Osteoarthritis is a chronic disease that causes numerous mobility and independence issues around the world. It is estimated that by 2025, more than one billion people will be affected by osteoarthritis by 20501. This disease is one of the leading causes of physical decline in people over the age of 60. With the global aging of the population, the health and economic impact of osteoarthritis is expected to intensify².

Long considered a benign disease, recent studies have shown that patients with osteoarthritis have a higher risk of mortality than the general population, particularly due to an excessive number of cardiovascular diseases, which are partly linked to a decline in physical abilities².

These comorbidities (diseases or health problems that exist alongside another primary disease) show how important it is to manage osteoarthritis holistically, taking into account all aspects of the patient's health. 

This is because osteoarthritis is associated with an increased risk of all-cause mortality, particularly cardiovascular mortality in the case of hip and knee osteoarthritis ^{27 28 29}.

In a society with an aging population and increasing rates of obesity, especially in developed countries⁴, the consequences of osteoarthritis may be underestimated by society and authorities due to a lack of awareness and research resources. 

However, its impact on the daily lives of those affected is considerable, and the associated costs, whether direct or indirect, are very significant...

A debilitating global disease with unmet medical needs to date:

Osteoarthritis is a serious disease. It causes pain and directly affects the mobility and independence of those affected. Osteoarthritis is one of the leading causes of disability worldwide in people over the age of 60¹. In 2019, hip and knee osteoarthritis ranked 12th globally among the factors that contributed most to years lived with disability, an increase of more than 30% over the past 20 years⁷. 

The joints most commonly affected by osteoarthritis are those of the hands (in 35 to 45% of cases), the spine (in 45 to 50% of cases), the knees (in 30% of cases, known as gonarthrosis) and the hips (in 10% of cases, known as coxarthrosis). Osteoarthritis of the spine is common in people aged 65–75, but it usually remains silent. Other joints—shoulders, toes, ankles, wrists, and elbows—are less commonly affected⁸. 

•    Nonsteroidal anti-inflammatory drugs (NSAIDs) provide relief but are suitable for very few patients. Long-term use of oral NSAIDs can cause serious side effects and upper gastrointestinal damage¹¹.

•    Opioid derivatives are generally poorly tolerated and have not been shown to have any clinically significant effect on osteoarthritis pain. Furthermore, the major risk of dependence is a real public health problem today²⁰. 

•    Corticosteroid injections can only be used during inflammatory flare-ups. The effects and quality of evidence, even in the short term, are weak, with a risk of post-infection²¹.

• After suffering from limited evidence of their effectiveness (delisting in March 2015), the therapeutic class of slow-acting anti-arthrosics (AASAL) in France is now strongly discouraged by osteoarthritis guidelines²³. These recommendations also apply to glucosamine and chondroitin sulfate as dietary supplements²⁴. 

• Hyaluronic acid injections (which are relatively expensive), intended to compensate for cartilage destruction, have not provided sufficient evidence of clinical efficacy beyond the placebo effect in randomized controlled trials, which explains why they have not been reimbursed on the French market by the national health insurance system since 2017. However, for some patients, this option remains a temporary relief solution with few side effects¹⁴.

Therefore, the only truly effective measures for improving patients' quality of life are weight loss, when necessary, and regular physical activity, which mobilizes and strengthens the joints while maintaining muscle strength. Unfortunately, it is not known whether this actually slows the progression of the disease. 

Finally, prosthetic replacement may be considered when the joint is too damaged, but this remains an invasive surgical procedure.

The role of surgery 

As the ultimate treatment for arthritic joints, the insertion of a prosthesis requires surgery (arthroplasty). It is mainly used in certain locations, particularly the hip and knee, when functional impairment is too severe and disability becomes severe (when walking is no longer possible for daily activities and/or the pain is too severe)¹³.

Arthroplasty involves replacing all or part of the diseased joint with an artificial joint (prosthesis). This artificial joint usually significantly improves patients' quality of life and mobility, but its effectiveness is limited to an average of 15 years. Although this surgery produces very good results for the hip, 20% of patients will continue to suffer after the operation⁸.

Surgery is also associated with a longer recovery time, a risk of nosocomial infection, and a risk of complications following general anesthesia, particularly in elderly patients. 

Given this proven unmet medical need, it is essential to develop new treatments to combat the pain associated with osteoarthritis.

Osteoarticular embolization  ? 

Intra-arterial embolization is a medical technique that can be used to treat certain musculoskeletal disorders, such as tendon pain. This method is based on a simple idea: in painful areas, such as tendons or muscle attachment points, new small blood vessels form. Embolization aims to block these abnormal vessels to reduce inflammation and relieve pain. 

In certain types of joint pain associated with musculoskeletal disorders (MSDs), inflammation can cause new blood vessels to form in the membrane surrounding the joint (called the synovium). This change in blood flow can perpetuate the pain.

Researchers therefore hypothesized that blocking these small abnormal vessels using a technique called embolization could reduce inflammation and, as a result, relieve pain^{15 16 19}. Clinical studies have demonstrated the effectiveness of this protocol for the knee and shoulder^{15 19}.

Embolization is a minimally invasive medical technique that can be performed regardless of the patient's age or the severity of the disease. It is performed under local anesthesia, which means that only the treated area is numbed, without the need to anesthetize the entire body^{16 30}.

The doctor accesses blood vessels^{16 30} by inserting a small tube (called a catheter) into an artery, often in the wrist (radial artery) or groin (femoral artery). This tube allows the doctor to navigate inside the blood vessels to the area to be treated, for example, the small arteries around the knee.

Once there, the doctor injects a product to block the vessels responsible for the pain or inflammation^{16 30}. The opening made in the skin is very small (1 to 2 mm) and is closed at the end of the procedure, either by simple pressure or with the help of a small device.

This outpatient technique often allows patients to return home the same day or the next day¹⁷. 

Imported from Japan, osteoarticular embolization is a new therapeutic tool that could play an increasingly important role in the treatment of chronic pain in mechanical osteoarticular pathologies prone to inflammatory flare-ups.

“Interventional radiologists are medical specialists who use medical imaging (such as ultrasound, CT scans preferably CBCT*, or MRI) to perform medical or surgical procedures.”

FOCUS: Interventional radiology?

Interventional radiologists are medical specialists who use medical imaging (such as ultrasound, CT scans, or MRI) to perform medical or surgical procedures.

Thanks to medical imaging, they can guide small instruments (such as needles or catheters) to:

•    treat pain (for example, in the joints or spine),

•    unblock or block blood vessels,

•    drain abscesses,

•    or even treat certain cancers.

These procedures are often less painful, have a shorter recovery time, and can sometimes avoid the need for conventional surgery.