Want to understand arthritis from the start

08.01.2026

Many patients come to a rheumatologist with a swollen, painful joint. They ask what is happening – and what it means for them. For rheumatologist and senior researcher Silje Watterdal Syversen, these questions have been a driving force.

She is now leading the START study ^[1] . The study follows patients with recent onset of arthritis, often within a few weeks of the first symptoms.

“START includes all forms of acute arthritis, including arthritis triggered by infections elsewhere in the body. These have often been omitted in previous research,” says Syversen.

From clinical frustration to research questions

– One of the things that frustrated me early on as a clinician was that I often couldn't give the patient a good answer about what to expect.

– We know that early and correct treatment can be crucial, but at the same time we lack knowledge that makes us confident about who needs rapid treatment – and who does not.

She began her clinical career at Diakonhjemmet Hospital in 2002. The plan was actually to study internal medicine, but a chance job choice after her rotation was the start of a long involvement in rheumatology.

In the encounter with patients with long-term and unclear joint problems, interest in research grew.

Rheumatology became a turning point

– I found it unsatisfactory not being able to explain why the disease developed differently from patient to patient.

Her doctoral thesis ^[2] was on biomarkers in rheumatoid arthritis. That is, biological characteristics, for example in blood or synovial fluid. She has always been interested in finding signs in the patient that can say something about the development of the disease and prognosis.

Since then, she has worked at the intersection of clinical practice and biology, with a clear goal: Research should be relevant to patients and applicable in everyday clinical practice.

Bridging the gap between biology and patient encounters

– There is a gap between what we know biologically and what we are actually able to use in meeting the patient. Much of my research is about closing this gap.

This perspective has followed her into the work with therapeutic drug monitoring, where the goal is to adapt treatment to the individual patient.

It has also helped shape the way she leads large clinical trials, such as NOR-DRUM and RA-DRUM.

The experiences from these studies have been crucial for how the START study is structured.

– Complex studies are only successful if they work in practice. If they become too complicated or too far removed from everyday clinical practice, we risk that the research will not be used, no matter how good the results are.

START: Patients are followed before the diagnosis is clear

– What is unique about START is that we start from the patient: with swollen joints, a short medical history and an unclear diagnosis.

Patients are followed for one year, with thorough clinical examinations, imaging studies and systematic collection of samples of biological material, such as blood, synovial fluid, synovial tissue and stool.

– The goal is to identify markers that can tell us something early about who develops chronic inflammatory joint disease and who does not.

The search for the body's early traces

– When we talk about markers, I usually tell patients that we are looking for the body's own clues. It could be proteins in the blood, immune cells in the synovial fluid or signals from the intestinal bacterial flora. These clues can help us understand whether the disease is likely to resolve, become chronic or will benefit from a particular treatment.

For the patients, participation does not involve experimental treatment, but often a more structured and close follow-up in an unclear phase.

User participation has been central to the design of the study.

When tests become knowledge – and security

“Much of what we collect is taken as part of a regular investigation anyway. The difference is that we systematize the samples and use them to learn,” says Syversen.

For many, it is meaningful to contribute to research that can help others in the same situation.

START is one of REMEDY's studies. It is at the intersection of precision medicine and treatment research. For Syversen, REMEDY has been crucial in being able to think long-term and ambitiously.

REMEDY as an engine for ambitious clinical research

REMEDY has a framework where clinical researchers and basic scientists meet and can plan together from the start, and with biobank and research support as a necessary framework.

– The close collaboration between clinical researchers, clinicians and basic scientists has been crucial to the relevance and quality of the study, she explains.

The study is also an important arena for recruiting new researchers, with PhD fellows and postdoctoral fellows, who receive clear roles and close supervision.

Teamwork and recruitment for the future of rheumatology

– Major studies are not a solo project. It's about teamwork, trust and common goals – and about building competence for the future.

Syversen would like to commend colleagues in the clinic for how this complex study has quickly gotten underway while ensuring that patients receive good treatment and follow-up.

Today, Silje Watterdal Syversen combines the role of consultant in rheumatology with a position as senior researcher, research management in REMEDY and leadership positions in the Norwegian Rheumatological Association.

From uncertain waiting to knowledge-based action

– The clinic provides the questions, research provides the answers, and leadership work is about putting the knowledge into practice.

Looking ten years ahead, she hopes START has contributed to a clear shift in how patients with newly occurring joint swelling are met.

– I hope we have moved from uncertain waiting to knowledge-based action. That patients receive faster clarifications, more targeted treatment and greater security – right from the start.

^[1] – Early Stratification of Acute Inflammatory Arthritis

^[2] completed in 2010