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Irreversible Haemochromatosis Arthropathy — RACP Adult Medicine MCQ

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ModerateRheumatologyIrreversible Haemochromatosis ArthropathyRACP Adult Medicine

A 45-year-old man with known haemochromatosis presents with a new polyarthropathy affecting his 2nd and 3rd MCPJs. X-rays show chondrocalcinosis and hook-like osteophytes of the metacarpal heads. Despite optimal iron depletion (ferritin 35 µg/L), his joint symptoms persist. Why?

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Correct answer: C — The chondrocalcinosis is unrelated to haemochromatosis

Haemochromatosis arthropathy (particularly the characteristic 2nd/3rd MCPJ involvement with CPPD deposition and hook-like osteophytes) is one of the few manifestations that does NOT improve with iron depletion. The joint damage from iron-mediated chondrocyte injury and CPPD crystal deposition is largely irreversible once established. This contrasts with hepatic iron loading, cardiac iron loading, and skin pigmentation, which all improve with phlebotomy. Management is symptomatic (analgesics, anti-inflammatory agents, joint replacement if severe).

Reference: eTG – 2025 – Rheumatology; EASL – 2010 – Haemochromatosis Guidelines