Musculoskeletal Involvement in Hereditary Hemochromatosis
Ankle radiographs showed a normal appearance. Magnetic resonance imaging of the right ankle revealed multiple intraosseous cysts in the talus (arrows in Fig., D and E); there were signs of pericystic edema in the T1 fat-suppressed sequence (arrowheads in Fig., A). Ankle arthropathy due to HH and chondrocalcinosis was diagnosed. Symptomatic treatment with analgesic drugs was prescribed until the current presentation.
Hereditary hemochromatosis arthropathy affects up to two-thirds of patients. It is the presenting symptom in 15% of the cases. Although HH may affect any joint, it has characteristic features that may aid differentiation from other rheumatic diseases such as younger age at onset, location, and male predominance.1
Musculoskeletal symptoms do not seem to respond to iron removal; therapy usually involves symptomatic relief with nonsteroidal anti-inflammatory drugs.1 These patients have a major risk of early secondary osteoarthritis and joint replacement surgery.