The metaverse: a new frontier for rheumatology

On 28 October 2021, the company Facebook formally changed its name to Meta. At the time of the name change, Mark Zuckerberg, the CEO of Meta, stated, ‘Today we are seen as a social media company, but in our DNA we are a company that builds technology to connect people, and the metaverse is the next frontier just like social networking was when we got started’ [1].

With one of the largest companies in the world so emphatically embracing the concept of the metaverse, other sectors of society—such as health care—should take notice. Indeed, clinicians and researchers, including in the field of rheumatology, are currently asking questions such as ‘What is the metaverse?’ and ‘How can and should this new realm of technology be used to connect patients and doctors and help promote progress in medicine?’

In general, the metaverse is a form of cyberspace that encompasses virtual reality (i.e. virtual worlds that continue to exist even when participants are not playing the game/interacting in that world) and augmented reality, which combines aspects of both the digital and physical worlds [2]. Although applications of the metaverse are, at the moment, most prolific in games that can be accessed through personal computers, consoles, and smartphones, there is a growing body of literature in medicine discussing how the metaverse can be applied to clinical care.

In the journal Nature Machine Intelligence, Wang and colleagues [3] have proposed a number of applications of what they have termed a metaverse of ‘medical technology and artificial intelligence’, abbreviated MeTAI. One such application entails widespread raw data sharing. The term ‘radiomics’ refers to a method of extracting features from medical images using data-characterization algorithms, and analysing these features to detect patterns not apparent to the naked eye [4]. In rheumatology, radiomics has been used to predict mortality in patients with RA-associated interstitial lung disease [5] and to distinguish between radiographic and non-radiographic axial SpA patients using MRI and clinical risk factors [6]. ‘Rawdiomics’ refers to efforts to use a deep learning workflow derived from raw data to yield diagnostic findings. The lack of widespread research access to tomographic raw data has been a worldwide problem for many years, but with MeTAI, the production of virtual ‘raw’ data can be increased and more easily disseminated. With such substantial amounts of raw data to be produced from CT and other complex imaging studies, rheumatology researchers will be able to create increasingly accurate models of disease and use these algorithms to better prognosticate for individual patients.

Aside from future applications of virtual reality to the practice of medicine, we are already seeing real-time implementation in rheumatologic care. Venuturupalli and colleagues conducted a study of 20 patients with conditions that included RA, lupus and FM and randomized these patients to two virtual reality modules; one module was a guided meditation environment and the other was a respiratory biofeedback environment. After experiencing both modules, patients demonstrated a statistically significant reduction in pain using a Visual Analogue Scale (VAS), and a significant reduction in anxiety using the Facial Anxiety Scale was seen after use of the guided meditation environment module [7]. In a study of 26 patients with FM, Tsigarides and colleagues allowed participants to use four interactive virtual reality programs that had been co-developed with industry partners for use in patients with chronic pain. Following the use of these programs, a 40% reduction in the mean McGill pain questionnaire short-form total score and a 24% reduction in the VAS score compared with baseline were observed [8]. Although small in size, these studies serve as a potential proof of concept and may lead to larger studies involving virtual reality modules for patients with rheumatic diseases and chronic pain conditions.

Indeed, one can foresee a future in which the metaverse as applied to rheumatology creates an entirely new reality for patients, fellows, and practising rheumatologists. Imagine a world in which patients with a myriad of conditions that cause pain and suffering can be prescribed headsets that allow them to use virtual and augmented reality programs to treat their symptoms effectively at relatively low cost and without fear of side effects. Patients with rheumatologic diseases that may be challenging to conceptualize, such as vasculitis, could be guided through virtual representations of their condition, perhaps by literally being led through a tour of their own blood vessels. Patients could also be connected through the metaverse to virtual avatars of real patients or AI-generated avatars representing others with the same disease, thereby creating global communities of support for patients with rheumatic conditions.

For fellows, medical education could be transformed by the ability to simulate, in a virtual world, the feeling of a tendon friction rub or sclerodactyly on exam, thereby enhancing training that applies to the detection of rare manifestations of rare diseases. Virtual reality scenarios would also allow rheumatology fellows to practice counselling patients, and fellows could even experience, through augmented reality, how it feels to be unable to button a shirt when RA is flaring, or to be unable to rise from a chair due to proximal muscle weakness in myositis. Such experiences could be open to practising rheumatologists as well, so as to continue to allow them to empathize with the patient experience. The metaverse could also create, for rheumatologists in practice, forums in which they could observe academic experts perform a virtual exam on a virtual patient or discuss challenging cases, thereby enhancing diagnostic reasoning skills and practice patterns for countless clinicians.

The world of medicine, and the field of rheumatology in particular, is clearly on the precipice of a new and exciting era in which the metaverse, in all its iterations, holds tremendous promise for enhancing research activities and improving the lives of patients. Undoubtedly, technical, legal and ethical issues will arise, and we as a specialty will need to grapple with these challenges. However, such obstacles are worth surmounting, as rheumatologists can and should lead the way in making virtual and augmented reality a part of the everyday lives of our patients.

Data availability

Data are available upon reasonable request by any qualified researchers who engage in rigorous, independent scientific research, and will be provided following review and approval of a research proposal and Statistical Analysis Plan (SAP) and execution of a Data Sharing Agreement (DSA). All data relevant to the study are included in the article.

Funding

No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

Disclosure statement: The author has declared no conflicts of interest.

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