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01-08-2013 | Original Article

Erosive and inflammatory joint changes in hereditary hemochromatosis arthropathy detected by low-field magnetic resonance imaging

Authors: Katja Frenzen, Christoph Schäfer, Gernot Keyßer

Published in: Rheumatology International | Issue 8/2013

Abstract

The aim of the article is to describe and characterize the hemochromatosis arthropathy of the hand by low-field MRI in symptomatic and asymptomatic patients. Forty-nine patients with hereditary hemochromatosis (37 with and twelve without arthropathy) were examined clinically and by low-field MRI of the hands. The examination showed heterogeneous degenerative and inflammatory joint changes such as erosions (in 84 % of all symptomatic patients), synovitis (77 %), bone marrow edema (38 %), subchondral cysts (30 %), tenosynovitis (30 %), joint space narrowing (73 %) and osteophytes (59 %) including hook-shaped osteophytes at MCP joints (32 %). Mild joint changes were also seen in a lower percentage of asymptomatic patients. This is the first larger study addressing the joint changes of the hand in hereditary hemochromatosis using low-field MRI. Our study emphasizes the inflammatory and destructive character of the arthropathy besides the well-known degenerative joint changes described in conventional X-ray. The impact of joint changes in asymptomatic patients deserves further investigation.

Olynyk JK, Cullen DJ, Aquilia S, Rossi E, Summerville L, Powell LW (1999) A population-based study of the clinical expression of the hemochromatosis gene. N Engl J Med 341:718–724PubMedCrossRef

Beutler E, Felitti VJ, Koziol JA, Ho NJ, Gelbart T (2002) Penetrance of 845G→A (C282Y) HFE hereditary haemochromatosis mutation in the USA. Lancet 359:211–218PubMedCrossRef

Adams PC, Reboussin DM, Barton JC, McLaren CE, Eckfeldt JH, McLaren GD, Dawkins FW, Acton RT, Harris EL, Gordeuk VR, Leiendecker-Foster C, Speechley M, Snively BM, Holup JL, Thomson E, Sholinsky P (2005) Hemochromatosis and iron-overload screening in a racially diverse population. N Engl J Med 352:1769–1778PubMedCrossRef

Allen KJ, Gurrin LC, Constantine CC, Osborne NJ, Delatycki MB, Nicoll AJ, McLaren CE, Bahlo M, Nisselle AE, Vulpe CD, Anderson GJ, Southey MC, Giles GG, English DR, Hopper JL, Olynyk JL, Powell LW, Gertig DM (2008) Iron-overload-related disease in HFE hereditary hemochromatosis. N Engl J Med 358:221–230PubMedCrossRef

Powell LW, Dixon JL, Ramm GA, Purdie DM, Lincoln DJ, Anderson GJ, Subramaniam VN, Hewett DG, Searle JW, Fletcher LM, Crawford DH, Rodgers H, Allen KJ, Cavanaugh JA, Bassett ML (2006) Screening for hemochromatosis in asymptomatic subjects with or without a family history. Arch Intern Med 166:294–301PubMedCrossRef

Asberg A, Hveem K, Thorstensen K, Ellekjter E, Kannelønning K, Fjøsne U, Halvorsen TB, Smethurst HB, Sagen E, Bjerve KS (2001) Screening for hemochromatosis: high prevalence and low morbidity in an unselected population of 65,238 persons. Scand J Gastroenterol 36:1108–1115PubMedCrossRef

Edwards CQ, Griffen LM, Ajoika RS, Kushner JP (1998) Screening for hemochromatosis: phenotype versus genotype. Semin Hematol 35:72–76PubMed

Rihl M, Kellner H (2004) Arthropathy of hereditary hemochromatosis. Z Rheumatol 63:22–29PubMedCrossRef

Zogg Th, Fuchs W, Kissling R (1987) Arthropathy in idiopathic hemochromatosis. Z Orthop 125:206–208PubMedCrossRef

10.

Jäger HJ, Mehring UM, Götz GF, Neise M, Erlemann R, Kapp HJ, Mathias KD (1997) Radiological features of the visceral and skeletal involvement of hemochromatosis. Eur Radiol 7:1199–1206PubMedCrossRef

11.

Schattenkirchner M, Fischbacher L, Giebner-Fischbacher U, Albert ED (1983) Arthropathy in idiopathic hemochromatosis. Klin Wschr 61:1199–1207PubMedCrossRef

12.

Dymock IW, Hamilton GBD, Laws JW, Williams R (1970) Arthropathy of haemochromatosis: clinical and radiological analysis of 63 patients with iron overload. Ann Rheum Dis 29:469–476PubMedCrossRef

13.

Mathews JL, Williams HJ (1987) Arthritis in hereditary hemochromatosis. Arthritis Rheum 30:1137–1141PubMedCrossRef

14.

Askari AD, Muir WA, Rosner IA, Moskowitz RW, McLaren GD, Braun WE (1983) Arthritis of hemochromatosis: clinical spectrum, relation to histocompatibility antigens, and effectiveness of early phlebotomy. Am J Med 75:957–965PubMedCrossRef

15.

Sahinbegovic E, Dallos T, Aigner E, Axmann R, Manger B, Englbrecht M, Schöniger-Hekele M, Karonitsch T, Stamm T, Farkas M, Karger T, Stölzel U, Keysser G, Datz C, Schett G, Zwerina J (2010) Musculoskeletal disease burden of hereditary hemochromatosis. Arthritis Rheum 62:3792–3798PubMedCrossRef

16.

Heiland GR, Aigner E, Dallos T, Sahinbegovic E, Krenn V, Thaler C, Weiss G, Distler JH, Datz C, Schett G, Zwerina J (2010) Synovial immunopathology in haemochromatosis arthropathy. Ann Rheum Dis 69:1214–1219PubMedCrossRef

17.

Wardle EN, Patton JT (1969) Bone and joint changes in hemochromatosis. Ann Rheum Dis 28:15–22PubMedCrossRef

18.

Horger M, Ioanoviciu S, Tzaribachev N (2006) Radiologic findings in hemochromatosis. Rofo 178:657–660PubMedCrossRef

19.

Moore EA, Vennart W, Jacoby RK, Hutton CW, Pittard S, Ellis RE (1993) Magnetic resonance manifestations of idiopathic hemochromatosis in the wrist. Br J Rheumatol 32:917–922PubMedCrossRef

20.

Eustace S, Buff B, McCarthy C, MacMathuana P, Gilligan P, Ennis JT (1994) Magnetic resonance imaging of hemochromatosis arthropathy. Skeletal Radiol 23:547–549PubMed

21.

Papakonstantinou O, Mohana-Borges AVR, Campell L, Trudell D, Haghighi P, Resnick (2005) Hip arthropathy in a patient with primary hemochromatosis: MR imaging findings with pathologic correlation. Skeletal Radiol 34:180–184PubMedCrossRef

22.

Schmid H, Struppler C, Braun GS, Kellner W, Kellner H (2003) Ankle and hindfoot arthropathy in hereditary hemochromatosis. J Rheumatol 30:196–199PubMed

23.

Ostendorf B, Scherer A, Backhaus M, Edelmann E, Kellner H, Schalm J, Rau R (2003) Imaging techniques in rheumatology: magnetic resonance imaging in rheumatoid arthritis. Z Rheumatol 62:274–286PubMedCrossRef

24.

Haugen IK, Lillegraven S, Slatkowsky-Christensen B, Haavardsholm EA, Sesseng S, Kvien TK (2011) Hand osteoarthritis and MRI: development and first validation of the proposed Oslo Hand Osteoarthritis MRI score. Ann Rheum Dis 70:1033–1038PubMedCrossRef

25.

Scherer A, Ostendorf B, Engelbrecht V, Poll LW, Becker A, Dann P, Peters R, Schneider M, Mödder U (2001) MR-morphological changes of the metacarpophalangeal joints in patients with rheumatoid arthritis: comparison of early and chronical stages. Rofo 173:902–907PubMedCrossRef

26.

Ejbjerg B, McQueen F, Lassere M, Haavardsholm E, Conaghan P, O’Connor P, Bird P, Peterfy C, Edmonds J, Szkudlarek M, Genant H, Emery P, Østergaard M (2005) The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the wrist joint. Ann Rheum Dis 64:i23–i47PubMedCrossRef

27.

Conaghan P, Bird P, Ejbjerg B, O’Connor P, Peterfy C, McQueen F, Lassere M, Emery P, Shnier R, Edmonds J, Østergaard M (2005) The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the metacarpophalangeal joints. Ann Rheum Dis 64:i11–i21PubMedCrossRef

28.

Tan AL, Grainger AJ, Tanner SF, Shelley DM, Pease C, Emery P, McGonagle D (2005) High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum 52:2355–2365PubMedCrossRef

29.

Tan AL, Toumi H, Benjamin M, Grainger AJ, Tanner SF, Emery P, McGonagle D (2006) Combined high-resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis. Ann Rheum Dis 65:1267–1272PubMedCrossRef

30.

Haugen IK, Bøyesen P, Slatkowsky-Christensen B, Sesseng S, van der Heijde D, Kvien TK (2012) Associations between MRI-defined synovitis, bone marrow lesions and structural features and measures of pain and physical function in hand osteoarthritis. Ann Rheum Dis 71:899–904PubMedCrossRef

31.

Haugen IK, Bøyesen P, Slatkowsky-Christensen B, Sesseng S, Bijsterbosch J, van der Heijde D, Kvien TK (2012) Comparison of features by MRI and radiographs of the interphalangeal finger joints in patients with hand osteoarthritis. Ann Rheum Dis 71:345–350PubMedCrossRef

32.

Chew FS (2005) Radiology of the hands: review and self-assessment module. Am J Roentgenol 184:157–168CrossRef

33.

Grainger AJ, Farrant JM, O’Connor PJ, Tan AL, Tanner S, Emery P, McGonagle D (2007) MR imaging of erosions in interphalangeal joint osteoarthritis: is all osteoarthritis erosive? Skeletal Radiol 36:737–745PubMedCrossRef

34.

Punzi L, Frigato M, Frallonardo P, Ramonda R (2010) Inflammatory osteoarthritis of the hand. Best Pract Res Clin Rheumatol 24:301–312PubMedCrossRef

35.

Backhaus M, Kamradt T, Sandrock D, Loreck D, Fritz J, Wolf KJ, Raber H, Hamm B, Burmester GR, Bollow M (1999) Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 42:1232–1245PubMedCrossRef

36.

Klarlund M, Østergaard M, Jensen KE, Madsen JL, Skjødt H, Lorenzen I (2000) Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: 1 year follow up of patients with early arthritis. The TIRA Group. Ann Rheum Dis 59:521–528PubMedCrossRef

37.

Hoving JL, Buchbinder R, Hall S, Lawler G, Coombs P, McNealy S, Bird P, Onnell D (2004) A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis. J Rheumatol 31:663–675PubMed

38.

Beltran J, Marty-Default E, Bencardino J, Rosenberg ZS, Steiner G, Aparisi F, Padrón M (1998) Chondrocalcinosis of the hyaline cartilage of the knee: MRI manifestations. Skeletal Radiol 27:369–374PubMedCrossRef

39.

Abreu M, Johnson K, Chung CB, de Lima JE, Trudell D, Terkeltaub R, Pe S, Resnick D (2004) Calcification in calcium pyrophosphate dihydrate (CPPD) crystalline deposits in the knee: anatomic, radiographic, MR imaging, and histology study in cadavers. Skeletal Radiol 33:392–398PubMedCrossRef

40.

Suan JC, Chhem RK, Gati JS, Norley CJ, Holdsworth DW (2005) 4 T MRI of chondrocalcinosis in combination with three- dimensional CT, radiography, and arthroscopy: a report of three cases. Skeletal Radiol 34:714–721PubMedCrossRef

41.

Feydy A, Lioté F, Carlier R, Chevrot A, Drapé J (2006) Cervical spine and crystal-associated diseases: imaging findings. Eur Radiol 16:459–468PubMedCrossRef

42.

Major NM, Helms CA, Genant HK (1993) Calcification demonstrated as high signal intensity on T1 weighted MR images of the disks of the lumbar spine. Radiology 189:494–496PubMed

43.

Josephson L, Lewis J, Jacobs B, Hahn PF, Stark DD (1988) The effects of iron oxides on proton relaxivity. Magn Reson Imaging 6:647–653PubMedCrossRef

44.

Brittenham GM, Farrell DE, Harris JW, Feldman ES, Danish EH, Muir WA, Tripp JH, Bellon EM (1982) Magnetic-susceptibility measurement of human iron stores. N Engl J Med 307:1671–1675PubMedCrossRef

45.

Stark DD (1991) Hepatic iron overload: paramagnetic pathology. Radiology 179:333–335PubMed

Title: Erosive and inflammatory joint changes in hereditary hemochromatosis arthropathy detected by low-field magnetic resonance imaging
Authors: Katja Frenzen
Christoph Schäfer
Gernot Keyßer
Publication date: 01-08-2013
Publisher: Springer Berlin Heidelberg
Published in: Rheumatology International / Issue 8/2013
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-013-2694-3

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