OBJECTIVE Hemorrhagic arthritis (HA) is a common disease of the musculoskeletal system caused by hemorrhage in the joints, leading to damages in the synovium and cartilage. Pure platelet-rich plasma (P-PRP) has been recently demonstrated to have anti-inflammatory and regenerative potential attributed to the various cytokines and growth factors that it contains. The aim of this study was to investigate the efficacy of P-PRP for the treatment of patients with mild and severe HA. METHODS Autologous blood was withdrawn from the New Zealand rabbits and injected into their left and right knees to establish the HA models. The injection was performed once a week and repeated for 8 weeks to establish the mild HA models and for 16 weeks to establish the severe HA models. One hundred microliters of P-PRP was injected into the left HA knees, and the same volume of sterile 0.9% saline was injected into the corresponding right knees. MRI examination, H&E staining, and toluidine blue staining were respectively performed to evaluate the histological difference of synovium and cartilage between the P-PRP treated and untreated mild and severe groups. Normal knees were set as the control group. RESULTS Pathological changes including tissue color, joint effusion, and synovium inflammation in the mild treated group were less severe compared to the other three experimental groups based on gross observation. The difference of joint cavity diameter between the mild treated and untreated groups was 2.67 ± 0.75 mm (95%CI, 1.20-4.14 mm), which was significantly larger than that between the severe treated and untreated groups (1.50 mm ± 0.48, 95%CI, 0.56-2.44 mm) (mean difference in joint cavity, 1.17 ± 0.32 mm; 95%CI, 0.49-1.85 mm; P < 0.01). MRI examination showed the synovitis and bone marrow edema were less severe in the treated groups compared to the corresponding untreated groups. H&E staining of the synovium suggested that the inflammation was much less and the cell number was much smaller in the treated than in the untreated HA knees in regard to both the mild and severe groups. The mean difference of cell number between the mild treated and untreated groups was 307.40 ± 14.23 (95%CI, 241.54-343.26; P < 0.001), which was 699.20 ± 82.80 (95%CI, 508.26-890.14; P < 0.001) between the severe treated and untreated groups. H&E staining and toluidine blue staining of the cartilage exhibited an obvious amelioration of inflammation and cartilage matrix loss after being treated with P-PRP for both groups, especially the mild group. CONCLUSIONS P-PRP was effective for the treatment of HA by inhibiting the development of synovitis and cartilage matrix loss in the affected joints, which was particularly obvious in the early-stage HA. This study supports the view that there is a great potential of P-PRP to be considered and used as a non-operative treatment for hemorrhagic arthritis at its early stage.

中文翻译：

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纯净的富含血小板的血浆有助于在兔出血性关节炎膝关节模型中修复受损的软骨和滑膜。

目的出血性关节炎（HA）是肌肉骨骼系统的常见疾病，由关节出血引起，导致滑膜和软骨受损。最近已证明，纯净的富含血小板的血浆（P-PRP）具有抗炎和再生的潜力，这归因于其所含的各种细胞因子和生长因子。这项研究的目的是研究P-PRP在轻度和重度HA患者中的疗效。方法从新西兰兔身上抽取自体血，并注入其左右膝盖以建立HA模型。每周进行一次注射，并重复8周以建立轻度HA模型，并重复16周以建立重度HA模型。将一百微升P-PRP注入左HA膝盖，然后将相同体积的0.9％无菌生理盐水注入相应的右膝。分别进行MRI检查，H＆E染色和甲苯胺蓝染色，以评估P-PRP治疗组与未治疗的轻，重度组之间滑膜和软骨的组织学差异。正常膝关节作为对照组。结果根据肉眼观察，与其他三个实验组相比，温和治疗组的病理变化（包括组织颜色，关节积液和滑膜炎症）不那么严重。温和治疗组和未治疗组之间的关节腔直径差异为2.67±0.75 mm（95％CI，1.20-4.14 mm），显着大于严重治疗组和未治疗组之间的关节腔直径差异（1.50 mm±0.48，95％） CI，0.56-2。44毫米）（关节腔中的平均差异为1.17±0.32毫米; 95％CI为0.49-1.85毫米; P <0.01）。MRI检查显示，与相应的未治疗组相比，治疗组的滑膜炎和骨髓水肿较轻。滑膜的H＆E染色表明，就轻度组和重度组而言，与未治疗的HA膝相比，治疗后的炎症要少得多，细胞数要少得多。轻度治疗组和未治疗组之间的平均细胞数差异为307.40±14.23（95％CI，241.54-343.26; P <0.001），之间为699.20±82.80（95％CI，508.26-890.14; P <0.001）严重的治疗组和未治疗组。H＆两组（尤其是轻度组）接受P-PRP治疗后，软骨的E染色和甲苯胺蓝染色均显示出明显的炎症改善和软骨基质丢失的改善。结论P-PRP通过抑制受影响关节的滑膜炎的发展和软骨基质的流失而有效治疗HA，这在HA的早期阶段尤为明显。这项研究支持以下观点：P-PRP在早期被认为是出血性关节炎的一种非手术治疗方法，具有很大的潜力。