ADOPTION of cutting-edge imaging technologies and innovative use of existing methods may revolutionize the diagnosis and treatment of inflammatory arthritis. This is according to a presentation delivered by Georg Schett, Friedrich-Alexander University, Erlangen, Germany, to attendees at the 2024 Congress of Clinical Rheumatology West, San Diego, California, September 26-29, 2024.
Schett highlighted the potential of machine learning in processing MRI data to differentiate between types of inflammatory arthritis, such as psoriatic arthritis (PsA) and rheumatoid arthritis (RA). “You can train a machine to recognize patterns of inflammation specific to certain diseases,” he said, suggesting that this approach could significantly enhance early diagnosis and disease differentiation.
In addition to machine learning, Schett emphasized the value of surface changes, like erosions and osteophytes, in identifying early disease onset. He proposed that high-resolution CT imaging could be pivotal for evaluating bone mass and detecting cortical bone changes in RA patients. CT can also help assess the effectiveness of treatments by identifying erosion repair, areas where traditional X-rays may fall short.
Schett introduced multispectral optoacoustic tomography (MSOT) as an exciting new tool. Combining laser and ultrasound, MSOT enables visualization of entheseal tissue in PsA and psoriasis patients, helping to predict which patients with psoriasis may progress to PsA.
While MRI can measure water content in tissues, Schett noted the future potential of measuring oxygen and tissue composition. Functional imaging, however, remains underdeveloped.
Schett also discussed the emerging role of fibroblast activation protein inhibitors, used in cancer treatments, to target fibroblasts in RA. PET imaging could assess tissue responses to these treatments, potentially guiding personalized therapy.
“We need better imaging to understand the tissue response in inflammation,” Schett concluded, underscoring the shift toward precision medicine in rheumatology.
Reference: Schett G. Imaging in Inflammatory Arthritis: Progress Towards Precision Medicine. The Congress of Clinical Rheumatology West. Sept. 26-29, 2024.
Anaya Malik | AMJ
