Tillmann Uhlig

• Skinnes, Mari Nilsen; Uhlig, Till; Johansen, Thomas; Eid, Idun; Fossmo, Hanne Ludt & Habberstad, Andreas [Vis alle 13 forfattere av denne artikkelen] (2026). Associations between work ability and work participation after rehabilitation: a longitudinal multicentre cohort study. EULAR Rheumatology Open (ERO). 2(2), s. 100163–100163. doi: 10.1016/j.ero.2026.03.011. Fulltekst i vitenarkiv
• Filippou, Georgios; Pezzoni, Laura; Filippucci, Emilio; Tedeschi, Sara K.; Pascart, Tristan & Adinolfi, Antonella [Vis alle 55 forfattere av denne artikkelen] (2026). Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions for disease elements in calcium pyrophosphate crystal deposition (CPPD). Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1016/j.ard.2026.05.019. Fulltekst i vitenarkiv
• Stjärne, Johan Folke Håkan; Aanesen, Fiona; Søhus, S.; Abhishek, A.; Dalbeth, N. & Hammer, Hilde Berner [Vis alle 11 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• Stewart, Sarah; Gamble, Gregory D.; Taylor, William J.; Harrison, Andrew; Merriman, Tony R. & Mihov, Borislav [Vis alle 26 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• Lampa, Jon; Nordström, Dan; Vollenhoven, Ronald van; Hetland, Merete Lund; Haavardsholm, Espen A. & Østergaard, Mikkel [Vis alle 71 forfattere av denne artikkelen] (2026). Certolizumab pegol, abatacept, tocilizumab or active conventional therapy in early rheumatoid arthritis: 48-week patient-reported outcomes from the NORD-STAR trial. The Lancet Rheumatology. 8(4), s. e285–e294. doi: 10.1016/s2665-9913(26)00007-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Pain, fatigue, and impaired health-related quality of life are common manifestations of rheumatoid arthritis. The aim of this study was to compare the effects of active conventional treatment with three different biological disease-modifying antirheumatic drugs (DMARDs) on patient-reported outcomes after 48 weeks, in patients with early rheumatoid arthritis using data from the NORD-STAR trial. Methods NORD-STAR was an investigator-initiated open-label randomised controlled trial done at 29 rheumatology centres across Denmark, Finland, Iceland, Norway, Sweden, and the Netherlands. Newly diagnosed patients aged 18 years or older, with rheumatoid arthritis (according to the 2010 American College of Rheumatology–European Allience of Associations for Rheumatology classification criteria for rheumatoid arthritis), symptom duration less than 24 months and who were naïve to DMARDs were randomly assigned (1:1:1:1) to receive active conventional treatment, certolizumab pegol, abatacept, or tocilizumab. The patient-reported outcomes assessed at baseline and weeks 4, 8, 12, 16, 24, 32, 40, and 48 included pain, patient's global assessment of disease activity, Health Assessment Questionnaire Disability Index, Fatigue, Short Form-36 (reflecting health-related quality of life, morning stiffness, and patient's acceptable symptom state). Linear mixed regression and logistic regression analyses were adjusted for sex, country, baseline patient-reported outcomes values, anti-citrullinated protein antibody status, and treatment group. Proportions of patients reporting improvements greater than or equal to the minimal clinically important difference (MCID) were assessed. There was lived experience involvement in the design and implementation of the study. This trial was registered with ClinicalTrials.gov, NCT01491815, and EudraCT, 2011-004720-35. Findings Between Dec 14, 2012, and Dec 11, 2018, 812 patients were enrolled and randomly assigned; after exclusion of 17 patients not receiving tocilizumab due to administrative issues, the intention-to-treat population consisted of 795 patients (200 [25%] received active conventional treatment, 203 [26%] received certolizumab pegol plus methotrexate, 204 [26%] received abatacept plus methotrexate, and 188 [24%] received tocilizumab plus methotrexate). 547 (69%) of 795 patients were female, 248 (31%) were male, the mean age was 54 years (SD 15). Between baseline and week 48 large and clinically relevant improvements in patient-reported outcomes were observed in all treatment groups. At 48 weeks the biological DMARD groups had larger improvements in pain, fatigue, physical component score, and bodily pain of SF-36 compared with the active conventional treatment group. For pain, improvement exceeding MCID was reported by 155 (76%) of 203 patients with certolizumab pegol plus methotrexate and 162 (79%) of 204 patients with abatacept plus methotrexate compared with 136 (68%) of 200 patients in the active conventional treatment group. In the group of patients with tocilizumab and methotrexate 132 (70%) of 188 patients reported pain improvement exceeding MCID. The absolute differences between the biological DMARD groups and the active conventional treatment group were otherwise generally marginal. Interpretation All treatment groups showed substantial improvements in patient-reported outcomes over time. Biological DMARDs produced somewhat greater gains in pain, fatigue, and physical quality of life measures than conventional treatments, though overall differences between groups were small. The results highlight that early treatment and effective disease control in rheumatoid arthritis lead to strong patient-reported benefits regardless of therapy type. Funding Stockholm County Council, Swedish Medical Research Council, Swedish Rheumatism Association, Academy of Finland, Finska Läkaresällskapet, South-Eastern Health Region Norway, HUS Institutional grant, Icelandic Society for Rheumatology, Interregional grant from all health regions in Norway, NordForsk, Regionernes Medicinpulje, The Research Fund of University Hospital Reykjavik, UCB, Bristol Myers Squibb.

• Uhlig, Tillmann; Karoliussen, Lars Fridtjof; Sexton, Joseph; Haavardsholm, Espen Andre; Provan, Sella Aarrestad & Solomon, D. H. [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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

• Nagafuchi, Yasuo; Maarseveen, Tjardo D.; Lend, Kristina; Rudin, Anna; Gudbjornsson, Bjorn & Nordström, Dan [Vis alle 21 forfattere av denne artikkelen] (2026). Hand-dominant joint involvement pattern associates with favourable, and polyarthritis with unfavourable, treatment response to both csDMARDs and bDMARDs in early rheumatoid arthritis: a combined analysis of NORD-STAR and BeSt trials. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1016/j.ard.2026.02.005. Fulltekst i vitenarkiv
• Lend, Kristina; Twisk, Jos W.R.; Koopman, Frieda A.; Rudin, Anna; Hetland, Merete Lund & Uhlig, Tillmann [Vis alle 17 forfattere av denne artikkelen] (2026). Flare risk after oral glucocorticoid bridging with methotrexate or intra-articular bridging with triple therapy in early rheumatoid arthritis. Journal of Internal Medicine. ISSN 0954-6820. doi: 10.1111/joim.70094. Fulltekst i vitenarkiv
• Skinnes, Mari Nilsen; Uhlig, Till; Johansen, Thomas; Morvik, Hild Kristin; Farsund, Nina & Fossen, Johanne [Vis alle 15 forfattere av denne artikkelen] (2026). Exploring differences in health-related benefit status in the year before, during and after specialist rehabilitation: a Norwegian case-control study. BMJ Open. 16(1). doi: 10.1136/bmjopen-2025-105722. Fulltekst i vitenarkiv
• 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. doi: 10.1016/j.ard.2025.10.029. Fulltekst i vitenarkiv
• Vasileiadis, Georgios K.; Zhang, Yuan; Laudette, Marion; Fatima, Tahzeeb; Ekwall, Anna-Karin Hultgård & Sureshkumar, Reshmi [Vis alle 23 forfattere av denne artikkelen] (2025). Acylcarnitine enrichment as a characteristic of rheumatoid arthritis fibroblast-like synoviocyte metabolic fingerprint. Journal of Translational Autoimmunity. 11, s. 100310–100310. doi: 10.1016/j.jtauto.2025.100310. Fulltekst i vitenarkiv
• Bardan, Imane; Uhlig, Till; Sexton, Joseph; Kvien, Tore Kristian Aaserud; Bakland, Gunnstein & Pawel, Mielnik [Vis alle 10 forfattere av denne artikkelen] (2025). Health-related Quality of Life in DMARD-treated adults with Juvenile Idiopathic Arthritis Compared to Rheumatoid Arthritis and the General Population. Journal of Rheumatology. ISSN 0315-162X. s. 0384–0384. doi: 10.3899/jrheum.2025-0384. Fulltekst i vitenarkiv Vis sammendrag

  Objective To explore health-related quality of life (HRQoL) measured by Short Form 36 (SF-36), SF-36 physical component score (PCS), SF-36 mental component score (MCS) and Short Form 6D (SF-6D) in adults with juvenile idiopathic arthritis (JIA) compared to rheumatoid arthritis (RA) and the general population. Methods We used six-month follow-up data from the Norwegian disease-modifying antirheumatic drug study (NOR-DMARD), including adult JIA and RA patients starting or switching disease-modifying anti-rheumatic drug (DMARD) treatment. Age- and gender adjusted regression analyses were used to compare outcomes between JIA, RA and the general Norwegian population. Results Register data was available for 232 JIA- and 2764 RA patients at six months follow-up. JIA patients had poorer physical, but similar mental health as RA (adjusted difference (95% CI): PCS -3.58 (-6.09 to -1.08); MCS 2.02 (-0.51 to 4.54)). Compared to the general population, PCS scores were lower in both JIA and RA (adjusted differences; JIA-general population: -15.70 (-18.21 to -13.19), RA-general population: -12.12 (-12.76 to -11.47), but MCS was similar across groups. Average SF-6D utility levels were comparable in JIA and RA, but lower than the general population. Similar proportions of JIA and RA experienced improvements exceeding minimal clinical important difference (MCID) in SF-36 scale scores, PCS, MCS and SF-6D after six months. Conclusion Compared to RA and the general population, JIA had lower physical HRQoL six months after DMARD initiation. Mental health composite scores were similar between JIA, RA and the general population. Both disease groups showed similar levels of improvement with treatment.

• Dalbeth, Nicola; Stewart, Sarah; Gamble, Gregory D; Mihov, Borislav; Stamp, Lisa K & Haslett, Janine [Vis alle 20 forfattere av denne artikkelen] (2025). Perceptions about asymptomatic hyperuricemia and views about urate‐lowering therapy in people with asymptomatic hyperuricemia. Arthritis care & research. ISSN 2151-464X. doi: 10.1002/acr.25639. Fulltekst i vitenarkiv Vis sammendrag

  Background/Aims Asymptomatic hyperuricemia is a precursor of gout and is also associated with cardiovascular disease and chronic kidney disease. The aim of this study was to understand perceptions about asymptomatic hyperuricemia and views about urate‐lowering therapy in people with asymptomatic hyperuricemia. Methods Participants in a multi‐national study of asymptomatic hyperuricemia completed questionnaires about their perceptions of hyperuricemia, concern about hyperuricemia‐associated health conditions, and willingness to take urate‐lowering medication. All had a screening serum urate of ≥0.48 mmol/L (8 mg/dL) and no current or previous symptoms of gout. Results Overall, participants perceived that hyperuricemia had no or very few consequences on their life. Dietary factors were the most reported cause, while 37% did not know the cause. Participants reported a wide range in concern about hyperuricemia and the risk of developing gout. Concern about the risk of developing kidney disease or cardiovascular disease was also highly variable but was higher than concern about elevated serum urate (P<0.001). Most did not think a urate‐lowering medication was necessary and there was moderate concern about the long‐term use of urate‐lowering medication. Medication necessity beliefs were most strongly associated with whether participants were willing to take urate‐lowering medication (partial R 2 =0.27, P<0.001). Conclusions Most participants perceived minimal consequences of asymptomatic hyperuricemia. Hyperuricemia was not well understood by participants, and biological causes were generally under‐recognised. Despite a range of concerns about hyperuricemia‐associated conditions, particularly kidney disease and cardiovascular disease, a urate‐lowering medication for asymptomatic hyperuricemia was not considered necessary, which aligns with most current management guidelines.

• Selldén, Tilia; Lend, Kristina; Lampa, Jon; Hetland, Merete Lund; Østergaard, Mikkel & Uhlig, Till [Vis alle 17 forfattere av denne artikkelen] (2025). Association of Soluble Immune Checkpoint Molecules PD1 and 4-1BB With CTLA-4Ig Treatment Response in Early Rheumatoid Arthritis. ACR Open Rheumatology. 7(7). doi: 10.1002/acr2.70069. Fulltekst i vitenarkiv Vis sammendrag

  Objective To investigate whether soluble immune checkpoint molecules in blood are associated with the treatment response to disease‐modifying antirheumatic drugs in early rheumatoid arthritis (eRA). Methods This study included 328 Swedish treatment‐naïve patients with eRA from the Nordic Rheumatic Diseases Strategy Trials and Registries (NORD‐STAR) study. Patients were randomized into four treatment groups: methotrexate (MTX) combined with CTLA‐4Ig (n = 90), anti–tumor necrosis factor (n = 83), anti–interleukin‐6 receptor (n = 76), or prednisolone (n = 79). The primary outcome was remission, defined by Clinical Disease Activity Index (CDAI) ≤2.8, assessed at 24 and 48 weeks. Plasma levels of soluble programmed cell death‐1 (sPD1) and soluble 4‐1BB (s4‐1BB) were measured by enzyme‐linked immunosorbent assay at baseline and at weeks 24 and 48 after treatment initiation. Results High baseline levels of sPD1 and s4‐1BB were both associated with CDAI remission at 24 weeks (odds ratio 1.31, 95% confidence interval [CI] 1.04–1.66 and odds ratio 1.50, 95% CI 1.07–2.11, respectively) in patients treated with CTLA‐4Ig with MTX, but not in any other treatment groups. Furthermore, baseline levels of sPD1 or s4‐1BB together with proportions of PD1 + T follicular helper (TFh) cells predicted treatment response to CTLA‐4Ig with MTX after 48 weeks, achieving 90% and 100% positive predictive value, respectively. Conclusion High plasma levels of sPD1 and s4‐1BB are associated with good response to CTLA‐4Ig with MTX therapy in patients with eRA. A combination of sPD1 or 4‐1BB levels and the proportions of PD1 + TFh cells in blood at baseline has potential for predicting remission after CTLA‐4Ig treatment.

• Selldén, Tilia; Ashour, Hossam M; Andersson, Kerstin; Gjertsson, Inger; Ekwall, Anna-Karin Hultgård & Lend, Kristina [Vis alle 21 forfattere av denne artikkelen] (2025). Low Th2 and high PD1+ TFh cells in blood predict remission after CTLA-4Ig treatment for 48 weeks in early rheumatoid arthritis. PLOS ONE. 20(8), s. 0330823–0330823. doi: 10.1371/journal.pone.0330823. Fulltekst i vitenarkiv Vis sammendrag

  Objective To determine whether baseline CD4 + T helper (Th) cell subset proportions in blood may serve as predictive biomarkers for achieving remission 48 weeks after initiating CTLA-4Ig, anti-tumor necrosis factor (TNF), or anti-interleukin 6 receptor (IL6R) treatment in patients with early rheumatoid arthritis (eRA). Methods This study included 60 untreated eRA patients from the larger randomized treatment trial NORD-STAR. They were treated with methotrexate (MTX) combined with either CTLA-4Ig (n = 17), anti-TNF (n = 22), or anti-IL6R (n = 21). Disease activity was assessed by clinical disease activity index (CDAI), C-reactive protein, and erythrocyte sedimentation rate. The primary outcome was remission (CDAI ≤ 2.8) at week 48, and the secondary outcomes were time to reach remission or sustained remission during the 48-week follow-up. CD4 + T cell subset proportions were analyzed fresh by flow cytometry at baseline and at 24 and 48 weeks. Results In CTLA-4Ig + MTX-treated patients, baseline Th2 together with PD1 + T follicular helper (TFh) cell proportions predicted CDAI remission at week 48 (AUC: 0.986, 95% CI 0.94–1.0). Survival analysis revealed that patients with Th2 proportions below 16.8% or PD1 + TFh proportions above 7.6% at baseline were more likely to achieve remission (log-rank p =  0.002 and p =  0.007, respectively), and sustained remission (log-rank p =  0.01 and p = 0.001, respectively), over the 48-week follow-up. CD4 + T cell subset proportions did not predict remission in patients treated with anti-TNF + MTX or anti-IL6R + MTX. Only CTLA-4Ig treatment reduced PD1 + TFh and PD1 neg TFh fractions after 48 weeks. Conclusion Circulating Th2 and PD1 + TFh cell proportions at baseline may serve as predictive biomarkers for achieving CDAI remission after 48 weeks of CTLA-4Ig treatment in eRA.

• Fatima, Tahzeeb; Zhang, Yuan; Vasileiadis, Georgios K.; Rawshani, Araz; Vollenhoven, Ronald van & Lampa, Jon [Vis alle 20 forfattere av denne artikkelen] (2025). Disease activity and treatment response in early rheumatoid arthritis: an exploratory metabolomic profiling in the NORD-STAR cohort. Arthritis Research & Therapy. ISSN 1478-6354. 27(1). doi: 10.1186/s13075-025-03616-6. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background The variability in treatment response in people with rheumatoid arthritis (RA) warrants the prediction of patients at high risk of treatment failure. Identification of biomarkers linked to clinical remission in RA is currently a challenge. Metabolomics may help to identify such biomarkers as it allows for a comprehensive exploration of disease-related variations that extends beyond the genome and proteome. This hypothesis-free exploratory metabolomics study aimed to profile serum metabolic alterations in early RA to understand the metabolic changes associated with disease activity and therapeutic response. Methods The study included 220 early RA participants from the NORD-STAR study, randomized at baseline into four arms, ranging from conventional anti-rheumatic treatment to biological drugs: methotrexate combined with prednisolone (1), certolizumab (2), abatacept (3), or tocilizumab (4). Untargeted metabolomics was performed in serum samples at baseline and 24-week follow-up. Participants achieving clinical disease activity index remission at 24 weeks were defined as responders. Machine learning models for treatment response were constructed using random forest, logistic regression, support vector machine and extreme gradient boosting algorithms based on selected features. Results We identified 278 metabolites, of which 39 were associated with baseline disease activity, including several acylcarnitines and amino acids. We also found 17 baseline metabolites associated with remission at 24 weeks in the overall cohort, including malic acid (β=-0.4), cytidine (β = 0.4), arginine (β = 0.3), and citrulline (β = 0.2), as well as specific metabolites and metabolic pathways associated with remission in the four treatment arms. Fifteen features were identified using machine learning-based multivariable selection. The best predictive model using logistic regression achieved AUC of 0.75 in training and 0.73 in the test set. Conclusions Our study has identified several baseline metabolites and metabolic pathways associated with disease activity and response to different treatments in early RA. By integrating metabolomics and clinical data, we developed predictive models for response to treatment in early RA, though their predictive performance remains limited.

• Christensen, Ingrid Egeland; Lillegraven, Siri; Sexton, Joseph; Kvien, Tore Kristian Aaserud; Uhlig, Till & Provan, Sella Aarrestad (2025). Longitudinal risk of serious infections in patients with inflammatory arthritis on immunomodulating therapy compared to controls. Rheumatology - Advances in Practice (Rheumap). 9(1). doi: 10.1093/rap/rkaf017. Fulltekst i vitenarkiv
• He, Yibo; Sareila, Outi; Johansson, Linda; Agelii, Monica Leu; Cheng, Lei & Lundquist, Anders [Vis alle 21 forfattere av denne artikkelen] (2025). Epitopes targeted by autoantibodies in presymptomatic individuals predict early rheumatoid arthritis. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1016/j.ard.2025.04.013. Fulltekst i vitenarkiv
• Hetland, Merete Lund; Heiberg, Marte Schrumpf; Sokka-Isler, Tuulikki; Rudin, Anna; Østergaard, Mikkel & Haavardsholm, Espen A. [Vis alle 21 forfattere av denne artikkelen] (2025). Treatment with methotrexate plus oral prednisolone versus triple therapy (methotrexate/sulfasalazine/hydroxychloroquine) plus intra-articular glucocorticoids in early rheumatoid arthritis: a prespecified nonrandomised subgroup analysis of clinical and radiographic data at 48 weeks from the NORD-STAR trial's conventional treatment arm. Annals of the Rheumatic Diseases. ISSN 0003-4967. 84, s. 937–948. doi: 10.1016/j.ard.2025.03.002. Fulltekst i vitenarkiv Vis sammendrag

  Objectives In the NOrdic Rheumatic Diseases Strategy Trials And Registries (NORD-STAR) trial, the active conventional arm had 2 nonrandomised regimens: arm 1A (oral group; Sweden, Norway, Netherlands, and Iceland) and arm 1B (injection group; Denmark and Finland). We report clinical, patient-reported, safety, and radiographic outcomes after 48 weeks. Methods Oral group received methotrexate plus oral prednisolone (20.0 mg/d, tapered rapidly, discontinued week 36); Injection group received triple therapy (methotrexate, sulphasalazine, hydroxychloroquine) and mandatory intra-articular glucocorticoid injections. The primary end point was analysed by logistic regression with several approaches for handling missing outcomes. Results In total, 137 and 80 patients were included in the oral group and injection group; 78% vs. 89% completed, respectively. At 48 weeks, adjusted clinical disease activity index remission ≤2.8 rates (95% CI) were 36% (28-44) and 55% (42-68), respectively; the risk difference (primary outcome) was 19% (2-35). Similarly, key secondary clinical, patient-reported and safety outcomes showed numerically better results in the injection group vs oral group, for example, infections occurred in 53% vs 30%, respectively. Radiographic progression (Δtotal van der Heijde-modified Sharp Score) was low: oral group: adjusted mean, 0.26 (95% CI, 0.08-0.43); injection group: adjustedd mean, 0.80 (95% CI, 0.55-1.05). Cumulative dose of oral/intra-articular glucocorticoids (median) was 1905 mg prednisolone for the oral group and 165 mg for the injection group. Conclusions In treatment-naïve patients with early rheumatoid arthritis, triple therapy and mandatory glucocorticoid joint injections had numerically better clinical outcomes, fewer withdrawals, fewer adverse events, and lower cumulative dose of glucocorticoids, but slightly worse radiographic outcomes than treatment with methotrexate and oral prednisolone. These findings, although nonrandomised, suggest a potential for optimising treatment strategy with conventional therapies in early rheumatoid arthritis.

• McGrath, Sarah; Sundbeck, Boel; Thorarinsdottir, Katrin; Jonsson, Charlotte A.; Camponeschi, Alessandro & Agelii, Monica Leu [Vis alle 20 forfattere av denne artikkelen] (2025). Transitional and CD21− PD-1+ B cells are associated with remission in early rheumatoid arthritis. BMC Rheumatology. 9(1). doi: 10.1186/s41927-025-00487-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Early initiation of effective treatment is associated with positive long-term prognosis for patients with rheumatoid arthritis (RA). Currently, there are no biomarkers in clinical use to predict treatment response. A predictor of treatment response may be the B-cell compartment, as this is altered in RA patients, making it a potential candidate for predicting treatment response. In this study, we sought to identify B-cell subset(s) at diagnosis that might be associated with Clinical Disease Activity Index (CDAI) remission at 24-week follow-up. Methods Seventy early RA patients from the NORD-STAR trial, recruited from two Swedish sites, and 28 matched healthy controls, were included in this spin-off study. In NORD-STAR, all patients were randomized to methotrexate (MTX) combined with 1) prednisolone, 2) anti-TNF (certolizumab-pegol), 3) CTLA4-Ig (abatacept), or 4) anti-IL-6R (tocilizumab). Circulating B-cell subsets at diagnosis were assessed by flow cytometry. The primary outcome measure was remission according to CDAI ≤ 2.8. A multivariate two-part discriminant analysis was performed to assess whether B-cell subpopulations at diagnosis could predict remission at 24 weeks. Subsequent univariable statistical analyses were performed using t-tests, Mann-Whitney U, or Kruskal-Wallis tests, as appropriate. Correlations were analyzed using Spearman or Pearson tests, depending on data type. The impact of specific B-cell populations on remission at week 24 was assessed using logistic regression models. The logistic regression model was also used to simultaneously visualize the sensitivity and specificity of the model for all possible values of the exposure (B-cell subpopulations) in predicting the outcome. Results Patients who achieved CDAI remission at 24 weeks had higher proportions of transitional (p < 0.01) and CD21− PD-1+ (p < 0.01) B cells at diagnosis compared to those who did not. When the two B-cell populations were combined, the sensitivity and specificity for remission, including all treatment arms, were 59% and 86%, respectively. Stratification of the patients by treatment arm revealed a significant negative correlation between the proportion of transitional B cells at baseline and disease activity after 24 weeks of treatment with either MTX and prednisolone or anti-IL-6R. Conclusions Our results indicate that transitional and CD21− PD-1+ B cells are associated with remission in early RA. Clinical trial number Not applicable.

• Uhlig, Till; Stjärne, Johan Folke Håkan; Karoliussen, Lars Fridtjof; Sexton, Joseph; Eskild, Tron Hovind & Provan, Sella Aarrestad [Vis alle 8 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• Kjørholt, Kaja Eriksrud; Sundlisæter, Nina Paulshus; Aga, Anna-Birgitte; Sexton, Joseph; Olsen, Inge Christoffer & Lexberg, Åse S. [Vis alle 21 forfattere av denne artikkelen] (2025). Three-Year Results of Tapering Tumor Necrosis Factor Inhibitor to Withdrawal Compared to Stable Tumor Necrosis Factor Inhibitor Among Patients With Rheumatoid Arthritis in Sustained Remission: A Multicenter Randomized Trial. Arthritis & Rheumatology. ISSN 2326-5191. 77(10), s. 1327–1336. doi: 10.1002/art.43199. Fulltekst i vitenarkiv Vis sammendrag

  Objective Tapering of tumor necrosis factor inhibitor (TNFi) treatment in rheumatoid arthritis (RA) remission is debated. We assessed the effect of tapering TNFi to withdrawal versus continued stable TNFi on flare-free survival and joint damage progression over three years. Methods ARCTIC REWIND was a multicenter open-label, noninferiority trial that included patients with RA in remission for ≥12 months taking stable TNFi therapy. Patients were randomized 1:1 to taper TNFi to withdrawal or continue stable treatment. The primary end points of the current study were flare-free survival and radiographic progression over three years. Flare-free survival was analyzed by Kaplan-Meier methods, flare rates were analyzed by Cox regression, and radiographic progression was analyzed by logistic mixed-effects models. Results of 99 randomized patients, 92 received the allocated therapy, and 80 completed the three-year follow-up. The mean baseline Disease Activity Score based on the 44 joint count was 0.8, and conventional synthetic disease-modifying antirheumatic drug comedication was used by 90% of patients. After three years, 25% (95% confidence interval [CI] 13%–38%) remained flare free in the tapering TNFi group, compared to 85% (95% CI 70%–93%) in the stable group, and the corresponding hazard ratio for flare was 9.4 (95% CI 3.9–22.8, P < 0.0001). In the tapering group, 6 of 41 (15%) experienced radiographic progression, compared with 3 of 38 (8%) in the stable group (risk difference 6.7%, 95% CI −7.1% to 20.5%, P = 0.3). Adverse events occurred in 81% of the patients in the tapering group and 89% of the patients in the stable group. Conclusion In contrast to those receiving stable TNFi treatment, a minority of patients with RA in remission tapering TNFi to withdrawal remained flare free over three years. There was no statistically significant difference in radiographic progression between the groups.

• Lend, Kristina; Twisk, Jos Wr; Kumar, Nupur; Dijkshoorn, Bas; Lampa, Jon & Rudin, Anna [Vis alle 17 forfattere av denne artikkelen] (2025). Glucocorticoid treatment in early rheumatoid arthritis is independently associated with increased PCSK9 levels: Data from a randomised controlled trial. RMD Open. 11(2). doi: 10.1136/rmdopen-2024-005129. Fulltekst i vitenarkiv
• Stewart, Sarah; Gamble, Greg; Taylor, William; Su, Isabel; Merriman, Tony & Mihov, Borislav [Vis alle 23 forfattere av denne artikkelen] (2024). Development of gout in people with asymptomatic hyperuricemia: study protocol for a 5-year prospective cohort. BMJ Open. 14(11), s. e090415–e090415. doi: 10.1136/bmjopen-2024-090415. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Liu, Jianyang; Idborg, Helena; Korotkova, Marina; Lend, Kristina; Vollenhoven, Ronald van & Lampa, Jon [Vis alle 16 forfattere av denne artikkelen] (2024). Urinary prostanoids are elevated by anti-TNF and anti-IL6 receptor disease-modifying antirheumatic drugs but are not predictive of response to treatment in early rheumatoid arthritis. Arthritis Research & Therapy. ISSN 1478-6354. 26(1). doi: 10.1186/s13075-024-03295-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Disease-modifying antirheumatic drugs (DMARDs) are widely used for treating rheumatoid arthritis (RA). However, there are no established biomarkers to predict a patient’s response to these therapies. Prostanoids, encompassing prostaglandins, prostacyclins, and thromboxanes, are potent lipid mediators implicated in RA progression. Nevertheless, the influence of DMARDs on prostanoid biosynthesis in RA patients remains poorly understood. This study aims to assess the impact of various DMARDs on urinary prostanoids levels and to explore whether urinary prostanoid profiles correlate with disease activity or response to therapy. Methods This study included 152 Swedish female patients with early RA, all rheumatoid factor (RF) positive, enrolled in the NORD-STAR trial (registration number: NCT01491815). Participants were randomized into four therapeutic regimes: methotrexate (MTX) combined with (i) prednisolone (arm ACT), (ii) TNF-α blocker certolizumab pegol (arm CZP), (iii) CTLA-4Ig abatacept (arm ABA), or (iv) IL-6R blocker tocilizumab (arm TCZ). Urine samples, collected before start of treatment and at 24 weeks post-treatment, were analyzed for tetranor-prostaglandin E metabolite (tPGEM), tetranor-prostaglandin D metabolite (tPGDM), 2,3-dinor thromboxane B2 (TXBM), 2,3-dinor-6-keto prostaglandin F1a (PGIM), leukotriene E4 (LTE4) and 12-hydroxyeicosatetraenoic acid (12-HETE) using liquid chromatography–mass spectrometry (LC–MS). Generalized estimating equation (GEE) models were used to analyze the change in urinary eicosanoids and their correlations to clinical outcomes. Results Patients receiving MTX combined with CZP or TCZ exhibited significant elevations in urinary tPGEM and TXBM levels after 24 weeks of treatment. Other eicosanoids did not show significant alterations in response to any treatment. Baseline urinary eicosanoid levels did not correlate with baseline clinical disease activity index (CDAI) levels, nor with changes in CDAI from baseline to week 24. Their levels were also similar between patients who achieved CDAI remission and those with active disease at week 24. Conclusions Treatment with anti-TNF or anti-IL6R agents in early RA patients leads to an increased systemic production of proinflammatory and prothrombotic prostanoids. However, urinary eicosanoid levels do not appear to be predictive of the response to DMARDs therapy.

• Holten, Karen; Sundlisæter, Nina Paulshus; Sexton, Joseph; Kjørholt, Kaja Eriksrud; Nordberg, Lena Bugge & Uhlig, Tillmann [Vis alle 11 forfattere av denne artikkelen] (2024). Agreement between patient-reported flares and clinically significant flare status in patients with rheumatoid arthritis in sustained remission: data from the ARCTIC REWIND trials. RMD Open. 10(3). doi: 10.1136/rmdopen-2024-004444. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To explore the agreement between patient-reported flare status and clinically significant flare status in patients with rheumatoid arthritis (RA) in sustained remission. Method Patients with RA in remission for ≥12 months on stable treatment were included in the ARCTIC REWIND tapering trials and pooled 12-month data used in current analyses. Patient-reported flare status was assessed according to the Outcome Measures in Rheumatology flare questionnaire; ‘Are you having a flare of your RA at this time?’ (yes/no). A clinically significant flare was defined as a combination of Disease Activity Score (DAS) >1.6, increase in DAS of ≥0.6 and 2 swollen joints, or the rheumatologist and patient agreed that a clinically significant flare had occurred. Agreement coefficient, sensitivity, specificity and predictive values of patient-reported flare status with regard to clinically significant flare status were determined. Results Of 248 patients, 64% were women, age 56.1 (11.8) years, disease duration 4.1 (2.8–7.4) years, DAS 0.8 (0.3). 35% of patients reported a flare at least once, clinically significant flares were recorded in 21%. 48/53 clinically significant flares (91%) led to an intensification of disease-modifying antirheumatic drugss. In 621/682 (91%) visits, patient-reported and clinically significant flare status were in agreement, agreement coefficient 0.89. Sensitivity and specificity were both 91%, positive predictive value of patient-reported flare status 46% and negative predictive value 99%. Conclusion Among patients in sustained remission, patient-reported flare status was accurate in ruling out a clinically significant flare. About half of the patient-reported flares were assessed to be clinically significant. These findings support a potential for using patient-reported flare status in remote monitoring of patients with RA in sustained remission.

• Holten, Karen; Sundlisæter, Nina Paulshus; Sexton, Joseph; Nordberg, Lena Bugge; Uhlig, Till & Kvien, Tore Kristian Aaserud [Vis alle 10 forfattere av denne artikkelen] (2024). Performance of the Rheumatoid Arthritis Impact of Disease (RAID) score in relation to flares in disease activity. RMD Open. 10(1). doi: 10.1136/rmdopen-2023-003486. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To explore the performance of the EULAR-initiated patient-reported Rheumatoid Arthritis Impact of Disease (RAID) questionnaire in relation to flares in disease activity, including comparison with other disease activity outcomes. Methods Patients with rheumatoid arthritis in sustained remission were randomised to continued stable treatment or tapering in the ARCTIC REWIND project. In patients with flares within 12 months, we compared RAID (total score and components) at the flare visit with the visit prior to and the visit following flare, using Wilcoxon signed-rank test. Similar analyses were performed for patient global assessment, Disease Activity Score (DAS) and C reactive protein (CRP). The discriminative accuracies of RAID, patient global assessment, DAS and CRP with respect to disease activity flares were assessed by receiver operating characteristic (ROC) analyses based on logistic regression models. Flare was defined as a combination of DAS >1.6, a DAS increase ≥0.6 and ≥two swollen joints (of 44 examined) or could be recorded if patient and rheumatologist agreed that a clinically significant flare had occurred. Results In total, 248 patients were included in the analyses, with 56 flares. RAID, patient global assessment, DAS and CRP all changed significantly at the visits related to flare (p<0.001). Area under the curve (95% CI) values indicated that RAID (0.88 (0.83 to 0.93)) was significantly more accurate than CRP (0.76 (0.69 to 0.84)) in discriminating flare, and less accurate than patient global assessment (0.92 (0.87 to 0.97)) and DAS (0.94 (0.90 to 0.98)). The RAID components with highest and lowest discriminative accuracies were pain (0.91 (0.86 to 0.95)) and sleep (0.69 (0.59 to 0.79)). Conclusion Disease activity flares were associated with a significant increase in median RAID, supporting its ability to respond to flare.

• Provan, Sella Aarrestad; Kristianslund, Eirik Klami; Michelsen, Brigitte; Uhlig, Tillmann; Sexton, Joseph & Kvien, Tore Kristian Aaserud (2024). Interstitial Lung Disease in Patients With Rheumatoid Arthritis or Psoriatic Arthritis Initiating Biologics and Controls: Data From 5 Nordic Registries. Journal of Rheumatology. ISSN 0315-162X. 51(11), s. 1111–1118. doi: 10.3899/jrheum.2024-0252. Fulltekst i vitenarkiv
• Vasileiadis, Georgios K.; Zhang, Yuan; Fatima, Tahzeeb; Vollenhoven, Ronald van; Lampa, Jon & Gudbjornsson, Bjorn [Vis alle 18 forfattere av denne artikkelen] (2024). Circulating Adipokines and Response to Treatment in Patients With Early Rheumatoid Arthritis. ACR Open Rheumatology. doi: 10.1002/acr2.11756. Fulltekst i vitenarkiv Vis sammendrag

  Objective The objective of this study was to determine if baseline adiponectin, leptin, and resistin levels are associated with response to antirheumatic treatment in early rheumatoid arthritis (RA). Methods This study included 341 participants of the Nordic Rheumatic Diseases Strategy Trials and Registries trial with untreated early RA, randomized at baseline into four treatment arms: methotrexate combined with (1) prednisolone, (2) certolizumab, (3) abatacept, or (4) tocilizumab. Follow-up was up to 48 weeks. Adipokines were measured in plasma at baseline with enzyme-linked immunosorbent assay. The primary outcome for this report was the difference in remission (Clinical Disease Activity Index [CDAI] ≤2.8) over 48 weeks stratified by median adipokine levels. Results At baseline, levels of adiponectin and leptin were not associated with markers of RA activity, whereas participants with higher resistin levels had higher C-reactive protein (CRP) levels, swollen joint count, and Disease Activity Score in 28 joints based on CRP compared to participants with lower resistin. Overall, participants with baseline adipokine levels above the median and those with adipokine levels below the median had similar mean CDAI and changes in CDAI throughout follow-up for up to 48 weeks. Adjusted Cox proportional hazards models did not show any effect of baseline adiponectin, leptin, and resistin levels on the likelihood of achieving CDAI remission (adiponectin: hazard ratio [HR] 1.08, 95% confidence interval [CI] 0.80–1.45, P = 0.62; leptin: HR 0.89, 95% CI 0.64–1.26, P = 0.52; resistin: HR 0.86, 95% CI 0.65–1.13, P = 0.26). Conclusion Baseline adiponectin, leptin, and resistin levels are not associated with the likelihood of achieving CDAI remission over 48 weeks of treatment in a large cohort of people with untreated early RA.

• Dubovyk, Violetta; Vasileiadis, Georgios K.; Fatima, Tahzeeb; Zhang, Yuan; Kapetanovic, Meliha Crnkic & Kastbom, Alf [Vis alle 25 forfattere av denne artikkelen] (2024). Obesity is a risk factor for poor response to treatment in early rheumatoid arthritis: a NORD-STAR study. RMD Open. 10(2). doi: 10.1136/rmdopen-2024-004227. Fulltekst i vitenarkiv Vis sammendrag

  Objective This report from the NORD-STAR (Nordic Rheumatic Diseases Strategy Trials and Registries) trial aimed to determine if obesity is associated with response to conventional and biological antirheumatic treatment in early rheumatoid arthritis (RA). Methods This report included 793 participants with untreated early RA from the randomised, longitudinal NORD-STAR trial, all of whom had their body mass index (BMI) assessed at baseline. Obesity was defined as BMI ≥30 kg/m2. All participants were randomised 1:1:1:1 to one of four treatment arms: active conventional treatment, certolizumab-pegol, abatacept and tocilizumab. Clinical and laboratory measurements were performed at baseline and at 8, 12, 24 and 48-week follow-up. The primary endpoint for this report was response to treatment based on Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) remission and Disease Activity Score with 28 joints using C-reactive protein (DAS28-CRP) <2.6 stratified by BMI. Results Out of 793 people included in the present report, 161 (20%) had obesity at baseline. During follow-up, participants with baseline obesity had higher disease activity compared with those with lower BMI, despite having similar disease activity at baseline. In survival analyses, obesity was associated with a lower likelihood of achieving response to treatment during follow-up for up to 48 weeks (CDAI remission, HR 0.84, 95% CI 0.67 to 1.05; SDAI, HR 0.77, 95% CI 0.62 to 0.97; DAS28-CRP <2.6, HR 0.78, 95% CI 0.64 to 0.95). The effect of obesity on response to treatment was not influenced by the treatment arms. Conclusion In people with untreated early RA followed up for up to 48 weeks, obesity was associated with a lower likelihood of good treatment response, irrespective of the type of randomised treatment received.

• Kjørholt, Kaja Eriksrud; Sundlisæter, Nina Paulshus; Aga, Anna-Birgitte; Sexton, Joseph; Olsen, Inge Christoffer & Fremstad, Hallvard [Vis alle 22 forfattere av denne artikkelen] (2024). Effects of tapering conventional synthetic disease-modifying antirheumatic drugs to drug-free remission versus stable treatment in rheumatoid arthritis (ARCTIC REWIND): 3-year results from an open-label, randomised controlled, non-inferiority trial. The Lancet Rheumatology. 6(5), s. e268–e278. doi: 10.1016/S2665-9913(24)00021-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Tapering of disease-modifying antirheumatic drugs (DMARDs) to drug-free remission is an attractive treatment goal for patients with rheumatoid arthritis, although long-term effects of tapering and withdrawal remain unclear. We compared 3-year risks of flare between three conventional synthetic DMARD treatment strategies in patients with rheumatoid arthritis in sustained remission. Methods In this open-label, randomised controlled, non-inferiority trial, we enrolled patients aged 18–80 years with rheumatoid arthritis who had been in sustained remission for at least 1 year on stable conventional synthetic DMARD therapy. Patients from ten hospitals in Norway were randomly assigned (2:1:1) with centre stratification to receive stable conventional synthetic DMARDs, half-dose conventional synthetic DMARDs, or half-dose conventional synthetic DMARDs for 1 year followed by withdrawal of all conventional synthetic DMARDs. The primary endpoint of this part of the study was disease flare over 3 years, analyse

• Scheffler, Julia M.; Drevinge, Christina; Lindholm, Catharina; Gjertsson, Inger; Lend, Kristina & Hetland, Merete Lund [Vis alle 23 forfattere av denne artikkelen] (2024). Circulating Baseline CXCR3⁺Th2 and Th17 Cell Proportions Correlate With Trabecular Bone Loss After 48 Weeks of Biological Treatment in Early Rheumatoid Arthritis. ACR Open Rheumatology. doi: 10.1002/acr2.11742. Fulltekst i vitenarkiv Vis sammendrag

  Objective The high prevalence of osteoporosis in rheumatoid arthritis (RA) is due to inflammation that stimulates differentiation of osteoclasts, a process involving circulating monocytes and T cell–derived factors. The aim of this study was to evaluate relations between circulating monocytes, T cell subsets, and changes in bone characteristics before and after treatment with biological disease-modifying antirheumatic drugs (bDMARDs) in RA. Methods Thirty patients with untreated early RA who met the American College of Rheumatology/EULAR 2010 criteria were included. Data were collected before and 48 weeks after treatment with methotrexate (MTX) together with one of three bDMARDs (abatacept, tocilizumab, or certolizumab pegol). Disease activity was measured using the Clinical Disease Activity Index, swollen or tender joint counts, C-reactive protein levels, and erythrocyte sedimentation rates. Proportions of monocyte and CD4+ T cell subsets in blood samples were analyzed by flow cytometry. Bone densitometry was performed using high-resolution peripheral quantitative computed tomography (HR-pQCT). Results HR-pQCT revealed an overall decrease in cortical (P = 0.009) and trabecular (P = 0.034) bone mineral density, although a subset of patients showed no bone loss after 48 weeks of treatment. The overall bone loss was not associated with age, body mass index, sex, intraarticular glucocorticoid injections, or baseline disease activity. Loss of trabecular bone volume fraction correlated with high proportions of circulating CXCR3+Th2 cells (r = −0.38, P = 0.04) and CXCR3+Th17 cells (r = −0.36, P = 0.05) at baseline. Similarly, no loss of trabecular bone volume fraction correlated with high proportions of regulatory T cells (r = 0.4, P = 0.03) at baseline. However, the associations were not significant when corrected for confounders and multiple testing. Conclusion MTX together with bDMARDs efficiently reduce disease activity but only prevent bone loss in a subset of patients with RA after 48 weeks of treatment. The correlations of circulating baseline T helper cell and regulatory T cell populations with trabecular bone changes suggest a potential novel role for these cells in systemic bone homeostasis during early RA.

• Major, Tanya J.; Takei, Riku; Matsuo, Hirotaka; Leask, Megan P.; Sumpter, Nicholas A. & Topless, Ruth K. [Vis alle 99 forfattere av denne artikkelen] (2024). A genome-wide association analysis reveals new pathogenic pathways in gout*. Nature Genetics. ISSN 1061-4036. doi: 10.1038/s41588-024-01921-5. Fulltekst i vitenarkiv
• 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), s. 1799–1806. doi: 10.1093/rheumatology/keae514. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Lend, Kristina; Lampa, Jon; Padyukov, Leonid; Hetland, Merete Lund; Schrumpf, Marte & Nordström, Dan C [Vis alle 21 forfattere av denne artikkelen] (2024). Association of rheumatoid factor, anti-citrullinated protein antibodies and shared epitope with clinical response to initial treatment in patients with early rheumatoid arthritis: data from a randomised controlled trial. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1136/ard-2024-226024. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To investigate whether rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPAs) and shared epitope (SE) allele-related genetic markers associate with treatment response to abatacept, certolizumab pegol or tocilizumab versus active conventional treatment (ACT). Methods Patients with treatment-naïve early rheumatoid arthritis were randomised in the NORD-STAR trial to ACT, certolizumab pegol, abatacept or tocilizumab, all with methotrexate. Centralised laboratory analyses for ACPA, RF and SE were performed. Clinical Disease Activity Index remission was analysed longitudinally with logistic generalised estimating equations. Differences in treatment effect across RF, ACPA and SE subgroups were assessed with interaction terms at 24 and 48 weeks, adjusted for sex, country, age, body mass index, Disease Activity Score of 28 joints based on C-reactive protein and smoking. Results In total, 778 patients were included. At 24 weeks, abatacept treatment showed a better response than ACT in the RF and/or ACPA-positive subgroups, but this effect was not significantly different from the negative subgroups. By 48 weeks, abatacept treatment showed better response regardless of RF/ACPA status. No differences were found across RF, ACPA, SE allele, valine at amino acid position 11 or valine-arginine-alanine haplotype subgroups for any biological treatment at 48 weeks. Conclusions Based on this randomised controlled trial, abatacept treatment was associated with a better response than ACT in the RF and/or ACPA-positive subgroup at 24 weeks, but this was no longer seen at 48 weeks; adding SE allele-related genetic markers did not strengthen the association. Moreover, ACPA, RF and SE allele-related genotypes were not, alone or in combination, associated with clinical responses of importance sufficiently strongly to warrant implementation in clinical practice.

• Dijkshoorn, Bas; Hansildaar, Romy; Vedder, Daisy; Soutari, Nida; Rudin, Anna & Nordström, Dan [Vis alle 19 forfattere av denne artikkelen] (2024). Impaired coagulation parameters in early RA are restored by effective antirheumatic therapy: a prospective pilot study. RMD Open. 10(4). doi: 10.1136/rmdopen-2024-004838. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To assess the effect of treatment on haemostatic parameters in patients with early rheumatoid arthritis (RA). Methods Patients with newly diagnosed RA started methotrexate and were randomised to additional conventional treatment, certolizumab pegol, abatacept or tocilizumab. Several biomarkers for haemostasis were analysed including parameters of the two global haemostatic assays—overall haemostatic potential (OHP) and endogenous thrombin potential (ETP), as well as single haemostatic factors—fibrinogen, prothrombin fragment 1+2 (F1+2), D-dimer, thrombin activatable fibrinolysis inhibitor (TAFI) and clot lysis time (CLT) in 24 patients at baseline, 12 and 24 weeks after the start of the treatment. Results At baseline, patients had elevated levels of the following biomarkers compared with reference values: fibrinogen, F1+2, D-dimer and parameters of the two global haemostatic assays, that is, ETP and OHP. After 24 weeks we observed a significant reduction in F1+2 (p<0.01), fibrinogen (p<0.01), D-dimer (p<0.01), OHP (p<0.01), ETP (p<0.01), CLT (p<0.01), TAFI (p<0.01) and an increase of OFP (p<0.01). Tocilizumab treatment resulted in the most significant reduction of global haemostatic assays after 24 weeks, that is, a reduction of OHP 73% (p<0.01) compared with certolizumab pegol arm 32% (p<0.01), abatacept arm 24% (p=0.25) or conventional treatment arm 7% (p=0.66). Conclusion Newly diagnosed RA patients have enhanced coagulation activation and impaired fibrinolysis as demonstrated by our results. Effective antirheumatic treatments during the first 24 weeks after diagnosis improved this haemostatic imbalance, with prominent effects of biological drugs and especially tocilizumab, compared with conventional treatment.

• Parodis, Ioannis; Girard-Guyonvarc'h, Charlotte; Arnaud, Laurent; Distler, Oliver; Domján, Andrea & Ende, Cornelia H M Van Den [Vis alle 25 forfattere av denne artikkelen] (2023). EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1136/ard-2023-224416. Fulltekst i vitenarkiv
• Skinnes, Mari Nilsen; Moe, Rikke Helene; Johansen, Thomas; Lyby, Peter Solvoll; Dahl, Kjersti & Eid, Idun [Vis alle 17 forfattere av denne artikkelen] (2023). Work Ability in the Year after Rehabilitation—Results from the RehabNytte Cohort. Journal of Clinical Medicine. 12(23). doi: 10.3390/jcm12237391. Fulltekst i vitenarkiv Vis sammendrag

  Background: There is limited knowledge regarding the impact of rehabilitation on work ability. The aim of this study was to explore factors associated with work ability 12 months fol- lowing a multidisciplinary rehabilitation program in a cohort with different diagnoses. Methods: Of 9108 potentially eligible participants for the RehabNytte research project, 3731 were eligible for the present study, and 2649 participants (mean age 48.6 years, 71% female) consented to contribute with work-related data, and were included. Self-perceived work ability was assessed by the Work Ability Score (WAS) (0–10, 10 = best), during the follow-up period using paired t-tests and logistic regression to examine associations between demographic and disease-related factors and work ability at 12-month follow-up. Results: The mean baseline WAS for the total cohort was 3.53 (SD 2.97), and increased significantly to 4.59 (SD 3.31) at 12-month follow-up. High work ability (WAS ≥ 8) at 12 months was associated with high self-perceived health at the baseline (OR 3.83, 95% CI 2.45, 5.96), while low work ability was associated with a higher number of comorbidities (OR 0.26, 95% CI 0.11, 0.61), medium pain intensity (OR 0.56, 95% CI 0.38, 0.83) and being married or cohabiting (OR 0.61, 95% CI 0.43, 0.88). There were no significant differences in work ability between participants receiving occupational and standard rehabilitation. Conclusions: Work ability increased significantly over the follow-up period. High work ability at 12-month follow-up was associated with high self-perceived health at baseline, while being married or cohabiting, having higher number of comorbidities, and experiencing medium baseline pain intensity was associated with lower work ability. Rehabilitation interventions targeting these factors may potentially enhance work ability, leading to a positive impact on work participation among people in need of rehabilitation.

• Dures, Emma; Farisoğulları, Bayram; Santos, Eduardo José Ferreira; Molto, Anna; Feldthusen, Caroline & Harris, Claire [Vis alle 26 forfattere av denne artikkelen] (2023). 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1136/ard-2023-224514. Fulltekst i vitenarkiv
• Østergaard, Mikkel; Vollenhoven, Ronald F Van; Rudin, Anna; Hetland, Merete Lund; Schrumpf, Marte & Nordström, Dan C [Vis alle 45 forfattere av denne artikkelen] (2023). Certolizumab pegol, abatacept, tocilizumab or active conventional treatment in early rheumatoid arthritis: 48-week clinical and radiographic results of the investigator-initiated randomised controlled NORD-STAR trial. Annals of the Rheumatic Diseases. ISSN 0003-4967. 82(10), s. 1286–1295. doi: 10.1136/ard-2023-224116. Fulltekst i vitenarkiv Vis sammendrag

  Background - The optimal first-line treatment in early rheumatoid arthritis (RA) is debated. We compared clinical and radiographic outcomes of active conventional therapy with each of three biological treatments with different modes of action. Methods - Investigator-initiated, randomised, blinded-assessor study. Patients with treatment-naïve early RA with moderate–severe disease activity were randomised 1:1:1:1 to methotrexate combined with (1) active conventional therapy: oral prednisolone (tapered quickly, discontinued at week 36) or sulfasalazine, hydroxychloroquine and intra-articular glucocorticoid injections in swollen joints; (2) certolizumab pegol; (3) abatacept or (4) tocilizumab. Coprimary endpoints were week 48 Clinical Disease Activity Index (CDAI) remission (CDAI ≤2.8) and change in radiographic van der Heijde-modified Sharp Score, estimated using logistic regression and analysis of covariance, adjusted for sex, anticitrullinated protein antibody status and country. Bonferroni’s and Dunnet’s procedures adjusted for multiple testing (significance level: 0.025). Results - Eight hundred and twelve patients were randomised. Adjusted CDAI remission rates at week 48 were: 59.3% (abatacept), 52.3% (certolizumab), 51.9% (tocilizumab) and 39.2% (active conventional therapy). Compared with active conventional therapy, CDAI remission rates were significantly higher for abatacept (adjusted difference +20.1%, p<0.001) and certolizumab (+13.1%, p=0.021), but not for tocilizumab (+12.7%, p=0.030). Key secondary clinical outcomes were consistently better in biological groups. Radiographic progression was low, without group differences. The proportions of patients with serious adverse events were abatacept, 8.3%; certolizumab, 12.4%; tocilizumab, 9.2%; and active conventional therapy, 10.7%. Conclusions - Compared with active conventional therapy, clinical remission rates were superior for abatacept and certolizumab pegol, but not for tocilizumab. Radiographic progression was low and similar between treatments.

• Lend, Kristina; Koopman, Frieda A.; Lampa, Jon; Jansen, Gerrit; Hetland, Merete L. & Uhlig, Till [Vis alle 18 forfattere av denne artikkelen] (2023). Methotrexate Safety and Efficacy in Combination Therapies in Patients With Early Rheumatoid Arthritis: A Post Hoc Analysis of a Randomized Controlled Trial. Arthritis & Rheumatology. ISSN 2326-5191. s. 1–14. doi: 10.1002/art.42730. Fulltekst i vitenarkiv Vis sammendrag

  Objective We investigated methotrexate safety and the influence of dose on efficacy outcomes in combination with three different biologic treatments and with active conventional treatment (ACT) in early rheumatoid arthritis (RA). Methods This post hoc analysis included 812 treatment-naïve patients with early RA who were randomized (1:1:1:1) in the NORD-STAR trial to receive methotrexate in combination with ACT, certolizumab-pegol, abatacept, or tocilizumab. Methotrexate safety, doses, and dose effects on Clinical Disease Activity Index (CDAI) remission were assessed after 24 weeks of treatment. Results Compared with ACT, the prevalence of methotrexate-associated side effects was higher when methotrexate was combined with tocilizumab (hazard ratio [HR] 1.48, 95% confidence interval [CI] 1.20–1.84) but not with certolizumab-pegol (HR 0.99, 95% CI 0.79–1.23) or with abatacept (HR 0.93, 95% CI 0.75–1.16). With ACT as the reference, the methotrexate dose was significantly lower when used in combination with tocilizumab (β −4.65, 95% CI −5.83 to −3.46; P < 0.001) or abatacept (β −1.15, 95% CI −2.27 to −0.03; P = 0.04), and it was numerically lower in combination with certolizumab-pegol (β −1.07, 95% CI −2.21 to 0.07; P = 0.07). Methotrexate dose reductions were not associated with decreased CDAI remission rates within any of the treatment combinations. Conclusion Methotrexate was generally well tolerated in combination therapies, but adverse events were a limiting factor in receiving the target dose of 25 mg/wk, and these were more frequent in combination with tocilizumab versus ACT. On the other hand, methotrexate dose reductions were not associated with decreased CDAI remission rates within any of the four treatment combinations at 24 weeks.

• Chen, Leanne; Gamble, Gregory D.; Horne, Anne; Drake, Jill; Doyle, Anthony J. & Uhlig, Till [Vis alle 8 forfattere av denne artikkelen] (2023). Changes in Tophus Composition During Urate-Lowering Therapy: A Dual-Energy Computed Tomography Study. Arthritis care & research. ISSN 2151-464X. doi: 10.1002/acr.25084. Fulltekst i vitenarkiv
• Lillegraven, Siri; Sundlisæter, Nina Paulshus; Aga, Anna-Birgitte; Sexton, Joseph; Olsen, Inge Christoffer & Lexberg, Åse [Vis alle 19 forfattere av denne artikkelen] (2023). Effect of tapered versus stable treatment with tumour necrosis factor inhibitors on disease flares in patients with rheumatoid arthritis in remission: a randomised, open label, non-inferiority trial. Annals of the Rheumatic Diseases. ISSN 0003-4967. 82(11), s. 1394–1403. doi: 10.1136/ard-2023-224476. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Many patients with rheumatoid arthritis (RA) require treatment with tumour necrosis factor inhibitor (TNFi) to reach remission. It is debated whether tapering of TNFi to discontinuation should be considered in sustained remission. The aim of ARCTIC REWIND TNFi was to assess the effect of tapering TNFi to withdrawal compared with stable treatment on the risk of disease activity flares in patients with RA in remission ≥1 year. Methods This randomised, open-label, non-inferiority trial was undertaken at nine Norwegian rheumatology departments. Patients with RA in remission ≥12 months on stable TNFi therapy were allocated by computer-based block-randomisation to tapering to discontinuation of TNFi or stable TNFi. Conventional synthetic disease-modifying antirheumatic co-medication was unchanged. The primary endpoint was disease flare during the 12-month study period (non-inferiority margin 20%), assessed in the per-protocol population. Results Between June 2013 and January 2019, 99 patients were enrolled and 92 received the allocated treatment strategy. Eighty-four patients were included in the per-protocol population. In the tapering TNFi group, 27/43 (63%) experienced a flare during 12 months, compared with 2/41 (5%) in the stable TNFi group; risk difference (95% CI) 58% (42% to 74%). The tapering strategy was not non-inferior to continued stable treatment. The number of total/serious adverse events was 49/3 in the tapering group, 57/2 in the stable group. Conclusion In patients with RA in remission for more than 1 year while using TNFi, an increase in flare rate was reported in those who tapered TNFi to discontinuation. However, most regained remission after reinstatement of full-dose treatment.

• Uhlig, Till; Karoliussen, Lars Fridtjof; Sexton, Joseph; Provan, Sella Aarrestad; Kvien, Tore Kristian Aaserud & Haavardsholm, Espen A. [Vis alle 7 forfattere av denne artikkelen] (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), s. 3886–3892. doi: 10.1093/rheumatology/kead124. Fulltekst i vitenarkiv Vis sammendrag

  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. [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Smedslund, Geir; Kotar, Martina & Uhlig, Till (2022). Sarcoidosis with musculoskeletal manifestations: systematic review of non-pharmacological and pharmacological treatments. Rheumatology International. ISSN 0172-8172. 42(12), s. 2109–2124. doi: 10.1007/s00296-022-05171-8. Fulltekst i vitenarkiv Vis sammendrag

  Abstract We aimed to summarise effects and use of non-pharmacological and pharmacological treatments for sarcoidosis with musculoskeletal manifestations. We systematically searched the Cochrane Library, Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, clinical.trials.gov, PROSPERO and PEDro for systematic reviews from 2014 to 2022 and for primary studies from date of inception to March 29, 2022, and studies with patients diagnosed with sarcoidosis with musculoskeletal manifestations. Inclusion criteria required that studies reported effects of non-pharmacological and/or pharmacological treatments or number of patients receiving these treatments. Results were reported narratively and in forest plots. Eleven studies were included. No systematic reviews fulfilled our inclusion criteria. None of the included studies had a control group. We found that between 23 and 100% received corticosteroids, 0–100% received NSAIDs, 5–100% received hydroxychloroquine, 12–100% received methotrexate, 0–100% received TNF inhibitors, and 3–4% received azathioprine. Only ten patients in one study had used non-pharmacological treatments, including occupational therapy, chiropractic and acupuncture. There are no controlled studies on treatment effects for patients with sarcoidosis with musculoskeletal manifestations. We found 11 studies reporting use of pharmacological treatments and only one study reporting use of non-pharmacological treatments. Our study identified major research gaps for pharmacological and non-pharmacological treatment in musculoskeletal sarcoidosis and warrant randomised clinical trials for both.

• Hammer, Hilde Berner; Rollefstad, Silvia Christin Hellerud; Semb, Anne Grete; Jensen, Gro Elisabeth; Karoliussen, Lars Fridtjof & Terslev, L [Vis alle 9 forfattere av denne artikkelen] (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), s. 1–5. doi: 10.1136/rmdopen-2022-002348. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 7 forfattere av denne artikkelen] (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, s. 1–11. doi: 10.1186/s13075-022-02772-3. Fulltekst i vitenarkiv Vis sammendrag

  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

• Lend, Kristina; Vollenhoven, Ronald F van; Lampa, Jon; Hetland, Merete Lund; Haavardsholm, Espen A. & Nordström, Dan [Vis alle 18 forfattere av denne artikkelen] (2022). Sex differences in remission rates over 24 weeks among three different biological treatments compared to conventional therapy in patients with early rheumatoid arthritis (NORD-STAR): a post-hoc analysis of a randomised controlled trial. The Lancet Rheumatology. 4(10), s. e688–e698. doi: 10.1016/S2665-9913(22)00186-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Rheumatoid arthritis is a chronic inflammatory disease with a well-recognised female preponderance. In this post-hoc analysis of the NORD-STAR trial, we aimed to examine sex differences in remission rates with three different biological treatments combined with methotrexate versus active conventional treatment over 24 weeks, in patients with early rheumatoid arthritis. Methods NORD-STAR was a multicentre, investigator-initiated, assessor-blinded, phase 4, randomised, controlled trial of early rheumatoid arthritis, done in Denmark, Finland, Iceland, Norway, Sweden, and the Netherlands. Newly diagnosed patients, naive to disease-modifying antirheumatic drugs, aged 18 years or older with early rheumatoid arthritis and with a symptom duration less than 24 months were randomly assigned (1:1:1:1) to receive active conventional treatment, certolizumab-pegol, abatacept, or tocilizumab. Sex was reported in case report forms by study physicians or by study nurses. Data on gender were not collected. Remission outcomes were analysed with logistic generalised estimating equations (GEE), using a logit link and exchangeable correlation matrix. The model included treatment, time, sex, and the relevant interactions. For this post-hoc analysis, the co-primary outcomes were differences in Clinical Disease Activity Index (CDAI) remission (CDAI score ≤2·8) between sexes over time and at week 24, assessed with interaction terms (men vs women within each treatment comparison) and using active conventional treatment as the reference. We present adjusted average marginal differences in remission rates (risk differences) with 95% CIs. Findings Between Dec 14, 2012, and Dec 11, 2018, 812 patients were enrolled and randomly assigned; 217 received active conventional treatment, 203 received certolizumab-pegol, 204 received abatacept, and 188 received tocilizumab. All 812 patients were included in this analysis; 561 (69%) were women and 251 (31%) were men. Observed CDAI remission rates at 24 weeks were numerically higher among men than among women despite comparable disease activity at baseline (55% vs 50% with active conventional treatment, 57% vs 52% with certolizumab-pegol, 65% vs 51% with abatacept, and 61% vs 40% with tocilizumab). In the adjusted analysis, with active conventional treatment as the reference, the only significant difference between men and women was in the tocilizumab group (pinteraction=0·015); men in the tocilizumab group had a higher probability of CDAI remission, on average over time, than did men in the active conventional treatment group (0·12; 95% CI 0·00 to 0·23), whereas women in the tocilizumab group had a lower probability of remission than did women in the active conventional treatment group (–0·05, 95% CI –0·13 to 0·02). Interpretation Numerically higher remission rates were observed in men than in women in all four treatment groups at week 24, suggesting that this generalised sex difference is not related to the treatment. The difference between men and women was significantly greater with tocilizumab, an interleukin (IL)-6 inhibitor, than with active conventional treatment, suggesting a possible additional sex-based effect specific for IL-6 blockade.

• Sumpter, Nicholas A; Takei, Riku; Cadzow, Murray; Topless, Ruth; Phipps-Green, Amanda & Murphy, Rinki [Vis alle 39 forfattere av denne artikkelen] (2022). Association of Gout Polygenic Risk Score With Age at Disease Onset and Tophaceous Disease in European and Polynesian Men With Gout. Arthritis & Rheumatology. ISSN 2326-5191. 75(5), s. 816–825. doi: 10.1002/art.42393. Fulltekst i vitenarkiv
• Sundlisæter, Nina Beate Paulshus; Sundin, Ulf Gunnar; Aga, Anna-Birgitte; Sexton, Joseph; Hammer, Hilde Berner & Uhlig, Till [Vis alle 9 forfattere av denne artikkelen] (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), s. 1–6. doi: 10.1136/rmdopen-2021-002013. Fulltekst i vitenarkiv Vis sammendrag

  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/.

Se alle arbeider i NVA

• Stjärne, Johan Folke Håkan; Hammer, Hilde Berner & Uhlig, Till (2026). (+) Urinsyregikt – ny studie: Kan bli anfallsfri med behandling. [Journal]. VG papir. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Uhlig, Till; Hammer, Hilde Berner; Merriman, Tony & Hexeberg, Sofie (2025). Nye funn om urinsyregikt. s. 16–18. Fulltekst i vitenarkiv
• Uhlig, Till (2025). (+) Urinsyregikt: Ny metode kan gi bedre liv. [Journal]. VG. Fulltekst i vitenarkiv Vis sammendrag

  Urinsyregikten kan bli mindre plagsom dersom en ny behandlingsmetode viser seg å svare til forventningene. Kanskje kan du også nyte mat og drikke som i dag trigger anfallene.

• Uhlig, Till (2025). Helse, Mannehelse | Hver tiende mann rammes av «fest-lidelsen». [Journal]. Fredriksstad Blad. Fulltekst i vitenarkiv Vis sammendrag

  Men gjør du dette kan du faktisk forsyne deg av herligheten.

• Uhlig, Till (2025). Reker, alkohol og – intense smerter. [Journal]. Nordlys. Fulltekst i vitenarkiv
• Uhlig, Till (2025). Kosthold, Helse | Reker, alkohol og – intense smerter. [Internet]. Avisa Gaula. Fulltekst i vitenarkiv Vis sammendrag

  Men gjør du dette kan du faktisk forsyne deg av herligheten.

• Uhlig, Till (2025). Kosthold, Helse | Reker, alkohol og – intense smerter. [Internet]. Sandnesposten – Siste nytt. Fulltekst i vitenarkiv Vis sammendrag

  Men gjør du dette kan du faktisk forsyne deg av herligheten.

• Uhlig, Till (2025). Urinsyregikt, Menn | Reker, alkohol og – intense smerter. [Internet]. Amta- Akershus Amtstidende. Fulltekst i vitenarkiv Vis sammendrag

  Men gjør du dette kan du faktisk forsyne deg av herligheten.

• Uhlig, Till; Hammer, Hilde Berner & Hexeberg, Sofie (2025). Fant ukjent årsak til urinsyregikt. s. 76–79. Fulltekst i vitenarkiv Vis sammendrag

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

• Fatima, Tahzeeb; Zhang, Yuan; Vasileiadis, Georgios K.; Rawshani, Araz; Vollenhoven, Ronald van & Lampa, Jon [Vis alle 20 forfattere av denne artikkelen] (2025). Correction: Disease activity and treatment response in early rheumatoid arthritis: an exploratory metabolomic profiling in the NORD-STAR cohort. Arthritis Research & Therapy. ISSN 1478-6354. 27(1). doi: 10.1186/s13075-025-03657-x. Fulltekst i vitenarkiv
• Aanesen, Fiona; Stjärne, Johan Folke Håkan; Berg, Inger Jorid; Søhus, Silje; Hammer, Hilde Berner & Uhlig, Till [Vis alle 11 forfattere av denne artikkelen] (2025). Digital oppfølging av urinsyregikt, ReMonit Gout prosjektet. Fulltekst i vitenarkiv Vis sammendrag

  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

• Uhlig, Till (2025). Nye urinsyregikt funn: Ingen anfall. [Journal]. Dagbladet +. Fulltekst i vitenarkiv
• Bardan, Imane; Uhlig, Till; Sexton, Joseph; Kvien, Tore Kristian Aaserud; Bakland, G. & Mielnik, P. [Vis alle 11 forfattere av denne artikkelen] (2025). POS0294 HEALTH-RELATED QUALITY OF LIFE IN ADULTS WITH JUVENILE IDIOPATHIC ARTHRITIS COMPARED TO PATIENTS WITH RHEUMATOID ARTHRITIS AND THE GENERAL POPULATION: DATA ON DMARD-TREATED PATIENTS FROM NOR-DMARD. doi: 10.1016/j.ard.2025.05.681. Fulltekst i vitenarkiv
• Uhlig, Till (2025). Lessons from the NOR-Gout study (Invited lecture). Fulltekst i vitenarkiv
• Uhlig, Till (2025). Jak-hemmere. Fulltekst i vitenarkiv
• Uhlig, Till (2025). Update in Gout. Fulltekst i vitenarkiv
• Uhlig, Till (2025). Urinsyregikt: Hver tiende mann rammes av "fest-lidelsen". [Journal]. Hammerfestingen avis. doi: https:/www.hammerfestingen.no/. Fulltekst i vitenarkiv
• Uhlig, Till (2025). Urinsyregikt: Borte for alltid. [Journal]. Dagbladet+. Fulltekst i vitenarkiv
• Uhlig, Till; Provan, Sella Aarrestad & Fryxelius, Anna (2025). Langtidsstudier. [Internet]. Revmatiker.no. doi: https:/www.revmatiker.no/forskningswebinar-hvordan-gar-det-med-revmatikere-pa-sikt/#%3A%7E%3Atext=Norsk%20Revmatikerforbund%20og%20REMEDY%20inviterer%20til%20forskningswebinar%20med%2Cog%20ledes%20av%20fagsjef%20i%20NRF%2C%20Anna%20Fryxelius.. Fulltekst i vitenarkiv
• Uhlig, Till; Karoliussen, L.F.; Sexton, J.; Provan, S. Aarrestad; Haavardsholm, E.A. & Hammer, H.B. (2025). ABS1116 HOW FAST CAN YOU REACH THE SERUM URATE TARGET DURING INTENSIVE URATE LOWERING THERAPY IN GOUT. doi: 10.1016/j.ard.2025.06.979. Fulltekst i vitenarkiv Vis sammendrag

  Flares and disease burden with monosodium urate crystal deposition in joints, as well as reduced health-related quality of life affect gout patients with increased serum urate (sUA) levels. Urate lowering therapy (ULT) with allopurinol or other drugs are internationally recommended to avoid flares and to obtain disease remission in gout. We lack knowledge on how fast intensive ULT can reach sUA target levels.

• Hagen, Gunhild; Arif, Sonia; Karoliussen, Lars Fridtjof; Sexton, Joseph; Haavardsholm, Espen Andre & Provan, Sella Aarrestad [Vis alle 8 forfattere av denne artikkelen] (2025). Treating gout to target serum urate improves health-related quality of life and utility over five years. Fulltekst i vitenarkiv
• Christensen, Ingrid Egeland; Lillegraven, Siri; Uhlig, Till & Provan, Sella Aarrestad (2025). Comment on: Longitudinal risk of serious infections in patients with inflammatory arthritis on immunomodulating therapy compared to controls: Reply. Rheumatology - Advances in Practice (Rheumap). 9(3). doi: 10.1093/rap/rkaf069. Fulltekst i vitenarkiv
• Safar, Solaf & Uhlig, Till (2025). Let us avoid fluctuations in serum urate in gout. Clinical Rheumatology. ISSN 0770-3198. doi: 10.1007/s10067-025-07629-z. Fulltekst i vitenarkiv
• Daniloff, Kathrine & Uhlig, Till (2024). Urinsyregik: Slik unngår du smerter i julen. [Journal]. Forskning.no. doi: https:/www.forskning.no/diakonhjemmet-sykehus-jul-mat-og-helse/urinsyregikt-slik-unngar-du-smerter-i-julen/2443246. Fulltekst i vitenarkiv
• Major, Tanya J.; Takei, Riku; Matsuo, Hirotaka; Leask, Megan P.; Sumpter, Nicholas A. & Topless, Ruth K. [Vis alle 99 forfattere av denne artikkelen] (2024). Correction to: A genome-wide association analysis reveals new pathogenic pathways in gout (Nature Genetics, (2024), 56, 11, (2392-2406), 10.1038/s41588-024-01921-5). Nature Genetics. ISSN 1061-4036. 56(11), s. 2577–2577. doi: 10.1038/s41588-024-02017-w. Fulltekst i vitenarkiv
• Uhlig, Till (2024). Adherence to gout treatment after 5 years in the NOR-Gout study. Fulltekst i vitenarkiv Vis sammendrag

  T. Uhlig, L. F. Karoliussen, J. Sexton, E. A. Haavardsholm, T. K. Kvien, F. Perez-Ruiz, H. B. Hammer. Background: To achieve low levels of serum urate patients need to adhere to taking their medication. This is expected to reduce flares. Urate lowering therapy (ULT) is expected to prevent new gout flares, but flares still do occur in the first year, and may be related to fluctuations in serum urate (SUA) in response to proinflammatory signals. Knowledge on the relationship between fluctuation in SUA and gout flares is sparse. Objectives: To study whether patients adhere to medication 5 years after uratel lowering therapsy (ULT) and whether high adherence is associated to patient or disease related characteristics. Methods: After 5 years 155 of 211 patients completed a follow-up assessment. Patients were during the first year treated with a treat-to-target intervention with tight controls and information on aspects of gout by a study nurse to achieve a serum urate (SUA) level <360 µmol or <300µmol/L if tophi. Patients (n=155) were at baseline xxx years,……… (Full antall….)Age was 56.4 (SD 13.7) years, 95.3% were females, disease duration 7.8 (SD 7.6) years. SUA decreased from mean 500 µmol/L at baseline to 311 µmol at 5 years. Adherence to medication was measured Fluctuations in SUA were defined with various measures of SUA: sum of changes between all visits, change between visits, and with standard deviation of SUA measurements over 2 years. Further, the frequency of patients exceeding SUA changes with threshold >30, >60 and >90 µmol was calculated. SUA changes between monthly visits, 3-month periods, during year 1 and year 2 were calculated. Fluctuations in SUA were then related to self-reported flares between visits, during the same 3-month periods, during year 1 year 2. Finally, SUA fluctuations were also related to flares in the subsequent period after SUA change . Results: The mean sum of SUA changes over 2 years was related to flares in all 3-month periods during year 1 (Table) and for year 1 overall (Figure). Other measures of SUA fluctuation (change, mean, standard deviation, exceeding thresholds of change) were generally not related to incidence of flare between individual visits, over 3-month periods, or year 1 overall.

• Uhlig, Till (2024). Har avslørt årsaken bak smertehelvete. Urinsyregikt: Podagramedisin hjelper 9 av 10. [Journal]. Dagbladet. Fulltekst i vitenarkiv
• Uhlig, Till (2024). Livsstil mot urinsyregikten. [Journal]. VG papirutgave. Fulltekst i vitenarkiv
• Uhlig, Till (2024). Non-adherence to urate lowering therapy in gout after 5 years is related to poor outcomes – results from the NOR-Gout study. Fulltekst i vitenarkiv Vis sammendrag

  Till Uhlig, Lars F. Karoliussen, Joe Sexton, Sella A. Provan, Espen A. Haavardsholm, Nicola Dalbeth, Hilde Berner Hammer. Objectives Patients with gout need adhere to medication over time 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 with a recent gout flare and serum urate >360 µmol/L had attended one year of tight-control visits during escalating urate lowering therapy according to a treat-to-target strategy. Clinical and patient reported data were collected at all time points and follow-up at 5 years included also included the Medication Adherence Report Scale (MARS-5) questionnaire for adherence. Results Most of the 163 patients at 5-year follow-up (baseline mean 56.4 years, 95% males) used ULT (95.1%). MARS-5 adherence scores after 5 years were high (median 24, interquartile range 22-25). Non-adherent patients in the lowest MARS-5 quartile had, compared to 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)(Figure 1). Baseline lower age, non-European origin, lower mental health scores and less joint pain during last flare were independently associated with non-adherence to medication (Table 1). Conclusions Gout patients had, 5 years after a treat-to-target intervention, high self-reported adherence to medication. Non-adherence was related to more flares and less frequent serum urate target achievement and associated to younger age as well as non-European origin. Clinicians should consider these factors to support adherence in gout.

• Uhlig, Till (2024). Reker, alkohol og - intense smerter. [Journal]. Bergensavisen. Fulltekst i vitenarkiv
• Vikse, Jens; Hammer, Hilde Berner; Nystad, Tone Wikene; Uhlig, Till & Haavardsholm, Espen A. (2024). Urinsyregikt. I Vikse, Jens; Haavardsholm, Espen A. & Molberg, Øyvind (Red.), Revmatologi. Universitetsforlaget. ISSN 9788215068589. s. 216–228. Fulltekst i vitenarkiv
• Vikse, Jens; Hammer, Hilde Berner; Nystad, Tone Wikene; Uhlig, Till & Haavardsholm, Espen A. (2024). Krystallartritt: en oversikt. I Vikse, Jens; Haavardsholm, Espen A. & Molberg, Øyvind (Red.), Revmatologi. Universitetsforlaget. ISSN 9788215068589. s. 213–215. Fulltekst i vitenarkiv
• Uhlig, Till (2024). Fatigue - kan vi gjøre noe for å behandle det? Fulltekst i vitenarkiv
• Uhlig, Till (2024). Remission Is the Mission in Gout. Journal of Rheumatology. ISSN 0315-162X. 51(11), s. 1057–1059. doi: 10.3899/jrheum.2024-0921. Fulltekst i vitenarkiv
• Uhlig, Till (2024). Urinsyregikt med smerter. [Journal]. Healthtalk. Fulltekst i vitenarkiv
• Uhlig, Till (2024). Supergrepet mot urinsyregikt. [Journal]. Dagbladet+ . Fulltekst i vitenarkiv
• Kjørholt, Kaja Eriksrud; Sundlisæter, Nina Beate Paulshus; Aga, Anna-Birgitte; Sexton, Joseph; Olsen, Inge Christoffer & Madland, Tor Magne [Vis alle 21 forfattere av denne artikkelen] (2024). OP0021 3-YEAR RESULTS OF TAPERING TNFi TO WITHDRAWAL COMPARED TO STABLE TNFi AMONG RHEUMATOID ARTHRITIS PATIENTS IN SUSTAINED REMISSION: A MULTICENTER RANDOMIZED TRIAL. Annals of the Rheumatic Diseases. ISSN 0003-4967. 83, s. 188–189. doi: 10.1136/annrheumdis-2024-eular.299. Fulltekst i vitenarkiv
• Heiberg, Marte Schrumpf; Kisten, Yogan; Kazemi, Amirhossein; Rezaei, Hamed; Klint, Erik af & Ljoså, Maud-Kristine Aga [Vis alle 26 forfattere av denne artikkelen] (2024). POS0474 ULTRASOUND REMISSION RATES AFTER 1 YEAR ARE HIGH IN EARLY RA PATIENTS ON INDUCTION TREATMENT: RESULTS FROM THE RANDOMIZED NORD-STAR TRIAL. Annals of the Rheumatic Diseases. ISSN 0003-4967. 83, s. 839–840. doi: 10.1136/annrheumdis-2024-eular.5080. Fulltekst i vitenarkiv
• Vikse, Jens; Hammer, Hilde Berner; Nystad, Tone Wikene; Uhlig, Till & Haavardsholm, Espen A. (2024). Kalsiumpyrofosfatartritt. I Vikse, Jens; Haavardsholm, Espen A. & Molberg, Øyvind (Red.), Revmatologi. Universitetsforlaget. ISSN 9788215068589. s. 229–230. Fulltekst i vitenarkiv
• Uhlig, Till (2024). 2024 Update on gout. Fulltekst i vitenarkiv
• Uhlig, Till (2023). Ekspertenes beste råd mot urinsyregikt. [Journal]. Dagbladet. Fulltekst i vitenarkiv
• Uhlig, Till (2023). Bedre livskvalitet for pasienter med revmatiske sykdommer. [Journal]. Dagbladet. Fulltekst i vitenarkiv
• Uhlig, Till (2023). Ny studie: Rett behandling for urinsyregikt. [Internet]. Dagbladet. Fulltekst i vitenarkiv
• Uhlig, Till (2023). Kombinasjonsbehandling med biologiske og andre avanserte legemidler. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(14). doi: 10.4045/tidsskr.23.0517. Fulltekst i vitenarkiv
• Skattør, Marianne; Uhlig, Till & Risum, Kristine (2022). Revidering av fagprosedyren «Trening ved polymyositt og dermatomyositt». Fulltekst i vitenarkiv
• Skattør, Marianne; Uhlig, Till & Risum, Kristine (2022). Revidering av fagprosedyren «Trening ved polymyositt og dermatomyositt». Fulltekst i vitenarkiv
• Østergaard, Mikkel; Vollenhoven, Ronald van; Rudin, Anna; Hetland, Merete L.; Schrumpf, Marte & Nordström, Dan [Vis alle 44 forfattere av denne artikkelen] (2022). CERTOLIZUMAB-PEGOL, ABATACEPT, TOCILIZUMAB OR ACTIVE CONVENTIONAL THERAPY IN EARLY RHEUMATOID ARTHRITIS: CLINICAL AND RADIOGRAPHIC 48-WEEKS RESULTS OF THE INVESTIGATOR-INITIATED RANDOMIZED NORD-STAR TRIAL. Annals of the Rheumatic Diseases. ISSN 0003-4967. 81, s. 38–40. Fulltekst i vitenarkiv
• Lillegraven, Siri; Sundlisæter, Nina Paulshus; Aga, Anna-Birgitte; Sexton, Joe; Olsen, Inge Christoffer & Fremstad, Hallvard [Vis alle 21 forfattere av denne artikkelen] (2022). Drug Free Remission in Rheumatoid Arthritis: Data from the Randomized Controlled ARCTIC REWIND Trial. Arthritis & Rheumatology. ISSN 2326-5191. 74, s. 3970–3972. doi: 10.1002/art.42355. Fulltekst i vitenarkiv

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