AB0503 GENICULAR ARTERY EMBOLIZATION IN THE MANAGEMENT OF PERSISTENT JUVENILE IDIOPATHIC ARTHRITIS OF THE KNEE: A CASE REPORT

Background Genicular artery embolization (GAE) is rapidly gaining popularity for treatment of patients with recurrent hemarthrosis following knee arthroplasty, and pain relief in mild-to-moderate osteoarthritis (OA) [1]. Despite the growing evidence safety efficacy GAE improving disability OA, it has yet to be reported inflammatory arthropathy, such as rheumatoid arthritis (RA) or juvenile idiopathic (JIA). Objectives To apply on an adult patient oligoarticular JIA refractory biologic therapy, measure improvement symptoms. Methods A 40-year-old woman history presented progressively worsening right swelling. She had tried several treatments past including oral analgesia (NSAIDS, acetaminophen, opioids), multiple intra-articular steroid injections, therapeutic arthrocentesis, DMARDs (MTX, SSZ, LEF), been therapy (adalimbumab) 8 months, no noticeable from any these strategies. Prior she score 8/10 VAS, Oxford Knee Score (OKS) 25. The procedure was subsequently performed outpatient basis under conscious sedation. four French angled tip catheter advanced into distal SFA angiography performed. This demonstrated characteristic synovial hyperemia (“blush”) synovium along medial joint space supplied by musculoarticular branch descending genicular (DGA), well lateral inferior (ILGA). Super-selection DGA using a 1.9 microcatheter, repeat angiogram confirming hyperemia. After administration intra-arterial nitroglycerin, then embolized 1.0 cc 100 – 300 μm Embospheres (Merit Medical Systems, South Jordan, UT). Post-embolization super-selective confirmed “pruned-tree” appearance branches, further hyperemia, keeping successful embolization. Results tolerated discharged home same-day. At 6 12 months follow-up, continued report substantial her symptoms rating 1 out 10 both rest mobalization. Her OKS 35 at months. remained remission Adalimumab post procedure. Figure shows comparison pre fat saturated T1 image. Pre GAE, there were thickening enhancement capsule. As shown 1, significant retraction devascularisation occurred. 1. Modulation Synovitis Post GAE: sagittal coronal contrast (gadolinium) image capsule (A+B). Coronal digital subtraction demonstrating corresponding arterial neovascularization/synovitis blush targeted (C). (12 month) (D). Conclusion We first case which showed dramatic sustained reduction pain. Though efficacy, safety, long-term clinical durability still need evaluation context positive result this posits exciting avenue investigation role transarterial rheumatologic disease. Reference [1]Heller DB, Beggin AE, Lam AH, Kohi MP, Heller MB. Geniculate Artery Embolization: Role Hemarthrosis Osteoarthritis. RadioGraphics. 2022 Jan;42(1):289-301. Acknowledgements: NIL. Disclosure Interests None Declared.