New PhD in REMEDY, Karen Holten
In the photo: Espen A. Haavardsholm, Anna-Birgitte Aga, Karen Holten, Nina P. Sundlisæter and Siri Lillegraven.
“I have looked at the correlation between what patients themselves report about their health and the medical measurements of disease activity. This can help us provide treatment and follow-up that is more tailored to the individual,” says Holten.
Fatigue, a major challenge in arthritis
Fatigue is a common consequence of chronic diseases such as arthritis, and many people find it very distressing.
– Fatigue cannot be measured directly, but patients report it in questionnaires, explains Holten.
Holten found that two out of three patients with a new arthritis diagnosis had fatigue before starting treatment. Before this study, little was known about how fatigue is related to disease activity in people with arthritis receiving modern treatment.
– Fortunately, most people got much better from their fatigue after they were treated according to modern treatment principles for newly occurring arthritis, she says.
Persistent fatigue, despite treatment
Even though the treatment works well, some patients still experience fatigue. Holten found that this is often related to factors other than the medical measures of disease activity, and she has identified risk factors for developing persistent fatigue.
– These findings can help clinicians identify patients at risk of long-term fatigue so that measures can be taken, says Holten.
Patients' assessment of illness provides valuable insight
Modern arthritis treatment often relies on blood tests and joint examinations to measure inflammation, but patients may have symptoms that these tests don't always pick up.
The study shows that patients' own experiences often correspond well with objective findings.
– Some patients experience symptoms that are not shown in standard measurements, explains Holten.
She believes the findings show that information captured using patient-reported outcome measures can provide early signals that the disease is about to flare up. It can also provide a good indication that the patient is being well treated, without the need for monitoring.
Data from the ARCTIC studies
The research is based on data from two large national studies, ARCTIC and ARCTIC REWIND. ARCTIC included patients who had recently been diagnosed with arthritis and who received early and targeted treatment. ARCTIC REWIND looked at what happens when patients without symptoms of disease activity taper off treatment. The studies included information on 489 patients with arthritis.
The way forward
On Monday, February 24, she passed her doctoral exam with flying colors. The doctorate is affiliated with the University of Oslo and completed at the REMEDY Center at Diakonhjemmet Hospital.
Holten has worked at the hospital since 2010. She completed her master's degree in Interdisciplinary Health Research in 2018 and started her doctoral work in 2020. The project was funded by the DAM Foundation and the Norwegian Rheumatology Association.
Now she is returning to her job as a nurse at the rheumatology ward at Diakonhjemmet Hospital.
– I enjoy my job, especially because the meetings with patients with rheumatic diseases are meaningful. Research and treatment go hand in hand with us and at REMEDY, so I imagine being able to continue with research as well, she says.
Trial lecture
The title of the lecture was The role of the nurse in the care of patients with rheumatoid arthritis - biological and psychosocial factors in the assessments and treatments.
Supervisors, committee and dissertation director
Main supervisor: Anna-Birgitte Aga
Co-supervisors: Espen A. Haavardsholm, Siri Lillegraven and Nina Paulshus Sundlisæter
Judging committee: Mwidimi Ndosimi, Jette Primdahl and Christine Råheim Borge
Discussion leader: John-Anker Zwart
The articles from the doctoral project
https://doi.org/10.1136/annrheumdis-2021-220750
https://doi.org/10.1136/rmdopen-2023-003486
https://doi.org/10.1136/rmdopen-2024-004444
We congratulate Karen Holten on her doctorate!
