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Intra-arterial Infusion of Temporary Embolic Agent as a New Treatment in a Patient With Osteoarthritis of the Fingers

Abstracts


Osteoarthritis (OA) of the hand is highly prevalent with women over the age of 50, and the distal interphalangeal (DIP) joint is the most common site. The initial treatment of DIP-OA is usually conservative. Non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular steroid injections only provide temporary relief of symptoms. Arterial embolization is an emergent minimally invasive procedure in treatment of knee and trapeziometacarpal OA with safety and durable efficacy. Herein, we present a case with symptomatic DIP-OA successfully treated by intra-arterial infusion of temporary embolic agent. A 67-year-old woman with osteoporosis presented to our out-patient department with a 2-year history of fingers pain of the right hand. She suffered with pain, swelling and stiffness in multiple DIP joints, with the worst pain at the DIP joint of the 3rd finger. Her finger pain is still annoying despite receiving conservative treatments and taking oral NSAIDs. On a 10-cm visual analog scale (VAS), the pain score was 8 cm at the first visit. The plain radiography of her right hand revealed DIP joint space narrowing of the 2nd-5th fingers, with joint space loss, osteophytes formation and subchondral sclerosis at the 3rd finger. An intra-arterial infusion of imipenem/cilastatin sodium (IPM/CS) under both ultrasound and fluoroscopy was performed. After local anesthesia, the radial artery (RA) in the distal forearm was antegradely punctured using a 21-gauge needle under ultrasound. Then, diluted IPM/CS was injected into distal RA directly, and the embolic agent moving to the target DIP joints was confirmed under fluoroscopy. The VAS score decreased to a 2 cm immediately after arterial embolization and kept decreasing to 0 cm in 1 month. Her swelling and stiffness were also partially improved. Her pain score was 0 cm in 6 months without taking any analgesic. Intra-arterial infusion of IPM/CS directly into RA is a minimally invasive procedure in treatment of DIP-OA of the hand with durable efficacy. Intra-arterial infusion of IPM/CS can be performed with or without fluoroscopy. It is a feasible treatment option for patients with refractory DIP-OA of the hand.