Minimally invasive procedures can reduce osteoarthritis, sacroiliac pain
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Key takeaways:
- Radiofrequency ablation and transcatheter arterial embolization both resulted in reduced pain for patients with OA or chronic SI pain.
- Physical function also improved at all assessed timepoints.
Radiofrequency ablation and transcatheter arterial embolization — both minimally invasive procedures — can improve pain and function in patients with osteoarthritis or chronic sacroiliac pain of degenerative origin, according to data.
“Over the last years, minimally invasive image-guided techniques such as radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) have emerged as promising options in benign painful musculoskeletal conditions refractory to conservative management,” Jacopo Ciaffi, MD, of the IRCCS Istituto Ortopedico Rizzoli, in Bologna, Italy, and colleagues wrote in Seminars in Arthritis and Rheumatism.
“To date, the main application of minimally invasive interventional procedures in the field of rheumatology is the management of symptomatic knee OA or chronic low back pain in patients refractory to conservative treatments and ineligible for surgery,” they added. “Additionally, the potential use of these techniques has been explored in painful musculoskeletal conditions of tendinous or entheseal origin, and in anatomical structures different from the knee, showing durable response.”
To analyze the efficacy of RFA and TAE for managing pain in OA and inflammatory arthritis, Ciaffi and colleagues conducted a systematic review of 164 published articles, as well as separate meta-analyses of 38 randomized controlled trials and 73 non-randomized studies of interventions. One of the studies involved patients with an inflammatory rheumatic musculoskeletal disease — axial spondyloarthritis — while the rest examined patients with OA or chronic sacroiliac pain of degenerative origin.
The main outcome was change in pain intensity from baseline to 1 month, assessed using the zero-to-10 visual analog scale. Additional assessments were made at 3, 6 and 12 months. Functional status was assessed in knee OA using the Western Ontario and McMaster Universities Osteoarthritis Index, and in sacroiliac pain using the Oswestry Disability Index.
According to the researchers, the meta-analysis of randomized controlled trials showed that the mean difference in visual analog scale 1 month after RFA was –3.98 (95% CI, –4.41 to –3.55) for the knee and –3.18 (95% CI, –3.96 to –2.39) for the sacroiliac joints.
Meanwhile, the meta-analysis for non-randomized studies of interventions showed the following mean differences in visual analog scale:
- knee RFA: –4.12 (95% CI, –4.63 to –3.61);
- knee TAE: –3.84 (95% CI, –4.77 to –2.92);
- hip RFA: –4.34 (95% CI, –4.96 to –3.71);
- shoulder RFA: –3.83 (95% CI, –4.52 to –3.15); and
- sacroiliac joints RFA: –4.93 (95% CI, –5.58 to –4.28).
Measures of physical function also improved at all assessed timepoints, the researchers added.
“Although the results of our meta-analysis should be interpreted with caution, it represents the most comprehensive evidence base currently available to support the use of minimally invasive interventional procedures in degenerative [rheumatic musculoskeletal diseases], in particular knee OA and chronic low back pain of sacroiliac origin,” Ciaffi and colleagues wrote.
“Nonetheless, the findings of our meta-analysis reveal that it might be time for rheumatologists to consider the implementation of such strategies also in the management of inflammatory arthritis,” they added. “High-quality [randomized controlled trials] with adequate patient samples and long-term follow-up would be needed to evaluate the risk-to-benefit ratio and to identify the positioning of these treatments in the therapeutic armamentarium of the rheumatologist.”
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