Henning Bliddal

• Frederiksberg Hospital

Introduction Hand osteoarthritis (OA) is a prevalent joint disorder with limited treatment options. Accumulating evidence suggests that the antidiabetic drug metformin has beneficial effects on knee OA and may likewise be beneficial for hand OA. The objective of this randomised, double-blinded, placebo-controlled trial is to investigate the effect...

Objective Obesity is a major risk factor for osteoarthritis (OA). Adipose tissues may be linked to OA development through secretion of potential proinflammatory cytokines including neutrophil gelatinase-associated lipocalin (NGAL). Our objective was to assess changes in serum NGAL after a low-calorie diet (LCD) and subsequent glucagon-like peptide...

Purpose Anterior cruciate ligament injury increases the risk of knee osteoarthritis, possibly via early onset of knee pain and changes in musculoskeletal function. This study compared knee muscle strength and movement biomechanics during walking and forward lunge between individuals with and without knee pain after anterior cruciate ligament recons...

Background The INtensive diet versus Knee Arthroplasty (INKA) trial is a randomised trial assessing weight loss as an alternative to knee arthroplasty (KA) in obese patients with severe knee osteoarthritis (OA) awaiting KA (NCT05172843). The external validity of the INKA trial may be hampered if the patients who participate differ from those who de...

Objective To assess the effect of electrically heated mittens on physical hand function in people with osteoarthritis of the hands compared with control mittens. Design Randomised controlled trial. Setting Osteoarthritis outpatient clinic, Copenhagen, Denmark. Participants 200 people with hand osteoarthritis aged 42-90 years. 100 participants we...

Purpose To investigate positional lumbar changes by weight-bearing MRI in low back pain (LBP) patients with hypermobile joints (Beighton score ≥ 4). Methods Patients referred to weight-bearing MRI went through a clinical examination, including Beighton’s test, answered back pain-related questionnaires, and were hereafter imaged in supine and stand...

Objective There are few effective osteoarthritis (OA) therapies. A novel injectable polyacrylamide hydrogel (iPAAG) previously demonstrated efficacy and safety up to week 26 in an open-label study of knee OA. Here we report longer-term effectiveness and safety data. Methods This multi-centre, open-label study included patients with symptomatic and...

Objective Despite scarce evidence, guidelines recommend weight loss as a management strategy for patients with gout. We investigated the effect of an intensive dietary intervention on body weight and clinical measures of gout severity in individuals with obesity and gout. Methods We conducted a 16‐week randomized nonmasked parallel‐group trial in...

Objective To compare illness perception (IP), pain, functional level and health-related quality of life (HR-QoL) between patients with musculoskeletal pain who participate versus those who do not participate in clinical research projects. Methods Data were collected between 1 January 2019 and 31 December 2021 in patients visiting the Outpatient Os...

Objective To explore the comparative effectiveness of pharmacological interventions for hand osteoarthritis (OA). Methods We systematically searched Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception until 26 December 2021, for randomised trials of pharmacological interventions for people with hand OA. Two revie...

Introduction The effectiveness of single intra-articular injections of polyacrylamide hydrogel (iPAAG) and hyaluronic acid (HA) was compared in subgroups of participants from an RCT based on baseline age, BMI or Kellgren-Lawrence (KL) grade. Methodology 239 participants were randomised to 6 mL iPAAG (Arthrosamid; n=119) or 6 mL HA (Synvisc-One; n=...

Objective: To investigate the prognostic value of illness perception (IP) on knee pain, quality of life (QoL) and functional level in elderly individuals reporting knee pain. Design: A prospective cohort study of 1552 elderly with knee pain comparing two previously established clusters based on the Brief Illness Perception questionnaire. Cluster...

Objectives: To assess non-inferiority of intra-articular injectable polyacrylamide hydrogel (iPAAG) to hyaluronic acid (HA) on symptomatic benefit in individuals with knee osteoarthritis (OA). Methods: This randomised, controlled, multi-centre trial recruited adults with symptomatic and radiographic knee OA from 3 clinical rheumatology sites in...

Background It is unclear whether sex or age modify the association of glucocorticoid (GC) use with reduced bone mineral density (BMD) in patients with rheumatoid arthritis (RA). Methods We studied cross-sectional data of RA patients with current or previous GC treatment in a single center cohort study (Rh-GIOP cohort). Our primary outcome was the...

Objective To assess the longer-term effect of the Good Life with osteoarthritis in Denmark (GLAD) exercise and education program relative to open-label placebo (OLP) on changes from baseline in core outcomes in individuals with knee osteoarthritis (OA). Methods In this 1-year follow-up of an open-label, randomized trial, patients with symptomatic...

Background Illness perception is related to management patterns and pain intensity, but among elderly with low back pain, this relation is unclear. The aims of this study were to analyse the associations between illness perception, pain intensity and health related quality of life in a group of elderly with low back pain and explore how different i...

Objective To identify contextual factors that modify the treatment effect of the ‘Good Life with osteoArthritis in Denmark’ (GLAD) exercise and education programme compared to open-label placebo (OLP) on knee pain in individuals with knee osteoarthritis (OA). Methods Secondary effect modifier analysis of a randomised controlled trial. 206 particpa...

Background: Only few studies have explored whether BMI across life is associated with knee OA. The aim of this study was to examine if the risk of knee arthroplasty related to adult BMI is modified by early lifetime overweight. Methods: A total of 22 083 female nurses were followed from 1st of May 1999 until 10th of August 2015, date of knee arthro...

Objective: The aim of this study was to evaluate the psychometric properties of the Danish version of the Fibromyalgia Impact Questionnaire - Revised (FIQR), when used to quantify the severity of disease burden in a Danish population of patients with chronic widespread pain (CWP), including fibromyalgia (FM). Method: A total of 924 participants...

Background The Fibromyalgia Impact Questionnaire - Revised (FIQR) is one of the most commonly used self-rating instruments developed to quantify the severity of disease burden and impact of disease on functional ability and social participation in patients with fibromyalgia (FM) [1]. The FIQR consists of 21 individual items categorized within three...

Background Ulnar drift is a common complication of Rheumatoid Arthritis (RA) (1,2). There is no clear consensus regarding the etiology of the hand deformity. Observations from corrective hand surgery and other studies have noted more pronounced inflammation in the radial site of the MCP-joints (3,4). This could partly explain the pathophysiology be...

Objective To assess if a change in physical activity occurred after a one-year weight loss period on either liraglutide or placebo in patients with knee osteoarthritis (OA) and overweight. Method This is secondary analysis of a one-year weight loss trial, with participants randomised (1:1) to either liraglutide 3 mg/day or placebo. The main outcom...

Background C-reactive protein (CRP) has prognostic value in hospitalized patients with COVID-19; the importance of CRP in pre-hospitalized patients remains to be tested. Methods: Individuals with symptoms of COVID-19 had a SARS-CoV-2 PCR oropharyngeal swab test, and a measurement of CRP was performed at baseline, with an upper reference range of 10...

Introduction The association between chronic widespread pain (CWP) and disability is well established. Although research support large interindividual differences in functional outcomes, limited studies are available on the socio-economic consequences of offering stratified treatment based on prognostic factors. Identification of predictors of long...

Objective To compare the efficacy of an exercise and education programme with open-label placebo given as intra-articular injections of inert saline on pain and function in individuals with knee osteoarthritis (OA). Methods In this open-label, randomised controlled trial, we recruited adults aged ≥50 years with symptomatic and radiographically con...

Objective Kellgren-Lawrence grades (KLG) are frequently used for patient selection in clinical trials. The Ahlbäck radiographic grading system has been developed for moderate and severe knee OA. KLG 3 is comparable to Ahlbäck 1 and KLG 4 is subdivided into Ahlbäck 2–5. The objective of this study was to investigate if the Ahlbäck scoring system is...

Background Contextual effects (i.e., placebo response ) refer to all health changes resulting from administering an apparently inactive treatment. In a randomized clinical trial (RCT), the overall treatment effect (i.e., the post-treatment effect in the intervention group) can be regarded as the true effect of the intervention plus the impact of co...

Knee pain is an early sign of later incident radiographic knee osteoarthritis (OA). However, the prevalence of knee pain in the general population is unknown. Additionally, it is unknown how people with knee pain choose to self-manage the condition and if the perception of the illness affects these choices. In this study, 9086 citizens between 60–6...

Introduction: Stakeholder involvement in research is emphasised to improve relevance. We aimed to identify, define and prioritise important research topics seen from the point of view of people with osteoarthritis (OA). Methods: We invited 1,315 members of the user panel of the Danish Rheumatism Association to answer an electronic survey that in...

Background Weight loss is critical for preventing and managing obesity-related diseases. There is a notable lack of valid and reliable means to manage patients with overweight/obesity and knee osteoarthritis (KOA). Objective To determine the efficacy and safety of liraglutide in a 30 mg/d dosing in patients with overweight/obesity and KOA. Method...

Objective This study investigated the effect of exercise therapy on inflammatory activity in synovitis and bone marrow lesions (BMLs) assessed by magnetic resonance imaging (MRI) in patients with knee OA. Methods 60 patients with knee OA were randomized 1:1 to 12 weeks of supervised exercise therapy 3 times/week (ET) or a no-attention control grou...

Objectives: The aim of this study was to determine the diagnostic performance of dual-energy computed tomography (DECT) to detect and distinguish crystal deposits in a phantom. The primary objective was to determine the cutoff DECT ratio and the cross-sectional area (CSA) of a crystal deposit necessary to differentiate monosodium urate (MSU), calc...

Background Knee osteoarthritis (OA) is a highly prevalent musculoskeletal condition causing pain, physical disability, and reduced quality of life. Exercise and patient education are non-pharmacological interventions for knee OA unanimously recommended as first-line treatments based on extensive research evidence. However, none of the numerous rand...

Background Physical inactivity is a global problem and patients with knee osteoarthritis (OA) are predisposed to inactivity and its health-related consequences. Current guidelines recommend exercise as primary treatment but whether this affects time spent physically inactive is unknown. The objective was to investigate changes in physical inactivit...

Study design: Randomized controlled trial with 1-year follow up. Objective: To assess whether people with low back pain (LBP) and self-reported physically demanding jobs, benefit from an occupational medicine intervention, in addition to a single hospital consultation and an MRI, at 1 year of follow-up. Secondly, to examine whether the positive...

Osteoarthritis (OA) is defined by clinical symptoms and radiological signs. Cartilage is crucial in the development, but all tissue components in and around the joint are affected by the disease. OA aetiopathogenesis is multifactorial and may be primary (idiopathic) or secondary, with an influence of heritable factors. Contributing to OA developmen...

Objectives: To study if clinical, radiographic and MRI markers can predict MRI and radiographic damage progression and achievement of stringent remission in patients with established RA in clinical remission followed by a targeted treatment strategy. Methods: RA patients (DAS28-CRP <3.2, no swollen joints) receiving conventional synthetic DMARDs...

Objectives To investigate biomechanical changes in lumbar disc herniations.Methods Patients with lumbar disc herniation verified on a 1.5–3-T magnetic resonance imaging (MRI) scanner were imaged in a weight-bearing 0.25-T MRI scanner in (1) standing position, (2) conventional supine position with relative lumbar flexion, and (3) supine position wit...

Objectives To explore whether trial population characteristics modify treatment responses across various interventions, comparators and rheumatic conditions. Methods In this meta-epidemiological study, we included trials from systematic reviews available from the Cochrane Musculoskeletal Group published up to 23 April 2019 in Cochrane Library with...

Background Achieving remission according to stringent criteria such as Simplified Disease Activity Index (SDAI) and ACR/EULAR Boolean remission is associated with a better long-term outcome in patients with RA ¹ . Possible predictors of achieving stringent remission in patients in clinical remission, following targeted treatment strategies, have no...

Background The effect of different treatment escalations on MRI inflammation in rheumatoid arthritis (RA) patients following an MRI treat-to-target (T2T) strategy has not previously been investigated. Objectives To compare the effect of different treatment escalations on MRI inflammation, physical function and disease activity in RA patients in cl...

Background There is a strong association between gout and obesity. Lowering urate is the cornerstone of gout management [1] and urate levels correlate strongly with central obesity. Previous studies suggest that weight loss has a positive effect on serum urate, however, the studies are sparse and small [2]. Objectives To assess the impact of an in...

Objectives We aimed to investigate existing literature on the impact of physical activity and exercise (PA) on joint biochemical markers (BM) and magnetic resonance imaging (MRI) outcomes in osteoarthritis (OA), and on this basis propose directions for future research. Design Literature Review. Method Original papers were identified in PubMed, Em...

Objective To study the impact of weight loss on inflammation in individuals with overweight and knee osteoarthritis (OA) using both static- and dynamic contrast-enhanced (DCE)-MRI and assess the association of these changes to pain. Design Individuals with overweight (BMI > 27) and knee OA were examined before and after a >5% weight loss over 8 we...

Objective To describe spontaneous changes in time spent being physically inactive that is measured continuously by accelerometry during an 8‐week weight‐loss intervention in overweight/obese individuals with knee osteoarthritis (OA). Methods This study was designed as an observational cohort study including individuals from an OA outpatient clinic...

Acoustic myography (AMG) is a non-invasive method to assess muscle function during daily activities. AMG has great scope for assessment of musculoskeletal problems. The aim of this study was to create an AMG data set for general clinical use and relate these findings to age and gender. 10 healthy subjects (5 men/5 women), in each decade from 20 to...

Isokinetic and isometric force measurements involving a dynamometer setup are widely used in training and in muscle assessment. For further understanding of the method, we investigated the activation of key functional muscles during isokinetic and isometric movements. During force measurements in an isokinetic Biodex System 3 ProTM, acoustic myogra...

Objective To investigate the association between pain and perfusion in bone marrow lesions with and without cysts assessed dynamic contrast-enhanced (DCE)-MRI in patients with knee osteoarthritis. Subjects and methods In a cross-sectional setting, perfusion in bone marrow lesions was assessed using 3 Tesla MRI and correlated (Spearman’s rank corre...

Magnetic resonance imaging (MRI) has an established role in the assessment of degenerative musculoskeletal conditions. However, conventional supine MRI findings often correlate poorly with clinical findings. Some patients experience accentuated back pain in the weight-bearing position. Therefore, supine MRI may underestimate the severity of degener...

Symptoms of degenerative lumbar spinal stenosis include back pain, radiculopathy, claudication, and muscular fatigue that tend to be predominant in the standing position or during walking. Lumbar spondylolisthesis is also a well-known cause of spinal stenosis, lateral recess, and neural foraminal narrowing that tends to become more severe in the up...

Background and Aims: Obesity is an increasing problem in patients after total knee replacement. The aim of this study was to investigate whether a weight loss intervention before primary total knee replacement would improve quality of life, knee function, mobility, and body composition 1 year after surgery. Material and Methods: Patients scheduled...

Objective: To evaluate the structural effects of weight loss on hip or knee osteoarthritis (OA) and to summarize which structural joint pathologies have been examined and the evidence for the outcome measurement instruments applied. Design: Based on a pre-specified protocol (available: PROSPERO CRD42017065263), we conducted a systematic search o...

Background: Exercise therapy is recommended for knee osteoarthritis (OA), but the underlying mechanisms of pain relief are not fully understood. The purpose of this study was to explore the effects of exercise on muscle perfusion assessed by dynamic contrast enhanced MRI (DCE-MRI) and its association with changes in pain in patients with knee OA....

Objective: The aim was to explore dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as an early marker of therapeutic response in patients with rheumatoid arthritis (RA) starting treatment with certolizumab pegol (CZP). Method: In 40 RA patients initiating CZP (27 patients) or 2 weeks of placebo (PCB) followed by CZP (13 patients), DCE...

Background: One of the big contributors to physical inactivity in the elderly population is osteoarthritis (OA) of the knee. Digital motivation seems to have a positive effect on individual physical inactivity level, but limited evidence exists on the effects of digital motivation on patients with knee OA. Objective: To investigate if motivation...

Introduction The Global Burden of Disease 2010 study ranked osteoarthritis (OA) as a leading cause of years lived with disability. With an ageing population, increasing body weight and sedentary lifestyle, a substantial increase especially in knee OA (KOA) is expected. Management strategies for KOA include non-pharmacological, pharmacological and s...

Background Occupational medicine seeks to reduce sick leave; however, evidence for an add-on effect to usual care is sparse. The objective of the GOBACK trial was to test whether people with low back pain (LBP) in physically demanding jobs and at risk of sick leave gain additional benefit from a 3-month complex intervention that involves occupation...

Objective In an eHealth setting, to investigate intra- and inter-rater reliability and agreement of joint assessments and disease activity score (DAS28CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training. Methods Patients with DAS28CRP ≤5.1 were included in a prospective cohort study (clinicaltr...

Abstract The condition of active muscles determines an individual′s ability to carry out daily activities and has implications for an athlete′s performance. Multi‐frequency bioimpedance (mfBIA) is a non‐invasive, well‐known, validated, and much used method to assess muscle condition. However, it is rarely used to its full potential. Our aim was to...

Background Weight loss is recommended as treatment of concomitant knee osteoarthritis (OA) and overweight. The GLP-1 receptor agonist liraglutide has been shown effective in maintaining or even further reducing weight loss, but the compound has not been tested in a population of patients with overweight and knee OA. Objectives The objective of thi...

Background Progression of structural joint damage occurs in 20-30 % of patients with rheumatoid arthritis (RA) in clinical remission¹. Magnetic resonance imaging (MRI)-detected synovitis and in particular osteitis/bone marrow edema (BME) are known predictors of structural progression in both active RA and in remission, but the predictive value of a...

Objective To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA). Methods An exploratory prospective cohort study enrolled patients with PsA initiating biologic or conventional synthetic disease‐modifying antirheumatic drugs in...

Introduction With an increasing prevalence of citizens of older age and with overweight, the health issues related to knee osteoarthritis (OA) will intensify. Weight loss is considered a primary management strategy in patients with concomitant overweight and knee OA. However, there are no widely available and feasible methods to sustain weight loss...

Objectives To investigate if self-reported high physical demand at work, objective physical workload using a job exposure matrix (JEM) and fear-avoidance beliefs are associated with reported sick leave in the previous year in persons with low back pain (LBP). Second, to investigate if the effects of fear-avoidance and self-reported high physical de...

Importance Whether using magnetic resonance imaging (MRI) to guide treatment in patients with rheumatoid arthritis (RA) improves disease activity and slows joint damage progression is unknown. Objective To determine whether an MRI-guided treat-to-target strategy vs a conventional clinical treat-to-target strategy improves outcomes in patients with...

Objective: To investigate differences in gait variability induced by two different single-dose opioid formulations and an inert placebo in healthy volunteers and knee osteoarthritis patients. Design: Experimental, randomized, double-blinded, crossover study of inert placebo (calcium tablets), 50 mg of tapentadol, and 100 mg of tramadol. Setting...

Objectives: To assess the efficacy and safety of methotrexate (MTX) in combination with an approved biological agent compared to biological monotherapy, in the management of patients with rheumatoid arthritis (RA). Methods: MEDLINE, EMBASE, CENTRAL and other sources were searched for randomised trials evaluating a biological agent plus MTX versu...

Objective: To assess the effect of quadriceps strengthening on quadriceps muscle force, power, and work and tibio-femoral compressive loads during walking in adults with knee osteoarthritis. Methods: Study design: Two-center, randomized, controlled trial. Intervention: Patients with knee osteoarthritis were randomly allocated to quadriceps str...

Background: Reduction in gadolinium (Gd) contrast agents is wanted due to the uncertainty of the potential side effects. Purpose: To investigate whether it is possible to reduce the contrast dose from conventional double dose to single dose when increasing the field strength from 1.5-T to 3-T for separating early cartilage degeneration from heal...

Background Early cartilage changes in knee osteoarthritis (OA) can be assessed by both intravenous (i.v.) and intra‐articular (i.a.) delayed gadolinium‐enhanced MRI of cartilage (dGEMRIC). Purpose To examine the relationship between i.a. dGEMRIC and delayed gadolinium‐enhanced MRI of menisci (dGEMRIM), and to investigate if the approach can be use...

Objectives: There is a drought of effective treatments of knee osteoarthritis (OA) and new therapies are needed. The present study has been conducted to establish an initial estimate of effectiveness of intra-articular (IA) injection of a proprietary 2.5% cross-linked polyacrylamide hydrogel (PAAG) for the treatment of knee OA symptoms and signs....

Background Targeting MRI remission in rheumatoid arthritis (RA) patients in clinical remission may improve clinical outcome and halt joint damage progression. Objectives To determine whether a treat-to-target (T2T) strategy based on structured MRI assessments targeting absence of osteitis/bone marrow oedema (BME) would lead to improved clinical an...

Background Pain is a major concern for patients with psoriatic arthritis (PsA) in spite of treatment with biologic/conventional disease modifying drugs (b/csDMARDS). Studies on the prognostic role of pain mechanisms in PsA, are scarce. Objectives To investigate the presence of widespread non-arthritic pain (WP) in patients with PsA, and determine...

Background Magnetic Resonance Imaging (MRI) bone marrow oedema (BME)/osteitis and MRI synovitis have been identified as predictors of structural damage progression in rheumatoid arthritis RA.1 2 Targeting MRI remission may reduce inflammation and halt damage progression. Objectives To investigate whether a 2 year treat-to-target (T2T) strategy tar...

Background Biomarker science has advanced to aid in distinguishing between different forms of arthritis: inflammatory arthritides such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA) and osteoarthritis (OA). Biomarkers are also used to assess disease activity. Diagnostic serum biomarkers such as rheumatoid factor (RF) and cyclic-citrulli...

Background Evidence is emerging that pain in rheumatoid arthritis (RA) exists without underlying inflammation. Our objective was to evaluate the prognostic value of pain classification at treatment initiation using the painDETECT questionnaire (PDQ). Outcomes were change in DAS28-CRP and RAMRIS synovitis score. Methods RA patients initiating a dis...