Hilde Berner Hammer

• Klingenberg, Lovisa; Bos-Haugen, Ida Kristin; Hammer, Hilde Berner; Maugesten, Øystein Gunnar; Mathiessen, Alexander & Gløersen, Marthe (2026). JOINT-SPECIFIC ASSOCIATIONS BETWEEN ULTRASOUND AND MRI-DETECTED SYNOVITIS AND RADIOGRAPHIC PROGRESSION IN HAND OSTEOARTHRITIS: A COMPARISON OF CMC1 AND INTERPHALANGEAL JOINTS. Osteoarthritis and Cartilage. ISSN 1063-4584. 34, p. 256–256. doi: 10.1016/j.joca.2026.01.351. Full text in Research Archive Show summary

  Purpose (the aim of the study): Synovitis is a well-established feature associated with structural progression in hand osteoarthritis (OA). In light of the new 2023 European Alliance of Associations of Rheumatology (EULAR) classification criteria for hand OA, which distinguish first carpometacarpal (CMC1) and interphalangeal OA as separate phenotypes, it remains unknown whether synovitis has similar prognostic value across these joint groups. We therefore aimed to determine whether baseline synovitis by ultrasound or magnetic resonance imaging (MRI) predicted radiographic progression over 3.5 years, looking at the CMC1 and the interphalangeal joints separately.

• Klingenberg, Lovisa; Haugen, Ida K; Hammer, Hilde Berner; Maugesten, Øystein Gunnar; Mathiessen, Alexander & Gløersen, Marthe (2026). Associations between synovitis and radiographic osteoarthritis progression in the first carpometacarpal and interphalangeal joints: results from the Nor-Hand study. RMD Open. 12(3), p. 007074–007074. doi: 10.1136/rmdopen-2026-007074. Full text in Research Archive Show summary

  Objectives To determine whether baseline synovitis detected by ultrasound or MRI predicts radiographic osteoarthritis (OA) progression in the first carpometacarpal (CMC1) and interphalangeal joints. Methods We included 201 participants with hand OA from the Nor-Hand cohort. The CMC1 and interphalangeal joints were examined by ultrasound (both hands) and MRI (dominant hand) at baseline. Grey-scale synovitis, power Doppler activity and MRI-defined synovitis were scored on 0–3 scales. Bilateral hand radiographs at baseline and follow-up were scored by the same reader. We examined whether synovitis at baseline predicted radiographic progression in the same joint defined as ≥1 increase in Kellgren-Lawrence grade, osteophytes or joint space narrowing or incident erosions. CMC1 and interphalangeal joints were analysed separately using logistic regression with generalised estimating equations, adjusted for age, sex, body mass index and follow-up time. Results Radiographic Kellgren-Lawrence progression occurred in 14.7% of CMC1 joints and 10.2% of interphalangeal joints. Baseline grey-scale synovitis was associated with radiographic progression in the CMC1 and interphalangeal joints with the strongest observed association between grade 3 synovitis and Kellgren-Lawrence progression (OR (95% CI) of 9.3 (2.2 to 39.6) and 23.4 (10.4 to 52.9), respectively). Similar relationships were found for power Doppler activity and MRI-defined synovitis. Conclusions Baseline synovitis detected by ultrasound and MRI was associated with radiographic progression in both CMC1 and interphalangeal joints, supporting inflammation as a relevant prognostic feature across hand OA phenotypes. Trial registration number NCT03083548 .

• Sahbudin, Ilfita; Trickey, Jeanette; Gouze, Hélène; Stoenoiu, Maria Simona; Filippou, Georgios & Sakellariou, Garifallia [Show all 43 contributors for this article] (2026). Defining age-related thresholds in hand, wrist, and foot ultrasound: an international, cross-sectional, observational study by the Outcome Measures in Rheumatology Ultrasound Working Group. The Lancet Rheumatology. doi: 10.1016/s2665-9913(26)00183-9. Full text in Research Archive
• Weber, Anders Bossel Holst; Terslev, Lene; Ammitzbøll-Danielsen, Mads; Frederiksen, Bill Aplin; Hammer, Hilde Berner & Overgaard, Benjamin Schultz [Show all 8 contributors for this article] (2026). Performance of an artificial intelligence model compared with multiple human experts in scoring synovitis and osteophyte severity on joint ultrasound images. EULAR Rheumatology Open (ERO). 2(1), p. 282–282. doi: 10.1016/j.ero.2026.01.015. Full text in Research Archive
• Frederiksen, Bill Aplin; Hammer, Hilde Berner; Terslev, Lene; Danielsen, Mads Ammitzbøll; Savarimuthu, Thiusius Rajeeth & Weber, Anders Bossel Holst [Show all 7 contributors for this article] (2026). Automated ultrasound with AI for osteophyte grading in hand osteoarthritis: comparison with expert rheumatologist assessment. BMC Rheumatology. 10(1). doi: 10.1186/s41927-026-00654-8. Full text in Research Archive
• Stjärne, Johan Folke Håkan; Aanesen, Fiona; Søhus, S.; Abhishek, A.; Dalbeth, N. & Hammer, Hilde Berner [Show all 11 contributors for this article] (2026). A self-management app in a digital treat-to-target gout-care approach: the ReMonit Gout feasibility study. Scandinavian Journal of Rheumatology. ISSN 0300-9742. doi: 10.1080/03009742.2026.2706265. Full text in Research Archive
• Mandl, Peter; Gessl, Irina; Kun, Lyubomyra; Filippou, Georgios; Kortekaas, Marion & Pineda, Carlos [Show all 30 contributors for this article] (2026). A global OMERACT ultrasound joint damage scoring system (GLODS) in rheumatoid arthritis. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1016/j.ard.2026.07.004. Full text in Research Archive
• Stewart, Sarah; Gamble, Gregory D.; Taylor, William J.; Harrison, Andrew; Merriman, Tony R. & Mihov, Borislav [Show all 26 contributors for this article] (2026). Musculoskeletal ultrasound findings in people with asymptomatic hyperuricemia: baseline analysis from the Transitions in Gout Research (TIGER) study using the OMERACT gout ultrasound semiquantitative scoring system. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1016/j.ard.2026.03.021. Full text in Research Archive
• Uhlig, Tillmann; Karoliussen, Lars Fridtjof; Sexton, Joseph; Haavardsholm, Espen Andre; Provan, Sella Aarrestad & Solomon, D. H. [Show all 7 contributors for this article] (2026). Duration and dose of allopurinol needed to attain the serum urate target in gout. Scandinavian Journal of Rheumatology. ISSN 0300-9742. doi: 10.1080/03009742.2026.2648357. Full text in Research Archive Show summary

  Objective: To examine, in patients with gout using escalating urate-lowering therapy (ULT), the treatment durationand allopurinol dose required to attain the serum urate (SU) target (< 360 μmol/L; < 6 mg/dL). Method: We studied patients in the NOR-Gout prospective cohort with a recent gout flare and increased SU(> 360 μmol/L). Patients escalated allopurinol dosage until reaching the SU treatment target of <360 µmol/L,switching, if needed, to febuxostat. Results: Of 211 patients, 95.2% were male; mean ± sd age was 56.7 ± 13.7 years, disease duration 8.1 years, 16.6%had clinical tophi, and 12.8% used allopurinol at cohort entry. Mean SU (μmol/L) was reduced from 500 at baseline to312 at 1 year and 325 at 2 years. Target SU was attained at least once during year 1 by 197 patients (93.4%). Mediantime to attaining the treatment target was 2 months (mean 2.9 months), and median allopurinol dose was 200 mg(mean 243 mg). Eighty per cent of patients reached the treatment target by 3 months. Patients with SU >480 μmol/L atbaseline needed a median of 3 months to attain target SU versus 2 months for patients with SU <480 μmol/L (log-rankp < 0.001). A switch to febuxostat was seen in 12.4% at year 1 and 15.1% at year 2. Conclusion: Treat-to-target ULT using allopurinol leads to attainment of the SU target within 2–3 months at lowdoses for most patients. Very few patients did not achieve the treatment target at least once during year 1. Trial registration: ACTRN12618001372279

• Yoshida, Yusuke; Hammer, Hilde Berner; Sexton, Joseph; Nordberg, Lena Kristine Bugge; Aga, Anna-Birgitte & Terslev, Lene [Show all 8 contributors for this article] (2025). How to score the wrist joint by ultrasound: exploration of the most sensitive joint assessment during follow-up of early or established rheumatoid arthritis. Arthritis Research & Therapy. ISSN 1478-6354. 27(1). doi: 10.1186/s13075-025-03668-8. Full text in Research Archive
• Hammer, Hilde Berner; Karoliussen, Lars Fridtjof; Terslev, Lene; Haavardsholm, Espen A. & Uhlig, Till (2025). Ultrasound-detected crystal depositions and clinical flares dissolve during successful urate-lowering therapy: 5-year follow-up results from the treat-to-target NOR-Gout study. Annals of the Rheumatic Diseases. ISSN 0003-4967. 85(2), p. 379–387. doi: 10.1016/j.ard.2025.10.029. Full text in Research Archive Show summary

  Objectives The aims of this 5-year study were to explore the maintenance of low serum uric acid (sUA) during treat-to-target urate-lowering therapy (T2T-ULT) and whether long-term low sUA results in continuous decrease of ultrasound-detected crystal depositions, complete dissolution of depositions, and reduction of flares. Methods Patients with a recent gout flare were included, initiated T2T-ULT, and were followed for 5 years (outpatient clinic year 1, general practitioner years 2-5) with visits at baseline, 1, 2, and 5 years. Each visit included assessment of sUA, ultrasound examination for crystal depositions (double contour, tophi, and aggregates) in bilateral hands, elbows, knees, ankles, feet, and number of flares the previous year. Calculations included independent or paired samples t-tests, analysis of variance (ANOVA), and linear regression analyses. Results Of the 209 patients included at baseline (mean age 56.4 years, disease duration 7.9 years), 163 patients were examined at 5 years. At the 5-year visit, sUA was reduced from 500 (baseline) to 337 μmol/L (P < .001), 71.2% had sUA <360 μmol/L, all ultrasound depositions were reduced (P < .001), full dissolution of double contour (83.4%) and tophi (63.2%) (where examining only first metatarsophalangeal joints identified most of these patients), and only 16% had flares the previous year all of whom had higher sUA and depositions (P = .035-.006). Conclusions Five years of T2T-ULT resulted in most patients achieving sUA target, reduction of crystal depositions, and dissolution of double contour and tophi in most patients. Only a few patients experienced flares, and they had higher levels of sUA and crystal depositions, supporting the importance of keeping sUA low.

• Provan, Sella Aarrestad; Hammer, Hilde Berner & Kleppang, Annette Løvheim (2025). Psychometric evaluation of the Norwegian version of the Revised Fibromyalgia Impact Questionnaire. Scandinavian Journal of Rheumatology. ISSN 0300-9742. p. 8–8. doi: 10.1080/03009742.2025.2573532. Full text in Research Archive Show summary

  Objectives: The Revised Fibromyalgia Impact Questionnaire (FIQ-R) is a composite questionnaire covering key domains of fibromyalgia disease burden. This study aimed to translate the FIQ-R into Norwegian, to assess face, content, and criterion validity, and to evaluate the psychometric properties of the Norwegian FIQ-R using Rasch analysis, in a sample of adults with fibromyalgia. Method: The FIQ-R was translated into Norwegian following established methodology in collaboration with patient research partners. Participants attending a patient education session for people with chronic musculoskeletal pain were asked to complete, anonymously, the translated FIQ-R, Fibromyalgia Self-reported Diagnostic Criteria (FSDC), 36-item Short Form Health Survey (SF-36), and Modified Health Assessment Questionnaire (MHAQ). Fibromyalgia cases were identified according to the FSDC. Correlations between FIQ-R, MHAQ, and SF-36 were calculated. Rasch analysis was performed. Results: In total, 241 participants (96.3% female) were classified as having fibromyalgia according to the FSDC. The translated FIQ-R had acceptable face and content validity. The correlation coefficients were moderate between FIQ-R and SF-36, and strong between FIQ-R and MHAQ. The FIQ-R formed a multidimensional scale, indicating two subscales: FIQ-R function and FIQ-R symptoms. Both subscales showed reversed threshold ordering and were consequently collapsed into five and four response categories, respectively. The resulting subscales were found to have good reliability and targeting. Conclusion: Owing to the lack of unidimensionality in the FIQ-R, it is recommended that both clinical and research applications rely on subscale scores rather than a total score.

• Røym, AL; Halse, A-KH; Nordal, HH; Eidsheim, M; Brokstad, KA & Bolton-King, Pernille [Show all 7 contributors for this article] (2025). Calprotectin (S100A8/A9) is not associated with ultrasound-detected synovitis in a longitudinal study of patients with psoriatic arthritis treated with biological disease-modifying anti-rheumatic drugs. Scandinavian Journal of Rheumatology. ISSN 0300-9742. p. 8–8. doi: 10.1080/03009742.2025.2523667. Full text in Research Archive
• Alm, Linda Mathsson; Westerlind, Helga; Gehring, Isabel; Hansson, Monika; Ghasemzadeh, Nasim & Rojas-Restrepo, Jessica [Show all 17 contributors for this article] (2025). Recognition of Glycine Versus Nonglycine Citrulline Motifs Dictating the HLA Class II Association of Anticitrullinated Protein Antibodies: Insights From Autoantibody Profiling of 6,900 Scandinavian Patients With Rheumatoid Arthritis. Arthritis & Rheumatology. ISSN 2326-5191. 77(9), p. 1179–1193. doi: 10.1002/art.43161. Full text in Research Archive Show summary

  Objective Rheumatoid arthritis (RA)–associated anticitrullinated protein antibodies (ACPAs) target various antigens by binding short citrulline amino acid motifs, resulting in heterogeneous ACPA profiles among patients. Here we analyzed ACPA patterns by recognized citrulline motifs in relation to the RA risk factors HLA-DRB1 shared epitope (SE) alleles and history of smoking. Methods Rheumatoid factor (RF) and anticyclic citrullinated peptide (CCP2) isotypes, 15 anti-Cit- and four anti-Carb/Acet-peptide-IgG, were centrally measured in 6,907 patients from five Scandinavian RA cohorts using fluoroenzyme immunoassay and a custom-made multiplex solid-phase microarray. HLA-DRB1 SE alleles were imputed from single-nucleotide polymorphism genotyping data. Results Single-citrulline peptides derived from four multicitrulline peptides (Cit Fibα36-50, Cit Fibβ60-74, Cit TNC5, and Cit Vim60-75) showed differential binding patterns, supporting recognition of citrulline motifs rather than long peptides. Four citrulline peptides (Cit Fibβ36-52, Cit Fibβ60-74-Cit3, Cit Fil307-324, and Cit Vim60-75-Cit1) captured 97% of IgG anti-CCP2+ patients. Patient subsets based on ACPA, anti-Carb/Acet, and RF displayed differences in ACPA composition and disease activity but not comorbidities. Different ACPAs overlapped, but when dichotomizing patients based on high reactivity to peptide citrulline motifs, only ACPA to nonglycine citrulline motif associated with HLA SE alleles. In IgG anti-CCP2+ patients, 90% of those with only high nonglycine ACPA were HLA SE allele carriers compared with 67% in the group with glycine motif–only ACPA (odds ratio 4.5). Smoking status associated with IgA and glycine motif ACPA. Conclusion Although citrulline-glycine motifs are prevalent ACPA targets, our data reveal that HLA SE alleles are primarily associated with ACPA to nonglycine citrulline motifs, providing insight in ACPA T cell dependance. Yet, the etiologic significance of ACPA targeting different protein structures remains unknown.

• Frederiksen, Bill Aplin; Hammer, Hilde Berner; Terslev, Lene; Ammitzbøll-Danielsen, Mads; Savarimuthu, Thiusius Rajeeth & Weber, Anders Bossel Holst [Show all 7 contributors for this article] (2025). Automated ultrasound system ARTHUR V.2.0 with AI analysis DIANA V.2.0 matches expert rheumatologist in hand joint assessment of rheumatoid arthritis patients. RMD Open. 11(3). doi: 10.1136/rmdopen-2025-005805. Full text in Research Archive Show summary

  Objective To evaluate the agreement and repeatability of an automated robotic ultrasound system (ARTHUR V.2.0) combined with an AI model (DIANA V.2.0) in assessing synovial hypertrophy (SH) and Doppler activity in rheumatoid arthritis (RA) patients, using an expert rheumatologist’s assessment as the reference standard. Methods 30 RA patients underwent two consecutive ARTHUR V.2.0 scans and rheumatologist assessment of 22 hand joints, with the rheumatologist blinded to the automated system’s results. Images were scored for SH and Doppler by DIANA V.2.0 using the EULAR-OMERACT scale (0–3). The agreement was evaluated by weighted Cohen’s kappa, percent exact agreement (PEA), percent close agreement (PCA) and binary outcomes using Global OMERACT-EULAR Synovitis Scoring (healthy ≤1 vs diseased ≥2). Comparisons included intra-robot repeatability and agreement with the expert rheumatologist and a blinded independent assessor. Results ARTHUR successfully scanned 564 out of 660 joints, corresponding to an overall success rate of 85.5%. Intra-robot agreement for SH: PEA 63.0%, PCA 93.0%, binary 90.5% and for Doppler, PEA 74.8%, PCA 93.7%, binary 88.1% and kappa values of 0.54 and 0.49. Agreement between ARTHUR+DIANA and the rheumatologist: SH (PEA 57.9%, PCA 92.9%, binary 87.3%, kappa 0.38); Doppler (PEA 77.3%, PCA 94.2%, binary 91.2%, kappa 0.44) and with the independent assessor: SH (PEA 49.0%, PCA 91.2%, binary 80.0%, kappa 0.39); Doppler (PEA 62.6%, PCA 94.4%, binary 88.1%, kappa 0.48). Conclusions ARTHUR V.2.0 and DIANA V.2.0 demonstrated repeatability on par with intra-expert agreement reported in the literature and showed encouraging agreement with human assessors, though further refinement is needed to optimise performance across specific joints.

• Gyllensten, Karen Sandvik; Sundin, Ulf Gunnar; Storrønning, Inger; Husby, Ivar Ervik; Haavardsholm, Erik & Hammer, Hilde Berner [Show all 9 contributors for this article] (2025). Short-Term Clinical and Radiological Results of the Infinity Ankle Arthroplasty: A Prospective Study. Foot & ankle specialist.. ISSN 1938-6400. doi: 10.1177/19386400251330086. Full text in Research Archive Show summary

  Background Ankle joint arthroplasty is increasingly used in primary or secondary end-stage osteoarthritis. Initial reports on the fourth-generation Infinity total ankle system showed a high failure rate due to component loosening. The objective of this study was to assess complications, reoperations, patient reported outcome measures (PROMs) and radiographic findings after 1 year. Methods Data were prospectively collected in a local ankle surgery registry between January 2018 and March 2023. All cases of primary ankle arthroplasty using the Infinity system with a 1-year follow-up were included (106 ankles in 101 patients). Complications, revisions, and reoperations were described after 1 and 2 years, and the 1-year postoperative PROMs (AOFAS Ankle-Hindfoot score, MOxFQ, EQ5D, and EQ5D-VAS) were compared to preoperative values. One-year postoperative radiographs were assessed for signs of loosening. Results The mean age was 65 years (SD 11.7), 55% were female, and the mean BMI was 27 kg/m2 (SD 4.2). Main indications for arthroplasty were chronic instability (27%), inflammatory joint disease (25%) and posttraumatic osteoarthritis (22%). After 1 year, there were 6 (5.5%) reoperations, of which 3 (2.7%) were prosthesis revisions, and 3 (2.7%) were outside the primary operative site. One (0.9%) reoperation was due to aseptic loosening of the tibia component. After 2 years, there was 1 additional reoperation with a tibial osteotomy and exchange of polyethylene insert. All PROMs improved significantly between the preoperative and the 1-year follow-up assessment, with mean change in AOFAS 35.9 (P < .01), MOxFQ 46.9 (P < .01), EQ5D 0.36 (P < .01), and EQ5D-VAS 13.2 (P < .01). There were findings of radiolucent lines and/or cysts on 1-year postoperative radiographs in 9 cases (9%). Conclusions We found an acceptable rate of early aseptic loosening. All PROMs demonstrated a significant improvement from preoperative to 1-year postoperative assessment.

• Uhlig, Till; Stjärne, Johan Folke Håkan; Karoliussen, Lars Fridtjof; Sexton, Joseph; Eskild, Tron Hovind & Provan, Sella Aarrestad [Show all 8 contributors for this article] (2025). Remission in gout is possible: 5-year follow-up in the NOR-Gout study. Seminars in Arthritis & Rheumatism. ISSN 0049-0172. 72. doi: 10.1016/j.semarthrit.2025.152698. Full text in Research Archive
• Høegh, Dekkerhus Caroline; Mathiessen, Alexander; Fjellstad, Caroline Mehl; Christensen, Barbara Therese Slatkovsky; Hammer, Hilde Berner & Bos-Haugen, Ida Kristin (2025). The frequency and severity of ultrasound-detected osteoarthritis features in the knees and their associations with pain: Cross-sectional analyses of the Nor-Hand study. Osteoarthritis and Cartilage Open. 7(3). doi: 10.1016/j.ocarto.2025.100640. Full text in Research Archive Show summary

  Objective To investigate the frequency and severity of ultrasound-detected osteophytes and synovitis in people with and without knee osteoarthritis (OA), and to explore the association between these ultrasound features and pain. Design In the Nor-Hand study, both knees were assessed for osteophytes (0–3 scale, four locations per knee) and grey-scale synovitis (0–3 scale). The frequency and severity of the ultrasound-detected features were compared in individuals with and without knee OA defined by the American College of Rheumatology criteria. Pain was self-reported in each knee (yes/no) and by the Western/Ontario McMaster University index (WOMAC). The associations between ultrasound-detected features and pain were examined by regression analyses adjusted for age, sex, and body mass index. Results We analyzed 286 participants. Osteophytes of all sizes were more common in participants with knee OA compared to those without (65.9 ​% vs. 40.8 ​%, p ​< ​0.001). No between-group difference was found for the frequency of any grey-scale synovitis (45.5 ​% vs. 44.7 ​%, p ​= ​0.67), while severe synovitis was more common in those with knee OA. Ultrasound-detected osteophyte sum score, but not synovitis, was associated with WOMAC pain (B ​= ​0.18, 95 ​% CI 0.03–0.32). Osteophytes of all sizes were associated with pain in the same knee with odds ratio (OR, 95 ​% CI) ranging from 1.85 (1.20–2.84) to 9.02 (4.04–20.10). Statistically significant association was found for severe synovitis only (OR ​= ​6.63, 95 ​% CI 2.26–19.43). Conclusions Ultrasound-detected osteophytes were prevalent in people with knee OA and were associated with pain. OA pathology in individuals without fulfilling the knee OA criteria may reflect early or subclinical OA.

• Stewart, Sarah; Gamble, Greg; Taylor, William; Su, Isabel; Merriman, Tony & Mihov, Borislav [Show all 23 contributors for this article] (2024). Development of gout in people with asymptomatic hyperuricemia: study protocol for a 5-year prospective cohort. BMJ Open. 14(11), p. e090415–e090415. doi: 10.1136/bmjopen-2024-090415. Full text in Research Archive Show summary

  Introduction The central biochemical cause of gout is hyperuricemia (elevated serum urate levels). Ultrasound features of monosodium urate (MSU) crystal deposition are common in people with asymptomatic hyperuricemia. However, it is unclear whether this is a precondition for the development of gout. This study aims to determine whether ultrasound imaging evidence of MSU crystal deposition predicts development of symptomatic gout over 5 years, in people who already have an increased risk of gout due to elevated serum urate concentrations (≥8 mg/dL). Methods and analysis This is a prospective, international, multicentre study. The study population comprises over 250 participants with asymptomatic hyperuricemia (serum urate ≥8.0 mg/dL). After the baseline assessments, participants are followed for 5 years or until the development of gout, defined by the 2015 American College of Rheumatology/European Alliance of Associations for Rheumatology gout classification criteria. Baseline assessments include anthropomorphic measures, laboratory tests, questionnaires, blood and urine specimen collection, plain radiographs of the feet and standardised ultrasound scans of the lower limbs, scored according to the Outcomes in Rheumatology (OMERACT) gout ultrasound scoring system. The primary outcomes are the development of gout and time course for development of gout in people with and without ultrasound evidence of MSU crystal deposition. Exploratory analyses will examine clinical, genetic and biological factors associated with development of MSU crystal deposition and gout. Ethics and dissemination This study protocol was approved by the New Zealand Ministry of Health Southern Health and Disability Ethics Committee (MEC/05/10/130/AM16) on 18 December 2018. The findings from this study will be published in peer-reviewed journals and will be presented at national and international conferences.

• Mandl, Peter; D'Agostino, Maria Antonietta; Navarro-Compán, Victoria; Geßl, Irina; Sakellariou, Garifallia & Abhishek, Abhishek [Show all 26 contributors for this article] (2024). 2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1136/ard-2023-224771. Full text in Research Archive Show summary

  Objective To formulate evidence-based recommendations and overarching principles on the use of imaging in the clinical management of crystal-induced arthropathies (CiAs). Methods An international task force of 25 rheumatologists, radiologists, methodologists, healthcare professionals and patient research partners from 11 countries was formed according to the EULAR standard operating procedures. Fourteen key questions on the role of imaging in the most common forms of CiA were generated. The CiA assessed included gout, calcium pyrophosphate deposition disease and basic calcium phosphate deposition disease. Imaging modalities included conventional radiography, ultrasound, CT and MRI. Experts applied research evidence obtained from four systematic literature reviews using MEDLINE, EMBASE and CENTRAL. Task force members provided level of agreement (LoA) anonymously by using a Numerical Rating Scale from 0 to 10. Results Five overarching principles and 10 recommendations were developed encompassing the role of imaging in various aspects of patient management: making a diagnosis of CiA, monitoring inflammation and damage, predicting outcome, response to treatment, guided interventions and patient education. Overall, the LoA for the recommendations was high (8.46–9.92). Conclusions These are the first recommendations that encompass the major forms of CiA and guide the use of common imaging modalities in this disease group in clinical practice.

• Kortekaas, Marion C.; Vanhaverbeke, Tine; Keen, Helen I; Terslev, Lene; Hammer, Hilde Berner & D’Agostino, Maria Antonietta [Show all 7 contributors for this article] (2024). Validation of HAND OA US inflammatory and structural damage score (HOUSE) for thumb-base joints: systematic review on truth and discrimination. Rheumatology. ISSN 1462-0324. 64(3), p. 919–934. doi: 10.1093/rheumatology/keae417. Full text in Research Archive
• Mulrooney, Elisabeth; Neogi, Tuhina; Dagfinrud, Hanne; Hammer, Hilde Berner; Pettersen, Pernille Steen & Kvien, Tore Kristian Aaserud [Show all 8 contributors for this article] (2024). Hand osteoarthritis phenotypes based on a biopsychosocial approach, and their associations with cross-sectional and longitudinal pain. Osteoarthritis and Cartilage. ISSN 1063-4584. doi: 10.1016/j.joca.2024.04.011. Full text in Research Archive Show summary

  Objective Hand osteoarthritis (OA) pain is characterized as heterogeneous and multifactorial. Differences in pain may be explained by underlying phenotypes, which have not been previously explored Design Latent class analysis determined classes of participants with hand OA from the Nor-Hand study baseline examination (2016–17) based on a biopsychosocial framework. Outcomes were hand and overall bodily pain intensity (Numeric Rating Scale, 0–10) at baseline and follow-up (2019–21), The relations of the classes to pain outcomes at baseline, follow-up, and change over time were analysed in separate models by linear regression, using the overall healthiest class as reference. Results Five classes differing in radiographic hand OA burden and OA burden in the lower extremities by ultrasound, demographic factors, psychosocial burden and pain sensitization was identified. Persons with the least severe OA but higher burden of biopsychosocial factors reported the most hand pain (beta 3.65, 95% CI 2.53, 4.75). Pain was less pronounced in persons with the most severe hand OA but low burden of biopsychosocial factors (beta 1.03, 95% CI 0.41, 1.65). Results were similar for overall bodily pain and at follow-up. Changes in pain were small, but the association between a separate class defined by higher levels of biopsychosocial burden and pain changes was significant. Conclusion The five hand OA phenotypes were associated with pain at baseline and 3.5 years later. The phenotype with the least OA severity, but higher burden of biopsychosocial factors reported more pain than the phenotype with the most severe OA, reflecting the symptom-structure discordance of the hand OA pain experience.

• Pettersen, Pernille; Haugmark, Trond; Berg, Inger Jorid; Hammer, Hilde Berner; Neogi, Tuhina & Zangi, Heidi Andersen [Show all 8 contributors for this article] (2024). Pain sensitization in fibromyalgia. Cross-sectional associations between quantitative sensory testing of pain sensitization and fibromyalgia disease burden. European Journal of Pain. ISSN 1090-3801. 29(1). doi: 10.1002/ejp.4771. Full text in Research Archive
• Sepriano, Alexandre; Ramiro, Sofia; Landewé, Robert; Heijde, Désirée van der; Ohrndorf, Sarah & FitzGerald, Olivier [Show all 23 contributors for this article] (2024). Adding ultrasound to treat-to-target shows no benefit in achieving clinical remission nor in slowing radiographic progression in rheumatoid arthritis: results from a multicenter prospective cohort. Clinical Rheumatology. ISSN 0770-3198. doi: 10.1007/s10067-024-06978-5. Full text in Research Archive
• Gløersen, Marthe; Hermann-Eriksen, Merete; Hove, Åshild; Kjeken, Ingvild; Mathiessen, Alexander & Hammer, Hilde Berner [Show all 7 contributors for this article] (2024). Lessons learned from the PICASSO trial regarding ultrasound examinations of osteoarthritic hand joints performed by occupational therapists. Ultraschall in der Medizin. ISSN 0172-4614. 45(3), p. 335–336. doi: 10.1055/a-2285-8206. Full text in Research Archive Show summary

  Objective: Our primary objectives are to assess whether intraarticular corticosteroid injections are superior to saline injections with regards to thumb base pain after 4 weeks, and to compare the efficacy of steroid injections, saline injections, and an occupational therapy intervention on thumb base pain after 12 weeks in people with painful inflammatory osteoarthritis (OA) of the first carpometacarpal (CMC-1) joint. Design: In this three-armed, double-blind, randomized multicenter trial, 354 participants with painful inflammatory CMC-1 OA from six Norwegian hospitals are recruited. Participants are randomized 1:1:1 to intraarticular steroid or saline injections in the CMC-1 joint or a multimodal occupational therapy intervention. The primary outcomes are thumb base pain measured on a numeric rating scale (NRS, range: 0-10) after 4 weeks and 12 weeks. Key secondary outcomes include synovitis by Magnetic Resonance Imaging (MRI) after 4 weeks and hand function by the Measure of Activity Performance of the Hand (MAP-Hand) questionnaire after 12 and 24 weeks. Other secondary outcomes are synovitis by clinical examination and ultrasound, measures of pain, function, stiffness, and health-related quality of life, and direct and indirect costs. Adverse events are recorded at each visit. The duration of the randomized controlled trial is 24 weeks, followed by an 80-week open-label observational phase to investigate the long-term efficacy and safety of repeated steroid injections and the occupational therapy intervention. Conclusions: The results from this trial will have important clinical implications and influence future guidelines on OA management of the CMC-1 joint.

• Uhlig, Tillmann; Karoliussen, Lars Fridtjof; Sexton, Joseph; Provan, Sella Aarrestad; Haavardsholm, Espen Andre & Hammer, Hilde Berner (2024). Non-adherence to urate lowering therapy in gout after 5 years is related to poor outcomes: results from the NOR-Gout study. Rheumatology. ISSN 1462-0324. 64(4), p. 1799–1806. doi: 10.1093/rheumatology/keae514. Full text in Research Archive Show summary

  Objectives Patients with gout need to adhere to medication over time to achieve good outcomes. We assessed self-reported adherence to medication with urate lowering therapy (ULT) 5 years after a treat-to-target intervention and studied how non-adherence was related to baseline demographic and disease variables. Methods Patients in the NOR-Gout observational study were included after a recent gout flare and serum urate >360 µmol/l. Patients [mean age 56.2 (S.D. 13.6), 94.5% males, 17.2% with tophi] attended tight-control visits over one year with escalating urate lowering therapy using a treat-to-target strategy. Five-year follow-up included the Medication Adherence Report Scale (MARS-5) questionnaire (range 5–25) for adherence. Flares and SUA target achievement were compared for 5-year adherence to medication. Results At 5 years most of the 163 patients used ULT (95.1%). MARS-5 adherence scores after 5 years were high (median 24, interquartile range 22–25). Patients in the lowest MARS-5 quartile had, compared with the highest quartile, more often a flare during the last year of follow-up (33.3% vs 9.5%, P = 0.004) and reached the 5-yr serum urate treatment target less frequently (45.2% vs 87.5%, P < 0.001). Baseline lower age (OR 0.56, 95%CI 0.39–0.79), non-European origin (OR 0.22, 95%CI 0.06–0.80), lower SF-36 mental health scores (OR 0.94, 95%CI 0.91–0.98) and less joint pain during last flare (OR 0.73, 95%CI 0.58–0.92) were independent risk factors for non-adherence to medication. Conclusions Patients reported high adherence to medication after 5 years. Non-adherence was related to more flares and less urate target achievement. Younger age and non-European origin were associated with non-adherence.

• Michelsen, Brigitte; Sexton, Joseph; Kvien, Tore Kristian Aaserud; Provan, Sella Aarrestad & Hammer, Hilde Berner (2024). Ultrasound evaluation contrasts clinical disease activity evaluation in rheumatoid arthritis patients with concomitant anxiety or depression. Seminars in Arthritis & Rheumatism. ISSN 0049-0172. 68, p. 1–6. doi: 10.1016/j.semarthrit.2024.152502. Full text in Research Archive Show summary

  Objectives To compare disease activity as assessed by ultrasonography (US) between rheumatoid arthritis (RA) patients with and without anxiety or depression, and to compare clinical disease activity and sociodemographic measures between these patient groups. Methods Anxious or depressed patients were identified by EuroQoL-5D-3L question “I am not/moderately/extremely anxious or depressed.” US assessments of 36 joints and 4 tendons were performed and power Doppler (PD) and grey scale (GS) sum scores calculated (both range 0–120). Comparisons between anxious/depressed and not anxious/depressed patients were performed in unadjusted analyses, adjusted logistic regression, and sensitivity analyses. Results A total of 201 RA patients starting biological disease-modifying antirheumatic drugs were included (82 % women, mean age 52 years, disease duration 10 years). Hundred-and-nine patients (54.2 %) were moderately or extremely anxious/depressed. Median (IQR) PD (13 (4, 21) vs. 10 (3, 20), p = 0.53) and GS (28 (18, 42) vs. 25 (14, 41), p = 0.51) sum scores were similar between anxious/depressed and not anxious/depressed patients, respectively, whereas composite scores of disease activity were significantly worse in the anxious/depressed patients (p < 0.001), as were also patient-reported outcomes, ESR, CRP and plasma calprotectin (all p ≤ 0.02). Sensitivity analyses confirmed these findings, except for CRP. Self-reported economy and sleep difficulties were also worse in the anxious/depressed patients and a higher proportion were not working (all p < 0.001). Conclusion This study highlights the negative impact of anxiety and depression on RA patients in standard care, and underscores the challenges in disease activity assessment. US examination may be a valuable objective tool in the evaluation of these patients.

• Gløersen, Marthe; Pettersen, Pernille Steen; Neogi, Tuhina; Sexton, Joseph; Kvien, Tore Kristian Aaserud & Hammer, Hilde Berner [Show all 7 contributors for this article] (2023). Associations between pain sensitization and measures of physical function in people with hand osteoarthritis: Results from the Nor-Hand study. Osteoarthritis and Cartilage. ISSN 1063-4584. 31(10), p. 1388–1395. doi: 10.1016/j.joca.2023.07.005. Full text in Research Archive Show summary

  Objective To examine whether pain sensitization is associated with hand and lower extremity function in people with hand osteoarthritis (OA) in the Nor-Hand study. Design Pain sensitization was assessed by pressure pain thresholds (PPTs) and temporal summation (TS). Hand function was assessed by Australian/Canadian Osteoarthritis Hand Index (AUSCAN) (range: 0–36), grip strength and Moberg pick-up test, and lower extremity function was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (range: 0–68), 30-s chair stand test, and 40-m walk test. We examined whether sex-standardized PPT and TS values were cross-sectionally associated with measures of physical function using linear regression analyses. Beta coefficients were presented per sex-specific standard deviation of PPT and TS. The mediating effect of pain was examined by causal-inference based mediation analysis. Results In 206 participants, higher PPTs at/near the hand, indicative of less peripheral and/or central pain sensitization, were associated with greater grip strength and better self-reported hand function (beta for PPT at finger joint on AUSCAN function: −1.41, 95% CI −2.40, −0.42). Higher PPTs at/near the hand, near the knee and at trapezius were associated with lower extremity function, although not statistically significant for all outcomes. Self-reported pain severity mediated the effect of PPT on self-reported function. TS was not associated with hand or lower extremity function. Conclusion Peripheral sensitization, and possibly central sensitization, was associated with impaired function. Effects of PPTs on self-reported function were mediated by self-reported pain, whereas there might be a direct effect of sensitization or effects through other mediators on performance-based function.

• Mulrooney, Elisabeth; Neogi, Tuhina; Dagfinrud, Hanne; Hammer, Hilde Berner; Pettersen, Pernille Steen & Gløersen, Marthe [Show all 9 contributors for this article] (2023). Comorbidities in people with hand OA and their associations with pain severity and sensitization: Data from the longitudinal Nor-Hand study. Osteoarthritis and Cartilage Open. 5(3). doi: 10.1016/j.ocarto.2023.100367. Full text in Research Archive Show summary

  Objective To determine whether the comorbidity burden and co-existing comorbidities are cross-sectionally and/or longitudinally associated with pain and pain sensitization in a cohort study of people with hand OA. Design We examined whether comorbidity burden and individual comorbidities based on the self-administered Comorbidity Index (range: 0–42) at baseline were associated with pain outcomes at baseline and 3 years follow-up. Pain outcomes included hand and overall bodily pain (range: 0–10) as well as pressure pain thresholds at the tibialis anterior muscle (kg/cm2) and temporal summation (distal radioulnar joint) as measures of central pain sensitization. We performed linear regression analyses adjusted for age, sex, body mass index, physical exercise and education. Results We included 300 and 196 participants in cross-sectional and longitudinal analyses, respectively. Using baseline data, the burden of comorbidities was associated with greater pain in hands (beta ​= ​0.61, 95% CI 0.37, 0.85) and overall body (beta ​= ​0.60, 95% CI 0.37, 0.87). Similar strength of associations was found between comorbidity burden (baseline) and follow-up pain. Among the individual comorbidities, back pain and depression were associated with nearly one unit higher pain score in hands and overall body at both baseline and follow-up. Only back pain was related to lower pressure pain thresholds at follow up (beta ​= ​−0.24, 95% CI −0.50, −0.001). Conclusion People with hand OA and greater comorbidity burden, co-existing back pain or depression reported greater pain severity than their counterparts, also 3 years later. These results acknowledge the relevance of accounting for comorbidities in the pain experience in people with hand OA.

• Ramiro, Sofia; Landewé, Robert; Heijde, Désireé Van Der; Sepriano, Alexandre; Fitzgerald, Oliver & Østergaard, Mikkel [Show all 30 contributors for this article] (2023). Stricter treat-To-Target in RA does not result in less radiographic progression: A longitudinal analysis in RA BIODAM. Rheumatology. ISSN 1462-0324. 62(9), p. 2989–2997. doi: 10.1093/rheumatology/kead021. Full text in Research Archive
• Westerlind, Helga; Glintborg, Bente; Hammer, Hilde Berner; Saevarsdottir, Saedis; Krogh, Niels Steen & Hetland, Merete Lund [Show all 10 contributors for this article] (2023). Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts. RMD Open. 9(3), p. 1–15. doi: 10.1136/rmdopen-2023-003027. Full text in Research Archive Show summary

  Objective Precision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions reaching remission vary across remission criteria, study types, disease-modifying antirheumatic drugs (DMARDs) and countries, and how they relate to other treatment outcomes. Methods We used data from eight existing large-scale, clinical RA registers and a pragmatic trial from Sweden, Denmark and Norway. In these, we defined three types of treatment cohorts; methotrexate monotherapy (as first DMARD), tumour necrosis factor inhibitors (TNFi) (as first biological DMARD) and rituximab. We developed a harmonised study protocol defining time points during 36 months of follow-up, collected clinical visit data on treatment response, retention, persistence and six alternative definitions of remission, and investigated how these outcomes differed within and between cohorts, by treatment. Results Cohort sizes ranged from ~50 to 22 000 patients with RA. The proportions reaching each outcome varied across outcome metric, but with small to modest variations within and between cohorts, countries and treatment. Retention and persistence rates were high (&gt;50% at 1 year), yet &lt;33% of patients starting methotrexate or TNFi, and only 10% starting rituximab, remained on drug without other DMARDs added and achieved American Congress of Rheumatology/European Alliance of Associations for Rheumatology or Simplified Disease Activity Index remission at 1 year. Conclusion Harmonisation of data from different RA data sources can be achieved without compromising internal validity or generalisability. The low proportions reaching remission, point to an unmet need for treatment optimisation in RA.

• Sirotti, Silvia; Terslev, Lene; Filippucci, Emilio; Iagnocco, Annamaria; Moller, Ingrid & Naredo, Esperanza [Show all 33 contributors for this article] (2023). Development and validation of an OMERACT ultrasound scoring system for the extent of calcium pyrophosphate crystal deposition at the joint level and patient level. The Lancet Rheumatology. 5(8), p. e474–e482. doi: 10.1016/S2665-9913(23)00136-4. Full text in Research Archive
• Parera, Ingrid Möller; Miguel, Maribel; Blasi, Joan; Piccaso, Riccardo; Hammer, Hilde Berner & Ortiz-Sagrista, Juan [Show all 9 contributors for this article] (2023). Ultrasound assessment of degenerative muscle sarcopenia: The University of Barcelona ultrasound scoring system for sarcopenia. RMD Open. 9:e002779, p. 1–9. doi: 10.1136/rmdopen-2022-002779. Full text in Research Archive Show summary

  Aim This study aimed to (1) determine the intraobserver and interobserver reliability of ultrasonographic measurement of muscle thickness (MT) and cross-sectional area (CSA) of the rectus femoris and biceps brachii, correlating these values with manual measurements on dissected cadavers and (2) develop the first semiquantitative musculoskeletal ultrasound (MSUS) scoring system of muscle morphology in sarcopenia and assess its intraobserver and interobserver reliability. In addition, the MSUS morphology score was compared with the corresponding histological images to verify concurrent validity. Methods Ten cryopreserved limbs of 10 cadavers aged 68–91 years were evaluated. The MSUS scoring system was based on the severity of muscle degeneration on a 3-point qualitative scale: grade 1 (normal), grade 2 (moderate changes) and grade 3 (severe changes). Reliability was assessed with intraclass correlation coefficient (ICC) for the MT and CSA and with Cohen’s kappa coefficients (κ) for the MSUS scoring system. Concurrent validity was analysed with ICC. Results The results showed excellent intraobserver and interobserver reliability for both the MSUS evaluation of MT and CSA (ICC ≥0.93). The MSUS scoring system showed excellent intraobserver reliability (κ=1.0) and very good interobserver reliability (κ=0.85). There was also a high intra- and inter-observer reliability for the histological scorings (ĸ ≥0.85 and mean ĸ=0.70, respectively), as well as high reliability between the histology and MSUS scoring systems (ICC=0.92). All results were statistically significant (p≤0.001). Conclusion MSUS measures of MT and CSA and the novel MSUS scoring system for degenerative muscle changes in sarcopenia was found to be reliable and strongly associated with histological findings.

• Uhlig, Till; Karoliussen, Lars Fridtjof; Sexton, Joseph; Provan, Sella Aarrestad; Kvien, Tore Kristian Aaserud & Haavardsholm, Espen A. [Show all 7 contributors for this article] (2023). Course and predictors of work productivity in gout - results from the NOR-Gout longitudinal 2-year treat-to-target study. Rheumatology. ISSN 1462-0324. 62(12), p. 3886–3892. doi: 10.1093/rheumatology/kead124. Full text in Research Archive Show summary

  Objectives In patients with gout there is a lack of longitudinal studies on the course of work productivity. We explored longitudinal changes in and predictors of work productivity over 2 years. Methods Patients in the NOR-Gout observational study with a recent gout flare and serum urate (sUA) >360 µmol/l attended tight-control visits during escalating urate lowering therapy according to a treat-to-target strategy. From the Work Productivity and Activity Impairment (WPAI) questionnaire, scores for work productivity and activity impairment were assessed over 2 years together with the Beliefs about Medicines Questionnaire and a variety of demographic and clinical variables. Results At baseline patients had a mean age of 56.4 years and 95% were males. WPAI scores at baseline were 5.0% work missed (absenteeism), 19.1% work impairment (presenteeism), 21.4% overall work impairment and 32.1% activity impairment. Work productivity and activity impairment improved during the first months, and remained stable at 1 and 2 years. Comorbidities were not cross-sectionally associated with WPAI scores at baseline, but predicted worse work impairment and activity impairment at year 1. The Beliefs about Medicines Questionnaire subscale with concerns about medicines at baseline independently predicted worse overall work impairment and worse activity impairment at year 1. Conclusions In patients with gout who were intensively treated to the sUA target, work productivity and activity impairment were largely unchanged and at 1 year predicted by comorbidities and patient concerns about medication.

• Uhlig, Till; Karoliussen, Lars Fridtjof; Sexton, Joseph; Kvien, Tore Kristian Aaserud; Haavardsholm, Espen A. & Taylor, W.J. [Show all 7 contributors for this article] (2023). Beliefs about medicines in gout patients: results from the NOR-Gout 2-year study. Scandinavian Journal of Rheumatology. ISSN 0300-9742. doi: 10.1080/03009742.2023.2213507. Full text in Research Archive Show summary

  Objective Adherence to urate-lowering therapy (ULT) in gout is challenging. This longitudinal study aimed to determine 2 year changes in beliefs about medicines during intervention with ULT. Method Patients with a recent gout flare and increased serum urate received a nurse-led ULT intervention with tight control visits and a treatment target. Frequent visits at baseline and 1, 2, 3, 6, 9, 12, and 24 months included the Beliefs about Medicines Questionnaire (BMQ), and demographic and clinical variables. The BMQ subscales on necessity, concerns, overuse, harm, and the necessity–concerns differential were calculated as a measure of whether the patient perceived that necessity outweighed concerns. Results The mean serum urate reduced from 500 mmol/L at baseline to 324 mmol/L at year 2. At years 1 and 2, 85.5% and 78.6% of patients, respectively, were at treatment target. The 2 year mean ± sd BMQ scores increased for the necessity subscale from 17.0 ± 4.4 to 18.9 ± 3.6 (p < 0.001) and decreased for the concerns subscale from 13.4 ± 4.9 to 12.5 ± 2.7 (p = 0.001). The necessity–concerns differential increased from 3.52 to 6.58 (p < 0.001), with a positive change independent of patients achieving treatment targets at 1 or 2 years. BMQ scores were not significantly related to treatment outcomes 1 or 2 years later, and achieving treatment targets did not lead to higher BMQ scores. Conclusion Patient beliefs about medicines improved gradually over 2 years, with increased beliefs in the necessity of medication and reduced concerns, but this improvement was unrelated to better outcomes.

• Uhlig, Till; Karoliussen, Lars Fridtjof; Sexton, Joseph; Kvien, Tore Kristian Aaserud; Haavardsholm, Espen A. & Hammer, Hilde Berner (2023). Lifestyle factors predict gout outcomes: Results from the NOR-Gout longitudinal 2-year treat-to-target study. RMD Open. 9(4). doi: 10.1136/rmdopen-2023-003600. Full text in Research Archive Show summary

  Objective Gout is associated with lifestyle, body mass index (BMI) and comorbidities, including dyslipidaemia. We studied how in actively treated patients, anthropometric measures and lipid levels changed over 2 years and whether they predicted gout outcomes. Methods Patients with a recent gout flare and elevated serum urate (sUA) received gout education and treat-to-target urate-lowering therapy over 1 year. Anthropometric measures with BMI, waist circumference (WC) and waist–height ratio (WHR) as well as lipid levels were measured yearly over 2 years. We examined whether baseline anthropometric measures and lipid levels were related to flares and to achieving the sUA target. Results At baseline, patients (n=211) were with mean age of 56.4 years and 95% were male. Over 2 years, anthropometric measures were largely unchanged while cholesterol and low-density lipoprotein cholesterol (LDL-C) were reduced at year 1. Anthropometric measures were associated with presence of tophi. Higher baseline WC (OR: 0.96 per cm, 95% CI: 0.93 to 0.99) decreased and high level of high-density lipoprotein cholesterol (OR: 5.1 per mmol/L, 95% CI: 1.2 to 22.1) increased the chance of sUA target achievement at year 2. High LDL-C (OR: 1.8 per mmol/L, 95% CI: 1.2 to 2.6) predicted the chance of having a gout flare during year 2. Conclusion In actively treated patients with gout, anthropometric measures were largely unchanged over 2 years and lipid levels were reduced. High WC and lipid levels predicted unfavourable gout outcomes after 2 years.

• Hammer, Hilde Berner; Pedersen, Sigve Lars; Jonsson, Maria Karolina; Mathsson-Alm, Linda; Gehring, Isabel & Sexton, Joseph [Show all 8 contributors for this article] (2023). Calprotectin, a sensitive marker of inflammation, is robustly assessed in plasma from patients with early or established rheumatoid arthritis by use of different laboratory methods. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 83(5), p. 330–335. doi: 10.1080/00365513.2023.2225223. Full text in Research Archive Show summary

  Calprotectin (S100A8/S100A9, MRP8/MRP14) is a major leukocyte protein found to be more sensitive than C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) as a marker of inflammation in patients with rheumatoid arthritis (RA). The present objective was to explore the robustness of calprotectin assessments by comparing two different laboratory methods assessing calprotectin in plasma samples from patients with early or established RA. A total of 212 patients with early RA (mean (SD) age 52(13.3) years, disease duration 0.6(0.5) years) and 177 patients with established RA (mean (SD) age 52.9(13.0) years, disease duration 10.0(8.8) years) were assessed by clinical, laboratory, and ultrasound examinations. Frozen plasma samples (−80 °C) were analysed for calprotectin levels at baseline, 1, 2, 3, 6 and 12 months by use of either enzyme-linked immunosorbent assay (ELISA) or fluoroenzyme immunoassay (FEIA). The ELISA technique used kits from Calpro AS and the FEIA technology was assessed on an automated Thermo Fisher Scientific instrument. The results showed high correlations between the two methods at baseline and during follow-up, with Spearman correlation at baseline 0.93 (p < 0.001) in the early and 0.96 (p < 0.001) in the established RA cohorts. The correlations between each of the two calprotectin assessments and clinical examinations had similar range. Calprotectin correlated well with clinical examinations, with at least as high correlations as CRP and ESR. The present study showed similar results for the two analytical methods, supporting the robustness of calprotectin analyses, and suggest calprotectin in plasma to be included in the assessments offered by clinical routine laboratories.

• Gløersen, Marthe; Pettersen, Pernille Steen; Neogi, Tuhina; Jafarzadeh, S. Reza; Vistnes, Maria & Thudium, Christian S. [Show all 11 contributors for this article] (2022). Associations of Body Mass Index With Pain and the Mediating Role of Inflammatory Biomarkers in People With Hand Osteoarthritis. Arthritis & Rheumatology. ISSN 2326-5191. 74(5), p. 810–817. doi: 10.1002/art.42056. Full text in Research Archive Show summary

  Objective To examine the association of body mass index (BMI) with pain in people with hand osteoarthritis (OA), and explore whether this association, if causal, is mediated by systemic inflammatory biomarkers. Methods In 281 Nor-Hand study participants, we estimated associations between BMI and hand pain, as measured by the Australian/Canadian Osteoarthritis Hand Index (AUSCAN; range 0–20) and Numerical Rating Scale (NRS; range 0–10); foot pain, as measured by NRS (range 0–10); knee/hip pain, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range 0–20); painful total body joint count; and pain sensitization. We fit natural-effects models to estimate natural direct and natural indirect effects of BMI on pain through inflammatory biomarkers. Results Each 5-unit increase in BMI was associated with more severe hand pain (on average increased AUSCAN by 0.64 [95% confidence interval (95% CI) 0.23, 1.08]), foot pain (on average increased NRS by 0.65 [95% CI 0.36, 0.92]), knee/hip pain (on average increased WOMAC by 1.31 [95% CI 0.87, 1.73]), generalized pain, and pain sensitization. Mediation analyses suggested that the effects of BMI on hand pain and painful total body joint count were partially mediated by leptin and high-sensitivity C-reactive protein (hsCRP), respectively. Effect sizes for mediation by leptin were larger for the hands than for the lower extremities, and were statistically significant for the hands only. Conclusion In people with hand OA, higher BMI is associated with greater pain severity in the hands, feet, and knees/hips. Systemic effects of obesity, measured by leptin, may play a larger mediating role for pain in the hands than in the lower extremities. Low-grade inflammation, measured by hsCRP, may contribute to generalized pain in overweight/obese individuals.

• Mulrooney, Elisabeth; Neogi, Tuhina; Dagfinrud, Hanne; Hammer, Hilde Berner; Pettersen, Pernille Steen & Gaarden, Torfinn Lødøen [Show all 10 contributors for this article] (2022). The associations of psychological symptoms and cognitive patterns with pain and pain sensitization in people with hand osteoarthritis. Osteoarthritis and Cartilage Open. 4(2), p. 1–7. doi: 10.1016/j.ocarto.2022.100267. Full text in Research Archive Show summary

  Objective To examine whether psychological symptoms and cognitive patterns are associated with self-reported pain and pain sensitization in people with hand osteoarthritis (OA). Design In the Nor-Hand study (n ​= ​300), people with hand OA self-reported psychological symptoms (Hospital Anxiety and Depression Scale), cognitive patterns (Pain catastrophizing Scale and Arthritis Self-Efficacy Scale) as well as their pain severity in hands, overall pain and multi-joint pain. Central pain sensitization was measured clinically by temporal summation and pressure pain threshold tests. We examined whether psychological symptoms and cognitive patterns were cross-sectionally associated with pain using linear regression. Beta coefficients (β) per one standard deviation of the independent variable were presented. Stratified analyses were performed in cases of significant interactions (p ​< ​0.10). Results Higher levels of anxiety, depressive symptoms and pain catastrophizing and low levels of self-efficacy were statistically significantly associated with higher levels of hand pain by Numeric Rating Scale (β ​= ​0.43, 0.48 and −0.57, respectively). Similar associations were found for overall pain, but not for measures of central pain sensitization. In stratified analyses, anxiety and depressive symptoms were more strongly related with pain in subgroups with younger age and higher comorbidity burden. Pain catastrophizing was more strongly related with pain in subgroups with younger age, overweight/obesity, higher comorbidity burden and poor sleep. Conclusion Psychological symptoms and cognitive patterns were associated with self-reported OA pain, especially in people with younger age, overweight/obesity, higher comorbidity burden and poor sleep. No associations were found for psychological symptoms and cognitive patterns with pain sensitization.

• Podewski, A.F.; Glimm, A.M.; Fischer, I.; Bruyn, G.A.W.; Hanova, P. & Hammer, Hilde Berner [Show all 12 contributors for this article] (2022). The MCP2 and the wrist plus two extensor compartments are the most affected and responsive joints/tendons out of the US7 score in patients with rheumatoid arthritis-an observational study. Arthritis Research & Therapy. ISSN 1478-6354. 24(1), p. 1–13. doi: 10.1186/s13075-022-02874-y. Full text in Research Archive Show summary

  Background There is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score. Methods RA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA. Results A total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p < 0.001) and the palmar side of the finger joints by PD (p < 0.001) were more frequently pathologic. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score’s information. No major differences between the groups of early and established RA could be detected. Conclusions The wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level.

• Hammer, Hilde Berner; Rollefstad, Silvia Christin Hellerud; Semb, Anne Grete; Jensen, Gro Elisabeth; Karoliussen, Lars Fridtjof & Terslev, L [Show all 9 contributors for this article] (2022). Urate crystal deposition is associated with inflammatory markers and carotid artery pathology in patients with intercritical gout: results from the NOR-Gout study. RMD Open. 8(2), p. 1–5. doi: 10.1136/rmdopen-2022-002348. Full text in Research Archive Show summary

  Background Gout is of unknown reason associated with cardiovascular disease. Ultrasound is sensitive for detecting crystal deposition and plasma calprotectin is a sensitive inflammatory marker. This study explores the associations between crystal deposition, inflammation and carotid artery pathology. Method A cross-sectional analysis of baseline assessments from the NOR-Gout study was undertaken. Crystal deposition was assessed by ultrasound (double contour, tophi, aggregates) and dual-energy CT (DECT) and laboratory assessments included plasma calprotectin. The carotid arteries were bilaterally examined for carotid intima–media thickness (cIMT) and presence of plaques. Spearman correlations, Mann-Whitney tests and linear regression analyses were used to explore associations between crystal deposition, inflammatory markers,and carotid pathology. Results 202 patients with intercritical gout (95.5% men, mean (SD) age 56.5 (13.8) years, disease duration 7.9 (7.7) years) were included. Calprotectin was correlated with all scores of crystal deposition by ultrasound (r=0.26–0.32, p&lt;0.001) and DECT (r=0.15, p&lt;0.05). cIMT was correlated with sum score aggregates (r=0.18–0.22, p&lt;0.05). Patients with large tophi had higher levels of calprotectin as well as more frequent carotid plaque (p&lt;0.05). Conclusions Study findings point towards crystal deposition contributing to subclinical inflammation with subsequent vascular implications. However, future longitudinal studies are needed to confirm such causal relationships.

• Uhlig, Till; Karoliussen, Lars Fridtjof; Sexton, Joseph; Kvien, Tore Kristian; Haavardsholm, Espen A. & Perez-Ruiz, Fernando [Show all 7 contributors for this article] (2022). One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study. Arthritis Research & Therapy. ISSN 1478-6354. 24:88, p. 1–11. doi: 10.1186/s13075-022-02772-3. Full text in Research Archive Show summary

  Objectives To explore the frequency and predictors of flares over 2 years during a treat-to-target strategy with urate-lowering therapy (ULT) in patients with gout. Methods In the treat-to-target, tight control NOR-Gout study patients started ULT with escalating doses of allopurinol. Flares were recorded over 2 years. Baseline predictors of flares during months 9–12 in year 1 and during year 2 were analyzed by multivariable logistic regression. Results Of 211 patients included (mean age 56.4 years, disease duration 7.8 years, 95% males), 81% (150/186) of patients experienced at least one gout flare during the first year and 26% (45/173) during the second year. The highest frequency of flares in the first year was seen during months 3–6 (46.8% of patients). Baseline crystal depositions detected by ultrasound and by dual-energy computed tomography (DECT) were the only variables which predicted flares both during the first period of interest at months 9–12 (OR 1.033; 95% CI 1.010–1.057, and OR 1.056; 95% CI 1.007–1.108) and also in year 2. Baseline subcutaneous tophi (OR 2.42, 95% CI 1.50–5.59) and prior use of colchicine at baseline (OR 2.48, 95% CI 1.28-4.79) were independent predictors of flares during months 9–12, whereas self-efficacy for pain was a protective predictor (OR 0.98 per unit, 95% CI 0.964–0.996). Conclusions In patients with gout, flares remain frequent during the first year of a treat-to-target ULT strategy, especially during months 3–6, but are much less frequent during year 2. Baseline crystal depositions predict flares over 2 years, supporting ULT early during disease course. Trial registration ACTRN12618001372279

• Tiulpin, Aleksei; Saarakkala, Simo; Mathiessen, Alexander; Hammer, Hilde Berner; Furnes, Ove Nord & Nordsletten, Lars [Show all 8 contributors for this article] (2022). Predicting total knee arthroplasty from ultrasonography using machine learning. Osteoarthritis and Cartilage Open. 4(4). doi: 10.1016/j.ocarto.2022.100319. Full text in Research Archive Show summary

  Objective To investigate the value of ultrasonographic data in predicting total knee replacement (TKR). Design Data from the Musculoskeletal Pain in Ullensaker study (MUST) was linked to the Norwegian Arthroplasty Register to form a 5–7 year prospective cohort study of 630 persons (69% women, mean (SD) age 64 (8.7) years). We examined the predictive power of ultrasound (US) features, i.e. osteophytes, meniscal extrusion, synovitis in the suprapatellar recess, femoral cartilage thickness, and quality for future knee osteoarthritis (OA) surgery. We investigated 4 main settings for multivariate predictive modeling: 1) clinical predictors (age, sex, body mass index, knee injury, familial OA and workload), 2) radiographic data (assessed by the Kellgren Lawrence grade, KL) with clinical predictors, 3) US features and clinical predictors. Finally, we also considered an ensemble of models 2) and 3) and used it as our fifth model. All models were compared using the Average Precision (AP) and the Area Under Receiver Operating Characteristic Curve (AUC) metrics. Results Clinical predictors yielded AP of 0.11 (95% confidence interval [CI] 0.05–0.23) and AUC of 0.69 (0.58–0.79). Clinical predictors with KL grade yielded AP of 0.20 (0.12–0.33) and AUC of 0.81 (0.67–0.90). The clinical variables with ultrasound yielded AP of 0.17 (0.08–0.30) and AUC of 0.79 (0.69–0.86). Conclusion Ultrasonographic examination of the knee may provide added value to basic clinical and demographic descriptors when predicting TKR. While it does not achieve the same predictive performance as radiography, it can provide additional value to the radiographic examination.

• Sundlisæter, Nina Beate Paulshus; Sundin, Ulf Gunnar; Aga, Anna-Birgitte; Sexton, Joseph; Hammer, Hilde Berner & Uhlig, Till [Show all 9 contributors for this article] (2022). Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study. RMD Open. 8(1), p. 1–6. doi: 10.1136/rmdopen-2021-002013. Full text in Research Archive Show summary

  Objective To investigate limiting factors of American College of Rheumatology (ACR)/EULAR Boolean remission in rheumatoid arthritis (RA), and compare patients who fulfil the criteria to patients who only partly fulfil the criteria, with respect to imaging inflammation and biologic disease modifying anti-rheumatic drug (DMARD) usage. Methods Patients with DMARD-naïve RA were treated according to current recommendations in the the ARCTIC trial (Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen). Limiting factors of reaching ACR/EULAR Boolean remission at 2 years were assessed. Imaging inflammation (ultrasound and MRI) in patients in remission was compared with patients failing to fulfil different components of the criteria. The OR of biologic therapy was calculated using logistic regression. Results Of 203 patients, 112 (55%) reached ACR/EULAR Boolean remission; 49 (24%) fulfilled three of four criteria. The main limiting factors were patient global assessment (PGA) (59%) and tender joints (22%). Imaging inflammation was not significantly different for patients in remission and patients not fulfilling the criteria due to elevated PGA and/or tender joints, but higher odds of using biologics (OR 3.63, 95% CI 1.73 to 7.61) were observed. Conclusions PGA and tender joints were the factors most often limiting achievement of ACR/EULAR Boolean remission. The level of imaging inflammation was not elevated in these patients compared with patients in remission, but the odds of using biologic DMARDs were higher. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

• Delcoigne, Bénédicte; Provan, Sella Aarrestad; Hammer, Hilde Berner; Giuseppe, Daniela Di; Frisell, Thomas & Glintborg, Bente [Show all 13 contributors for this article] (2022). Do patient-reported measures of disease activity in rheumatoid arthritis vary between countries? Results from a Nordic collaboration. Rheumatology. ISSN 1462-0324. 61(11), p. 4286–4296. doi: 10.1093/rheumatology/keac081. Full text in Research Archive Show summary

  Abstract Objectives To investigate whether patient-reported outcomes vary across countries and are influenced by cultural/contextual factors. Specifically, we aimed to assess inter-country differences in tender joint count (TJC), pain and patient’s global health assessment (PGA), and their impact on disease activity (DAS28-CRP) in RA patients from five Nordic countries. Methods We collected data (baseline, 3- and 12-months) from rheumatology registers in the five countries comprising RA patients starting a first ever MTX or a first ever TNF inhibitor (TNFi). In order to assess the role of context (=country), we separately modelled TJC, pain and PGA as functions of objective variables (CRP, swollen joint count, age, sex, calendar period and disease duration) with linear models. Analyses were performed at each time point and for both treatments. We further assessed the impact of inter-country differences on DAS28-CRP. Results A total of 27 645 RA patients started MTX and 19 733 started a TNFi. Crude inter-country differences at MTX start amounted to up to 4 points (28 points scale) for TJC, 10 and 27 points (0–100 scale) for pain and PGA, respectively. Corresponding numbers at TNFi start were 3 (TJC), 27 (pain) and 24 (PGA) points. All differences were reduced at 3- and 12-months, and attenuated when adjusting for the objective variables. The variation in predicted DAS28-CRP across countries amounted to &amp;lt;0.5 units. Conclusions Inter-country differences in TJC, pain and PGA are greater than expected based on differences in objective measures, but have a small clinical impact on DAS28-CRP across countries.

• Hammer, Hilde Berner & Caporali, Roberto (2022). Controversies in rheumatology: ultrasound for monitoring of RA-do we need it? Rheumatology. ISSN 1462-0324. 61(11), p. 4245–4251. doi: 10.1093/rheumatology/keac228. Full text in Research Archive Show summary

  Clinical joint examination is the cornerstone for evaluation of patients with RA. However, since large discrepancies have been shown even between experienced rheumatologists in evaluation of joint inflammation, and tender joints may have limited value in reflecting inflammation, US has in recent decades been introduced in the clinical assessments of RA patients. US has high accordance with other imaging modalities and enables detection of clinically difficult pathologies and contributes to assessments of joints difficult to evaluate clinically. However, there is no general agreement on the optimal use of US in rheumatology, and the prevalence of machines as well as the level of experience differs greatly between countries. In addition, standardized use of US in treat-to-target follow-up of RA patients was found not to have any added value. Thus, how to use US in monitoring of RA patients is open for debate. The present article will discuss the pros and cons for using US in the clinical setting.

• Uhlig, Till; Karoliussen, Lars Fridtjof; Sexton, Joseph; Kvien, Tore Kristian; Haavardsholm, Espen A. & Perez-Ruiz, F. [Show all 7 contributors for this article] (2022). Fluctuation and change of serum urate levels and flares in gout: results from the NOR-Gout study. Clinical Rheumatology. ISSN 0770-3198. 41, p. 3817–3823. doi: 10.1007/s10067-022-06416-4. Full text in Research Archive Show summary

  A gout attack may evolve after a purine-rich diet or alcohol and after starting urate-lowering therapy (ULT). The relationships between fluctuation and change in serum urate (SU) with the occurrence of flares were investigated in this study. In the prospective NOR-Gout study, gout patients with increased SU and a recent flare were treated to target with ULT over 1 year, with follow-up at year 2 with SU and flare as outcomes. SU and flares were assessed at both monthly and 3-monthly intervals until target SU was reached. Fluctuation over periods and changes in SU between two time points were assessed and compared in patients with and without flares. At year 1, 186 patients completed follow-up (88.2%) and 173 (82.0%) at year 2. Mean age (SD) at baseline was 56.4 (13.7) years, disease duration was 7.8 (7.6) years, and 95.3% were men. The first-year SU fluctuation and change were related to flare occurrence during year 1 (both p < 0.05). High fluctuation with an absolute sum of all SU changes during the first 9 months was related to flares over 3-month periods (all p < 0.05), and high fluctuation during the first 3 months was related to flares in months 3–6 (p = 0.04). Monthly and high SU changes or again reaching higher SU levels > 360 µmol/l were not related to flares. Fluctuation and change in SU were related to flare occurrence during the first year of ULT, while changes between visits and reaching SU levels > 360 µmol/L were not related to flares.

• Gløersen, Marthe; Pettersen, Pernille Steen; Neogi, Tuhina; Slatkowsky-Christensen, Barbara; Kvien, Tore Kristian & Magnusson, Karin [Show all 8 contributors for this article] (2022). Associations of pain sensitisation with tender and painful joint counts in people with hand osteoarthritis: results from the Nor-Hand study. RMD Open. 8. doi: 10.1136/rmdopen-2021-001774. Full text in Research Archive Show summary

  Objective: To examine associations of pain sensitisation with tender and painful joint counts and presence of widespread pain in people with hand osteoarthritis (OA). Methods: Pressure pain thresholds (PPT) at a painful finger joint and the tibialis anterior muscle, and temporal summation (TS) were measured in 291 persons with hand OA. We examined whether sex-standardised PPT and TS values were associated with assessor-reported tender hand joint count, self-reported painful hand and total body joint counts and presence of widespread pain using linear and logistic regression analyses adjusted for age, sex, body mass index, education and OA severity. Results: People with lower PPTs at the painful finger joint (measure of peripheral and/or central sensitisation) had more tender and painful hand joints than people with higher PPTs. PPT at tibialis anterior (measure of central sensitisation) was associated with painful total body joint count (beta=−0.82, 95% CI −1.28 to –0.35) and presence of widespread pain (OR=0.57, 95% CI 0.43 to 0.77). The associations between TS (measure of central sensitisation) and joint counts in the hands and the total body were statistically non-significant. Conclusion This cross-sectional study suggested that pain sensitisation (ie, lower PPTs) was associated with joint counts and widespread pain in hand OA. This knowledge may be used for improved pain phenotyping of people with hand OA, which may contribute to better pain management through more personalised medicine. Further studies are needed to assess whether a reduction of pain sensitisation leads to a decrease in tender and painful joint counts.

• Sundin, Ulf Gunnar; Sundlisæter, Nina Beate Paulshus; Aga, Anna-Birgitte; Sexton, Joseph; Nordberg, Lena Kristine Bugge & Hammer, Hilde Berner [Show all 10 contributors for this article] (2021). Value of MRI and ultrasound for prediction of therapeutic response and erosive progression in patients with early rheumatoid arthritis managed by an aggressive treat-To-Target strategy. RMD Open. 7:e001525(1), p. 1–11. doi: 10.1136/rmdopen-2020-001525. Full text in Research Archive Show summary

  Objectives To investigate if inflammation detected by MRI or ultrasound at rheumatoid arthritis (RA) onset is predictive of erosive progression or poor response to methotrexate monotherapy, and to investigate if subclinical inflammation in remission is predictive of future treatment escalation or erosive progression. Methods In a 2-year study, 218 patients with disease-modifying antirheumatic drug-naïve early RA were treated by a tight-control treat-to-target strategy corresponding to current recommendations. MRI and ultrasound were performed at regular intervals. Baseline imaging-based inflammation measures were analysed as predictors for early methotrexate failure and erosive progression using univariate and multivariate regression adjusted for clinical, laboratory and radiographic measures. In patients in remission after 1 year, imaging measures were analysed as predictors of treatment escalation and erosive progression during the second year. The added value of imaging in prediction models was assessed using receiver operating characteristic analyses. Results Baseline MRI inflammation was associated with MRI erosive progression and ultrasound with radiographic erosive progression. No imaging inflammation measure was associated with early methotrexate failure. Imaging inflammation was present in a majority of patients in clinical remission. Tenosynovitis was associated with treatment escalation, and synovitis and tenosynovitis with MRI/radiographic erosive progression during the second year. Imaging information did not improve prediction models for any of the outcomes. Conclusions Imaging-detected inflammation, both at diagnosis and in remission, is associated with elements of future disease development. However, the lack of a significant effect on prediction models indicates limited value of systematic MRI and ultrasound in management of early RA.

• Naredo, Esperanza; Rodriguez-Garcia, Sebastián C.; Terslev, Lene; Martinoli, Carlo; Klauser, Andrea & Hartung, Wolfgang [Show all 41 contributors for this article] (2021). The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. Ultraschall in der Medizin. ISSN 0172-4614. 43(3), p. 252–273. doi: 10.1055/a-1640-9183. Full text in Research Archive Show summary

  The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.

• Hammer, Hilde Berner; Hansen, Ib M.J.; Järvinen, Pentti; Leirisalo-Repo, Marjatta T.; Ziegelasch, Michael & Agular, Birte [Show all 7 contributors for this article] (2021). Major reduction of ultrasound-detected synovitis during subcutaneous tocilizumab treatment: results from a multicentre 24 week study of patients with rheumatoid arthritis. Scandinavian Journal of Rheumatology. ISSN 0300-9742. 50, p. 262–270. doi: 10.1080/03009742.2020.1845394. Full text in Research Archive
• Christiansen, Sara Nysom; Filippou, Georgios; Scirè, Carlo Alberto; Balint, Peter V.; Bruyn, George AW & Dalbeth, Nicola [Show all 24 contributors for this article] (2021). Consensus-based semi-quantitative ultrasound scoring system for gout lesions: Results of an OMERACT Delphi process and web-reliability exercise. Seminars in Arthritis & Rheumatism. ISSN 0049-0172. 51(3), p. 644–649. doi: 10.1016/j.semarthrit.2020.11.011. Full text in Research Archive
• Fodor, Daniela; Rodriguez-Garcia, Sebastián C.; Cantisani, Vito; Hammer, Hilde B.; Hartung, Wolfgang & Klauser, Andrea [Show all 41 contributors for this article] (2021). The EFSUMB guidelines and recommendations for musculoskeletal ultrasound - Part I: Extraarticular pathologies. Ultraschall in der Medizin. ISSN 0172-4614. doi: 10.1055/a-1562-1455. Full text in Research Archive Show summary

  The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.

• Hammer, Hilde Berner; Agular, Birte & Terslev, Lene (2021). Fatigue Is Not Associated With Objective Assessments of Inflammation During Tocilizumab Treatment of Patients With Rheumatoid Arthritis. ACR Open Rheumatology. 4(3), p. 202–208. doi: 10.1002/acr2.11379. Full text in Research Archive Show summary

  Objective: In patients with rheumatoid arthritis (RA), the relation between fatigue and disease activity is not established, and our objective was to explore in post hoc analyses the associations between fatigue and subjective as well as objective assessments of inflammation during follow-up of patients with RA initiating biologic treatment. Methods: In a Nordic multicenter study, patients with RA starting tocilizumab were examined for fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue sum score) as well as patient-reported outcome measures (PROMs) (patient's global disease activity, joint pain, and Health Assessment Questionnaire Disability Index), clinical examinations (examiner's global disease activity, 28 tender/swollen joint counts), laboratory variables (erythrocyte sedimentation rate, C-reactive protein), and ultrasound assessments (semiquantitative scoring [0-3]) of gray scale and Doppler of 36 joints and 4 tendons) at baseline and 4, 12, and 24 weeks. The associations were explored by using nonparametric tests, including the Wilcoxon rank test, the Mann-Whitney U test, Spearman correlations, and a linear regression and linear mixed model. Results: One hundred ten patients were included (83% female, mean [SD] age 55.6 [12.1] years, mean [SD] RA duration 8.7 [9.5] years, 81% anti-cyclic citrullinated peptide positive). Fatigue, PROMs, and clinical, laboratory, and ultrasound variables all decreased significantly during follow-up, already at 4 weeks (P < 0.001). Fatigue was both cross-sectionally and longitudinally associated with PROMs, whereas there were no or low associations with clinical, laboratory, or ultrasound assessments of inflammation. Baseline fatigue was predictive of PROMs at 12 and 24 weeks (P < 0.05 and P < 0.001, respectively) but not of any objective assessments. Conclusion: Fatigue was primarily associated with subjective assessments of disease activity. Thus, the present study supports fatigue to reflect other aspects of RA disease activity than inflammation.

• Uhlig, Till; Karoliussen, Lars Fridtjof; Sexton, Joseph; Borgen, Tove; Haavardsholm, Espen A. & Kvien, Tore Kristian [Show all 7 contributors for this article] (2021). 12-month results from the real-life observational treat-to-target and tight-control therapy NOR-Gout study: Achievements of the urate target levels and predictors of obtaining this target. RMD Open. 7(1). doi: 10.1136/rmdopen-2021-001628. Full text in Research Archive Show summary

  Objectives Gout is often not adequately treated, and we aimed to apply urate lowering treatment (ULT) combined with individual information to achieve target serum urate (sUA) in clinical practice, and to identify predictors of achievement of this sUA target. Methods Patients with a recent gout flare and sUA &gt;360 µmol/L (&gt;6 mg/dL) were consecutively included in a single-centre study and managed with a treat-to-target approach combining nurse-led information about gout with ULT. All patients were assessed with tight controls at baseline, 1, 2, 3, 6, 9 and 12 months including clinical examination, information on demographics, lifestyle, self-efficacy and beliefs about medicines. The treatment target was sUA &lt;360 µmol/L and multivariable logistic regression was used to identify predictors of target attainment with ORs and 95% CIs. Results Of 211 patients (mean age 56.4 years, disease duration 7.8 years, 95% males), 186 completed the 12-month study. Mean sUA levels decreased from baseline mean 500 to 311 µmol/L at 12 months with 85.5% achieving the treatment target. Alcohol consumption at least weekly versus less frequently (OR 0.14; 95% CI 0.04 to 0.55) as well as beliefs in overuse of medicines (OR per unit 0.77; 95 CI 0.62 to 0.94) decreased the chance of reaching the treatment target, while higher self-efficacy for arthritis symptoms (OR 1.49 per 10 units; 95% CI 1.09 to 2.05) increased the likelihood. Conclusions This study shows that target sUA can be achieved with ULT in most patients. Less self-reported alcohol consumption, low beliefs in overuse of medicines and higher self-efficacy are associated with treatment success.

• Costantino, Félicie; Carmona, Loreto; Boers, Maarten; Backhaus, Marina; Balint, Peter V. & Bruyn, George A. [Show all 23 contributors for this article] (2021). EULAR recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). Annals of the Rheumatic Diseases. ISSN 0003-4967. 80(7), p. 840–847. doi: 10.1136/annrheumdis-2020-219816. Full text in Research Archive
• Sande, Nina Krafft; Bøyesen, Pernille Helen; Aga, Anna-Birgitte; Hammer, Hilde Berner; Flatø, Berit & Roth, Johannes [Show all 7 contributors for this article] (2021). Development and reliability of a novel ultrasonographic joint-specific scoring system for synovitis with reference atlas for patients with juvenile idiopathic arthritis. RMD Open. 7(2). doi: 10.1136/rmdopen-2021-001581. Full text in Research Archive Show summary

  Objective To develop an ultrasonographic image acquisition protocol and a joint-specific scoring system for synovitis with reference atlas in patients with juvenile idiopathic arthritis (JIA) and to assess the reliability of the system. Methods Seven rheumatologists with extensive ultrasound experience developed a scanning protocol and a semiquantitative joint-specific scoring system for B-mode (BM) synovitis for the elbow, wrist, metacarpophalangeal 2–3, proximal interphalangeal 2–3, hip, knee, ankle and metatarsophalangeal 2–3 joints. An ultrasonographic reference atlas for BM synovitis, divided in four age groups (2–4, 5–8, 9–12, 13–18 years), and power Doppler (PD) activity was then developed. Reliability was assessed for all joints on still images and in a live exercise including 10 patients with JIA, calculated by intraclass correlation coefficient (ICC) and weighted kappa. Results A scanning protocol and scoring system for multiple joints with reference atlas composed of images with four different score levels for BM and PD were developed. Still image scoring for BM synovitis on joint level showed good to excellent intra-reader reliability (ICC/kappa ranges: 0.75–0.95/0.63–0.91) and moderate to excellent inter-reader reliability (ICC/kappa ranges: 0.89–0.99/0.50–0.91). Still image scoring for PD activity showed excellent intra-reader and inter-reader reliability (ICC/kappa: 0.96/0.91 and ICC/kappa: 0.97/0.80, respectively). In the live scoring, inter-reader reliability (ICC/kappa) was moderate to excellent for BM synovitis (0.94/0.51) and PD activity (0.91/0.60). Conclusion An ultrasonographic image acquisition protocol and joint-specific scoring system with reference atlas were developed and demonstrated moderate to excellent reliability for scoring of synovitis in patients with JIA. This can be a valuable tool in clinical practice and future research.

• Taylor, William J.; Dalbeth, Nicola; Saag, Kenneth; Singh, Jasvinder A.; Rahn, Elizabeth J. & Mudano, Amy S. [Show all 27 contributors for this article] (2021). Flare rate thresholds for patient assessment of disease activity states in Gout. Journal of Rheumatology. ISSN 0315-162X. 48(2), p. 293–298. doi: 10.3899/jrheum.191242. Full text in Research Archive
• Pettersen, Pernille Steen; Neogi, Tuhina; Magnusson, Karin; Mathiessen, Alexander; Hammer, Hilde Berner & Uhlig, Till [Show all 8 contributors for this article] (2021). Associations between joint pathologies and central sensitization in persons with hand osteoarthritis: Results from the Nor-Hand study. Rheumatology. ISSN 1462-0324. 61(6), p. 2316–2324. doi: 10.1093/rheumatology/keab708. Full text in Research Archive Show summary

  Objective: Pain sensitization is associated with pain severity in persons with hand osteoarthritis (OA). What contributes to pain sensitization is unclear. This study explores whether hand OA pathologies and symptom duration are related to central sensitization. Method: Participants with hand OA in the Nor-Hand study underwent bilateral hand radiography and ultrasound examination. Central sensitization was assessed with pressure pain thresholds (PPT) at remote sites (wrist, trapezius and tibialis anterior muscles) and temporal summation (TS). We examined whether hand OA pathologies, independent of each other, including structural severity (Kellgren-Lawrence sum score, presence of erosive hand OA), inflammatory severity (greyscale synovitis and power Doppler activity sum scores) and symptom duration, were related to central sensitization, adjusting for age, sex, body mass index, comorbidities and OA-severity of knee/hip. Results: In 291 participants (88% women, median age 61, IQR 57-66 years) Kellgren-Lawrence, greyscale synovitis and power Doppler activity sum scores were not associated with lower PPTs at remote sites. Persons with erosive hand OA had lower PPTs at the wrist (adjusted beta -0.75, 95%CI -1.32, -0.19) and tibialis anterior (adjusted beta -0.82, 95%CI -1.54, -0.09) and had greater TS (adjusted beta 0.56, 95%CI 0.12, 1.01) compared with persons with non-erosive disease. No associations were found for symptom duration. Conclusions: A person's overall amount of structural or inflammatory hand OA pathologies does not appear to drive central sensitization. Although persons with erosive hand OA showed greater signs of central sensitization, the small differences suggest that central sensitization is mainly explained by other factors than joint pathologies.

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• Hammer, Hilde Berner (2026). Hands-on session: Fast ultrasound protocols in Rheumatology: Point of Care. Full text in Research Archive
• Hammer, Hilde Berner (2026). Presence of crystal deposits in the first metatarsophalangeal joint is closely related to local erosions; results from the 5-year NOR-Gout study. doi: https:/scientific.sparx-ip.net/archiveeular/index.cfm?view=home. Full text in Research Archive
• Aanesen, Fiona & Hammer, Hilde Berner (2026). Smertene forsvant hos de fleste. Stor norsk studie om urinsyregikt gir håp. [Journal]. VG papir. Full text in Research Archive
• Stjärne, Johan Folke Håkan; Hammer, Hilde Berner & Uhlig, Till (2026). (+) Urinsyregikt – ny studie: Kan bli anfallsfri med behandling. [Journal]. VG papir. Full text in Research Archive Show summary

  Den norske studien kan få stor betydning for behandlingen av den smertefulle sykdommen. Anfallene og smertene forsvant helt hos de fleste pasientene. Én ting var helt avgjørende for det gode resultatet.

• Hammer, Hilde Berner (2026). E-læringskurset «Hvordan leve godt med fibromyalgi» er lansert! | Norsk Revmatikerforbund. Full text in Research Archive Show summary

  Har du fibromyalgi? Da er den viktigste medisinske anbefalingen å lære om sykdommen. Det er medisinsk “best practice” og kan bidra til mindre symptomer og bedre livskvalitet.

• Hammer, Hilde Berner & Aanesen, Fiona (2026). Smertene forsvant hos de fleste. Stor norsk studie om urinsyregikt gir håp. [Journal]. VG. Full text in Research Archive
• Hammer, Hilde Berner & Melvær, Helga (2025). Kobles til alvorlig smertesykdom. [Journal]. Dagbladet. Full text in Research Archive
• Uhlig, Till; Hammer, Hilde Berner; Merriman, Tony & Hexeberg, Sofie (2025). Nye funn om urinsyregikt. p. 16–18. Full text in Research Archive
• Hammer, Hilde Berner & Abrahamsen, Cathrine (2025). Nye funn om smertelidelse. [Journal]. Dagbladet. doi: https:/redir.opoint.com/?key=tkVxtGgWt9TSGVkgzqj3. Full text in Research Archive
• Hammer, Hilde Berner (2025). Overlege om fibromyalgi: - Kan bli frisk. [Internet]. KK. Full text in Research Archive Show summary

  Overlege og sykepleier fra Diakonhjemmet har lang erfaring med fibromyalgi-pasienter. Nå deler de grepene for at diagnosen skal bli enklere å leve med, og hvordan man kan bli bedre.

• Daniloff, Kathrine; Hammer, Hilde Berner & Stjärne, Johan Folke Håkan (2025). Kan en app forebygge smerteanfall ved urinsyregikt? | Diakonhjemmet. [Internet]. NTB. Full text in Research Archive Show summary

  En ny studie ved Diakonhjemmet sykehus undersøker effekten av mestringsappen Urika for pasienter med urinsyregikt. Studien skal undersøke om oppfølging med appen kan være like effektiv som tradisjonell oppfølging.

• Uhlig, Till; Hammer, Hilde Berner & Hexeberg, Sofie (2025). Fant ukjent årsak til urinsyregikt. p. 76–79. Full text in Research Archive Show summary

  En ny og omfattende studie avslører ukjent årsak til hvorfor man får urinsyregikt. Det kan ha stor betydning for behandlingen framover, ifølge ekspert.

• Aanesen, Fiona; Stjärne, Johan Folke Håkan; Berg, Inger Jorid; Søhus, Silje; Hammer, Hilde Berner & Uhlig, Till [Show all 11 contributors for this article] (2025). Digital oppfølging av urinsyregikt, ReMonit Gout prosjektet. Full text in Research Archive Show summary

  BAKGRUNN OG FORMÅL Urinsyregikt er den vanligste inflammatoriske revmatiske sykdommene blant voksne, og forekomsten er økende. Det finnes effektiv medikamentell behandling for å senke urinsyrenivået i blod, og dermed unngå anfall med smertefulle leddbetennelser. Dessverre er det mange pasienter som ikke får oppfølging i henhold til anbefalinger og/eller har lav etterlevelse av behandlingen. ReMonit Gout er et pågående forskingsprosjekt med mål om å utvikle og teste en mestringsapp for pasienter med urinsyregikt. Appen kan potensielt bidra til å gi flere pasienter oppfølging i tråd med anbefalte retningslinjer, og spare pasienter og helsepersonell for tid og ressurser. Prosjektet har fått støtte fra Helse Sør-Øst, Stiftelsen Dam og REMEDY. Delmålene for prosjektet er: 1) Å utvikle og teste anvendbarheten av mestringsappen Urika, for pasienter som følges opp i spesialisthelsetjenesten. 2) Å teste om digital oppfølging med Urika-appen ikke er underlegen ‘state-of-the art’ oppfølging i spesialisthelsetjenesten, i å oppnå og vedlikeholde et lavt serum urinsyrenivå (<360/<300 μmol/L). 3) Å tilpasse Urika-appen til pasienter som kun følges opp av fastlegen, og teste om appen er anvendbar til bruk i primærhelsetjenesten. METODE Brukermedvirkere, forskere og klinikere har utviklet innholdet i Urika-appen sammen med firmaet Youwell. Urika-appen inneholder bl.a. informasjon om urinsyregikt, påminnelser om medisin og blodprøver, oversikt over urinsyrenivå, og en algoritme for utregning av medisindose til den enkelte pasient. Appen ble testet i en anvendbarhetsstudie ved Diakonhjemmet sykehus av pasienter som startet urinsyresenkende behandling. Pasientene svarte på spørreskjema ved studiestart, månedlig, og etter 3 måneder. I tillegg deltok 10 pasienter i semistrukturerte intervjuer om erfaringer med appen, og vi samlet data fra appen om bruk og registreringer. Videre skal vi gjennomføre en randomisert kontrollert ikke-underlegenhetsstudie (RCT) ved Diakonhjemmet sykehus. Totalt 168 pasienter med urinsyregikt vil bli randomisert til enten digital oppfølging med Urika-appen, eller til dagens telefonbaserte oppfølging fra sykepleier. Hovedutfallsmålet er andelen pasienter med lavt serum urinsyrenivå (<360/<300 μmol/L) ved 12 måneder. Vi vil også gjøre en helseøkonomisk evaluering. Urika-appen skal videreutvikles for primærhelsetjenesten i samarbeid med brukerrepresentanter og fastleger. Deretter vil vi rekruttere 30 pasienter og 10 fastleger til å teste appen i en anvendbarhetsstudie, for å evaluere anvendbarheten av appen for pasienter med urinsyregikt som følges opp av fastlegen. Pasientene og fastlegene vil bli spurt om å svare på spørreskjema og delta i semistrukturerte intervjuer om erfaringer med bruk av Urika-appen som støtte i behandlingen i primærhelsetjenesten. RESULTATER Etter utvikling og teknisk testing av Urika-appen, ble 21 pasienter inkludert i anvendbarhetsstudien ved Diakonhjemmet Sykehus fra mars-juni 2024, alle var menn med en gjennomsnittsalder på 50 år. Appen skåret høyt på brukervennlighet, og det ble rapportert få uønskede hendelser/feil med appen. Totalt 87% av endepunktene for anvendbarhet ble nådd. Det var over den prespesifiserte akseptable grensen for anvendbarhet (≥70%), og inkluderte kliniske utfallsmål, teknisk og operasjonell anvendbarhet. Urika-appen ble forbedret basert på resultatene fra anvendbarhetsstudien. Inklusjon av deltakere til RCTen startet i juni 2025, det var inkludert 5 pasienter i studien ved utgangen av august 2025. Vi har fått innspill fra fastleger og brukerrepresentanter med forslag om tilpasninger av Urika-appen for bruk i primærhelsetjenesten, og praktisk gjennomføring av anvendbarhetsstudien blant pasienter som følges opp av fastlegen. Vi vil gjøre nødvendige endringer og teknisk prøving av appen før vi begynner rekruttering av pasienter og fastleger til studien. KONKLUSJON I ReMonit Gout prosjektet har vi utviklet mestringsappen Urika for å støtte pasienter som skal starte urinsyresenkende behandling. Vi skal teste appen blant pasienter med urinsyregikt som følges opp i spesialist- og primærhelsetjenesten. Hvis Urika-appen viser seg å være anvendbar og ikke underlegen vanlig klinisk oppfølging, vil personer med urinsyregikt

• Hammer, Hilde Berner (2025). MEDISINENE SOM HJELPER - fibromyalgi. [Journal]. Dagbladet. Full text in Research Archive
• Terslev, Lene & Hammer, Hilde Berner (2025). Monitoring gout with ultrasound: is it useful in daily practice? Joint Bone Spine. ISSN 1297-319X. p. 105965–105965. doi: 10.1016/j.jbspin.2025.105965. Full text in Research Archive
• Hammer, Hilde Berner; Askling, J.; Sexton, J.; Glintborg, B.; Kragstrup, T.W. & Haavardsholm, E.A. (2025). POS0457 Swollen joints and assessor's global, but not tender joints and patient's global, predict power Doppler remission in established RA. doi: 10.1016/j.ard.2025.05.840. Full text in Research Archive Show summary

  For patients with rheumatoid arthritis (RA), remission is the primary treatment goal. However, there are several definitions of remission, with composite scores such as DAS28 including both patient-reported and clinical assessments. Several studies have questioned how well patient reported outcomes are associated to remission if the definition of remission is absence of objectifiable inflammation. Power Doppler (PD) ultrasound is a sensitive and easily available method to detect vascularization indicating inflammatory activity and can be used to assess remission (PD remission).

• Hammer, Hilde Berner; Karoliussen, L.F.; Terslev, L.; Haavardsholm, E.A. & Uhlig, T. (2025). POS1244 PATIENTS STILL HAVING FLARES AFTER 5 YEARS OF URATE LOWERING THERAPY HAVE HIGHER LEVELS OF ULTRASOUND DETECTED CRYSTAL DEPOSITION; RESULTS FROM THE NOR-GOUT STUDY. doi: 10.1016/j.ard.2025.06.594. Full text in Research Archive Show summary

  Gout is treated with urate lowering therapy (ULT) to avoid monosodium urate (MSU) crystal deposition and flares. Ultrasound is a sensitive method for detecting elementary lesions in gout and defined as double contour (DC), tophi and aggregates. The NOR-Gout study is a five-year follow-up study consecutively including patients with crystal-proven gout who had a recent flare and serum uric acid (sUA) level >360 μmol/L, and they had a treat-to-target follow-up on ULT during the first year [1].

• Lillejordet, Even; Sundlisæter, Nina Paulshus; Sexton, Joseph; Fongen, Birgit Camilla; Moholt, Ellen & Ljoså, Maud-Kristine Aga [Show all 19 contributors for this article] (2025). POS1047 CLINICAL AND ULTRASOUND FEATURES IN AN INCEPTION COHORT OF TREATMENT NAÏVE PATIENTS WITH PSORIATIC ARTHRITIS. Annals of the Rheumatic Diseases. ISSN 0003-4967. 84(Supplement 1), p. 1149–1149. doi: https:/www.sciencedirect.com/science/article/pii/S0003496725024537. Full text in Research Archive Show summary

  Background: Assessing a newly diagnosed patient with psoriatic arthritis (PsA) can be challenging, and the correct evaluation of clinical features may influence treatment decisions and prognosis. Current treatment recommendations underline this, as patients are stratified based on features such as enthesitis, predominant axial disease, or predominant skin and nail disease [1]. Ultrasound can be an important clinical tool to ensure correct treatment decisions from the onset of the disease. Objectives: To describe the clinical and ultrasound characteristics of treatment naïve PsA patients starting their first disease-modifying anti-rheumatic drug, including structured assessment of disease activity in joints, entheses, skin, and nails. Methods: Patients diagnosed with PsA who fulfilled the ClASsification for Psoriatic Arthritis (CASPAR) criteria starting their first disease-modifying antirheumatic drug were included in an ongoing Norwegian multi-center study (NCT05291819). Patients underwent extensive clinical and ultrasound assessments. The clinical examination of joints included assessments of 66/68 swollen (SJC) and tender (TJC) joints and identification of dactylitis. The presence of enthesitis was evaluated clinically according to the Leeds Enthesitis Index (LEI) and the Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis scoring system. Skin- and nail involvement was assessed by psoriasis body surface area (BSA), static Physician Global Assessment of Psoriasis (sPGA), and modified Nail Psoriasis Severity Index (mNAPSI). The Disease Activity Index for Psoriatic Arthritis (DAPSA) was used to assess the disease activity, and patient-reported outcomes were collected, such as patient global assessment of disease, pain, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All patients underwent a comprehensive ultrasound protocol with evaluation of 74 joints, 20 tendons of the hands, and 14 entheses, all scored according to OMERACT definitions. Ultrasound inflammation was defined by power Doppler (PD) >0 in any joint, enthesis, flexor tendon sheath of the fingers, or within a peritenonitis proximal to the MCP joints. The grayscale (GS) sum score is comprised of joints, the flexor tendons of the hands, peritenonitis, and the inflammatory enthesis findings of hypoechogenicity and increased thickness. Results: A total of 111 consecutive patients were included in this analysis; 64% were male, and the mean (SD) age was 44.2 (14.0) years. 93% of the patients had a history of psoriasis, while in the remaining 7% it was present in a first-degree family member (Table 1). Physician-reported history of arthritis was the most prevalent disease feature, identified in 86% of patients. A history of axial involvement was documented in 29%, enthesitis in 30%, and nail psoriasis in 47% of patients. At the time of assessment, the median (IQR) SJC was 2 (1-4) and TJC 4 (2-8). Patient global assessment of disease activity visual analog scale (VAS) was 59 (41-70), VAS pain was 60 (40-70), and CRP 5 mg/L (2-11 mg/L), whereas the VAS physician global assessment of disease was 25 (15-40). 80% had a SJC>0. The baseline DAPSA had a median (IQR) value of 18.4 (12.5-28.3), corresponding to moderate disease activity. The skin disease among the patients was mild. Although 87% had any psoriasis plaque, the median (IQR) BSA was 2% (1-4%), sPGA score 3 (2-4), and mNAPSI score 1 (0-8). The median ultrasound GS sum score was 11 (5-22) (Table 2). When focusing solely on the GS score for joints, a GS >1 was observed in 75% of patients. The median PD sum score was 3 (0-7), with 69% having a value >0 in any of the ultrasound-examined structures. 52% had any joint with PD>0. A PD-signal >0 was observed in an enthesis in 35% of the patients, with the lateral epicondyle being the most commonly affected enthesis (12%), followed by the proximal patellar tendon insertion (11%). Additionally, peritenonitis was identified in 19%, and flexor tenosynovitis in 21%. Conclusion: In this treatment naïve early PsA inception cohort with an aim to include all PsA patients starting DMARD treatment, extensive examinations illustrated the heterogeneous nature of the disease. After skin psoriasis, arthritis was the feature affecting most patients, with clinically swollen joints in 80% and ultrasound PD joint synovitis in 52%. Other aspects of PsA, such as a clinical finding of dactylitis and ultrasound findings of enthesitis, tenosynovitis, and peritenonitis, each had an overall prevalence of at least 20%, reflecting the diversity of this patient population. Ultrasound might add useful information about inflammation in a number of structures. In conclusion, extensive examination of affected structures is necessary to guide treatment decisions in early PsA.

• Hagen, Gunhild; Arif, Sonia; Karoliussen, Lars Fridtjof; Sexton, Joseph; Haavardsholm, Espen Andre & Provan, Sella Aarrestad [Show all 8 contributors for this article] (2025). Treating gout to target serum urate improves health-related quality of life and utility over five years. Full text in Research Archive
• Gløersen, Marthe; Kjeken, Ingvild; Tveter, Anne Therese; Kazemi, Amirhossein; Sexton, Joseph & Dziedzic, Krysia [Show all 38 contributors for this article] (2025). Study protocol for the PICASSO trial: A randomized placebo-controlled trial to investigate the efficacy and safety of intraarticular steroid injections and an occupational therapy intervention in painful inflammatory carpometacarpal-1 osteoarthritis. doi: 10.1016/j.ocarto.2024.100542. Full text in Research Archive
• Hammer, Hilde Berner & Goll, Guro Løvik (2024). Persontilpasset medisin. [Internet]. Revmatiker.no. doi: https:/www.revmatiker.no/aktivitet/forskningswebinar-5-desember/. Full text in Research Archive
• Hammer, Hilde Berner (2024). Continuous reduction in ultrasound detected crystal depositions over 5 years follow-up: Results from the NOR-Gout study. Full text in Research Archive Show summary

  Hilde Berner Hammer, Lars Karoliussen, Lene Terslev, Espen A Haavardsholm, Till Uhlig. Background: Ultrasound (US) is sensitive for detecting monosodium urate (MSU) crystal depositions in gout, described as double contour (DC), tophi and aggregates. Depositions decreased during the first year of serum urate lowering treatment (ULT) in the NOR-Gout study (1). Objectives: As part of the NOR-Gout study to explore the US changes in depositions after 2 and 5 years on ULT. Methods: Patients with crystal-proven gout and a recent gout flare with serum uric acid (sUA) level >360 μmol/L were consecutively included in the NOR-Gout study (1,2). During the first year they had frequent visits for ULT adjustment to achieve sUA <360 μmol/L (or <300 μmol/L if clinical tophus) and US was performed at baseline and after 3, 6 and 12 months. Patients were then followed by their general practitioner to keep the ULT target, and met for study visits at year 2 and 5. The US assessment (General Electric E9) included a semi-quantitative scoring of MSU crystal depositions using the OMERACT scoring system (3), with bilateral examination of radiocarpal, metacarpophalangeal2, knee, ankle and metatarsophalangeal1 joints as well as triceps, quadriceps, patellar (proximal and distal) and Achilles tendons and insertions. Sum scores of US depositions (DC, tophi, and aggregates, respectively) were calculated, and changes from baseline were explored by paired samples T-test. Results: 209 patients were included (mean (SD) age 56.4 (13.8) years, time since first flare (disease duration) 7.9 (7.7) years, 95.5% men). Mean (SD) sUA (μmol/L) during the study were 500 (77) at baseline, 341 (61) at 3 months, 327 (60) at 6months, 312 (49) at 12 months, 325 (70) at 2 years and 337 (83) at 5 years. The US sum scores (DC, tophi, and aggregates, respectively) decreased during the study (p<0.001 for all lesions) shown in the table and figure. At 2 (n=172) and 5 (n=161) years, a sum score of zero was found in 70.9% and 83.2% respectively, for DC, with corresponding percentages of 33.1 and 62.7 for tophi, and 7.6 and 23.6 for aggregates. At least one flare was described by 26.6% between year 1 and 2, and 15.4% had ≥ 1 flare between year 2 and 5. Conclusion: The amount of crystal depositions decreased not only during treat to target ULT the first year of the study, but also when the patients were followed by their general practitioner between year 1 and 5. Patients and clinicians should be encouraged to comply to ULT to remove the depositions in joints and tendons and thereby reduce the burden of gout. References: 1. Hammer HB et al. Ann Rheum Dis 2020 2. Uhlig T et al. RMD Open 2021 3. Christiansen SN et al. Semin Arthritis Rheum 2021

• Gløersen, Marthe; Pettersen, Pernille Steen; Maugesten, Øystein Gunnar; Mulrooney, Elisabeth; Mathiessen, Alexander & Gammelsrud, Heidi [Show all 14 contributors for this article] (2024). Corrigendum to “Study protocol for the follow-up examination of the Nor-Hand study: A hospital-based observational cohort study exploring pain and biomarkers in people with hand osteoarthritis” [Osteoarthr. Cartil. Open 3 (2021) 100198] (Osteoarthritis and Cartilage Open (2021) 3(3), (S2665913121000613), (10.1016/j.ocarto.2021.100198)). Osteoarthritis and Cartilage Open. 6(1). doi: 10.1016/j.ocarto.2022.100274. Full text in Research Archive
• Vikse, Jens; Hammer, Hilde Berner; Nystad, Tone Wikene; Uhlig, Till & Haavardsholm, Espen A. (2024). Urinsyregikt. In Vikse, Jens; Haavardsholm, Espen A. & Molberg, Øyvind (Ed.), Revmatologi. Universitetsforlaget. ISSN 9788215068589. p. 216–228. Full text in Research Archive
• Vikse, Jens; Hammer, Hilde Berner; Bader, Lucius & Haavardsholm, Espen A. (2024). Leddsmerter. In Vikse, Jens; Haavardsholm, Espen A. & Molberg, Øyvind (Ed.), Revmatologi. Universitetsforlaget. ISSN 9788215068589. Full text in Research Archive
• Vikse, Jens; Hammer, Hilde Berner; Nystad, Tone Wikene; Uhlig, Till & Haavardsholm, Espen A. (2024). Krystallartritt: en oversikt. In Vikse, Jens; Haavardsholm, Espen A. & Molberg, Øyvind (Ed.), Revmatologi. Universitetsforlaget. ISSN 9788215068589. p. 213–215. Full text in Research Archive
• Vikse, Jens; Haavardsholm, Erik; Lillejordet, Even; Aaløkken, Trond Mogens; Hammer, Hilde Berner & Diamantopoulos, Andreas P [Show all 8 contributors for this article] (2024). Bildeundersøkelser. In Vikse, Jens; Haavardsholm, Espen A. & Molberg, Øyvind (Ed.), Revmatologi. Universitetsforlaget. ISSN 9788215068589. Full text in Research Archive
• Hammer, Hilde Berner (2024). PROFESSOR: - GOD EFFEKT MOT FIBROMYALGI. [Journal]. Dagbladet, papirutgave. Full text in Research Archive
• Hammer, Hilde Berner (2024). Guide til riktig smertestillende Farene ved feil bruk. [Journal]. VG, papirutgave. Full text in Research Archive
• Hammer, Hilde Berner (2024). NYTT HÅP FOR FIBROMYALGI-RAMMEDE STOR, NORSK STUDIE: 76 prosent ble bedre - nå får fastlegene ny opplæring. [Journal]. Dagbladet, papirutgave. Full text in Research Archive
• Hammer, Hilde Berner (2024). METODEN SOM HJALP MOT URINSYREGIKT. [Journal]. Dagbladet, papirutgave. Full text in Research Archive
• Hammer, Hilde Berner (2024). Gout patients achieving recommended serum uric acid levels over 5 years obtain low scores of ultrasound depositions; results from the NOR-Gout study. Full text in Research Archive Show summary

  Hilde Berner Hammer, Lars Fritjof Karoliussen, Lene Terslev, Espen A. Haavardsholm, Till Uhlig Background Ultrasound (US) is sensitive for detecting monosodium urate (MSU) crystal depositions in gout, described as double contour (DC), tophi and aggregates. After persistent urate lowering treatment (ULT) we had at 1 year seen a significant decrease of the US depositions of MSU, and 85.3% of patients achieved the serum uric acid (sUA) target of <360 µmol/L (i.e. < 6 mg/dL) and 96.2% had <400 µmol/L (1). The patients were after the first year followed on ULT by their general practitioner and had follow-up study visits at year 2 and 5. Objectives To explore whether the amount of US detected depositions at 2 and 5 years after initiation of ULT were related to achievement of the sUA target. Methods Patients had clinical, laboratory and US assessments at baseline, 1, 2 and 5 years. The US examination (General Electric E9) included a semi-quantitative scoring of MSU depositions using the OMERACT scoring system (2) with bilateral examination of radiocarpal, metacarpophalangeal2, knee, ankle, and metatarsophalangeal1 joints as well as triceps, quadriceps, patellar (proximal and distal) and Achilles tendons and insertions. Total sum scores of US depositions (DC, tophi and aggregates, respectively) were calculated. Changes from baseline were explored by separate paired samples T-test for patients with sUA levels < or > 360 µmol/L. Differences between US depositions dependent on sUA levels at 5 years were assessed by independent sample T-test. Results 209 patients were included at baseline (mean (SD) age 56.4 (13.8) years, time since first flare (disease duration) 7.9 (7.7) years, 95.5% men). Mean sUA (µmol/L) during the study were 500 at baseline, 312 (n=184) at 1 year, 325 (n=173) at 2 years and 337 (n=161) at 5 years. At 2 years, 78.6% had sUA <360 µmol/L and 89% <400 µmol/L, with a slight reduction at 5 years; 71.4% and 82.6%, respectively. From 1 to 5 years, the sum scores of US (DC, tophi, and aggregates) decreased for patients with sUA <360 µmol/L (p<0.001) (figure 1), but for patients having >360 µmol/L at the visits, significant decreases were only found for tophi between year 1 and 2 (p=0.001) and for aggregates between year 2 and 5 (p=0.02). Patients with sUA >360 µmol/L versus <360 µmol/L at 2 years (n=37 vs 136) had higher scores of DC (p=0.02) and at 5 years (n= 46 vs 115) the patients with sUA >360 µmol/L had higher scores of DC (p<0.001), tophi (p=0.008) and aggregates (p=0.046). Figure 2 shows the US depositions at 5 years according to sUA levels, and highest scores were found in patients with sUA levels > 400 µmol/L (p<0.001). Conclusion After treat-to-target ULT in the first year, 5-year reductions in US depositions were most favourable in patients who had a sUA levels <360 µmol/L. Our findings support the recommendation to keep a low sUA level over time. References: 1. Hammer HB et al. Ann Rheum Dis 2020 2. Christiansen SN et al. Semin Arthritis Rheum 2021

• Vikse, Jens; Hammer, Hilde Berner; Nystad, Tone Wikene; Uhlig, Till & Haavardsholm, Espen A. (2024). Kalsiumpyrofosfatartritt. In Vikse, Jens; Haavardsholm, Espen A. & Molberg, Øyvind (Ed.), Revmatologi. Universitetsforlaget. ISSN 9788215068589. p. 229–230. Full text in Research Archive
• Hammer, Hilde Berner (2024). Slik påvirker søvn helsen din. [Journal]. VG . Full text in Research Archive
• Hammer, Hilde Berner (2024). Urinsyregikt kobles til hjertesykdom. [Journal]. VG papirutgave. Full text in Research Archive
• Hammer, Hilde Berner (2023). Avliver 6 artrosemyter. [Journal]. VG online og papirutgave. Full text in Research Archive
• Hammer, Hilde Berner (2023). Pasienter med fibromyalgi fikk mindre smerter etter terapi. [Internet]. Forskning.no. Full text in Research Archive
• Hammer, Hilde Berner (2023). God effekt mot fibromyalgi kommentar fra oss om farmakologi. [Journal]. Dagbladet online og papirutgave. Full text in Research Archive
• Delcoigne, Bénédicte; Provan, Sella Aarrestad; Hammer, Hilde Berner; Giuseppe, Daniela Di; Frisell, Thomas & Glintborg, Bente [Show all 13 contributors for this article] (2022). Erratum: Correction to: Do patient-reported measures of disease activity in rheumatoid arthritis vary between countries? Results from a Nordic collaboration (Rheumatology (Oxford, England) (2022) 61 11 (4286-4296)). Rheumatology. ISSN 1462-0324. 61(12), p. 4998–4998. doi: 10.1093/rheumatology/keac151. Full text in Research Archive
• Sundlisæter, Nina Beate Paulshus; Aga, Anna-Birgitte; Olsen, Inge Christoffer; Hammer, Hilde Berner; Uhlig, Till & Heijde, Désirée van der [Show all 9 contributors for this article] (2021). Joint tenderness and ultrasound inflammation in DMARD-naïve patients with early rheumatoid arthritis. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1136/annrheumdis-2021-220265. Full text in Research Archive
• Maugesten, Øystein Gunnar; Mathiessen, Alexander; Hammer, Hilde Berner; Hestetun, Sigrid Valen; Kvien, Tore Kristian & Uhlig, Till [Show all 8 contributors for this article] (2021). Correction to: Validity and diagnostic performance of fluorescence optical imaging measuring synovitis in hand osteoarthritis: baseline results from the Nor-Hand cohort. Arthritis Research & Therapy. ISSN 1478-6354. 23. doi: 10.1186/s13075-021-02469-z. Full text in Research Archive

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