HFE-Related Hemochromatosis: An Update for the Rheumatologist

  • Emma Husar-Memmer
  • Andreas Stadlmayr
  • Christian Datz
  • Jochen Zwerina
Part of the following topical collections:
  1. Topical Collection on Orphan Diseases


Hereditary hemochromatosis is a frequent disease in Caucasian populations. It leads to progressive iron overload in a variety of organs. The most common cause is the C282Y homozygous mutation in the HFE gene. The classical triad of skin hyperpigmentation, diabetes, and liver cirrhosis is nowadays rare but musculoskeletal symptoms are common in HFE-related hemochromatosis. Typically the second and third metacarpophalangeal joints, and the wrist, hip, and ankle joints are affected. Clinical symptoms include osteoarthritis-like symptoms, pseudogout attacks, and synovitis sometimes resembling rheumatoid arthritis. Radiographs show degenerative changes with joint space narrowing, osteophytes, and subchondral cysts. Chondrocalcinosis in the wrist and knee joints is seen in up to 50 % of patients. Although most other organ manifestations regress during phlebotomy, musculoskeletal symptoms often persist or even become worse. Importantly, patients are at an increased risk of severe large-joint arthritis necessitating joint replacement surgery. Therefore, future research should focus on the pathogenesis and treatment options for HH arthropathy.


Hemochromatosis HFE gene Iron overload Arthropathy Chondrocalcinosis Diagnosis Clinical presentation Screening 


Compliance with Ethics Guidelines

Conflict of Interest

Jochen Zwerina was supported by a Start Up Grant of the German Society of Rheumatology (DGRh) and is a member of the medical board of the German Hemochromatosis Patient Organization. Emma Husar-Memmer, Andreas Stadlmayr, and Christian Datz declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Emma Husar-Memmer
    • 1
  • Andreas Stadlmayr
    • 2
  • Christian Datz
    • 2
  • Jochen Zwerina
    • 1
  1. 1.Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical DepartmentHanusch HospitalViennaAustria
  2. 2.Department of Internal MedicineHospital OberndorfOberndorfAustria

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