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

机译：血液引起的关节损伤：急性关节出血与微出血的破坏作用

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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.
机译：目的。血液暴露四天会导致体外不可逆的软骨损伤。相反，在犬模型中，在4周内每周两次间歇性关节腔内血液注射（模仿微出血）仅导致短暂性损伤。在这项研究中，评估了在膝关节关节炎的犬模型中急性关节出血是否比微出血更有害。设计。七只狗在2周内两次连续4次每天进行关节腔内血液注射（模仿2次急性4天关节出血）。另外七只狗接受了相同的血液负荷，但在4周内间歇性地进行了8次注射，两次注射之间至少间隔了1天（在相同的时间间隔内模拟了微出血）。对侧膝盖作为对照。最后一次注射后十周，评估软骨基质更新和滑膜炎症。结果。仅在急性关节出血后，新形成的软骨和总（驻留）软骨基质糖胺聚糖的释放才增加（分别为P = 0.04和P = 0.01）。此外，在具有急性关节出血的动物中，软骨中的糖胺聚糖含量降低（P = 0.01），而在具有微出血的动物中则没有。两组均观察到轻度滑膜炎症（均P <0.0001），但两组之间无差异。结论与微出血不同，有2次急性关节出血导致软骨损伤延长，而与滑膜炎症水平无关。该模型表明，就关节损伤而言，微出血比急性关节出血的破坏力要小，这在临床实践中可能与治疗关节出血有关。

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