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Identification of Common Pathogenic Pathways Involved in Hemochromatosis Arthritis and Calcium Pyrophosphate Deposition Disease: a Review

  • Crystal Arthritis (M Pillinger, Section Editor)
  • Published:
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Abstract

Objectives

Arthritis is a common clinical manifestation of hereditary hemochromatosis (HH), and HH is one of a handful of conditions linked to calcium pyrophosphate deposition (CPPD) in joints. The connection between these two types of arthritis has not yet been fully elucidated. In light of new pathogenic pathways recently implicated in CPPD involving bone, we reviewed the literature on the etiology of hemochromatosis arthropathy (HHA) seeking shared pathogenic mechanisms.

Results

Clinical observations reinforce striking similarities between HHA and CPPD even in the absence of CPP crystals. They share a similar joint distribution, low grade synovial inflammation, and generalized bone loss. Excess iron damages chondrocytes and bone cells in vitro. While direct effects of iron on cartilage are not consistently seen in animal models of HH, there is decreased osteoblast alkaline phosphatase activity, and increased osteoclastogenesis. These abnormalities are also seen in CPPD. Joint repair processes may also be impaired in both CPPD and HHA.

Conclusions

Possible shared pathogenic pathways relate more to bone and abnormal damage/repair mechanisms than direct damage to articular cartilage. While additional work is necessary to fully understand the pathogenesis of arthritis in HH and to firmly establish causal links with CPPD, this review provides some plausible hypotheses explaining the overlap of these two forms of arthritis.

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Funding

This work was partially supported by a VA Merit Review Grant I01BX004454 (AKR).

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Authors and Affiliations

  1. Research Division, cc-117, Zablocki VA Medical Center, 5000 W. National Ave, Milwaukee, WI, 53295-1000, USA

    Ann K. Rosenthal

  2. Division of Rheumatology, Department of Medicine, Medical College of Wisconsin and Zablocki VA Medical Center, Milwaukee, WI, USA

    Elizabeth Mitton-Fitzgerald, Claudia M. Gohr & Ann K. Rosenthal

  3. Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey, USA

    Charlene M. Williams

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  1. Elizabeth Mitton-Fitzgerald
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Correspondence to Ann K. Rosenthal.

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Mitton-Fitzgerald, E., Gohr, C.M., Williams, C.M. et al. Identification of Common Pathogenic Pathways Involved in Hemochromatosis Arthritis and Calcium Pyrophosphate Deposition Disease: a Review. Curr Rheumatol Rep 24, 40–45 (2022). https://doi.org/10.1007/s11926-022-01054-w

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