Håvard Halland Fretheim

• Vallara, Rachele; Andersson, Anna Helena; Bassi, Ilaria; Brunborg, Cathrine; Giancotti, Gilda & Diep, Phuong Phuong [Vis alle 22 forfattere av denne artikkelen] (2026). Clinical Profiles and Lung Function Trajectories of Patients With Idiopathic Inflammatory Myopathy Associated Interstial Lung Disease: A Comparative Study of Pulmonology and Rheumatology Settings. Chest. ISSN 0012-3692. doi: 10.1016/j.chest.2026.03.008. Fulltekst i vitenarkiv
• Kastrati, Kastriot; Sprecher, Marco; Weber, Florine; Langballe, Emily Violette Eng; Molnar, Daniel & Göthans, Lena Theresa [Vis alle 32 forfattere av denne artikkelen] (2026). Treatment patterns, disease progression and survival in Sjögren disease-associated interstitial lung disease: a multicentre European cohort study. Journal of Autoimmunity. ISSN 0896-8411. 163. doi: 10.1016/j.jaut.2026.103611. Fulltekst i vitenarkiv
• Bjørkekjær, Hilde Jenssen; Bruni, Cosimo; Broch, Kaspar; Brunborg, Cathrine; Carreira, Patricia E & Airò, Paolo [Vis alle 63 forfattere av denne artikkelen] (2025). A comparative analysis of risk stratification tools in SSc-associated pulmonary arterial hypertension: a EUSTAR analysis. Rheumatology. ISSN 1462-0324. 64(6), s. 3643–3656. doi: 10.1093/rheumatology/keaf053. Fulltekst i vitenarkiv Vis sammendrag

  Objectives The 2022 European Society of Cardiology and European Respiratory Society (ESC/ERS) guidelines for pulmonary arterial hypertension (PAH) recommend risk stratification to optimize management. However, the performance of generic PAH risk stratification tools in patients with SSc-associated PAH remains unclear. Our objective was to identify the most accurate approach for risk stratification at SSc-PAH diagnosis. Methods In this multicentre, international cohort study from the European Scleroderma Trials and Research (EUSTAR) group database, we screened 11 risk stratification tools upon SSc-PAH diagnosis. We compared the performance of the three top-ranked tools to predict mortality with the ESC/ERS three-strata model, the currently recommended tool for baseline risk assessment. We also assessed the impact of incorporating SSc-specific characteristics into the tools. Kaplan–Meier analyses and Cox regression with area under the ROC curve (AUC) were conducted. Results The ESC/ERS three-strata model had a lower ability to predict mortality than the ESC/ERS four-strata model, ‘SPAHR updated’ and ‘REVEAL Lite 2’. The ESC/ERS four-strata model divided ‘intermediate-risk’ patients into two groups with significantly different long-term survival rates and is the easiest applicable tool. Incorporating SSc-specific characteristics did not significantly improve the predictive ability of any model, but a low diffusing capacity of the lung for carbon monoxide (DLCO) was an independent predictor of mortality. Conclusion Considering its ability to predict mortality, risk segregation capabilities and clinical applicability, this study provides a rationale for using the simplified ESC/ERS four-strata model at SSc-PAH diagnosis as an alternative to the comprehensive ESC/ERS three-strata model. We propose considering DLCO as an individual prognostic marker in SSc-PAH.

• Hoffmann-Vold, Anna-Maria; Petelytska, Liubov; Fretheim, Håvard Halland; Aaløkken, Trond Mogens; Becker, Mike Oliver & Bjørkekjær, Hilde Jenssen [Vis alle 26 forfattere av denne artikkelen] (2025). Predicting the risk of subsequent progression in patients with systemic sclerosis-associated interstitial lung disease with progression: a multicentre observational cohort study. The Lancet Rheumatology. 7(7), s. e463–e471. doi: 10.1016/s2665-9913(25)00026-8. Fulltekst i vitenarkiv
• Bruni, Cosimo; Tofani, Lorenzo; Fretheim, Håvard; Liem, Sophie I E; Velauthapillai, Arthiha & Bjørkekjær, Hilde Jenssen [Vis alle 16 forfattere av denne artikkelen] (2025). A screening tool to detect interstitial lung disease in systemic sclerosis: the ILD-RISC score. Rheumatology. ISSN 1462-0324. 64(12), s. 6285–6293. doi: 10.1093/rheumatology/keaf445. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objectives As a screening tool for the presence of systemic sclerosis-associated interstitial lung disease (SSc-ILD) on high-resolution computed tomography (HRCT) is missing, we aimed to develop the ILD-RISC score, a risk algorithm to guide physicians in ordering HRCTs, with specific focus on follow-up visits. Methods The nominal group technique was used to select items for the multivariable logistic regression with backward selection. The ILD-RISC score was developed from baseline visits of the derivation cohort. After identifying a cut-off favoring sensitivity >85% from the ROC curve, it was validated in a separate cross-sectional cohort, and then applied longitudinally in a specific SSc cohort with negative baseline HRCT. Results In the derivation cohort (533 patients), 13 variables associated with the presence of SSc-ILD on HRCT were tested. The ILD-RISC score, including FVC%, DLCO/SB%, digital ulcers ever, age and SSc autoantibodies, showed an area under the curve of 79.1% (75.3–83.0%) for the presence of SSc-ILD on HRCT. An ILD-RISC score ≥0.3 had sensitivity 85.6% and specificity 53.6%, as confirmed in the validation cohort (247 patients). Among 819 patients with negative baseline HRCT, 170 developed SSc-ILD: a low ILD-RISC score was detected in almost 50% of the follow-up visits, supporting the sparing of HRCTs. Conclusion The ILD-RISC score was developed and validated to predict the presence of SSc-ILD. Thus, the ILD-RISC score may help to decide when to order HRCTs at follow-up, allowing the reduction of costs and radiation exposure, but also at the time of SSc diagnosis when resources are limited.

• Hoffmann-Vold, Anna-Maria; Kastrati, K.; Sprecher, M.; Langballe, Ellen Melbye; Diep, Phuong Phuong & Fretheim, Håvard Halland [Vis alle 18 forfattere av denne artikkelen] (2025). ABS0838 IMPROVING EARLY ILD DETECTION IN SJÖGREN DISEASE: A RISK ESTIMATION TOOL FOR CLINICAL PRACTICE. Annals of the Rheumatic Diseases. ISSN 0003-4967. 84, s. 2094–2095. doi: 10.1016/j.ard.2025.06.1699. Fulltekst i vitenarkiv Vis sammendrag

  Interstitial lung disease (ILD) affects 10-15% of patients with Sjögren's disease (SjD), leading to increased morbidity and mortality. Early detection is crucial for optimizing disease management and improving patient outcomes. Current guidelines recommend screening SjD patients at-risk for ILD using high-resolution computed tomography (HRCT). To date, risk factor-based estimation tools for ILD in SjD patients are there are no criteria for referral to HRCT in clinical practice.

• Tschalèr, Lucas; Jordan, Suzana; Aaløkken, Trond Mogens; Becker, Mike; Brunborg, Cathrine & Bruni, Cosimo [Vis alle 18 forfattere av denne artikkelen] (2025). Validation of a semi-quantitative method to assess interstitial lung disease severity and progression in systemic sclerosis by standard and low-dose HRCT scans. RMD Open. 11(1). doi: 10.1136/rmdopen-2024-004938. Fulltekst i vitenarkiv Vis sammendrag

  Background While the presence of distinct imaging abnormalities by high-resolution CT (HRCT) defines interstitial lung disease (ILD), there is a relative lack of validated methods to quantify these abnormalities in clinical practice, limiting ILD severity and progression assessments. We aimed to validate a semi-quantitative method for lung fibrosis assessment in patients with systemic sclerosis associated ILD (SSc-ILD) by standard and low-dose HRCT, considering lung structure and function as integral components of ILD evaluation. Methods SSc patients from Oslo and Zurich with HRCT images, pulmonary function tests, including forced vital capacity (FVC), diffusing capacity for carbon monoxide (DLCO) and the 6-minute walk test with oxygen (O2) desaturation were enrolled. We validated the semi-quantitative fibrosis extent method by HRCT using criteria for content and construct validity, discrimination, sensitivity to change and feasibility, as well as inter- and intra-rater variability. Results 65 SSc patients from Zurich and 90 from Oslo were included. Significant correlations were observed between the extent of fibrosis on HRCT and FVC (r=−0.517, p<0.001), DLCO (r=−0.400, p<0.001) and O2 desaturation (r=−0.500, p<0.001), indicating content, construct and criterion validity. Discrimination and sensitivity to change assessments showed moderate correlation with DLCO (r=−0.377, p=0.003) but not with FVC or O2 desaturation. Inter- and intra-rater variability demonstrated excellent reliability (κ=0.891 and κ=0.996, respectively), with HRCT quantification averaging 9–15 min, indicating high feasibility. Conclusion This study confirms that semi-quantitative fibrosis assessment of HRCT for SSc-ILD meets most validation criteria, supporting its use in clinical practice and showing additive value of structural to functional ILD assessment.

• Fretheim, Håvard Halland; Barua, Imon Shoumitra; Bakland, Gunnstein; Dhainaut, Alvilde Sofie Strand; Halse, Anne Kristine Hjorteseth & Nordgård, Maylen Carstens [Vis alle 21 forfattere av denne artikkelen] (2025). Faecal microbiota transplantation in patients with systemic sclerosis and lower gastrointestinal tract symptoms in Norway (ReSScue): a phase 2, randomised, double-blind, placebo-controlled trial. The Lancet Rheumatology. 7(5), s. e323–e332. doi: 10.1016/S2665-9913(24)00334-5. Fulltekst i vitenarkiv Vis sammendrag

  Background: Gastrointestinal tract involvement is highly prevalent in systemic sclerosis, with few treatment options. We assessed the efficacy and safety of faecal microbiota transplantation using standardised anaerobic cultivated human intestinal microbiome (ACHIM) as a novel treatment option for patients with systemic sclerosis and symptomatic lower gastrointestinal tract involvement. Methods: In this phase 2, randomised, double-blind, placebo-controlled trial done at four university hospitals in Norway, we enrolled adults aged 18-85 years with systemic sclerosis and moderate-to-severe lower gastrointestinal tract symptoms (bloating or diarrhoea). Participants were randomly assigned 1:1 to intestinal infusions of placebo or ACHIM at weeks 0 and 2, stratified by worst symptom (bloating or diarrhoea). The primary endpoint was change in worst lower gastrointestinal tract symptom (bloating or diarrhoea) from week 0 to week 12, measured using the University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 scoring system in the intention-to-treat population. Safety was assessed at weeks 0, 2, 4, 6, and 12 in all participants who received at least one infusion. A person with lived experience of systemic sclerosis was involved in the study planning and conduct. This trial was registered at ClinicalTrials.gov, NCT04300426. Findings: Between Sept 24, 2020, and Jan 14, 2022, 67 participants were enrolled and randomly allocated to placebo (n=34) or ACHIM (n=33). Mean age was 58·91 years (SD 11·59). 62 (93%) of 67 participants were women, five (7%) were men, and 50 (75%) were anti-centromere antibody positive. Change in worst lower gastrointestinal tract symptom from week 0 to week 12 did not differ between participants who received ACHIM (-0·13, 95% CI -0·37 to 0·11) and participants who received placebo (-0·33, -0·57 to -0·09; average marginal effect 0·20, 95% CI -0·12 to 0·52; p=0·22). Adverse events, mostly mild and short-lived gastrointestinal tract symptoms, were reported by 16 (48%) of 33 participants in the ACHIM group and 19 (56%) of 34 in the placebo group. During gastroscopy, one participant had a duodenal perforation. Interpretation: Faecal microbiota transplantation with ACHIM was well tolerated in participants with systemic sclerosis but did not result in an improvement in lower gastrointestinal tract symptoms. Funding: KLINBEFORSK. Translation: For the Norwegian translation of the abstract see Supplementary Materials section.

• Scheidegger, Moritz; Boubaya, Marouane; Garaiman, Alexandru; Barua, Imon Shoumitra; Becker, Mike & Bjørkekjær, Hilde Jenssen [Vis alle 15 forfattere av denne artikkelen] (2024). Characteristics and disease course of untreated patients with interstitial lung disease associated with systemic sclerosis in a real-life two-centre cohort. RMD Open. 10(1). doi: 10.1136/rmdopen-2023-003658. Fulltekst i vitenarkiv
• Strahm, Noemi; Didriksen, Henriette; Fretheim, Håvard Halland; Molberg, Øyvind; Midtvedt, Øyvind & Farstad, Inger Nina [Vis alle 13 forfattere av denne artikkelen] (2023). Effects of faecal microbiota transplantation on the small intestinal mucosa in systemic sclerosis. Rheumatology. ISSN 1462-0324. 62(8), s. 2918–2929. doi: 10.1093/rheumatology/kead014. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objectives In SSc, gastrointestinal tract (GIT) involvement is a major concern, with no disease-modifying and limited symptomatic therapies available. Faecal microbiota transplantation (FMT) represents a new therapeutic option for GIT-affliction in SSc, showing clinical promise in a recent controlled pilot trial. Here, we aim to investigate effects of FMT on duodenal biopsies collected from SSc patients by immunohistochemistry and transcriptome profiling. Methods We analysed duodenal biopsies obtained pre-intervention (week 0) and post-intervention (weeks 2 and 16) from nine SSc patients receiving an intestinal infusion of FMT (n = 5) or placebo (n = 4). The analysis included immunohistochemistry (IHC) with a selected immune function and fibrosis markers, and whole biopsy transcriptome profiling. Results In patients receiving FMT, the number of podoplanin- and CD64-expressing cells in the mucosa were lower at week 2 compared with baseline. This decline in podoplanin- (r = 0.94) and CD64-positive (r = 0.89) cells correlated with improved patient-reported lower GIT symptoms. Whole biopsy transcriptome profiling from week 2 showed significant enrichment of pathways critical for cellular and endoplasmic reticulum stress responses, microvillus and secretory vesicles, vascular and sodium-dependent transport, and circadian rhythm. At week 16, we found enrichment of pathways mandatory for binding activity of immunoglobulin receptors, T cell receptor complexes, and chemokine receptors, as well as response to zinc-ions. We found that 25 genes, including Matrix metalloproteinase-1 were upregulated at both week 2 and week 16. Conclusion Combining selective IHC and unbiased gene expression analyses, this exploratory study highlights the potential for disease-relevant organ effects of FMT in SSc patients with GIT involvement. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT03444220.

• Schniering, Janine; Maciukiewicz, Malgorzata; Gabrys, Hubert S.; Brunner, Matthias; Blüthgen, Christian & Meier, Chantal [Vis alle 17 forfattere av denne artikkelen] (2022). Computed tomography-based radiomics decodes prognostic and molecular differences in interstitial lung disease related to systemic sclerosis. European Respiratory Journal. ISSN 0903-1936. 59(5), s. 1–15. doi: 10.1183/13993003.04503-2020. Fulltekst i vitenarkiv Vis sammendrag

  Background Radiomic features calculated from routine medical images show great potential for personalised medicine in cancer. Patients with systemic sclerosis (SSc), a rare, multiorgan autoimmune disorder, have a similarly poor prognosis due to interstitial lung disease (ILD). Here, our objectives were to explore computed tomography (CT)-based high-dimensional image analysis (“radiomics”) for disease characterisation, risk stratification and relaying information on lung pathophysiology in SSc-ILD. Methods We investigated two independent, prospectively followed SSc-ILD cohorts (Zurich, derivation cohort, n=90; Oslo, validation cohort, n=66). For every subject, we defined 1355 robust radiomic features from standard-of-care CT images. We performed unsupervised clustering to identify and characterise imaging-based patient clusters. A clinically applicable prognostic quantitative radiomic risk score (qRISSc) for progression-free survival (PFS) was derived from radiomic profiles using supervised analysis. The biological basis of qRISSc was assessed in a cross-species approach by correlation with lung proteomic, histological and gene expression data derived from mice with bleomycin-induced lung fibrosis. Results Radiomic profiling identified two clinically and prognostically distinct SSc-ILD patient clusters. To evaluate the clinical applicability, we derived and externally validated a binary, quantitative radiomic risk score (qRISSc) composed of 26 features that accurately predicted PFS and significantly improved upon clinical risk stratification parameters in multivariable Cox regression analyses in the pooled cohorts. A high qRISSc score, which identifies patients at risk for progression, was reverse translatable from human to experimental ILD and correlated with fibrotic pathway activation. Conclusions Radiomics-based risk stratification using routine CT images provides complementary phenotypic, clinical and prognostic information significantly impacting clinical decision making in SSc-ILD.

• Didriksen, Henriette; Molberg, Øyvind; Mehta, Adi; Jordan, Suzana; Palchevskiy, Vyacheslav & Fretheim, Håvard Halland [Vis alle 16 forfattere av denne artikkelen] (2022). Target organ expression and biomarker characterization of chemokine CCL21 in systemic sclerosis associated pulmonary arterial hypertension. Frontiers in Immunology. 13. doi: 10.3389/fimmu.2022.991743. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Systemic sclerosis (SSc) is a heterogenous disorder that appears to result from interplay between vascular pathologies, tissue fibrosis and immune processes, with evidence for deregulation of chemokines, which normally control immune trafficking. We recently identified altered levels of chemokine CCL21 in SSc associated pulmonary arterial hypertension (PAH). Here, we aimed to define target organ expression and biomarker characteristics of CCL21. Materials and methods To investigate target organ expression of CCL21, we performed immunohistochemistry (IHC) on explanted lung tissues from SSc-PAH patients. We assessed serum levels of CCL21 by ELISA and Luminex in two well-characterized SSc cohorts from Oslo (OUH, n=552) and Zurich (n=93) University hospitals and in 168 healthy controls. For detection of anti-CCl21 antibodies, we performed protein array analysis applying serum samples from SSc patients (n=300) and healthy controls. To characterize circulating CCL21 in SSc, we applied immunoprecipitation (IP) with antibodies detecting both full length and tailless and a custom-made antibody detecting only the C-terminal of CCL21. IP products were analyzed by SDS-PAGE/western blot and Mass spectrometry (MS). Results By IHC, we found that CCL21 was mainly expressed in the airway epithelial cells of SSc patients with PAH. In the analysis of serum levels of CCL21 we found weak correlation between Luminex and ELISA (r=0.515, p&amp;lt;0.001). Serum levels of anti-CCL21 antibodies were higher in SSc patients than in healthy controls (p&amp;lt;0.001), but only 5% of the SSc population were positive for anti-CCL21 antibodies in SSc, and we found no correlation between anti-CCl21 and serum levels of CCL21. By MS, we only identified peptides located within amino acid (aa) 23-102 of CCL21, indicating that CCL21 in SSc circulate as a truncated protein without the C-terminal tail. Conclusion This study demonstrates expression of CCL21 in epithelial lung tissue from SSc patients with PAH, and indicate that CCL21 in SSc circulates as a truncated protein. We extend previous observations indicating biomarker potential of CCL21, but find that Luminex is not suitable as platform for biomarker analyses. Finally, in vivo generated anti-CCL21 antibodies exist in SSc, but do not appear to modify serum CCL21 levels in patients with SSc-PAH.

• Leeuwen, Nina M. van; Boonstra, Maaike; Fretheim, Håvard Halland; Brunborg, Cathrine; Midtvedt, Øyvind & Garen, Torhild Oddveig [Vis alle 10 forfattere av denne artikkelen] (2022). Gastrointestinal symptom severity and progression in systemic sclerosis. Rheumatology. ISSN 1462-0324. 61(10), s. 4024–4034. doi: 10.1093/rheumatology/keac118. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objectives To evaluate the severity and evolution of patient-reported gastrointestinal tract (GIT) symptoms in systemic sclerosis (SSc) patients, assess predictive factors for progression and determine the impact of standard of care treatment. Methods SSc patients from the Leiden and Oslo cohorts were included. We assessed clinical data and patient-reported GIT symptoms measured by the validated University of California, Los-Angeles Gastrointestinal-tract (UCLA-GIT) score at baseline and annually. GIT severity and progression was determined. Logistic regression was applied to identify risk factors associated with baseline GIT symptom severity. Linear mixed-effect models were applied to assess progression in GIT symptom burden and to identify predictive factors. We repeated all analysis in patients with early disease (inception cohort) to exclude the effect of longstanding disease and increase insights in development of GIT symptom burden early in the disease course. Results We included 834 SSc patients with baseline UCLA GIT scores, 454 from Leiden and 380 from Oslo. In the total cohort, 28% reported moderate-severe GIT symptoms at baseline, with increased risk for severity conferred by ACA, smoking and corticosteroid use, while use of calcium channel blockers appeared protective. In the inception cohort, 23% reported moderate-severe GIT symptoms at baseline, with increased risk for females and with smoking. Over time, symptom burden increased mainly for reflux/bloating. Female sex and ACA predicted GIT symptom progression. Conclusion High GIT symptom burden is present early in SSc disease course. Both for prevalence and for progression of GIT symptom burden, female sex and smoking were identified as risk factors.

• Tennøe, Anders; Murbræch, Klaus; Didriksen, Henriette; Ueland, Thor; Palchevskiy, Vyacheslav & Weigt, Stephen S. [Vis alle 14 forfattere av denne artikkelen] (2022). Serum markers of cardiac complications in a systemic sclerosis cohort. Scientific Reports. 12(4661 ). doi: 10.1038/s41598-022-08815-8. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Primary cardiac involvement is one of the leading causes of mortality in systemic sclerosis (SSc), but little is known regarding circulating biomarkers for cardiac SSc. Here, we aimed to investigate potential associations between cardiac SSc and candidate serum markers. Serum samples from patients of the Oslo University SSc cohort and 100 healthy controls were screened against two custom-made candidate marker panels containing molecules deemed relevant for cardiopulmonary and/or fibrotic diseases. Left (LV) and right ventricular (RV) dysfunction was assessed by protocol echocardiography, performed within three years from serum sampling. Patients suspected of pulmonary hypertension underwent right heart catheterization. Vital status at study end was available for all patients. Descriptive analyses, logistic and Cox regressions were conducted to assess associations between cardiac SSc and candidate serum markers. The 371 patients presented an average age of 57.2 (± 13.9) years. Female sex (84%) and limited cutaneous SSc (73%) were predominant. Association between LV diastolic dysfunction and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) (OR 0.41, 95% CI 0.21–0.78, p = 0.007) was identified. LV systolic dysfunction defined by global longitudinal strain was associated with angiopoietin 2 (ANGPT2) (OR 3.42, 95% CI 1.52–7.71, p = 0.003) and osteopontin (OPN) (OR 1.95, 95% CI 1.08–3.52, p = 0.026). RV systolic dysfunction, measured by tricuspid annular plane systolic excursion, was associated to markers of LV dysfunction (ANGPT2, OPN, and TRAIL) (OR 1.67, 95% CI 1.11–2.50, p = 0.014, OR 1.86, 95% CI 1.25–2.77, p = 0.002, OR 0.32, 95% CI 0.15–0.66, p = 0.002, respectively) and endostatin (OR 1.86, 95% CI 1.22–2.84, p = 0.004). In conclusion, ANGPT2, OPN and TRAIL seem to be circulating biomarkers associated with both LV and RV dysfunction in SSc.

• Hilberg, Ole; Hoffmann-Vold, Anna-Maria; Smith, Vanessa; Bouros, Demosthenes; Kilpeläinen, Maritta & Guiot, Julien [Vis alle 18 forfattere av denne artikkelen] (2022). Epidemiology of interstitial lung diseases and their progressive-fibrosing behaviour in six European countries. European Respiratory Journal Open Research (ERJ Open Research). 8:00597-2021, s. 1–16. doi: 10.1183/23120541.00597-2021. Fulltekst i vitenarkiv
• Didriksen, Henriette; Molberg, Øyvind; Fretheim, Håvard Halland; Gude, Einar; Jordan, Suzana & Brunborg, Cathrine [Vis alle 13 forfattere av denne artikkelen] (2021). Association of Lymphangiogenic Factors With Pulmonary Arterial Hypertension in Systemic Sclerosis. Arthritis & Rheumatology. ISSN 2326-5191. 74(7), s. 1277–1287. doi: 10.1002/art.41665. Fulltekst i vitenarkiv
• Hoffmann-Vold, Anna-Maria; Fretheim, Håvard Halland; Sarna, Vikas Kumar; Barua, Imon Shoumitra; Nordgård, Maylen Carstens & Distler, Oliver [Vis alle 16 forfattere av denne artikkelen] (2021). Safety and efficacy of faecal microbiota transplantation by Anaerobic Cultivated Human Intestinal Microbiome (ACHIM) in patients with systemic sclerosis: Study protocol for the randomised controlled phase II ReSScue trial. BMJ Open. 11(6). doi: 10.1136/bmjopen-2020-048541. Fulltekst i vitenarkiv Vis sammendrag

  Introduction In the multisystem inflammatory disorder systemic sclerosis (SSc), gastrointestinal tract (GIT) affliction is highly prevalent. There are no known disease modifying therapies and the negative impact is substantial. Aiming for a new therapeutic principle, and inspired by recent work showing associations between gut microbiota changes and GIT symptoms in SSc, we performed a pilot study on faecal microbiota transplantation (FMT) with the single-donor bacterial culture ‘Anaerobic Cultivated Human Intestinal Microbiome (ACHIM)’. Motivated by positive pilot study signals, we designed the ReSScue trial as a phase II multicentre, placebo-controlled, randomised 20-week trial to evaluate safety and efficacy on lower GIT symptoms of FMT by ACHIM in SSc. Methods and analyses We aim to include 70 SSc participants with moderate to severe lower GIT symptoms, defined by the validated patient-reported University of California Los Angeles Scleroderma Clinical Trial Consortium GIT 2.0 2.0 questionnaire. The trial includes three parts. In part A1 (induction phase) lasting from week 0 to week 12, participants will be randomised 1:1 to repeat infusions of 30 mL ACHIM or placebo at week 0 and 2 by gastroduodenoscopy. In part A2, which is an 8-week subsequent maintenance phase, all study participants will receive 30 mL ACHIM at week 12 and followed until week 20 on continued blind. In part B, which will last until the last participant completes part A2, the participants will be followed through a maximum 16-week extended monitoring period, for longer-term data on safety and intervention effects. Primary endpoint is change from baseline to week 12 in UCLA GIT subscale scores of diarrhoea or bloating, depending on the worst symptom at baseline evaluated separately for each patient. Secondary endpoints are safety measures and changes in UCLA GIT scores (total, diarrhoea and bloating).

• Hoffmann-Vold, Anna-Maria; Fretheim, Håvard Halland; Meier, Chantal & Maurer, Britta (2020). Circulating biomarkers of systemic sclerosis – interstitial lung disease. Journal of Scleroderma and Related Disorders (JSRD). ISSN 2397-1983. 5(25), s. 41–47. doi: 10.1177/2397198319894851. Fulltekst i vitenarkiv
• Fretheim, Håvard Halland; Halse, Anne-Kristine; Seip, Marit; Bitter, Helle; Wallenius, Marianne & Garen, Torhild Oddveig [Vis alle 11 forfattere av denne artikkelen] (2020). Multidimensional tracking of phenotypes and organ involvement in a complete nationwide systemic sclerosis cohort. Rheumatology. ISSN 1462-0324. 59(10), s. 2920–2929. doi: 10.1093/rheumatology/keaa026. Fulltekst i vitenarkiv Vis sammendrag

  Objective. SSc is a severe, heterogeneous multi-organ disease where population-based estimates on phenotypic spectrum, overall disease burden and societal impact are largely missing. Here the objective was to provide the first-ever complete national-level data on phenotype and major organ afflictions in SSc. Methods. A stepwise strategy was applied to find and characterize every SSc patient resident in Norway from 2000 to 2012. First we identified every case in the country registered with an International Classification of Diseases, Tenth Revision code for SSc (M34). Next we manually reviewed all cases coded as M34 to determine whether they met the 1980 ACR and/or 2013 ACR/EULAR classification criteria for SSc and could be included in the Norwegian SSc cohort (Nor-SSc). Finally, all disease features from SSc onset to study end were reviewed. Results. The Nor-SSc cohort included 815 SSc patients. The mean age at diagnosis was 53 years, with 84% females and 77% limited cutaneous SSc. The estimated incidence increased from 4 per million in 2000 to 13 per million in 2012. We identified high cumulative frequencies of internal organ involvement, coexistence of multiple organ afflictions across disease subsets and autoantibody status and stable frequencies of pulmonary arterial hypertension across haemodynamic definitions, but indications of referral-related differences in pulmonary hypertension detection rates across the study area. Conclusion. This nationwide cohort study provides new, unbiased evidence for a high disease burden in SSc patients of Caucas

• Fretheim, Håvard Halland; Chung, Brian K.; Didriksen, Henriette; Bækkevold, Espen Sønderaal; Midtvedt, Øyvind & Brunborg, Cathrine [Vis alle 18 forfattere av denne artikkelen] (2020). Fecal Microbiota Transplantation in Systemic Sclerosis: A Double-Blind, Placebo-Controlled Randomized Pilot Trial. PLOS ONE. 15:e0232739(5), s. 1–14. doi: 10.1371/journal.pone.0232739. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Systemic sclerosis (SSc) is an auto-immune, multi organ disease marked by severe gastrointestinal (GI) involvement and gut dysbiosis. Here, we aimed to determine the safety and efficacy of fecal microbiota transplantation (FMT) using commercially-available anaerobic cultivated human intestinal microbiota (ACHIM) in SSc. Methods Ten patients with SSc were randomized to ACHIM (n = 5) or placebo (n = 5) in a double-blind, placebo-controlled 16-week pilot. All patients had mild to severe upper and lower GI symptoms including diarrhea, distention/bloating and/or fecal incontinence at baseline. Gastroduodenoscopy transfer of ACHIM or placebo was performed at weeks 0 and 2. Primary endpoints were safety and clinical efficacy on GI symptoms assessed at weeks 4 and 16. Secondary endpoints included changes in relative abundance of total, immunoglobulin (Ig) A- and IgM-coated fecal bacteria measured by 16s rRNA sequencing. Results ACHIM side effects were mild and transient. Two placebo controls experienced procedure-related serious adverse events; one developed laryngospasms at week 0 gastroduodenoscopy necessitating study exclusion whilst one encountered duodenal perforation during gastroduodenoscopy at the last study visit (week 16). Decreased bloating, diarrhea and/or fecal incontinence was observed in four of five patients in the FMT group (week 4 or/and 16) and in two of four in the placebo group (week 4 or 16). Relative abundance, richness and diversity of total and IgA-coated and IgM-coated bacteria fluctuated more after FMT, than after placebo. Conclusions FMT of commercially-available ACHIM is associated with gastroduodenoscopy complications but reduces lower GI symptoms by possibly altering the gut microbiota in patients with SSc.

• Lemmers, Jacqueline MJ; Fretheim, Håvard Halland; Knaapen, Hanneke KA; Hoogen, Frank Van Den; Haren-Willems, Jolanda HGM van & Duijnhouwer, Anthony L [Vis alle 10 forfattere av denne artikkelen] (2020). Selexipag treatment in patients with systemic sclerosis–associated pulmonary arterial hypertension in clinical practice, a case series. Journal of Scleroderma and Related Disorders (JSRD). ISSN 2397-1983. 5(3), s. N7–N11. doi: 10.1177/2397198320916082. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To describe the efficacy and safety in all patients with systemic sclerosis–associated pulmonary arterial hypertension who started selexipag between 09-2016 and 06-2018 in two pulmonary arterial hypertension expert centers. Methods: All patients with systemic sclerosis–associated pulmonary arterial hypertension diagnosed by right heart catheterization and treated with selexipag were included. Every 12 weeks, treatment effect was assessed by (1) the opinion of the expert team and (2) the abbreviated risk assessment, consisting of functional class, six-minute walking distance, and N-terminal prohormone of brain natriuretic peptide level at baseline and during follow-up. Side effects and adverse events were registered. Results: We included 13 systemic sclerosis–associated pulmonary arterial hypertension patients, 10 patients were female, median age (interquartile range) of 68 (58–75) years, median systemic sclerosis disease duration of 7.4 (4.7–13.5) years, and median pulmonary arterial hypertension duration of 4 (2.5–7.5) years. Two patients discontinued selexipag within 4 weeks due to side effects. The remaining 11 patients had a median follow-up duration of 48 (interquartile range = 24–72) weeks. Two patients died (one pulmonary arterial hypertension–related, the other systemic sclerosis–related). According to the expert team, 8 of 11, 9 of 10, and 5 of 7 patients stabilized or improved at 12, 24, and 48 weeks, respectively. According to the abbreviated risk assessment at study end, 3 of 11 patients had 1 low-risk criterion. No previously unrecorded side effects were reported. Conclusion: Adding selexipag to background therapy in a high-risk cohort of systemic sclerosis–associated pulmonary arterial hypertension patients provided sustained stabilization of symptoms with an acceptable safety profile. Improvement was reached in only two of our patients. Further research should focus on systemic sclerosis–associated pulmonary arterial hypertension patients treated with multiple targeted treatments, preferably these patients should be prospectively followed in international registries.

• Hoffmann-Vold, Anna-Maria; Fretheim, Håvard Halland; Halse, Anne-Kristine; Seip, Marit; Bitter, Helle & Wallenius, Marianne [Vis alle 13 forfattere av denne artikkelen] (2019). Tracking impact of interstitial lung disease in systemic sclerosis in a complete nationwide cohort. American Journal of Respiratory and Critical Care Medicine. ISSN 1073-449X. 200(10), s. 1258–1266. doi: 10.1164/rccm.201903-0486OC. Fulltekst i vitenarkiv Vis sammendrag

  Rationale: Interstitial lung disease (ILD) represents a major challenge in systemic sclerosis (SSc), but there are no precise, population-based data on its overall impact, limiting opportunities for screening and management strategies. Objectives: Evaluate impact of ILD in a unique, nationwide, population-based SSc cohort. Methods: ILD was assessed prospectively in the Norwegian SSc (Nor-SSc) cohort, including all 815 patients with SSc resident in the country from 2000 to 2012. Lung high-resolution computed tomography (HRCT) scans were available for fibrosis quantification at baseline (n = 650, 80%) and follow-up. Pulmonary function tests were assessed at baseline (n = 703, 86%) and follow-up. Vital status and standardized mortality ratios (SMRs) were estimated at study end (2018) in the 630 incident Nor-SSc cases and 15 individually matched control subjects. Cumulative survival rates were computed. Measurements and Main Results: At baseline, 50% of the subjects with SSc (n = 324) had ILD by HRCT and 46% displayed pulmonary function declines consistent with ILD progression. Mortality correlated with extent of lung fibrosis as SMR increased from 2.2 with no fibrosis to 8.0 with greater than 25% fibrosis. SMR was inversely related to baseline FVC% and increased at all FVC levels below 100%. In patients with normal-range baseline FVC (80–100%), the 5- and 10-year survival rates correlated with presence or absence of lung fibrosis, being 83% and 80%, respectively, with no fibrosis and 69% and 56%, respectively, with lung fibrosis (P = 0.03). Conclusions: The mere presence of ILD at baseline appears to affect outcome in SSc, suggesting that all patients with SSc should undergo a baseline pulmonary function test and lung HRCT screening to diagnose ILD early and tailor further management.

• Tennøe, Anders H; Murbraech, Klaus; Andreassen, Johanna; Fretheim, Håvard Halland; Midtvedt, Øyvind & Garen, Torhild Oddveig [Vis alle 12 forfattere av denne artikkelen] (2019). Systolic Dysfunction in Systemic Sclerosis: Prevalence and Prognostic Implications. ACR Open Rheumatology. 1(4), s. 258–266. doi: 10.1002/acr2.1037. Fulltekst i vitenarkiv Vis sammendrag

  Objective Primary cardiac involvement is presumed to account for a substantial part of disease‐related mortality in systemic sclerosis (SSc). Still, there are knowledge gaps on the evolution and total burden of systolic dysfunction in SSc. Here we evaluated prospective left ventricular (LV) and right ventricular (RV) systolic function in an unselected SSc cohort and assessed the burden of systolic dysfunction on mortality. Methods From the Oslo University Hospital cohort, 277 SSc patients were included from 2003‐2016 and compared with healthy controls. Serial echocardiographies were reevaluated in order to detect change in systolic function. Right heart catheterization was performed on patients suspected of pulmonary hypertension. Descriptive and regression analyses were conducted. Results At baseline, LV systolic dysfunction by ejection fraction less than 50%, or a global longitudinal strain greater than −17.0%, was found in 12% and 24%, respectively. RV systolic dysfunction measured by tricuspid annular plane systolic excursion (TAPSE) less than 17 mm was evident in 10%. Follow‐up echocardiography was performed after a median of 3.3 years (interquartile range [IQR] 1.5‐5.6). At follow‐up, LV systolic function remained stable, whereas RV function evaluated by TAPSE deteriorated (mean 23.1 to 21.7 mm, P = 0.005) equaling a 15% prevalence of RV systolic dysfunction. RV systolic function predicted mortality in multivariable models (hazard ratio 0.41, 95% confidence interval [CI] 0.19‐0.90, P value 0.027), whereas LV systolic function lost predictive significance when adjusted for TAPSE. Conclusion In this unselected and prospective study, systolic dysfunction of the LV and RV was a frequent complication of SSc. LV systolic function remained stable across the observation period, whereas RV function deteriorated and predicted mortality.

• Elhai, Muriel; Hoffmann-Vold, Anna-Maria; Avouac, Jérôme; Pezet, Sonia; Cauvet, Anne & Leblond, Agnés [Vis alle 11 forfattere av denne artikkelen] (2019). Performance of Candidate Serum Biomarkers for Systemic Sclerosis?Associated Interstitial Lung Disease. Arthritis & Rheumatology. ISSN 2326-5191. 71(6), s. 972–982. doi: 10.1002/art.40815. Fulltekst i vitenarkiv Vis sammendrag

  Objective Interstitial lung disease (ILD ) in systemic sclerosis (SS c) runs a highly variable course, and prediction tools are highly desired. The aim of this study was to assess the diagnostic and prognostic performance of 4 candidate serum biomarkers for SS c‐associated ILD . Methods Serum samples from a combined cohort of SS c patients (from Paris, France and Oslo, Norway; n = 427) were analyzed by enzyme‐linked immunosorbent assay for concentrations of lung epithelial–derived surfactant protein D (SP ‐D), Krebs von den Lungen 6 glycoprotein (KL ‐6), CCL 18, and OX 40 ligand (OX 40L). Lung fibrosis was measured by high‐resolution computed tomography and pulmonary function tests. Associations of these candidate biomarkers with baseline disease involvement and prediction of disease progression over time (mean ± SD follow‐up 3.2 ± 4.4 years) were investigated. Results In SS c patients at baseline, serum levels of KL ‐6 correlated with the forced vital capacity (FVC ) (r = −0.317, P < 0.001), diffusing capacity for carbon monoxide (r = −0.335, P < 0.001), and extent of lung fibrosis (r = 0.551, P < 0.001). In multivariate analyses, serum levels of KL ‐6 and SP ‐D, but not CCL 18 and OX 40L, were associated with lung fibrosis (odds ratio [OR ] 2.41, 95% confidence interval [95% CI ] 1.43–4.07 [P = 0.001] and OR 3.15, 95% CI 1.81–5.48 [P < 0.001], respectively). In SS c patients with ILD at baseline, longitudinal, multivariate analyses showed that CCL 18 serum levels were an independent predictor of a >10% decrease in the FVC (hazard ratio [HR ] 2.90, 95% CI 1.25–6.73; P = 0.014) and de novo development of extensive disease (HR 3.71, 95% CI 1.02–13.52; P = 0.048). Matrix‐based logistic regression models for the diagnosis and prognosis of SS c‐associated ILD were constructed, and these models discriminated 3 groups of risk (mild, moderate, or high) for the diagnosis or worsening of lung fibrosis according to the serum levels of SP ‐D (for diagnosis) and serum levels of CCL 18 (for progression of disease). Conclusion These results show that SP ‐D is a relevant diagnostic biomarker for SS c‐associated ILD , whereas KL ‐6 could be used to assess the severity of lung fibrosis. CCL 18 appears to be a potential predictive marker for progression of ILD in SS c.

• Hoffmann-Vold, Anna-Maria; Hesselstrand, Roger; Fretheim, Håvard Halland; Ueland, Thor; Andreassen, Arne K. & Brunborg, Cathrine [Vis alle 12 forfattere av denne artikkelen] (2018). CCL21 as a Potential Serum Biomarker for Pulmonary Arterial Hypertension in Systemic Sclerosis. Arthritis & Rheumatology. ISSN 2326-5191. 70(10), s. 1644–1653. doi: 10.1002/art.40534. Fulltekst i vitenarkiv
• Hoffmann-Vold, Anna-Maria; Fretheim, Håvard Halland; Midtvedt, Øyvind; Kilian, Karin Renate; Angelshaug, Marianne & Chaudhary, Asad [Vis alle 12 forfattere av denne artikkelen] (2018). Frequencies of borderline pulmonary hypertension before and after the DETECT algorithm: Results from a prospective systemic sclerosis cohort. Rheumatology. ISSN 1462-0324. 57(3), s. 480–487. doi: 10.1093/rheumatology/kex435. Fulltekst i vitenarkiv
• Wu, Wanlong; Jordan, Suzana; Becker, Mike Oliver; Dobrota, Rucsandra; Maurer, Britta & Fretheim, Håvard Halland [Vis alle 11 forfattere av denne artikkelen] (2018). Prediction of progression of interstitial lung disease in patients with systemic sclerosis: The SPAR model. Annals of the Rheumatic Diseases. ISSN 0003-4967. 77(9), s. 1326–1332. doi: 10.1136/annrheumdis-2018-213201. Fulltekst i vitenarkiv
• Tennøe, Anders; Murbræch, Klaus; Andreassen, Johanna; Fretheim, Håvard Halland; Garen, Torhild Oddveig & Gude, Einar [Vis alle 10 forfattere av denne artikkelen] (2018). Left ventricular diastolic dysfunction predicts mortality in patients with systemic sclerosis. Journal of the American College of Cardiology. ISSN 0735-1097. 72(15), s. 1804–1813. doi: 10.1016/j.jacc.2018.07.068. Fulltekst i vitenarkiv Vis sammendrag

  Background Primary cardiac affection is common and is a major cause of death in systemic sclerosis (SSc), but there are knowledge gaps regarding the effect of cardiac dysfunction on mortality. Objectives The purpose of this study was to evaluate diastolic function in a large, unselected SSc cohort and assess the effect of diastolic dysfunction (DD) on mortality. Methods SSc patients followed prospectively at the Oslo University Hospital from 2003 to 2016 with available echocardiographies and matched control subjects were included. DD was assessed by echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Pulmonary hypertension (PH) was diagnosed by right heart catheterization. Vital status was available for all patients. Cox regression analyses with hazards ratios (HRs) were conducted. Results Diastolic function was assessed in 275 SSc patients at baseline and in 186 patients at follow-up. At baseline, 46 of the 275 SSc patients (17%) were diagnosed with DD and 195 (71%) had normal diastolic function. After a median follow-up of 3.4 years (interquartile range: 1.6 to 6.2 years), the proportion of DD increased from 17% to 29%. During follow-up, 57% of patients with DD at baseline died, compared with 13% of patients with normal diastolic function. At baseline, 86 patients had performed right heart catheterization, and 43 were diagnosed with PH; of these 60% deceased. In multivariable Cox regression analyses, DD was a stronger predictor of death (HR: 3.7; 95% CI: 1.69 to 8.14; c-index 0.89) than PH (HR: 2.0; 95% CI: 1.1 to 3.9; c-index 0.84). Conclusions DD is frequent in SSc, and the presence of DD is associated with high mortality. DD exceeds PH with respect to predicting mortality.

Se alle arbeider i NVA

• Reinås, Karl Henrik Storhaug; Rootwelt-Revheim, Mona-Elisabeth; Fretheim, Håvard Halland; Johnsrud, Kjersti; Midtvedt, Øyvind & Sherwani, Alexander Gul [Vis alle 8 forfattere av denne artikkelen] (2026). Time is crucial: An Interaction analysis study of dilemmas between patients with inflammatory rheumatic diseases and health care professionals at a PET-CT facility. Annals of Rheumatic diseases. 34(2-4), s. 2387–2387. doi: https:/eular.sharepoint.com/sites/AbstractBookletPublication/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2FAbstractBookletPublication%2FShared%20Documents%2FEULAR%202026%20Abstract%20Book%20%28pre-Congress%29.pdf&parent=%2Fsites%2FAbstractBookletPublication%2FShared%20Documents&p=true&ga=1. Fulltekst i vitenarkiv Vis sammendrag

  Background: Communication between health care professionals (HCP) and patients is essential in how to learn coping strategies for how to live satisfactorily with Inflammatory rheumatic diseases (IRDs). Communication act as a key resource for knowledge-sharing. It also supports a process of meaning-making, enabling both HCP and persons with IRDs to gain insights into the patients’ condition when the communication can occur in a safe, secure and trustful manner within the context of the health care sector. Person-centred care (PCC) emphasises that the relation between the HCP and patient should be in the form of a partnership, where the patients’ experiences are necessary to merge with the HCP’s professional training (evidence-based education) and clinical experience, to lay the best foundation for a fruitful collaboration that could benefit the tailor-made diagnosis and treatment trajectory. To facilitate an increase in health literacy (HL) for patients through communication, PCC could be useful, as one of several available intervention approaches. Even though PCC is implemented and known to various degrees, the principles are often used implicitly by showing empathy and concern for the patient’s condition and well-being. Oftentimes HCPs are facing communicative dilemmas for what to say and how to say it, to make their message as understandable and acceptable for the patient as possible, while avoiding misunderstandings that could prevent the communication to work properly. Preparation sessions for positron emission tomography and computer tomography (PET-CT), using fluorodeoxyglucose (FDG), are a health care setting that could make visible the challenges in implementing PCC for IRD patients under time-pressure. Time constraints are often present in the health care sector. As a result, time is crucial in shaping how HCPs are abled or constrained to help the patients to increase their HL. Objectives: Communicative dilemmas need to be resolved to ensure that patients receive the health care they need and get the knowledge required for conducting the PET-CT procedure. Such knowledge, combined with the rationale behind the procedure, also helps lay the foundation for the patients to understand on which conditions the image-taking and diagnostic information is based. To understand how HL could be increased in IRD-patients undergoing a preparation session for PET-CT, we asked: 1) In what way does the use of time in the health care encounter restrict or afford possibilities for learning? and 2) What communicative dilemmas do preparation sessions for PET-CT procedures entail? Methods: Fourteen patients (57.9±11.7 years, 9 women) with indications of IRDs (diagnosis=IgG4-related disease, sarcoidosis, spondyloarthritis, Kawasaki, unknown) and ten HCPs (31.2±5.5 years, 6 women) (7 radiographers and 3 biomedical scientists) taking part in a preparation session for a PET-CT scan at a large Norwegian hospital were videorecorded in November 2024-September 2025. A rheumatologist referred the IRD-patients to the study, whereupon they were called to confirm their interest in taking part in the study and later signed a written consent form before undergoing the procedure, as did the HCPs. Video recordings of the sessions were transcribed and analysed with interaction analysis (1), where the standardised structure of the interactional pattern was described and themes were identified through parts of the transcripts that thematized similar interaction sequences. Communicative dilemmas were used as an analytic lens, to investigate how the interaction sequences of interest were built up. Results: The interaction analysis identified four communicative dilemmas. 1) Informing about the time vs. overemphasising the duration, 2) Informing about the radioactive substance vs. provoking concerns, 3) Informing about the venous cannula insertion vs. making the venous cannula insertion too invasive and into focus, and 4) Timing the procedure accurately, adequately and correct vs. not be able to open for the experiences, concerns and small talk in the interaction. Balancing the emphasis between carrying out the medical procedure and explicitly recognizing the patient as an autonomous and capable individual was a significant challenge for HCPs, particularly when compounded by the constraints of limited time. The agency of the patient was shown through their initiation of asking questions and in how they followed up and responded to questions from the HCPs, while the HCPs differed in the degree to how much they deviated from the procedure’s checklist and added other kinds of information through their communication than they were required to from the standardised procedure and practice. Conclusions: Overall, we see that how to give precise, correct and enough information without worrying the patient unnecessary is a continuous challenge, that needs to be solved satisfactorily to help the patient cope with the situation and provide meaningful learning opportunities that could increase the HL for both patients and HCPs. The necessity to time the procedure, due to the radioactive substance and queue of patients, is a constraining factor in the context that limit the options for communication approaches that can be chosen and could sometimes make it harder to find satisfactory solutions for the communicative dilemmas the situation entails. However, it seems possible to provide information to patients that could improve the patients understanding of the procedure and the foundation for the diagnostic information through the images taken, despite time pressure, adapted to the needs and interests of the patients. Longitudinal studies could shed light on what IRD-patients have learned through the communication with HCPs in preparation sessions for PET-CT scans and how this could help living well and cope with the chronic disease. REFERENCES: [1] Jordan B, Henderson A. Interaction Analysis: Foundations and Practice. The Journal of the learning sciences. 1995;4(1):39–103. Acknowledgments: NIL. Disclosure of Interests: None declared. DOI: 10.1136/annrheumdis-2026-eular.C.29

• Hoffmann-Vold, Anna-Maria; Fretheim, Håvard Halland; Didriksen, Henriette & Molberg, Øyvind (2020). The potential of fecal microbiota transplantation in systemic sclerosis. Expert Review of Clinical Immunology. ISSN 1744-666X. VOL. 16,(NO. 2,), s. 117–118. doi: 10.1080/1744666X.2019.1707665. Fulltekst i vitenarkiv
• Fretheim, Håvard Halland; Seip, Marit; Halse, Anne-Kristine; Bitter, Helle; Wallenius, Marianne & Aaløkken, Trond Mogens [Vis alle 10 forfattere av denne artikkelen] (2018). Characteristics of mild to to moderate lung disease in systemic sclerosis and impact of survival, data from the population-based, nationwide norwegian cohort. Annals of the Rheumatic Diseases. ISSN 0003-4967. 77, s. A418–A418. doi: 10.1136/annrheumdis-2018-eular.7121. Fulltekst i vitenarkiv
• Hoffmann-Vold, Anna-Maria; Fretheim, Håvard Halland; Halse, Anne-Kristine; Seip, Marit; Wallenius, Marianne & Bitter, Helle [Vis alle 9 forfattere av denne artikkelen] (2017). Norway as a national reference population for systemic sclerosis; preliminary results from a complete, nationwide cohort. Arthritis & Rheumatology. ISSN 2326-5191. 69. Fulltekst i vitenarkiv

Se alle arbeider i NVA