Rheumatoid arthritis: transarterial microembolization for refractory localized joint inflammation

Transarterial microembolization targets periarticular neovascularization in localized joint pain that persists despite systemic therapy. We report a 31-year-old woman with rheumatoid arthritis involving the elbow, knee, and ankle. The patient underwent selective transarterial microembolization, with intra-arterial imipenem/cilastatin delivered to angiographically identified neovessels. Post-embolization angiography demonstrated decreased hypervascularity. Over 12 months, pain and function improved, and magnetic resonance imaging showed reduced synovial proliferation, periarticular edema, and bone marrow edema. The systemic therapy regimen was maintained unchanged during follow-up. Adverse events were transient and limited to brief procedure-related pain and localized skin discoloration. These observations are hypothesis-generating and support prospective evaluation of TAME as a localized adjunct to systemic immunomodulation.