Haemochromatosis is a systemic disease that affects many organ systems, including the joints, and is characterised by haemosiderin and calcium pyrophosphate deposition.

For a general discussion and links to other system-specific manifestations, please refer to the article on haemochromatosis.

Pathology

Haemochromatosis arthropathy is considered non-inflammatory, although, as in idiopathic osteoarthritis, patients may experience inflammatory flares ⁵.

Microscopic appearance

Synovial haemosiderin deposition differentiates haemochromatosis arthropathy from osteoarthritis and rheumatoid arthritis ⁵.

Associations

• calcium pyrophosphate deposition disease (CPPD): often seen concurrently ^ref

Radiographic features

• arthropathy

  • most commonly involves the hands at the 2nd and 3rd metacarpophalangeal joints and interphalangeal joints of the finger ⁵

  • can also affect large joints, e.g. hip, ankle, elbow, shoulder ⁵

  • symmetrical loss of joint space, subchondral cysts ⁵

  • hook-like (or drooping or beak-like) osteophytes projecting from radial ends of 2^nd and 3^rd metacarpal heads are considered characteristics but are non-specific as they are also seen in osteoarthritis ⁵

    • more extensive involvement from the second to the fifth MCP and radial hook-like osteophytes are more characteristic than in CPPD ³

• chondrocalcinosis: particularly knee mensici, triangular fibrocartilage, pubic symphysis and spine ⁵

• generalised osteoporosis (~25%) or osteopenia (~40%) ⁴

Differential diagnosis

On imaging consider:

• calcium pyrophosphate deposition disease (CPPD)

• osteoarthritis 

  • distal hand joints rather than MCP joints

• psoriatic arthritis

See also

• polyarticular disease