Embolization treatment eases swelling and pain from recurring rheumatoid arthritis

A 61-year-old woman whose rheumatoid arthritis had left her wrist and fingers swollen, painful and deformed experienced noticeable relief after a minimally invasive embolization procedure. Two months after radial-artery microembolization at Taipei Tzu Chi Hospital, her wrist swelling had decreased and her finger movement had improved.

The woman had received long-term care from a rheumatology and immunology clinic. Although medication had brought her inflammation indicators under control, several joints continued to flare up. She needed regular painkillers, while the disease had already restricted movement and altered the shape of her joints.

Radiologist Chang Hsu-chao said rheumatoid arthritis is a chronic autoimmune disease in which the immune system attacks the synovial lining of the joints. More than 90% of patients develop symptoms in the hands or wrists during the disease course, he said. Prolonged inflammation can damage surrounding cartilage and bone and, in severe cases, cause ligament rupture or deformities such as swan-neck, boutonniere and Z-shaped thumb changes.

The main treatment remains medication to control the body’s immune inflammation. But patients with persistent pain and swelling in one or a few joints may undergo microembolization. Doctors first use angiography to examine blood flow through the radial and ulnar arteries, then inject an embolic medicine that travels to the small vessels around the finger joints. The procedure is covered by Taiwan’s national health insurance, although patients pay for the medication themselves.

Joint discomfort may improve noticeably the day after treatment, with the strongest effect generally appearing after two months. Pain falls by more than half in about 60% to 80% of patients, according to Chang, and benefits can last from several months to several years. Because rheumatoid arthritis is chronic and progressive, however, symptoms and abnormal vessels may return if systemic inflammation is not controlled. People with severe peripheral artery blockage, infectious diseases, diabetes or poor circulation should not receive the procedure because of the risk of tissue ischemia and necrosis.