Embolisation of abnormal neovessels relieves osteoarthritic knee pain

By Lucy Piper, Senior medwireNews Reporter

Transcatheter arterial embolisation relieves knee pain in patients with moderate osteoarthritis who are resistant to pharmacological pain management, research suggests.

“This treatment is based on the notion that increased number of blood vessels and accompanying nerves are a possible source of chronic pain and that occlusion of these abnormal vessels might reduce such pain”, explain the researchers, led by Yuji Okuno (Edogawa Hospital, Tokyo, Japan).

The technical success rate in 14 patients with mild to moderate knee osteoarthritis was 100%. All abnormal neovessels were located within periarticular soft tissues surrounding the knee joints.

Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores rapidly improved following the procedure. WOMAC pain scores fell from an average of 12.2 to 3.3 at 1 month and 1.7 at 4 months, while total scores fell from 47.3 to 11.6 and 6.3, respectively.

These improvements were maintained in most patients at the final follow-up an average of 12 months later.

The mean overall visual analogue scale scores also decreased significantly, from 70 before treatment to 29 a week after therapy and to 21 and 13 at 1 and 4 months, respectively.

“From our experiences, there were two distinct time points when pain and symptoms improved”, notes the team.

One was soon after embolisation, which the researchers attributed to decreased abnormal blood flow reducing the accompanying sensory nerve stimulation.

There was also a later onset of improvement occurring several weeks or months after embolisation, which is likely to be due to a suppression of inflammation, the researchers suggest.

“Transcatheter arterial embolization might act by stopping the influx of inflammatory cells in synovial tissues and thus have a beneficial effect against inflammation and pain”, they write in Cardiovascular Interventional Radiology.

There were no major adverse events with the procedure and the one incidence of moderate subcutaneous haemorrhage at the puncture site resolved within a week. There were no cases of tissue necrosis, dermal ulcer, tendon or ligament rupture or peripheral paraesthesia.

The team concludes that “transcatheter embolization targeting abnormal neovascularization in osteoarthritis is a feasible and safe interventional radiology procedure”.

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