Background: Transarterial periarticular embolization (TAPE) is a new minimal invasive endovascular technique originally developed for the treatment of pain in knee osteoarthritis. TAPE is not yet used to treat monoarthritis in the context of inflammatory rheumatic joint disease.

Objectives: The present concept of proof study evaluated the potential role of TAPE in the treatment of monoarthritis within the context of inflammatory rheumatic joint diseases. Furthermore, it compares the results of TAPE in knee osteoarthritis with those obtained from inflammatory rheumatic joint disease.

Methods: This proof-of-concept study included 19 joints in 16 patients (9 female, 7 male). The study population comprised 13 patients with knee osteoarthritis and 3 patients (6 joints) with inflammatory rheumatic joint disease (including 1 patients with rheumatoid arthritis, 1 patients with psoriatic arthritis, and 1 patients with spondyloarthritis) with an inadequate therapeutic response to intra-articular therapies and/or pain therapy. All patients showed a persistent peripheral monoarthritis of different joint region despite systemic disease-modifying antirheumatic drug (DMARD). The embolisation of small periarticular arteries was performed using the temporary embolic agent imipenem/cilastatin. With regard to TAPE in inflammatory rheumatic joint disease, 3 knee joints, 2 ankle joints, and one radiocarpal joint were treated with TAPE. All patients with knee osteoarthritis (Kellgren-Lawrence Grade 2-3) received TAPE of the knee joint. The severity of pain was measured using the visual analogue scale (VAS), and the safety outcomes were documented. Additionally, periarticular circumference (cm) and range of motion (using the neutral-zero method) were measured in all patients, while follow-up ultrasound and MRI assessments were conducted in a subset of patients.

Results: The median VAS score decreased from 5 (interquartile range: 2-7) (baseline measurement) to 1 (interquartile range: 0-3) at the first day post TAPE and 1 (interquartile range: 0-2) on the third month following TAPE for all patients. In the subgroup-analysis, equal results were observed for knee-ostheoarthritis (baseline measurement: VAS 5 [interquartile range: 2-6,5]; first day post TAPE: VAS 1 [interquartile range: 0-2] and month 3 post TAPE: VAS 1 [interquartile range: 0-3,5]) versus inflammatory rheumatic joint disease (baseline measurement: VAS 5,5 [interquartile range: 5-7]; first day post TAPE: VAS 2,5 [interquartile range: 1-3]) and month 3 post TAPE: VAS 2 [interquartile range: 1-4]). One day after the procedure, 63.2% (12/19) patients demonstrated a reduced periarticular circumference, and 52.6% (10/19) patients showed an improved range of motion. In particular, in patients with inflammatory rheumatic joint disease, ultrasound and MRI demonstrated a reduction of synovitis and joint effusion. TAPE was technically successful in all patients (knee, ankle, and elbow). No intra-procedural complications were observed. In one patient, a transient cutaneous erythema (resolved within seven days) developed and one access-site hematoma occurred. It is important to note that no systemic disease flares were triggered and no long-term complications occurred.

Conclusions: This proof-of-concept study demonstrates that TAPE is both feasible and safe, and associated with significant pain reduction in patients with inflammatory rheumatic monoarthritis refractory to DMARD-therapy. It is recommended that larger prospective clinical studies are conducted in order to evaluate the long-term efficacy, safety, and potential of TAPE in inflammatory rheumatic joint diseases.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.