REMEDY together with Professor Margreet Kloppenburg from Leiden University Medical Center (the Netherlands) and professor David T. Felson from Boston University (USA).

Occupational therapist Merete HermannEriksen and senior researcher Rikke H. Moe from REMEDY participated in the international expert panel together with other osteoarthritis experts from Europe, USA, Asia, and Australia.

Quality Indicator

Questionnaires

for Hip, Knee and Hand Osteoarthritis

In 2024, two parallel processes were undertaken to update and revise the quality indicator questionnaire for hip and knee osteoarthritis as well as develop ing a new quality indicator questionnaire for hand osteoarthritis. The work on developing a new quality indicator questionnaire for hand osteoarthritis was led by Professor Ingvild Kjeken from REMEDY in collaboration with expert researchers from UK, France, Sweden, the Netherlands, and Turkey. The update and revision of the quality indicator questionnaire for hip and knee osteoarthritis was led by Professor Nina Østerås from REMEDY together with expert researchers from Ireland, UK, the Netherlands, Austria, Australia, Germany, and New Zealand. Several other researchers, clinicians, and patient research partners from REMEDY participated in the two processes.

Main

International Collaborators

The main international collaborators in the map below represent major institutions across the globe that significantly strengthen the research conducted in the REMEDY center:

Parker Institute, Denmark

• Prof. Henning Bliddal

Keele University, UK

• Prof. Krysia Dziedzic

University of Iceland, Iceland

• Prof. Saedis Saevarsdottir

Leiden University, the Netherlands

• Prof. Désirée van der Heijde

• Prof. Tom Huizinga

• Prof. Margreet Kloppenburg

Queen Mary University of London, UK

• Prof. Costantino Pitzalis

Harvard University, USA

• Prof. Daniel H. Solomon

Boston University, USA

• Prof. Tuhina Neogi

• Prof. David Felson

University of Toronto, Canada

• Prof. Gillian Hawker

Lund University, Sweden

• Prof. Martin Englund

Karolinska University, Sweden

• Prof. Johan Askling

• Prof. Jon Lampa

University of Oulu, Finland

• Prof. Simo Saarakkala

Copenhagen University, Denmark

• Prof. Mikkel Østergaard

• Prof. Merete Hetland

• Prof. Lene Terslev

Aarhus University, Denmark

• Prof. Annette de Thurah

Vienna Medical University, Austria

• Prof. Daniel Aletaha

Free University Berlin, Germany

• Prof. Xenofon Baraliakos

Sorbonne University, France

• Prof. Laure Gossec

• Prof. Jérémie Sellam

Escola Superior de Enfermagem de Lisboa, Portugal

• Researcher Ricardo Ferreira

Visiting Professor Daniel H. Solomon

An International Expert at REMEDY

Over the past two years, Professor Daniel H. Solomon has been a highly valued visiting professor at REMEDY, contributing his unique expertise and inspiration to the center’s research environment.

As a Professor of Medicine at Harvard Medical School and the Matthew H. Liang Distinguished Chair in Arthritis and Population Health at the Brigham and Women’s Hospital in Boston, MA, USA, Professor Solomon is recognized as a world­leading researcher in rheumatology.

His research focuses on a wide range of topics, including health services research, pharmacoepidemiology, comorbidity, and quality of care in the treatment of rheumatic diseases and osteoporosis.

With over 450 original scientific articles and numerous prestigious awards, he has left a significant mark on the field. During his two years with REMEDY, he has strengthened collaborations between REMEDY and international research communities, mentored young researchers, and contributed to the development of new research initiatives.

As Professor Solomon’s visiting professorship draws to a close, his contributions to REMEDY highlight the trans ­

formative potential of international collaboration in enhancing research quality and driving innovation.

What motivated you to accept the role as a visiting professor at REMEDY? I have long­standing collaborations with many of the REMEDY investi gators. These relationships have allowed me to recognize the many strengths of the REMEDY center and its people. In addition, I have had the good fortune to host several REMEDY investigators in Boston for clinical research training. Thus, I know that REMEDY investigators are world­class.

You have led several pivotal studies in rheumatology and osteoporosis. What would you highlight as a milestone in your research career?

I have published 100s of papers in rheumatology and osteoporosis, so its hard to pick one area of my research as a milestone. Much of my work has focused on comorbidities in patients with rheumatoid arthritis, with a particular focus on cardiovascular disease. My work on

cardiovascular diseases in rheumatoid arthritis has spanned my entire 30 years in rheumatology. Early studies began by estimating the relative risk of cardiovascular events in rheumatoid arthritis. We then examined risk factors for cardiovascular disease among patients with rheumatoid arthritis, focusing on developing a risk score that could be used by clinicians. This risk score has been validated in Sweden and recently in China. We continually try to make this work relevant for the clinician and patient and are now working on treatment protocols that might impact cardiovascular outcomes in rheumatoid arthritis.

You are known for being an excellent mentor for younger researchers. What is your approach to supporting and inspiring the next generation of scientists? Is there a piece of advice you always share with your mentees? I like to get to know the people who I am mentoring: what are their career and personal goals, what role will research play in their professional life, what are their personal strengths and

weaknesses, and what do they like to do outside of research. Understanding these issues allows me to help find projects that will fit their goals and allow them to succeed. I have many pieces of advice that I like to share with mentees. Some of them include: study topics that excite you and will matter to patients; learn the methods well and the rest will follow; and tell your research story as clearly as possible.

With an impressive and very productive career, what are your strategies to manage the wide range of responsibilities as a researcher, clinician, and leader? This is a great question and one that many young researchers ask me – how do I balance and prioritize all of the activities of an academic rheumatologist. I always start by saying that priorities change over time and that one should regularly re­consider whether you are prioritizing appropriately for where you are in your career. At the start of a career, researchers need to spend a lot of time raising funds (at least in the US), which means writing grants. You also have to

bolster your reputation, which means writing a lot of papers. Thus, time spent on clinical activities cannot be too large. Over time, as a researcher’s reputation grows, leadership opportunities often follow. However, researchers may need to approach local institutions, national organizations, or research groups soliciting for opportunities to lead. Navigating these issues is not easy; good mentors are willing to help a young researcher decide on priorities.

What are your thoughts about working in an international academic environment, such as the collaboration with REMEDY and Diakonhjemmet Hospital?

I find international collaborations very exciting and interesting on multiple levels. First, its great to find common interests across clinical researchers who work in different parts of the world. Second, it’s fascinating to understand the local nuances of how research is undertaken. Finally, I love to meet intelligent and nice people who can teach me about their culture.

Are there any differences between the Norwegian and US approaches to research? What can the Norwegian system learn from the US? While the funding approaches are different, the research approaches are very similar. One of the great strengths of Norway is the array of available national datasets, allowing researchers to include large swaths of the national population in a study. This is very challenging for us in the US, but the US has a very large and diverse population, which comes with its own set of research benefits.

On a more personal note – how do you unwind from a career as busy as yours? Do you have any hobbies or interests outside of medicine?

I have many hobbies. I grew up as an athlete and played on the tennis team at college. I still play tennis and squash. I also took up painting during the pandemic. Painting is a great hobby and very meditative, but please, don’t ask me to show you my paintings! In addition, my wife and I love to travel, especially to Scandinavia.

Implementation

Leader Per Olav Vandvik, Professor, MD PhD

Leader

Leticia Kawano­Dourado, Senior Researcher, MD PhD

Leader

Eirik Klami Kristianslund, Postdoc Researcher, MD PhD

Aims

To bridge the gap between new research findings and clinical practice through BMJ Rapid Recommendations, including their adaptation for national contexts and practical implementation.

Additionally, these recommendations present a valuable opportunity to deliver trustworthy, accessible, and timely guidance to a global audience, particularly in the realm of personalized medicine.

Viewpoint

REMEDY is committed to translating findings from its clinical research program into practice. In partnership with Diakonhjemmet Hospital, the Norwegian Rheumatism Association, and MAGIC Evidence Foundation, clinical practice guidelines are developed based on high­quality clinical trials conducted by REMEDY, such as the guideline on proactive therapeutic drug

monitoring of biologic drugs for immune mediated inflammatory diseases successfully published in the BMJ in 2024. The translation of REMEDY research results into clinical practice guidelines employs advanced standards and methods to produce trustworthy guidelines. Guideline development is triggered by the results from REMEDY randomized controlled trials with the potential to significantly impact clinical practice.

Local Implementation

Further integration into a Norwegian scenario was achieved through a collaboration with the Norwegian Society of Rheumatology, that translated and adapted the proactive clinical practice guideline of therapeutic drug monitoring to the Norwegian setting. A research project has been started to assess the implementation of this guideline, within the context of Enhancing the Evidence Ecosystem (E3) – an implementation research project from MAGIC and Lovisenberg Diaconal Hospital funded by South­Eastern Hospital Trust.

Looking ahead, integrating evidence­based decision support into digital patient systems, including electronic health records, is a primary goal. This aligns with MAGIC EVIDENCE’s mission, and REMEDY collaborates with external partners to advance this objective.

The Digital and Trusthworty Evidence Ecosystem

McMaster University

Systematic reviews / network meta-analysis with evidence summaries

REMEDY

Potentially practice changing evidence published

Tools and platforms

Trustworthy evidence

Digitally structured data

Universal standards Coordination and support

Evaluate impact in practice

MAGIC app

Produced trustworthy guidance ready for submission and review

Common methodology

Culture for sharing

BMJ

Disseminate guidance to policy makers, clinicians and patients globally, ready for re-use and adaptation

E3

Implement guidance and decision support

• The publication of a clinical practice guideline on proactive therapeutic drug monitoring of biologic drugs for immune­mediated inflammatory diseases in BMJ.

Figure 1: The figure illustrates the Digital and Trustworthy Evidence Ecosystem, where the ultimate goal is to increase value and reduce waste in healthcare and research by facilitating the flow (arrows) from producing, synthesizing, disseminating and implementing evidence into practice.

• The national adaptation of this guideline in Norway by the Norwegian Society for Rheumatology (Norsk revmatologisk forening).

• Research project started to monitor the effect of these guidelines on the implementation of proactive therapeutic drug monitoring during maintenance treatment with infliximab in Norway.

05 Research Projects

Overview of Research Projects

The REMEDY project portefolio represents the broad approach to assessment of rheumatic and musculoskeletal disease treatment. More information about the specific projects can be found at en.remedy-senter.no/

ALERT

Health literacy in immigrants with inflammatory joint disease

A qualitative study exploring health literacy in immigrants with inflammatory joint disease

ARCTIC

Remission in patients with rheumatioid arthritis

A randomized controlled trial investigating the use of ultrasound in clinical follow­up

ARCTIC FORWARD

10­year follow­up of patients with rheumatoid arthritis receiving early treat­to­target treatment

The project aim to explore the long­term consequences of current recommended treatment

ARCTIC REWIND

Treatment strategies in rheumatoid arthritis after achieving long­term disease control

A randomized controlled trial comparing tapering /discontinuation of disease­modifying drugs to stable treatment

BackToBasic

Anti­inflammatory drugs for long­term low back pain and Modic changes

A randomized controlled trial to explain a possible effect of infliximab

Better Diet study

Dietary advice to patients with inflammatory joint diseases with increased risk of cardiovascular disease

Randomized controlled trial assessing whether a 4­min information about heart­friendly diet is as effective as individually adapted 60­min dietary guidance

BIKE

Biopsies of synovitis from the knee joint of patients with rheumatoid arthritis and osteoarthritis

A study aiming to establish good methods for ultrasound­guided biopsies of synovitis in joints

BioTest

Experimental precision medicine

Observational study investigating whether biopsies from joints can help predict who will benefit from which treatment

BOOGIE

Dynamics in bone turnover markers in relation to glucocorticoid treatment in patients with an inflammatory joint disease

Observational study investigating changes in bone markers during and after treatment

BRIDGE

Continuity and quality in the rehabilitation of patients with musculoskeletal diseases

Care pathway

Development of a treatment pathway for patients with hand osteoarthritis

Diagnostic puzzle

A digital tool to improve disease perception and health literacy in patients with autoimmune rheumatic diseases

A multicenter randomized controlled trial to improve continuity and quality in rehabilitation of people with rheumatic and musculoskeletal diseases

A randomized controlled trial and a qualitative study assessing the effect and experience with task shifting in hand osteoarthritis

Development of a web­page with information on different autoimmune rheumatic diseases

DigiOA

Digital osteoarthritis treatment

A randomized controlled trial comparing an exercise program provided through an app with regular followup with a physical therapist in patients with hip or knee osteoarthritis

DRIVE

Digital rehabilitation and innovative enterprises

Feasibility of a mobile app designed for good workflow in the rehabilitation process

EULAR rec hip knee OA

EULAR recommendations for treatment of hip and knee osteoarthritis

A EULAR task force aiming to update of the EULAR recommendations for non­pharmacological core management of hip and knee osteoarthritis

ExeHeart

Improved Cardiovascular Health for Patients with Inflammatory Joint Disease

A randomized controlled trial investigating whether 12­week high­intensity training improve cardiovascular health and provide better risk factor control than current practice

Exercise in SpA

An overview of reporting of exercise interventions in spondyloarthritis

A systematic review with meta­analyses

Happy Hands

An app for digital self­management of hand osteoarthritis

A multicenter randomized controlled trial assessing the effecacy, cost­effectiveness and experiences with use of the Happy Hands app

HIFSAT

Hip fracture surgical approach trial

A randomized controlled trial comparing two different surgical procedures in patients with hip fracture

Hip Fracture

Diakonhjemmet hip fracture database

A database with over 7000 hip fracture patients collected since 2006

MERINO

Methotrexate in the treatment of erosive hand osteoarthritis

Randomized controlled trial on the efficacy of methotrexate on pain in people with hand osteoarthritis

MethMax

Maximixing treatment effect

A clinical trial assessing if providing methotrexate subcutaneously is more effective than tablets

EU­funded study on difficult to treat rheumatoid arthritis

Analyses of available data, a prospective study, and a randomized controlled trial will be performed.

MOVE-JIA

Best management of juvenile ideopathic arthritis

Randomized controlled trial assessing optimal management of patients with juvenile idiopathic arthritis

MyJIA

Strategies towards personalised treatment in juvenile ideopathic arthritis

A multicenter randomized controlled trial investigating different treatments in patients with juvenile ideopathic arthritis

NCR

The Norwegian Cardio­Rheuma register

A register on the incidence, prevalence and mortality of cardiovascular disease in patients with inflammatory joint disease

NOECON

Health economics in the treatment of patients with inflammatory joint disease

A register study assessing the health economics of treat­to­target treatment in patients with inflammatory joint disease

NOR-CACTUS

Comparison of treatment strategies for carpal tunnel syndrom

A multicenter randomized controlled trial comparing injection treatment and surgery in patients with carpal tunnel syndrom

NOR-DMARD

The Norwegian Antirheumatic Drug Register

An observational study of patients with inflammatory joint disease treated with biological drugs in clinical practice

NOR-DRUM

The Norwegian therapeutic drug monitoring study

A randomized controlled trial investigating the effectiveness of therapeutic drug monitoring in achieving remission in patients receiving infliximab treatment

NOR-PAIN

Pain in people with inflammatory joint disease

An observational study on people with systemic inflammatory joint disease, looking at how biopsychosocial factors are relevant to patient­reported outcomes and treatment response

NORD-STAR

The Nordic rheumatic disease strategy trials and registries study

A multicenter randomized trial in the Nordic countries investigating the effect of active conventional treatment compared three different biologic drugs in early rheumatoid arthritis

NOR-Flare

Remote monitoring of patients with rheumatoid arthritis

A randomized controlled trial comparing remote monitoring to standard follow­up at the hospital in patients with rheumatoid arthritis

NOR-Gout

Gout in Norway

A cohort study investigating outcomes after intensive treatment with the objective to lower serum urate in gout patients

Nor-Hand

Longitudinal observational study of people with hand osteoarthritis

An observational study of people with hand osteoarthritis aiming for increased understanding of pain

NOR-SPRINT

Follow­up of newly diagnosed patients with psoriatic arthritis with and without imaging

A randomized controlled trial assessing whether structured imaging contributes to significantly improved disease control in patients with psoriatic arthritis

Nor-vaC

Immunological response to COVID ­19 vaccine in patients on immunosuppressive therapy

A large cohort study ealuating the immunological response to COVID ­19 vaccines in people on immunosuppressive treatment due to chronic gastrointestial or inflammatory joint disease

PICASSO

Painful inflammatory carpometacarpal­1 osteoarthritis treatment with intraarticular corticosteroids saline or occupational therapy

A randomized controlled trial assessing the effect of corticosteroid injections, saline injections and non­pharmacological treatment

OA-AID

Decision aids and remote monitoring to support shareded decision­making

A randomized controlled trial evaluating a self­management app to increase knowledge and facilitate shared decision making in patients with knee osteoarthritis

QI-HOA

Quality indicators for hand osteoarthritis

Development and testing of a questionnaire to assess patientreported quality of hand osteoarthritis care

QI-OA

Quality indicators for hip and knee osteoarthritis

Update, revision and testing of a questionnaire to assess patientreported quality of hip and knee osteoarthritis care

RA-DRUM

Therapeutic drug monitoring in rheumatoid arthritis

A clinical trial assessing whether therapeutic drug monitoring improves efficacy of biological treatment in rheumatoid arthritis

RehabNytte

Specialised rehabilitation in patients with musculoskeletal diseases

A longitudinal multicenter study aiming at better and more efficient rehabilitation services

ReMonit

Follow­up of patients with spondyloarthritis

A randomized controlled trial comparing two new remote follow­up strategies with standard follow­up at the hospital

ReMonit Gout

Remote monitoring and selfmanagement of gout

A randomized controlled trial investigating a self­management app for patients with gout starting medical treatment to lower their serum uric acid level

RemoteUX

User experience with remote monitoring for patients with inflammatory joint diseases

A qualitative study assessing patients’ and health professionals’ experiences with remote care from the ReMonit trial and the NOR­Flare trial

RIMRA

Rheumatic immune­related adverse events in patients treated with immunotherapy

A study aiming to describe the clinical presentation and disease course of rheumatic immune­related adverse events in patients treated with immunotherapy

SPACE

Spondyloarthritis caught early

A study examining outcomes of spondylarthritis from early disease onset

SPARK

Spondyloarthritis kondis

Development and evaluation of a personalised digital exercise intervention in patients with spondyloarthritis in a randomized controlled trial

SQUEEZE

Maximising impact of prescription drugs in rheumatoid arthritis

A large European consortium comprising several projects addressing different approaches to rheumatoid arthrtitis treatment

START

Stratification of acute inflammatory arthritis

An observational study of patients with new­onset arthritis with the aim of identifying markers for rapid diagnosis and personalised treatment

SURF-RA

Survey of risk factors in rheumatoid arthritis

Survey of cardiovascular disease and risk factor management in patients with rheumatoid arthritis across world regions

Tankegods

Understanding and coping with chronic illness

A study aiming at increased knowledge and improved communication among patients and health professionals.

Zebra

Better prevention of hip fractures

A randomized controlled trial to assess if immediate or delayed treatment of zoledronic acid is equally good after hip fracture

06

Outreach and Publications

SLIK BEHANDLES ARTROSE

RIKTIGST

January

VG, FRONT PAGE

EULAR Recommendations

The European recommendations for the non­pharmacological treatment of hip and knee osteoarthritis were revised based on new research. The initiative was led by Professor Nina Østerås and Associate Professor Tuva Moseng.

They emphasized the importance of ensuring that individuals with osteoarthritis receive recommended treatments to reduce pain, improve function, and enhance quality of life.

The report resulted in extensive media coverage, reaching both clinicians and patients.

February

NRK: NYHETSMORGEN

ExeHeart Study

A study from Diakonhjemmet Hospital shows that high­intensity interval training (HIIT) provides significant benefits for patients with inflammatory joint disease without increasing disease activity.

PhD candidate Kristine Røren Nordén evaluated a 12 ­ week HIIT program delivered by physical therapists in primary care. Published in BMJ Rheumatic & Musculoskeletal Diseases Open, the ExeHeart study confirms that HIIT is both feasible and highly beneficial.

March

DAGENS MEDISIN

Therapeutic Drug Monitoring (TDM)

TDM improves outcomes for patients receiving infliximab, a biologic medication used to treat rheumatic and intestinal diseases.

Researchers found that patients who developed antibodies against infliximab had poorer treatment responses, experiencing fewer initial successes and more cases of lost efficacy and disease worsening over time.

“This highlights the importance of monitoring to optimize treatment,” lead author Marthe Kirkesæther Brun told Dagens Medisin

April

DAGBLADET

Praising New Guidelines for Psoriatic Arthritis Treatment

New research introduces three updated guidelines for treating psoriatic arthritis, now being implemented in Norway: faster initiation of immunosuppressive therapy, personalized treatment plans, and the use of biologic drugs for patients with spinal inflammation.

“This approach significantly reduces symptoms, and some patients feel completely healthy with this treatment,” say consultant physicians Even Lillejordet and Karen Minde Fagerli.

NY BEHANDLING GIR HÅP

NY BEHANDLING GIR HÅP

May

VG, FRONT PAGE New Approach to Prevent Disease Worsening in Chronic Inflammation

Patients with inflammatory diseases affecting the joints, intestines, or skin benefit from biologic TNF inhibitors.

Physician and researcher Marthe Kirkesæther Brun, writing in The Lancet Rheumatology, highlights a new method to prevent disease progression when medication effectiveness declines.

July

VG, FRONT PAGE Take the Stairs to Ease Osteoarthritis

Choosing stairs over elevators can significantly reduce knee and hip osteoarthritis discomfort by protecting and strengthening affected joints.

“When a joint is in use, the cartilage is lubricated. Physical activity strengthens the joint and promotes overall joint health.”

“Using the joints, as you do when climbing stairs, is one of the best things you can do,” Nina Østerås explains, senior researcher and Professor of physical therapy.

Trapper opp mot artrose

September

FYSIOTERAPEUTEN, FRONT PAGE

Increased Need for Digital Solutions

“As the workload for physical therapists rises alongside the growing prevalence of musculoskeletal disorders, we see digital health technology as a key solution for ensuring the sustainability of healthcare services,” physical therapist and PhD candidate Lars Martinsen says in the press release.

Martinsen is the lead author of the recently published article.

Bedre hjertehelse på 12 uker

November

VG, FRONT PAGE

High-Intensity Training Boosts Cardiac Health in Rheumatic Patients

Patients with rheumatic diseases face a higher risk of cardiovascular issues. New research shows that high­intensity interval training (HIIT) is safe and significantly improves cardiac health in this group.

“High­intensity training can safely be a valuable part of treatment,” Kristine Røren Nordén says, who recently completed her PhD.

December

DAGBLADET, FRONT PAGE

Large-Scale Study Debunks Myth About Gout

A major study has disproven the belief that gout is caused solely by poor lifestyle or diet.

Researchers analyzed genetic data from 2.6 million people worldwide. While certain foods, like red meat, can trigger attacks, the primary cause is high uric acid levels and the immune system’s response to it.

Professor Till Uhlig, senior researcher at REMEDY and study co­author, adds: “Hereditary genes play a significant role in why some people develop gout.”

Posters and Presentations

OARSI World Congress 2024

Location: Vienna, Austria

Dates: April 25–28, 2024

Overview: The OARSI World Congress 2024 in Vienna gathered international osteoarthritis researchers and practitioners to discuss breakthroughs in osteoarthritis research and treatment. The congress offered a dynamic forum for presenting cutting­edge research findings and fostering collaborative efforts in the pursuit of effective management strategies for osteoarthritis.

REMEDY Contributions: Seven researchers from REMEDY participated at OARSI. Professor Nina Østerås delivered an oral presentation on findings from the linkage of the SAMBA study with registry data on joint replacement surgery. Additionally, PhD candidate Daniel H. Bordvik presented a poster on the relationship between pain and sleep among hand osteoarthritis patients in the Nor­Hand study. Senior researcher Ida K. Bos­Haugen was acknowledged for her contributions as Secretary and member of the OARSI Board since 2019.

EULAR Annual Congress 2024

Location: Vienna, Austria

Dates: June 12–15, 2024

Overview: The EULAR Annual Congress 2024 in Vienna served as a vibrant platform for the exchange of scientific knowledge and clinical best practices in rheumatic and musculoskeletal diseases. The congress included a diverse range of sessions focusing on new research, therapeutic approaches, and patient care, attracting healthcare professionals, researchers, and patient organizations from Europe and beyond.

REMEDY Contributions: About 40 researchers from REMEDY participated at EULAR this year, participating in a wide array of sessions, with invited lectures, oral abstract sessions, poster presentations, study groups, and symposiums. Rikke H. Moe was elected as EULAR Vice­President HPR, serving at the EULAR Board for the next two years. Anna­Maria Hoffmann­Vold covered a What Is New session about interstitial lung disease, Nina Østerås presented the EULAR recommendations for non­pharmacological core management of hip and knee osteoarthritis, Inger Jorid Berg presented novel and clinically relevant data from the ReMonit trial in a late breaking abstract session, and Silje W. Syversen and our Guest Professor Désirée van der Heijde debated Therapeutic Drug Monitoring: To monitor or not?

Nina Østerås

Rikke H. Moe was elected as EULAR Vice­President HPR

MUSS Conference 2024

Location: Gardermoen, Oslo, Norway

Dates: October 31– November 1, 2024

Overview: Held in Gardermoen, Oslo, the MUSS Conference 2024 centered on multidisciplinary approaches in the management of musculoskeletal diseases. The conference featured scientific presentations, interactive workshops, and expert panel discussions, emphasizing integrated care strategies and the latest technological innovations in treatment. REMEDY contributed as a partner in the 2024 conference, which had a new record of 147 participants.

REMEDY Contributions: Five researchers from REMEDY held oral presentations at the MUSS conference. Ingvild Kjeken and Anne Therese Tveter presented results from the development and testing of the Happy Hands app, and Unni Olsen presented from the Care Pathway trial, both focusing on patients with hand osteoarthritis. Nina Østerås presented results from the ReMonit trial, while Joachim Sagen presented the new EULAR guidelines on user involvement in research. Additionally, two REMEDY researchers (Sella Provan and Rikke H. Moe) contributed in the organizing committee of the MUSS Conference.

Nina Østerås, Rikke Helene Moe, Anne Therese Tveter, Ingvild Kjeken and Unni Olsen

ACR Convergence 2024

Location: Washington, D.C., USA

Dates: November 8–13, 2024

Overview: The ACR Convergence 2024 brought together rheumatology professionals from around the globe to Washington D.C., highlighting the latest advancements in rheumatology research and clinical care. The event featured a comprehensive program, including workshops, presentations, and networking opportunities, aiming to foster collaboration and innovation within the field.

REMEDY Contributions: About 10 researchers from REMEDY participated at the ACR Convergence this year, with oral abstract presentations and poster presentations. A special highlight was the opening ceremony, where the ACR honors outstanding individuals who have made significant contributions to rheumatology research. This year, both our guest professors were honored, with Professor Daniel H. Solomon receiving the Distinguished Clinical Investigator Award, and Professor Désirée van der Heijde receiving the Distinguished International Rheumatology Professional Award. Congratulations to both!

Publications

Ahmadzay, Z. F., Heberg, J., Jorgensen, J. B., Ornbjerg, L. M., Ostergaard, M., Moller-Bisgaard, S., Michelsen, B., Loft, A. G., Jones, G. T., Hellamand, P., Scherer, A., Nissen, M. J., Pavelka, K., Zavada, J., Laas, K., Vorobjov, S., Nordstrom, D., Sokka-Isler, T., Regierer, A. C., Reich, A., Gudbjornsson, B., Thorarinsdottir, K., Iannone, F., Favalli, E. G., van de Sande, M., Provan, S. A., Kvien, T. K., Rodrigues, A. M., Goncalves, C. F., Codreanu, C., Mogosan, C., Rotar, Z., Prikmajer, K. P., Castrejon, I., Otero-Varela, L., Di Giuseppe, D., Wallman, J. K., Ciurea, A., Moller, B., Kenar-Artin, G., Yildirim, T. D., Macfarlane, G. J., Rotariu, O., Glintborg, B., & Hetland, M. L. (2024). Recording of non-musculoskeletal manifestations, comorbidities and safety outcomes in European spondyloarthritis registries: a survey. Rheumatol Adv Pract, 8(4), rkae135. https://doi.org/10.1093/rap/rkae135

Alirezaylavasani, A., Egner, I. M., Dahl, B., Chopra, A., de Matos Kasahara, T., Goll, G. L., Jahnsen, J., Grodeland, G., Vaage, J. T., Lund-Johansen, F., Holter, J. C., Halvorsen, B., Jorgensen, K. K., Munthe, L. A., & Kared, H. (2024). Deficient SARS-CoV-2 hybrid immunity during inflammatory bowel disease. Clin Immunol, 271, 110404. https://doi.org/10.1016/j.clim.2024.110404

Alnaqbi, K. A., Al Adhoubi, N., Aldallal, S., Al Emadi, S., Al-Herz, A., El Shamy, A. M., Hannawi, S., Omair, M. A., Saad, S. A., & Kvien, T. K. (2024). Consensus-Based Overarching Principles and Recommendations on the Use of Biosimilars in the Treatment of Inflammatory Arthritis in the Gulf Region. BioDrugs, 38(3), 449-463. https://doi.org/10.1007/s40259-023-00642-1

Amesbury, R., Ragati-Haghi, H., Mathiessen, A., Laffaye, T., Stein, R. I., Collins, J. E., Kent Kwoh, C., & Duryea, J. (2024). Gender differences in patterns of cartilage loss: Data from the Osteoarthritis Initiative. Osteoarthritis Cartilage, 32(9), 1149-1153. https://doi.org/10.1016/j.joca.2024.04.010

Aringer, M., Distler, O., Hoffmann-Vold, A. M., Kuwana, M., Prosch, H., & Volkmann, E. R. (2024). Rationale for phosphodiesterase-4 inhibition as a treatment strategy for interstitial lung diseases associated with rheumatic diseases. RMD Open, 10(4). https://doi.org/10.1136/rmdopen-2024-004704

BBayramoglu, N., Englund, M., Haugen, I. K., Ishijima, M., & Saarakkala, S. (2024). Deep Learning for Predicting Progression of Patellofemoral Osteoarthritis Based on Lateral Knee Radiographs, Demographic Data, and Symptomatic Assessments. Methods Inf Med, 63(1-02), 1-10. https://doi.org/10.1055/a-2305-2115

Bento da Silva, A., Ramiro, S., van Lunteren, M., Marques, M. L., van de Sande, M., Fongen, C., Exarchou, S., Ramonda, R., van der Heijde, D., & van Gaalen, F. A. (2024). Baseline and 2-year differences in spinal symptoms and spinal and hip mobility in early axial spondyloarthritis and non-axial spondyloarthritis chronic back pain patients. RMD Open, 10(4). https://doi.org/10.1136/rmdopen-2024-004713

Berdal, G., Kjeken, I., Linge, A. D., Aasvold, A. M., Tennebo, K., Eppeland, S. G., Hagland, A. S., Ohldieck-Fredheim, G., Valaas, H. L., Bo, I., Klokkeide, A., Azimi, M., Dager, T. N., & Sand-Svartrud, A. L. (2024). Examining the Building Blocks of Health Behavior Change in Rheumatology Rehabilitation: A Theory-Driven Qualitative Study. J Multidiscip Healthc, 17, 3649-3662. https://doi.org/10.2147/JMDH.S472713

Berdal, G., Sand-Svartrud, A. L., Linge, A. D., Aasvold, A. M., Tennebo, K., Eppeland, S. G., Hagland, A. S., Ohldieck-Fredheim, G., Lindtvedt Valaas, H., Bo, I., Klokkeide, A., Sexton, J., Azimi, M., Dager, T. N., & Kjeken, I. (2024). Does follow-up really matter? A convergent mixed methods study exploring follow-up across levels of care in rehabilitation of patients with rheumatic and musculoskeletal diseases. Disabil Rehabil, 46(23), 5531-5544. https://doi.org/10.1080/09638288.2024.2310170

Bianchi, M., Kozyrev, S. V., Notarnicola, A., Sandling, J. K., Pettersson, M., Leonard, D., Sjöwall, C., Gunnarsson, I., Rantapää-Dahlqvist, S., Bengtsson, A. A., Jönsen, A., Svenungsson, E., Enocsson, H., Kvarnström, M., Forsblad-d’Elia, H., Bucher, S. M., Norheim, K. B., Baecklund, E., Jonsson, R., Hammenfors, D., Eriksson, P., Mandl, T., Omdal, R., Padyukov, L., Andersson, H., Molberg, Ø., Diederichsen, L. P., Syvänen, A. C., Wahren-Herlenius, M., Nordmark, G., Lundberg, I. E., Rönnblom, L., & Lindblad-Toh, K. (2024). Unraveling the Genetics of Shared Clinical and Serological Manifestations in Patients With Systemic Inflammatory Autoimmune Diseases. Arthritis Rheumatol https://doi.org/10.1002/art.42988

Bolla, E., Semb, A. G., Kerola, A. M., Ikdahl, E., Petri, M., Pons-Estel, G. J., Karpouzas, G. A., Sfikakis, P. P., Quintana, R., Misra, D. P., Borba, E. F., Garcia-de la Torre, I., Popkova, T. V., Artim-Esen, B., Troldborg, A., Fragoso-Loyo, H., Ajeganova, S., Yazici, A., Aroca-Martinez, G., Direskeneli, H., Ugarte-Gil, M. F., Mosca, M., Goyal, M., Svenungsson, E., Macieira, C., Hoi, A., Lerang, K., Costedoat-Chalumeau, N., Tincani, A., Mirrakhimov, E., Acosta Colman, I., Danza, A., Massardo, L., Blagojevic, J., Yilmaz, N., Tegzova, D., Yavuz, S., Korkmaz, C., Hachulla, E., Moreno Alvarez, M. J., Munoz-Louis, R., Pantazis, N., Tektonidou, M. G., Surf, S. L. E., & collaborators, A. P. S. (2024). Prevalence and target attainment of traditional cardiovascular risk factors in patients with systemic lupus erythematosus: a cross-sectional study including 3401 individuals from 24 countries. Lancet Rheumatol, 6(7), e447-e459. https://doi.org/10.1016/S2665-9913(24)00090-0

Borrego-Yaniz, G., Ortiz-Fernández, L., Madrid-Paredes, A., Kerick, M., Hernández-Rodríguez, J., Mackie, S. L., Vaglio, A., Castañeda, S., Solans, R., Mestre-Torres, J., Khalidi, N., Langford, C. A., Ytterberg, S., Beretta, L., Govoni, M., Emmi, G., Cimmino, M. A., Witte, T., Neumann, T., Holle, J., Schönau, V., Pugnet, G., Papo, T., Haroche, J., Mahr, A., Mouthon, L., Molberg, Ø., Diamantopoulos, A. P., Voskuyl, A., Daikeler, T., Berger, C. T., Molloy, E. S., Blockmans, D., van Sleen, Y., Iles, M., Sorensen, L., Luqmani, R., Reynolds, G., Bukhari, M., Bhagat, S., Ortego-Centeno, N., Brouwer, E., Lamprecht, P., Klapa, S., Salvarani, C., Merkel, P. A., Cid, M. C., González-Gay, M. A., Morgan, A. W., Martin, J., & Márquez, A. (2024). Risk loci involved in giant cell arteritis susceptibility: a genome-wide association study. Lancet Rheumatol, 6(6), e374-e383. https://doi.org/10.1016/s2665-9913(24)00064-x

Bosch, P., Sepriano, A., Marques, M. L., van der Heijde, D., Landewe, R., van Lunteren, M., de Bruin, L., de Hooge, M., Bastiaenen, C., Exarchou, S., Ramonda, R., Fagerli, K. M., van Gaalen, F. A., & Ramiro, S. (2024). Change in different classes of chronic back pain suspicious of axial spondyloarthritis: a latent transition analysis of the SPACE cohort. RMD Open, 10(3). https://doi.org/10.1136/rmdopen-2024-004584

Brun, M. K., Gehin, J. E., Bjorlykke, K. H., Warren, D. J., Klaasen, R. A., Sexton, J., Sandanger, O., Kvien, T. K., Mork, C., Jahnsen, J., Bolstad, N., Jorgensen, K. K., Haavardsholm, E. A., Goll, G. L., & Syversen, S. W. (2024). Clinical consequences of infliximab immunogenicity and the effect of proactive therapeutic drug monitoring: exploratory analyses of the randomised, controlled NOR-DRUM trials. Lancet Rheumatol, 6(4), e226-e236. https://doi.org/10.1016/S2665-9913(23)00341-7

Bøyesen, P., & Kirkhus, E. (2024). Can whole-body MRI assessment replace clinical joint examination in assessing disease activity in children with juvenile idiopathic arthritis? Rheumatology, 63(12), 3201-3202. https://doi.org/10.1093/rheumatology/keae329

Bøyesen, P., & Weiss, P. (2024). Paediatric rheumatic diseases: insights from the bench, imaging and trials. Rheumatology, 63(SI2), SI107-SI109. https://doi.org/10.1093/rheumatology/keae355

CChristiansen, S. N., Horskjaer Rasmussen, S., Ostergaard, M., Pons, M., Michelsen, B., Pavelka, K., Codreanu, C., Ciurea, A., Glintborg, B., Santos, M. J., Sari, I., Rotar, Z., Gudbjornsson, B., Macfarlane, G. J., Relas, H., Iannone, F., Laas, K., Wallman, J. K., van de Sande, M., Provan, S. A., Castrejon, I., Zavada, J., Mogosan, C., Nissen, M. J., Loft, A. G., Barcelos, A., Erez, Y., Pirkmajer, K. P., Grondal, G., Jones, G. T., Hokkanen, A. M., Chimenti, M. S., Vorobjov, S., Di Giuseppe, D., Kvien, T. K., Otero-Varela, L., van der Horst-Bruinsma, I., Hetland, M. L., & Ornbjerg, L. M. (2024). Effectiveness of secukinumab in radiographic and non-radiographic axial spondyloarthritis: a European routine-care observational study. RMD Open, 10(3). https://doi.org/10.1136/rmdopen-2024-004166

Christiansen, S. N., Horskjaer Rasmussen, S., Pons, M., Michelsen, B., Glintborg, B., Gudbjornsson, B., Grondal, G., Vencovsky, J., Loft, A. G., Rotar, Z., Pirkmajer, K. P., Nissen, M. J., Baranova, J., Macfarlane, G. J., Jones, G. T., Iannone, F., Caporali, R., Laas, K., Vorobjov, S., Giuseppe, D. D., Olofsson, T., Provan, S. A., Fagerli, K. M., Castrejon, I., Otero-Varela, L., van de Sande, M., van der Horst-Bruinsma, I., Nordstrom, D., Kuusalo, L., Bernardes, M., Hetland, M. L., Ostergaard, M., & Midtboll Ornbjerg, L. (2024). Patient-reported outcomes in axial spondyloarthritis and psoriatic arthritis patients treated with secukinumab for 24 months in daily clinical practice. Semin Arthritis Rheum, 65, 152388. https://doi.org/10.1016/j.semarthrit.2024.152388

da Silva, A. B., Ramiro, S., Boel, A., van Lunteren, M., Marques, M. L., van de Sande, M., Fongen, C., Exarchou, S., Ramonda, R., van der Heijde, D., & van Gaalen, F. (2024). Do quality of life and work productivity change in early axial spondyloarthritis and non-axial spondyloarthritis patients after two years? Rheumatology (Oxford) https://doi.org/10.1093/rheumatology/keae346

D

Decary, S., de Wit, M., Naye, F., Barton, J. L., Fraenkel, L., Li, L. C., Brooks, P., Stacey, D., Maxwell, L. J., Campbell, W., Hofstetter, C., Voshaar, M., Meara, A., Christensen, R., Boonen, A., Suarez-Almazor, M. E., Meade, T., March, L., Jull, J. E., Alten, R., Morgan, E. M., Stewart Hazlewood, G., Barber, C. E. H., Guillemin, F., El-Miedany, Y., Mittoo, S., Robertson, T. W., Bartlett, S. J., Singh, J. A., Mannion, M., Nasef, S. I., Boel, A., Adebajo, A., Arnaud, L., Gill, T. K., Moholt, E., Burt, J., Jayatilleke, A., Hmamouchi, I., Berthelsen, D. B., Blanco, F. J., Mather, K., Maharaj, A., Sharma, S., Caso, F., Beaton, D., Shea, B., Fong, C., Fernandez, A. P., Mackie, S., Nikiphorou, E., Jones, A., Greer-Smith, R., Sloan, V. S., Akpabio, A., Strand, V., Lee, R. R., Umaefulam, V., Monti, S., Abaza, N., Schultz, G., Stones, S., Gossec, L., Nielsen, S. M., Cavallo, S., Srinivasalu, H., Constien, D., Evans, V., Tugwell, P., & Toupin-April, K. (2024).

Consensus on the definitions and descriptions of the domains of the OMERACT Core Outcome Set for shared decision making interventions in rheumatology trials. Semin Arthritis Rheum, 65, 152381. https://doi.org/10.1016/j.semarthrit.2024.152381

Del Galdo, F., Lescoat, A., Conaghan, P. G., Bertoldo, E., Čolić, J., Santiago, T., Suliman, Y. A., Matucci-Cerinic, M., Gabrielli, A., Distler, O., Hoffmann-Vold, A. M., Castellví, I., Balbir-Gurman, A., Vonk, M., Ananyeva, L., Rednic, S., Tarasova, A., Ostojic, P., Boyadzhieva, V., El Aoufy, K., Farrington, S., Galetti, I., Denton, C. P., Kowal-Bielecka, O., Mueller-Ladner, U., & Allanore, Y. (2024). EULAR recommendations for the treatment of systemic sclerosis: 2023 update. Ann Rheum Dis https://doi.org/10.1136/ard-2024-226430

Dijkshoorn, B., Hansildaar, R., Vedder, D., Soutari, N., Rudin, A., Nordstrom, D., Gudbjornsson, B., Lend, K., Uhlig, T., Haavardsholm, E. A., Grondal, G., Hetland, M. L., Heiberg, M. S., Ostergaard, M., Horslev-Petersen, K., Lampa, J., van Vollenhoven, R. F., Antovic, A., & Nurmohamed, M. T. (2024). Impaired coagulation parameters in early RA are restored by effective antirheumatic therapy: a prospective pilot study. RMD Open, 10(4). https://doi.org/10.1136/rmdopen-2024-004838

Dobrota, R., Garaiman, A., Fligelstone, K., Tyrrell Kennedy, A., Roennow, A., Allanore, Y., Carreira, P. E., Czirjak, L., Denton, C., Hesselstrand, R., Sandqvist, G., Kowal-Bielecka, O., Bruni, C., Matucci-Cerinic, M., Mihai, C., Gherghe, A. M., Mueller-Ladner, U., Kvien, T., Heiberg, T., Distler, O., & Becker, M. O. (2024). Performance of the EULAR Systemic sclerosis Impact of Disease (ScleroID) questionnaire as a patient-reported outcome measure for patients with diffuse systemic sclerosis. RMD Open, 10(4). https://doi.org/10.1136/rmdopen-2024-004653

Dubovyk, V., Vasileiadis, G. K., Fatima, T., Zhang, Y., Kapetanovic, M. C., Kastbom, A., Rizk, M., Soderbergh, A., Zhao, S. S., van Vollenhoven, R. F., Hetland, M. L., Haavardsholm, E. A., Nordstrom, D., Nurmohamed, M. T., Gudbjornsson, B., Lampa, J., Ostergaard, M., Heiberg, M. S., Sokka-Isler, T., Grondal, G., Lend, K., Horslev-Petersen, K., Uhlig, T., Rudin, A., & Maglio, C. (2024). Obesity is a risk factor for poor response to treatment in early rheumatoid arthritis: a NORD-STAR study. RMD Open, 10(2). https://doi.org/10.1136/rmdopen-2024-004227

EEspinosa-Ortega, F., Lodin, K., Dastmalchi, M., Vencovsky, J., Diederichsen, L. P., Shinjo, S. K., Danieli, M. G., Selva-O’Callaghan, A., de Visser, M., Griger, Z., Ceribelli, A., Gómez-Martin, D., Andersson, H., Vázquez-Del Mercado, M., Chinoy, H., Lilleker, J. B., New, P., Krogh, N. S., Lundberg, I. E., & Alexanderson, H. (2024). Autoantibodies and damage in patients with idiopathic inflammatory myopathies: A longitudinal multicenter study from the MYONET international network. Semin Arthritis Rheum, 68, 152529. https:// doi.org/10.1016/j.semarthrit.2024.152529

Essouma, M., de Araujo, D. B., Day, J., Conticini, E., Riopel, M. A., Elias, A. M., Paula, V. T., Omori, C. H., Guimarães, J. B., Gibson, D., Saad-Magalhaes, C., Appenzeller, S., Schiffenbauer, A., Machado, P. M., Feldman, B. M., Paik, J. J., Christopher-Stine, L., Rider, L. G., Reed, A., van der Kooi, A. J., Marrani, E., Naddaf, E., Kirkhus, E., Sanner, H., Bauer-Ventura, I., Lilleker, J. B., Gupta, L., Lucchini, M., Dimachkie, M. M., Tolend, M., Arabi, T. M. A., Moghadam-Kia, S., O’Hanlon, S., Phaneuf, S., Shinjo, S. K., & Doria, A. S. (2024). A protocol for scoping reviews on the role of whole-body and dedicated body-part magnetic resonance imaging for assessment of adult and juvenile idiopathic inflammatory myopathies. Rheumatol Int, 44(11), 2403-2409. https://doi.org/10.1007/s00296-024-05649-7

Ferreira, R. J. O., Henriques, A., Moe, R. H., Matos, C., Tveter, A. T., Osteras, N., Nogueira, P., Costa, A. S., Haavardsholm, E. A., Carmona, L., & Richards, D. (2024). Presentation of the first international research network to foster high-quality clinical trials testing non-pharmacological interventions (TRACTION network). BMJ Open, 14(7), e081864. https://doi. org/10.1136/bmjopen-2023-081864

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The REMEDY center is funded by a large grant (128 million NOK) from the Research Council of Norway and generous funding (32 million NOK) from the Olav Thon Foundation.

The individual research projects conducted within the REMEDY center are wholly or partly funded by:

• Research Council of Norway (different programs/grants)

• South­Eastern Norway Regional Health Authority

• Program for Clinical treatment research (KLINBEFORSK)

• Horizon Europe

• The Coalition for Epidemic Preparedness Innovations (CEPI)

• DAM Foundation

• Norwegian Health Association

• Diakonhjemmet Hospital Research Fund

• Norwegian Women’s Public Health Association (NKS)

• Norwegian Rheumatism Association Research Fund

• Anders Jahre´s Foundation for the Promotion of Science

• The Norwegian Fund for PostGraduate Training in Physiotherapy

• Dr. Trygve Gythfeldt and Wife’s Research Foundation

• Pahles Legacy

• Eckbos Legacy

• Grethe Harbitz Legacy

• Karen Fossum Legacy

• NordForsk

• EULAR

• Scandinavian Rheumatology Research Foundation

• The EuroSpA Coordinating Centre

• Klaveness Innovation Support

• Pharmaceutical IIR grants (Novartis Norway AS, Galapagos Biopharma Norway AS, Pfizer AS, Boehringer Ingelheim Norway KS, Bristol­Myers Squibb SARL)

• Own contribution from the Host and Partner institutions