Research projects

Clinical trials

Strategies towards personalized treatment of juvenile idiopathic arthritis (JIA). The MyJIA trial
A national randomized study of the efficacy of different treatment strategies and possible risk factors for treatment failure. Selective immune inhibitors reduce joint inflammation in patients with juvenile arthritis (JIA), but only 20-40% obtain sustained remission. Adapted treatment with glucocorticoid injections in inflamed joints is frequently used (often under anesthesia in children), but there are no controlled studies of the effect of this treatment. Our hypothesis is that JIA patients who start treatment with tumor necrosis factor (TNF)-inhibitors have an additional effect of glucocorticoid injections in inflamed joints. In addition, we will investigate whether a personalized approach to drug concentration, sensitive imaging of joint inflammation (ultrasound, MRI), as well as genetic and biochemical inflammation profiling can be used to differentiate JIA patients with different treatment responses. 202 JIA patients starting TNF-inhibitor treatment are randomized to A) simultaneous intra-articular glucocorticoid injections versus B) no injections. Outcome measures are sustained remission, improved health status and increased quality of life. Possible risk factors for treatment failure will be analyzed. Patients are recruited from all health regions through an established collaboration. Unit of Pediatric Rheumatology, Oslo University Hospital, is the coordinating centre.

Moving towards evidence-based treatment strategies for children with juvenile idiopathic arthritis in sustained remission: the MOVE-JIA randomized controlled trial
In this national randomized controlled trial, we aim to optimize the management of patients with juvenile idiopathic arthritis (JIA) who are in stable disease remission. Balancing the risk of JIA flare with the long-term burden of medications and their side effects is a crucial concern for patients, parents, and caregivers. The "MOVE-JIA" trial: a national study that will include JIA patients in sustained remission treated with tumor necrosis factor (TNF)-inhibitor and methotrexate. In total 150 JIA patients will be randomized into three groups: A) Gradual TNF-inhibitor withdrawal, B) Gradual methotrexate withdrawal, or C) Continued stable treatment with both TNF-inhibitor and methotrexate. The primary goal is to measure how many patients experience a disease flare within a year. 

The MOVE-JIA trial will be the first study to investigate if reducing methotrexate is less likely to cause disease flares compared to reducing TNF-inhibitor in JIA patients. The study will also assess whether single treatment with either TNF- inhibitor or methotrexate is as effective as combination of both treatments. All pediatric rheumatology units in Norway participate, ensuring the swift application of the results into clinical practice. Unit of Pediatric Rheumatology, Oslo University Hospital, is the coordinating centre.

Translational and multidisciplinary research 

Towards personalized doses of TNF-inhibitors in juvenile idiopathic arthritis
The aim is to identify the optimal serum level of TNF inhibitors in children and develop strategies for therapeutic drug monitoring in JIA. Samples and data from a prospective 48-week study of children with JIA starting on TNF-inhibitors (the MYJIA trial) are used. Mapping of serum concentration of and antibody formation against biological drugs are performed, and possible correlations with disease activity and treatment response will be analyzed.

The importance of molecular signatures in juvenile idiopathic arthritis
Signatures based on transcriptional, cellular and genetic risk and their relation to disease activity and treatment response in are assessed. Blood samples are collected in a prospective 48-week study of children with JIA who start treatment with a TNF inhibitor (the MyJIA trial). The analyzes are done in collaboration between medical genetics and rheumatology, OUS.

The MyJIA open extension study
The aim is to assess the long-term added efficacy of intra-articular glucocorticoid injections in JIA patients followed-up 36 months after starting TNF inhibitor therapy. In this open extension study of the MyJIA trial, the long-term outcome  in JIA patients receiving TNF-inhibitor treatment is assessed. Sustained remission, health status, quality of life, patient satisfaction and safety will be described.

Evaluation of ultrasound in children with juvenile idiopathic arthritis 
The aim is to develop and evaluate an ultrasonographic scanning protocol and joint-specific scoring system for synovitis with age-divided reference atlas for patient with juvenile idiopathic arthritis. This tool was a reliable and valid instrument in the assessment of joint inflammation in children. Further, ultrasound findings using this atlas and scoring system, reflect overall disease activity in patients with JIA and may be a useful outcome measure in future research and clinical practice.

Synovial fluid analyses in children and adolescents with rheumatic disease
The project investigates whether genetic fingerprinting from the synovial fluid's white blood cells can differentiate between subgroups of childhood arthritis and predict their treatment response. The goal is to improve the understanding of joint changes at a cellular level in JIA.

Whole-body Magnetic Resonance Imaging assessments of chronic non-bacterial osteomyelitis (CNO) in children and adolescents and juvenile idiopathic arthritis
Whole body MRI findings children with rheumatic diseases will be compared with those in healthy children (that have been published in collaboration with our research group).

Juvenile idiopathic arthritits in adults - disease activity, effectiveness of disease modifiying drugs, health-related quality of life and work participation
Objective for the project is to assess disease activity, response and remission rates of methotrexate and biologic disease modifying anti-rheumatic drugs in adults with juvenile idiopathic arthritis compared to matched rheumatoid arthritis patients. In addition, explore health-related quality of life and work participation in adults with juvenile idiopathic arthritis that receives arthritis treatment, compared with controls from the Norwegian general population. Data from the Norwegian DMARD study (NOR-DMARD).  

Disease progression, cardiovascular risk and patient reported outcome into adulthood in Juvenile Idiopathic Arthritis
Objective for the project is to assess outcome and identify risk factors for unfavourable outcomes in adults with JIA, including remission rates, cardiovascular risks and function, physical and psychosocial limitations, and quality of life. Satisfaction with biological drugs versus methotrexate and treatment responses in JIA are described. We also identify genetic factors, disease variables and pain predicted persistent disease activity, poor patient reported health and/or arterial stiffness. 

 
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