Interventional procedure offers patients a year or more of pain relief from osteoarthritis
New research details the potential of an interventional radiology procedure to provide long-term pain relief for patients suffering from knee osteoarthritis (KOA).
KOA is a painful condition of the knee joint that can be debilitating. It gradually worsens over time, often requiring surgery once it progresses to the point of affecting a person’s ability to perform everyday activities. However, not all patients are candidates for major surgery, which leaves many to suffer when conservative methods fall short.
Genicular artery embolization (GAE) is an interventional procedure that involves embolizing certain arteries that supply blood to the knee joint. This reduces inflammation and pain, and allows patients to achieve relief without having to undergo surgery and months of physical therapy during recovery.
“In KOA, low-grade inflammation and pro-angiogenic signals promote neoangiogenesis in the synovium and osteochondral junction, along with nerve growth that can become pain-sensitized; GAE is thought to target these abnormal vessels to suppress inflammation, angiogenesis, and neural sensitization,” Bedros Taslakian, MD, with the department of radiology at NYU Grossman School of Medicine, and colleagues explained in the Journal of Interventional Radiology. “This mechanism of action suggests both opportunities for symptomatic relief and disease modifying effects; however, the specific biochemical changes induced, and their long-term impact require further validation.”
To get a better idea of the safety and long-term efficacy of GAE, researchers conducted a prospective, single-arm clinical trial of patients with symptomatic KOA for whom conservative management did not provide relief over a period of three months. Each patient was treated via GAE using 250-μm microspheres, following up 1-, 3- and 12-months post-procedure. Participants also provided baseline blood samples (to check for inflammatory markers) and underwent MRI exams of the knee before and 3 months after GAE.
The procedure technical success rate was 100% and no adverse events occurred. The clinical success rate was 62%, with a mean VAS pain score decrease of 48.5% at 1 month, 50.8% at 3 months and 55.4% at 12 months; similarly, WOMAC pain scores improved by 39.6% at 1 month, 50.1% at 3 months and 43.7% at 12 months.
What’s more, patients’ bloodwork at 12 months revealed statistically significant decreases in the serum levels of vascular endothelial growth factor (VEGF) and Interleukin-1 receptor antagonist (IL-1Ra), both of which likely contributed to the patients reduction in pain and inflammation. The authors suggested these markers offer a more objective means of measuring the effectiveness of GAE.
“Research suggests that VEGF contributes to the structural alterations associated with OA, including cartilage degradation, subchondral bone sclerosis, and osteophyte formation,” they explained. “Given these associations, VEGF can potentially serve as a biomarker for objective evaluation of treatment response in KOA, and GAE may slow the progression of KOA by reducing VEGF levels. A decrease in VEGF levels would ideally be associated with stabilization or lack of progression in the structural components of OA.”
The team added that VEGF levels should be studied further on larger sample sizes within the OA population to determine its utility as an objective biomarker.
Learn more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.