Blood-Induced Joint Damage The Devastating Effects of Acute Joint Bleeds versus Micro-Bleeds

• Published in: Cartilage Vol. 4; no. 4; pp. 313 - 320
• Main Authors: van Meegeren, Monique E.R., Roosendaal, Goris, Jansen, Nathalie W.D., Lafeber, Floris P.J.G., Mastbergen, Simon C.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.10.2013
• Subjects: joint damage; micro-bleeds; acute joint bleed; cartilage; hemarthrosis
• ISSN: 1947-6035; 1947-6043
• DOI: 10.1177/1947603513497569

Objective: Four days of blood exposure leads to irreversible cartilage damage in vitro. In contrast, intermittent intra-articular blood injections twice a week during 4 weeks (mimicking micro-bleeds) in a canine model resulted in transient damage only. In this study, it was evaluated whether acute joint bleeds are more harmful than micro-bleeds in a canine model of knee arthropathy. Design: Seven dogs received 4 sequential daily intra-articular blood injections twice in 2 weeks (mimicking 2 acute 4-day joint bleeds). Seven other dogs received the same blood load but in a total of 8 injections intermittently over the 4-week period with at least 1 day in between (mimicking micro-bleeds over the same timespan). Contralateral knees served as controls. Ten weeks after the last injection cartilage matrix turnover and synovial inflammation were evaluated. Results: Only after the acute joint bleeds the release of newly formed and total (resident) cartilage matrix glycosaminoglycans were increased (P = 0.04 and P = 0.01, respectively). Furthermore, in animals with the acute joint bleeds cartilage glycosaminoglycan content was decreased (P = 0.01) and not in animals with micro-bleeds. Mild synovial inflammation was observed in both groups (both P < 0.0001) but was not different between groups. Conclusions: In contrast to micro-bleeds, 2 acute joint bleeds lead to prolonged cartilage damage independent of the level of synovial inflammation. This model suggests that micro-bleeds are less devastating than acute joint bleeds with respect to joint damage, which might be of relevance to treatment of joint bleeds in clinical practice.