Dialogue Seminar 2026 - From mud baths to new treatment options

From long hospital stays and careful escalation of medications to early targeted treatment, less stressful treatment for children and new studies on hand osteoarthritis. At the Dialogue Seminar 2026, patients, researchers and practitioners met to talk about where rheumatology stands today – and what might be next.

September 8, 2026

The dialogue seminar is held every autumn in collaboration between the Norwegian Rheumatology Association and the research center REMEDY at Diakonhjemmet Hospital  . This year's theme was "New treatment methods, what does it mean for you?".

Through presentations and questions from the audience, developments were highlighted both historically and through research that is currently taking place.

From inpatient care to outpatient clinic

Professor emeritus and senior researcher Tore Kvien opened by outlining the long lines in rheumatology.

When he started as a doctor at the Southern Norway Rheumatism Hospital in 1976, the reality was completely different from today. Patients could be hospitalized for at least four weeks, the treatment was still rooted in the spa tradition, and rheumatology surgery had a much greater role because many patients developed serious joint damage.

The development at Diakonhjemmet Hospital illustrates how much has happened. When Kvien started at the hospital in 1986, rheumatology and rheumatology surgery had a total of 45 beds and around 3,000 outpatient consultations a year.

Today there are five beds, while outpatient activity has increased to around 50,000 consultations annually. Rheumatology has gone from being largely an inpatient specialty to becoming an outpatient specialty. See the development of the outpatient clinic at Diakonhjemmet Hospital  

However, something is the same. Kvien highlighted the interdisciplinary treatment, where doctors, nurses, physiotherapists, occupational therapists and pharmacists, among others, collaborate around the patient, as an important tradition that is still being built on.

The goal is to prevent damage

The treatment strategy itself has also changed fundamentally in inflammatory rheumatic diseases.

Previously, the principle was often "go low, go slow": You started carefully and gradually increased the treatment.

Today, the strategy is to make the diagnosis early, set a specific treatment goal, and adjust the treatment if the goal is not reached.

The goal is not just for the patient to get a little better. In rheumatoid arthritis, for example, it is about getting the disease activity down to a level that prevents damage to cartilage and bone, pain and loss of function.

The development of biological drugs from the late 1990s was a new turning point.

Later, **biosimilar drugs have made it possible to treat far more people at a lower cost. Kvien highlighted, among other things, the Norwegian NOR-SWITCH study, which showed that patients could switch from the original drug *infliximab to a biosimilar drug without any inferior effect.

– Early treatment, early, early, early. It is incredibly important, summarized Kvien.

Can children avoid injections and anesthesia?

How can modern treatment be made both better and less burdensome? That question was central when consultant and senior researcher Anna-Birgitte Aga at Oslo University Hospital presented research on juvenile idiopathic arthritis, also known as childhood arthritis.

The principles are similar to those used in adults: Treatment should start early, the child is closely monitored, and treatment is adjusted if the goal is not reached. In children, the goal is inactive disease – that there are no longer symptoms or signs of active arthritis.

Aga also emphasized that many of the most important research questions arise in meetings with patients and families.

“The good research questions often come up in the clinic,” she said.

One of these questions was whether children who start treatment with a TNF inhibitor also need cortisone injections directly into inflamed joints. For children, such injections can involve anesthesia, absence from school and a significant burden on the entire family.

Nearly one hundred children participated in the MinJIA study. All started with TNF inhibitors, while a lottery determined whether they would also receive cortisone injections into the inflamed joints.

The result was that the same number achieved inactive disease in the two groups. According to Aga, the study thus shows that joint injections are not necessary when children start TNF inhibitors. The result has already changed practice at her department. It means that many children can avoid both painful injections and anesthesia.

When can treatment be tapered off?

When modern treatment allows children to become symptom-free, a new question arises: Do they have to continue with all the treatment?

This is being investigated in an ongoing study in which children and adolescents who have had inactive disease over time are assigned to different treatment strategies. Some continue with both TNF inhibitors and methotrexate, while others taper off one of the drugs.

At the seminar, Aga said that 85 of the planned 150 participants were included in the MOVE-JIA study. The goal is to gain better knowledge about how treatment can be reduced without the disease flaring up again.

Knowing that exercise is good is not always enough

Physiotherapist and researcher Camilla Fongen focused attention on physical activity and exercise.

For people with rheumatic disease, physical activity is an important part of treatment. At the same time, there is a big difference between knowing that exercise is good and actually doing it in a daily life with pain, fatigue and varying illnesses.

Fongen showed how research can contribute to more individually tailored support, and how users themselves must be involved when new solutions for training, lifestyle and self-management are developed.

The same principle – developing measures together with those who will actually use them – was repeated in several of the research projects that were presented later at the seminar.

Much we still don't know about hand osteoarthritis

Professor and rheumatologist Ida K. Bos-Haugen addressed hand osteoarthritis – a very common disease where good answers to several basic treatment questions are still lacking.

Today's treatment follows a stepwise model. Everyone with hand osteoarthritis should receive information about the disease and advice on treatment.

At Diakonhjemmet Hospital, both rheumatologists and general practitioners can refer to osteoarthritis courses.

Hand exercises are central, and if necessary, patients can receive aids or orthoses for osteoarthritis in the thumb's root joint.

Then, anti-inflammatory gel or tablets, cortisone injections and finally surgery may be appropriate.

But Bos-Haugen pointed out that the documentation for several of the treatments is still limited.

Anti-inflammatory gel is recommended for hand osteoarthritis and has fewer systemic side effects than equivalent medications in tablet form. However, the recommendation is based on few studies, and the documented additional effect compared to placebo has been relatively modest.

Therefore, the researchers are planning a new study together with two centers in Denmark. The study is scheduled to start in the first part of 2027 and include 300 people with hand osteoarthritis. Half of them will be recruited from Diakonhjemmet Hospital.

Participants will receive either active anti-inflammatory gel or placebo gel. The study will last six weeks and involve three visits to the hospital. Interested parties can register now.

PICASSO is approaching full recruitment

The researchers are also investigating cortisone injections into the thumb's root joint more closely.

Although cortisone reduces inflammation, it is still uncertain how effective the injections are in hand osteoarthritis.

In the PICASSO study, participants are randomly assigned to receive cortisone injections, saline injections, or hand training and exercises.

At the Dialogue Seminar, Bos-Haugen said that the study was only missing eight participants and that the researchers hoped to complete the recruitment during October.

Participants who receive non-pharmacological treatment will receive support for self-management through the Happy Hands app. At the seminar, 2027 was mentioned as a possible time for when the app could also be available outside the study.

Testing methotrexate for hand osteoarthritis

Another question is whether drugs used for inflammatory joint diseases can also help individuals with hand osteoarthritis.

Methotrexate is a basic treatment for rheumatoid arthritis, among other conditions. Previous research has shown some pain-relieving effects in people with hand osteoarthritis who also have clear signs of inflammation.

In the MERINO study, researchers at Diakonhjemmet Hospital have therefore investigated methotrexate in a subgroup of patients with extensive structural changes and inflammation in the hands. Results are expected in 2027.

Why is weight linked to hand pain?

One of the newer research tracks Bos-Haugen presented concerns the connection between body weight and pain.

That being overweight can contribute to knee osteoarthritis through increased mechanical stress is intuitive. More surprising is the finding of a clear correlation between body weight and pain also in people with hand osteoarthritis.

– In our study, we found a fairly clear correlation between weight and the degree of pain in the hands of those with hand osteoarthritis, said Bos-Haugen.

Since we don't walk on our hands, the explanation cannot be mechanical stress. Bos-Haugen pointed to low-grade inflammation in the body and hormones and other signaling substances produced in adipose tissue as possible explanations.

New study to test GLP-1 treatment

New drugs that affect the GLP-1 system have shown significant weight loss and pain reduction in people with knee osteoarthritis and obesity. Now, researchers want to investigate whether such treatment can also reduce pain in people with hand osteoarthritis and obesity.

This will be done in the BOOST study, which is scheduled to start in 2027. More than 200 participants will be included at eleven centers in Norway, and Bos-Haugen invited interested parties to register now. It is worth noting that those who have used drugs with GLP-1 cannot be included in the study.

The medicine should not stand alone. People with hand osteoarthritis and obesity should also contribute as user collaborators to develop diet and exercise programs that the participants can actually manage to follow over time.

– In any case, you should never use these medications without also exercising at the same time or making an effort to eat healthier, Bos-Haugen emphasized.

She was also clear that the new drugs are not a "quick fix." They can cause side effects, and weight gain can return when treatment ends.

Patients' questions were answered

The dialogue with the participants was a central part of the seminar.

Kvien was asked questions about fatigue, among other things. He emphasized that fatigue is not just being tired, but an exhaustion that can have several causes and be very stressful.

Aga answered questions about methotrexate as tablets or injections, tapering off prednisolone, and the development of antibodies against biological drugs. Bos-Haugen was asked about weight loss, surgery for osteoarthritis, and the connection between X-ray findings and pain.

Bos-Haugen emphasized that the degree of osteoarthritis on the images does not necessarily correspond to the severity of the patient's symptoms. Some may have major changes and little pain, while others have significant symptoms without such dramatic findings. Therefore, a decision about surgery cannot be made based on X-rays alone.

Research together with those concerned

Throughout the entire Dialogue Seminar, one common thread ran through: Better treatment is not just about developing new medicines.

It is also about investigating whether the treatment we already use is actually necessary, finding out which patients benefit from which measures, reducing the burden of treatment, and developing solutions that work in everyday life.

For researchers, patients are necessary partners – both as participants in clinical studies and as user collaborators when research questions and new treatment options are developed.

That is also the very idea behind the Dialogue Seminar: to bring together patients, clinicians and researchers in the same room and let the questions go both ways.

The outpatient clinic from 1980 to today