Transarterial periarticular embolisation in inflammatory rheumatic monoarthritis: a proof-of-concept study

Transarterial periarticular embolisation (TAPE) is a minimally invasive endovascular technique established for the treatment of knee osteoarthritis (OA). Its role in inflammatory rheumatic monoarthritis has not yet been investigated. This proof-of-concept study evaluated the feasibility, safety, and clinical effects of TAPE in inflammatory rheumatic monoarthritis and compared outcomes with those in knee OA.

Seventeen joints in 14 patients (7 female, 7 male) were treated, including eleven patients with knee OA and three patients (6 joints) with inflammatory rheumatic joint diseases (rheumatoid arthritis, psoriatic arthritis, or spondyloarthritis) refractory to intra-articular and systemic therapy with disease-modifying antirheumatic drugs (DMARDs). TAPE was performed using the temporary embolic agent imipenem/cilastatin. Treated joints included knees, ankles, and one radiocarpal joint. Pain was assessed using the visual analogue scale (VAS). Safety outcomes, periarticular circumference, and joint range of motion were evaluated, with ultrasound and MRI follow-up performed in a subset of patients.

Median VAS scores decreased from 5.0 (IQR 3.00-6.00) at baseline to 1.0 (IQR 0.0-3.0) at day 1 and 1.0 (IQR 0.00-4.25) at day 90 post TAPE. Comparable pain reduction was observed in knee OA and inflammatory rheumatic joint disease. Reduced periarticular circumference was observed in 70.6% and improved joint range of motion in 58.8% of patients. Imaging demonstrated reduced synovitis and joint effusion in inflammatory cases. TAPE was technically successful in all patients and no adverse events occurred.

TAPE is a feasible, safe, and well-tolerated treatment associated with clinically meaningful pain reduction in therapy-refractory inflammatory rheumatic monoarthritis. Larger prospective studies are warranted.