Advanced Magnetic Resonance Imaging of Cartilage Components in Hemophilic Joints Reveals that Cartilage Hemosiderin Correlates with Joint Deterioration

Toxic iron levels contribute to hemophilic joint deterioration, according to a study published in Hemophilia.

In this study, researchers recruited 23 participants with hemophilia A or B of all severity levels (severe, moderate, or mild) who were seen consecutively during routine clinic visits over the duration of four months to undergo an MRI examination at 3T and 4-echo 3D-UTE-Cones sequences of one painful or uncomfortable arthropathic joint. The study population was evaluated with a combination of Hemophilia Joint Health Scores (HJHS), and pain scores (visual analogue scale [VAS]). Two musculoskeletal radiologists scored the MRI findings using the International Prophylaxis Study Group (IPSG) MRI scale and each was blinded to the other’s scoring. The researchers used descriptive data to delineate the patient cohort while implementing the Spearman rank test to distinguish correlations between cartilage (T2) MRI findings with pain, HJHS and MRI IPSG scores. Subsequent to testing, two patients in this cohort underwent total knee arthroplasty (TKA), which enabled the linking of histological data with MRI results.

According to the findings of the study, MRI scores did not correlate with pain scores or HJHS. Sixteen joints had enough cartilage for UTE‐T2 analysis, while T2 values for cartilage inversely linked with HJHS (rs = −0.81, P < 0.001) and MRI scores (rs = −0.52, P = 0.037). The authors noted that this outcome was unexpected since UTE‐T2 values diminish with enhanced joint status in patients with osteoarthritis and indicates that iron was present and responsible for the effects. Moreover, histological analysis of cartilage confirmed iron deposition within chondrocytes, associated with low UTE‐T2 values.

“Iron accumulation can occur in cartilage (not only in synovium) and shows a clear association with joint health,” the study authors wrote of their findings. “Since findings from our study revealed that the amount of cartilage iron is associated with deteriorating clinical and imaging joint status, we hypothesize that cartilage iron plays a significant role in the progression of hemophilic arthroplasty. Therefore, cartilage iron could be considered a biomarker of joint health that may become directly quantifiable with innovative joint-specific MRI T2 sequences, thus guiding the adjustment of therapeutic strategies to optimize joint health in patients with hemophilia.”