Transarterial embolization in inflammatory arthritis: will rheumatology shape the debate or inherit it?

Abstract The expanding use of transarterial embolization for musculoskeletal pain, most commonly operationalized as genicular artery embolization in osteoarthritis, raises a broader question that rheumatology has not yet systematically addressed: might a vessel-targeted, image-guided intervention complement pharmacological care in selected patients with inflammatory arthritis? Despite advances in treat-to-target strategies, a single persistently inflamed joint can remain the dominant source of pain and disability while composite disease activity scores indicate target achievement. When that joint is refractory and systemic escalation is either disproportionate or infeasible, the therapeutic options are narrow and poorly evidenced. This review argues that the rheumatology community should be defining where, when, and for whom transarterial embolization might have a legitimate place–its positioning within the inflammatory arthritis therapeutic landscape–rather than allowing this to be shaped, by default, through fragmented case-based experience and a literature centred predominantly outside the discipline. Drawing on the neurovascular biology of synovitis, the osteoarthritis evidence, and emerging reports in inflammatory conditions, we map the scenarios in which the question is starting to surface and outline what a deliberate positioning effort would require. In doing so, we recognise that no prospective, randomised, or disease-specific data currently support transarterial embolization in this setting, and that the available signal is limited to isolated case reports. However, defining a shared language now, before uncritical diffusion occurs, is a prerequisite for responsible investigation.