Rapid encapsulation of most foreign bodies composed of lead occurs via fibrosis, and this process essentially removes them from exposure to circulating body fluid with a subsequent drop in serum lead levels [
13,
16,
17]. However, exposure of a leaded bullet to synovial fluid leads to rapid degradation and hence result in systemic absorption, causing local and systemic symptoms of lead intoxication [
3,
4,
6,
7,
10,
14]. Two factors responsible for the dissolution of lead fragments in synovial fluid are the presence of hyaluronic acid and the ph of synovial fluid [
8]. On the other hand mechanical destruction of joint may be caused by several factors. Firstly the initial trauma may cause fractures of articular bone, leading to an incongruous and irregular joint surface. Motion of such surfaces against each other may lead to joint destruction. Secondly, when a bullet hits the bone; its articular cartilage, bone and pieces of lead may fragment, leading to intra articular debris that can pit and erode the joint surfaces. Thirdly, a bullet embedded in bone may extend partially into the joint; further motion can results in additional destruction of cartilage [
10‐
12,
14,
18]. Toxic histologic manifestations of intra-articular lead have also been reported in animal models by Bolanos et al [
19] and Harding et al [
20]. Harding et al [
20] studied the effects of intra-articular lead implants on the synovium, articular cartilage and meniscus of white rabbits at 4, 6, 10 and 14 weeks. Articular and meniscal changes that Harding et al came across were chondrocyte proliferation, disorganization of the columnar epithelium. Tide mark duplication and unequal thickness of the cartilage was observed in the articular cartilage while the synovium showed both cellular and stromal hyperplasia [
20].
If lead arthropathy is identified, removal of lead fragments [
14,
15,
21] is mandatory along with other procedure/s as indicated by the condition of the joint. Intraarticular lead poisoning has been reported in the literature in the context of gout, synovitis and degenerative joint diseases along with systemic lead poisoning [
3,
4,
7,
10,
13,
14,
16,
22,
23]. All patients with lead arthropathy should be evaluated for systemic lead toxicity [
18].