Advanced Imaging Needed for Improved Axial Psoriatic Arthritis Diagnosis
A new study published in Rheumatology highlights the limitations of current imaging techniques in detecting early axial psoriatic arthritis (PsA) and calls for advanced imaging modalities to better visualize spinal ligamentous soft tissue involvement.
Magnetic resonance imaging (MRI) has significantly advanced the understanding of inflammatory arthritis, particularly in axial spondyloarthritis. It has clarified the role of subfibrocartilaginous osteitis and perientheseal vertebral body osteitis, as well as their contribution to spinal new bone formation. However, researchers emphasize that MRI fails to adequately visualize spinal entheseal soft tissue and contiguous ligamentous structures in early axial PsA, leaving a crucial gap in diagnostic accuracy.
"Established or late-stage axial PsA cases often exhibit impressive para-marginal or chunky syndesmophytosis on conventional X-ray that pathologically represents entheseal soft tissue ossification," the study notes. This suggests that ligamentous pathology plays a major role in disease progression and should be a primary focus of imaging advancements.
The study calls for a refined imaging approach to better define early disease, predict outcomes, and guide therapy selection. Researchers argue that current imaging methods overlook a critical component of PsA immunopathology, making it difficult to establish a gold standard for axial PsA diagnosis.
"We issue a clarion call to focus advanced imaging methodology on spinal ligamentous soft tissue that represents the last hidden backwater of PsA immunopathology that needs visualization," the authors stated.
These findings underscore the need for innovative imaging solutions to improve the diagnosis, prognosis, and management of axial PsA, particularly in early-stage disease.
Reference
Abacar K, Rennie WJ, Raychaudhuri SP, Chaudhari AJ, McGonagle D. Focusing on ligamentous soft tissue inflammation for the future understanding of early axial psoriatic arthritis. Rheumatology (Oxford). 2024;63(Supplement_2):ii7-ii14. doi:10.1093/rheumatology/keae568
