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Oxygenation-driven multimodal photoacoustic/ultrasonic imaging enhances evaluation of enthesitis disease activity in psoriatic arthritis

Year: 2025

Type: article

Abstract: Conventional ultrasound (US) evaluation of enthesitis in psoriatic arthritis (PsA) is limited by its inability to quantify metabolic alterations such as hypoxia, a key driver of disease activity. We introduce an oxygenation-integrated multimodal photoacoustic/ultrasound (PA/US) imaging framework designed to quantify entheseal oxygen saturation (SO 2 ) for assessing entheseal disease activity in PsA. In this cross-sectional study, 25 PsA patients underwent bilateral PA/US imaging of 12 entheses, where ultrasound lesions were scored using the Outcome Measures in Rheumatology scoring system, and PA-derived SO 2 levels, quantified via dual-wavelength PA imaging, were classified into hyperoxia or hypoxia groups using k-means clustering. This approach provides metabolic insights complementary to conventional ultrasonic assessment. A composite score integrating hypoxia with US parameters was validated against clinical disease activity indices (Disease Activity Score 28-C-reactive protein, DAS28-CRP; Disease Activity Index for Psoriatic Arthritis, DAPSA). Among 300 entheses, 103 (34.3%) exhibited PA positivity, with 40 (38.8%) classified as hypoxia. Hypoxia scores independently predicted DAS28-CRP ([Formula: see text] = 0.618, p = 0.001) and DAPSA ([Formula: see text] = 0.612, [Formula: see text]). The hypoxia-optimized PAUS score demonstrated superior correlation with disease activity indices compared to conventional US (DAS28-CRP: r = 0.615, p = 0.001 versus r = 0.474, p = 0.017; DAPSA: r = 0.743, [Formula: see text] versus r = 0.567, p = 0.003), alongside superior diagnostic accuracy for minimal disease activity (area under the curve, AUC 0.776 versus 0.614, p = 0.008) and low disease activity (AUC 0.853 versus 0.772, p = 0.009). This multimodal scoring system enhances the stratification of PsA disease activity by providing unique metabolic insights, offering a potential tool for therapeutic monitoring and guiding treat-to-target strategies.

Source: Journal of Innovative Optical Health Sciences

DOI: 10.1142/s1793545825500270