Rheumatoid arthritis: transarterial microembolization for refractory localized joint inflammation

Area of Science:

• Interventional Radiology
• Rheumatology
• Vascular Medicine

Background:

• Rheumatoid arthritis (RA) can cause persistent localized joint pain despite systemic therapy.
• Periarticular neovascularization contributes to inflammation and pain in RA.
• Current systemic treatments may not fully address localized inflammatory processes.

Purpose of the Study:

• To evaluate the safety and efficacy of transarterial microembolization (TAME) as a localized treatment for RA.
• To assess TAME's impact on periarticular neovascularization and associated symptoms.
• To explore TAME as an adjunct to existing systemic immunomodulatory therapy for RA.

Main Methods:

• Selective transarterial microembolization targeting angiographically identified neovessels in affected joints.
• Intra-arterial delivery of imipenem/cilastatin during the procedure.
• Assessment of hypervascularity via post-embolization angiography.
• Clinical evaluation of pain and function over 12 months.
• Magnetic resonance imaging (MRI) to assess changes in synovial proliferation, edema, and bone marrow edema.

Main Results:

• Post-embolization angiography showed reduced hypervascularity.
• Significant improvement in pain and joint function over a 12-month follow-up period.
• MRI revealed decreased synovial proliferation, periarticular edema, and bone marrow edema.
• The patient's systemic therapy regimen remained unchanged.
• Adverse events were transient, including procedure-related pain and skin discoloration.

Conclusions:

• Transarterial microembolization (TAME) demonstrates potential as a localized adjunct therapy for rheumatoid arthritis.
• TAME effectively reduced neovascularization and improved clinical outcomes in a case study.
• Further prospective studies are warranted to validate TAME for RA management.