'Better imaging' can improve understanding of inflammatory arthritis
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SAN DIEGO — New imaging technologies, and improved use of the ones currently available, may move rheumatology closer to precision medicine in inflammatory arthritis, according to a speaker at the 2024 Congress of Clinical Rheumatology West.
“I want to talk about better imaging to better understand inflammatory arthritis,” Georg Schett, MD, of Friedrich-Alexander University, in Germany, told attendees.
In his presentation, Schett argued that expanded use of machine learning could help clinicians diagnose undifferentiated arthritis. Entering MRI data into machine learning systems could also be beneficial in distinguishing between the inflammation found in psoriasis, psoriatic arthritis, rheumatoid arthritis or other conditions, he added.
“We can differentiate psoriatic arthritis from rheumatoid arthritis,” Schett said. “You can basically train a machine to recognize a certain pattern of inflammation which is imminent to a certain disease. The more you feed the system, the better this differentiation will get.”
In addition, understanding surface changes can help clinicians diagnose patients sooner, according to Schett.
“Surface changes can also teach us in imaging about the early onset of disease,” he said, noting the presence of erosions and osteophytes as potential targets for imaging. “There is an increasing potential that that is a better way to tell what is going on in arthritis.”
MRI is not the only imaging technique that can be leveraged in this way. According to Schett, high resolution CT can be used for determining bone mass in osteoporosis.
“We can use it also for changes in cortical bone in patients with rheumatoid arthritis,” he said.
CT can also be used to determine whether treatments are working, Schett added.
“With CT, you can also check if you have repair of erosions,” he said.
Importantly, conventional X-ray may be insufficient to view the full scope of these erosions, according to Schett.
“You need a 3D approach,” he said.
Meanwhile, regarding the use of functional imaging in inflammatory arthritis, Schett was less bullish.
“We do not do functional imaging so well,” he said. “It is in its infancy.”
In his comments, Schett said he sought to expand both the use and understanding of currently available methodologies, as well as set goals to find new methodologies.
“There are new possibilities to understand imaging,” he said.
For example, he noted that MRI measures water content.
“We are currently trying to measure oxygen or tissue content,” he said.
One example of a new technology is multispectral optoacoustic tomography (MSOT), according to Schett.
“It is a very simple technology that combines laser with ultrasound,” he said.
This technology allows clinicians to see entheseal tissue in PsA and psoriasis patients, Schett added.
“It is evident that PsA and psoriasis are clustered together,” he said. “The metabolic changes in the tissue have happened already in psoriasis in the enthesis.”
According to Schett, this technology could help determine which psoriasis patients may be likely to progress to PsA.
Lastly, regarding the reaction of tissue to inflammatory arthritis, Schett noted the example of activated fibroblasts that can be found in both cancer and RA.
“We should better understand the tissue response in inflammation,” he said.
A class of drugs called fibroblast activation protein inhibitors can be used to mitigate these fibroblasts. Once this treatment is initiated, imaging can be used to determine its efficacy.
“You basically can detect it with a PET machine, and you can stage a tissue response in the entire patient,” Schett said.
This approach is largely being used in cancer at the moment, but Schett said he believes that it may have applicability in RA.
“We thought this could be very interesting to disentangle inflammation from fibrosis,” he said. “This gives us tools to understand what kind of therapies we should use.”
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Schett G. Imaging in Inflammatory Arthritis: Progress Towards Precision Medicine. Presented at The Congress of Clinical Rheumatology West; Sept. 26-29, 2024. (hybrid meeting).
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