Arthritis, CPPD, pseudogout, joint pain, joint replacements, etc.

Joint pain & fatigue are typically the first presenting symptoms in someone with IO.  Unfortunately, they are also the symptoms which are  most often ignored
or attributed to as being age related or due to the stressors of life & work.

Click on the title to view articles/abstracts/sites referring to joint involvement.

• A 24-year-old patient with decreased libido and erectile dysfunction as initial manifestations of hemochromatosis Dtsch Med Wochenschr. 2000 Dec 1: In subfertility from an endocrine disorder primary hemochromatosis should be considered in the differential diagnosis. Only early diagnosis and prompt iron depletion may improve the prognosis of these patients.

• ABC of diseases of liver, pancreas, and biliary system Other causes of parenchymal liver disease 
   BMJ 2001;322:290-292 ( 3 February ) Haemochromatosis is the commonest inherited liver disease in the United Kingdom. It affects about 1 in 200 of the population and is 10 times more common than cystic fibrosis.

• A fatal case of Vibrio vulnificus presenting as septic arthritis. Arch Intern Med 2001 Nov 26 Although V vulnificus infection is uncommon, it is frequently fatal and is usually attributed to ingestion of raw shellfish or traumatic exposure to a marine environment; patients are also often found to have a hepatic disorder (cirrhosis, alcohol abuse, or hemochromatosis) or an immunocompromised health status, and most commonly present with septicemia or a wound infection.

• A history of phlebotomy therapy for hemochromatosis.  Crosby WH. Chapman Cancer Center, Joplin, MO Am J Med Sci 1991 Jan  The earlier the disease is discovered, the less risk of morbidity and mortality. Screening tests (serum iron, total iron-binding capacity, serum ferritin) are recommended for all blood relatives of index cases of this hereditary disease and for all clinics where complications of hemochromatosis may be treated: liver disorder however mild, diabetes mellitus, heart disease, arthropathies, sterility, impotence, premature menopause, and abnormal pigmentation of the skin.

• Annals of Internal Medicine SUPPLEMENT DIAGNOSIS AND MANAGEMENT 
  Diagnosis of Hemochromatosis, Annals of Internal Medicine, 1 December 1998. 129:925-931.Lawrie W. Powell, MD; D. Keith George, MD; Sharon M. McDonnell, MD; and Kris V. Kowdley, MD

• Answers to your questions about hereditary hemochromatosis 
  from The College of American Pathologists (CAP) Dec 18, 2001

• Arthritis in hemochromatosis   J Rheumatol 1993 Mar We reviewed the clinical and radiographic features of arthropathy in 25 subjects with hemochromatosis.

• Arthropathy as the presenting symptom in hereditary hemochromatosis, a case report

• Arthropathy of genetic hemochromatosis: a major and distinctive manifestation of the disease
  Clin Exp Rheumatol 2001 Jan-Feb Genetic hemochromatosis is not a rare disease and represents a frequently underestimated cause of arthropathy.

• Arthropathy in hereditary hemochromatosis  Curr Opin Rheumatol 2001 Jan; Arthropathy is one of the leading clinical manifestations of hereditary hemochromatosis (HH). Although cirrhosis of the liver is crucial for mortality in patients with HH, arthropathy has the greatest impact on the quality of life

• Articular cartilage in the degenerative arthropathy of hemochromatosis   Arthritis Rheum 1982 Dec Iron was readily demonstrated in chondrocytes in 3 of 4 hemochromatosis articular cartilages studied.

• Bone and joint involvement in genetic hemochromatosis: role of cirrhosis and iron overload.
  J Rheumatol 1997 Sep With multivariate analysis we found that osteoporosis was highly influenced by the degree of iron overload, playing an independent role in accelerating bone loss in patients with GH.

• Chondrocalcinosis, may also be called: familial articular calcium gout, calcium pyrophospate arthropathy, calcium pyrophosphate dihydrate deposition disease, CPPDD

• Clinical report of three patients with hereditary hemochromatosis and movement disorders 
  Mov Disord 2000 Nov HH should be investigated more systematically in patients with movement disorders.

• Clinical spectrum and management of haemochromatosis 
  Baillieres Clin Haematol 1994 Dec Further strategies have to evaluate the design of screening programmes in order to diagnose more patients in the precirrhotic and asymptomatic stage.

• CPPD Deposition Disease 
  The University of Washington Department of Orthopaedics and Sports Medicine

• Current concepts in rational therapy for haemochromatosis.  
  Drugs. 1991 Jun . Venesection should be continued until all excess iron stores are removed as judged by failure of a rise in haemoglobin concentration on cessation of phlebotomy. Screening of first degree relatives should commence from a young age (e.g. 10 years).

• Current diagnosis: hereditary metabolic diseases of the liver
  (primary hemochromatosis, Wilson disease] Schweiz Rundsch Med Prax 1996 Nov [article in German]

• Diagnosis and management of hemochromatosis
  by Dr. Anthony Tavill, Director of the Maurice and Sadie Friedman Center For Digestive Diseases and Liver Disorders, Mathile and Morton J. Stone Professor of Digestive Diseases and Liver Disorders at the Mt. Sinai Medical Center, Professor of Medicine and Nutrition at Case Wetern Reserve University. [Excellent & thorough article of diagnosis & treatment.  This is a pdf file] 

• Diagnosis and treatment of genetic hemochromatosis Rev Prat. 2000 May 1 [Article in French]
  Moirand R, Guillygomarc'h A, Brissot P, Deugnier Y. The disease can be lethal due to liver disease, carcinoma or heart disease, but life expectancy goes to normal if patients are treated before the occurrence of cirrhosis. Treatment relies on regular venesections. Familial screening is essential.

• Disease-Related Conditions in Relatives of Patients with Hemochromatosis
  Zaneta J. Bulaj, M.D., Richard S. Ajioka, Ph.D., John D. Phillips, Ph.D., Bernard A. LaSalle, B.S., Lynn B. Jorde, Ph.D., Linda M. Griffen, B.A., Corwin Q. Edwards, M.D., and James P. Kushner, M.D.  Volume 343:1529-1535  November 23, 2000  Number 21  In conclusion, our data emphasize the importance of screening relatives of persons with hemochromatosis.

• Diseases associated with calcium pyrophosphate deposition disease 
  Semin Arthritis Rheum 1992 Dec Hemochromatosis stands alone in clearly associating not only with chondrocalcinosis but also with structural change and chronic arthropathy

• Dr. Rose's Peripheral Brain--HEMOCHROMATOSIS

• Effect of gradual accumulation of iron, molybdenum and sulfur, slow depletion of zinc and copper, ethanol or fructose ingestion and phlebotomy in gout   Med Hypotheses 1999 Nov, phlebotomy is suggested as therapy for gout patients, in order to eliminate the accumulated Fe

• Effect of venesection on bone mineral density in an eugonadal woman with haemochromatosis
  J Gastroenterol Hepatol 1999 Feb Following venesection of 8 L blood (4 g iron) over 17 months and calcium supplementation, her bone density rose significantly

• Effects of Iron Overload  Harvard University website  2-1999

• Epidemiology, clinical spectrum and prognosis of hemochromatosis,
  abnormality in liver function tests (75%), weakness and lethargy (74%), skin hyperpigmentation (70%), diabetes mellitus (48%), arthralgia (44%), impotence (45% in males), and ECG abnormalities (31%) were the most frequent findings and symptoms at diagnosis.  Adv Exp Med Biol 1994

• Elevated parathyroid hormone 44-68 and osteoarticular changes in patients with genetic hemochromatosis Arthritis Rheum 1999 Apr  Liver iron overload syndromes, especially genetic hemochromatosis, are associated with elevated circulating levels of PTH fragments containing the 44-68 region, which appears to play a role in osteoarticular changes. This increase seems to be a consequence of iron overload.

• Ferritin Physiology Overview of the function of ferritin with a section on hemochromatosis.

• Ferrous [Fe++] but not ferric [Fe] ions inhibit de novo formation of calcium pyrophosphate dihydrate crystals: possible relationships to chondrocalcinosis and hemochromatosis. 
  J Rheumatol 1988 Feb  These experiments suggest that at biological concentrations, Fe++ acts to inhibit CPPD formation but that [Fe++] depletion therapy by removal of inhibition effects may facilitate CPPD crystal formation in articular tissues.

• FINAL DIAGNOSES: 
  A case of Hereditary Hemochromatosis with dilated cardiomyopathy, micronodular cirrhosis, history of chronic alcoholism from Department of Pathology, University of Pittsburgh School of Medicine.

• Genetic Haemochromatosis:   A guideline on Diagnosis & Therapy compiled on behalf of the Clinical Task Force of the  British Committee for Standards in Haemotology  2/2000 [a pdf file]

• Genetic Health-What Is Hemochromatosis?
  By Amanda Ewart Toland, PhD  Reviewed by Chris Friedrich, MD, PhD Last updated September 1, 2000

• Gold in Kupffer cells, Pt. had R.A.   View of slide.

• Haemochromatosis and exercise related joint pains e-letters 
  CLINICAL REVIEW Lesson of the week: Ian McCurdie and J David Perry BMJ 1999

• Haemochromatosis may present as exercise related joint pains without arthropathy, early treatment improving outcome, Case reports including x-ray pictures of hips, hands, knees. CLINICAL REVIEW Lesson of the week: Ian McCurdie and J David Perry BMJ 1999

• Hand and wrist arthropathies of hemochromatosis and calcium pyrophosphate deposition disease: distinct radiographic features Radiology 1983 May; Radiographic features of hand and wrist involvement in 26 patients with hemochromatosis and in 26 patients with idiopathic calcium pyrophosphate dihydrate (CPPD) crystal deposition disease were compared.

• Hemochromatosis: A Common, Rarely Diagnosed Disease 
  By Vincent J. Felitti, MD, FACP  Commentary by David Baer, MD, FACP.  Hemochromatosis is the most common, life-threatening genetic disorder in North America, yet most physicians have never personally diagnosed a case: all see an unrecognized case in their offices every two weeks

• Hemochromatosis arthropathy--an early manifestation of genetic hemochromatosis 
  Z Rheumatol 1997 May-Jun This investigation shows that knowledge of the typical signs of hemochromatotic arthropathy could lead to an earlier diagnosis of genetic hemochromatosis which is necessary to prevent the complications of iron overload in those patients

• Hemochromatosis, A simple genetic trait,
  Dr. Richard D. Press, Oregon Health Sciences University With the discovery of the causative gene, the disorder stands revealed as America's single most common mendelian disease. Unlike other genetic diseases, it is already curable. Indeed, genetic screening makes it potentially preventable.

• Hemochromatosis at the intersection of classical medicine and molecular biology  
  C R Acad Sci III 2001 Sep

• Hemochromatosis can now be appropriately defined as the presence of two hemochromatosis alleles with or without organ injury, and with or without the presence of iron overload. [I have not been able to retrieve the url to the website from where this came, so if anyone locates it, please let me know!]

• Hemochromatosis:  Conemaugh Health System   Hemochromatosis is a condition that develops when too much iron builds up in the body. Excess iron is stored in the organs, such as the kidneys, liver, and heart, and in the joint tissues.

• Hemochromatosis, Cooley Dickinson Hospital    Editor: George R Bowers MD CDH Oncology  January 2000 Volume 4: No. 1.   Hemochromatosis is a common, genetically transmitted disease. The diagnosis of hemochromatosis is sometimes difficult and frequently missed. This issue will review the pathogenesis, diagnosis and treatment of this fascinating disease. Ms. Kathy Fleming will review the management of a most troubling complication of therapy---lymphedema. 

• Hemochromatosis eMedicine Journal, December 7 2001, Volume 2, Number 12, Authored by Sandor Joffe, MD, Section Chief of Abdominal Imaging, Department of Radiology, Beth Israel Medical Center  This article covers the pathophysiology of hemochromatosis as well as the techniques in using ULS, CT & MRI to identify iron deposition in the organs. Pictures & descriptions from scans of the abdomen are shown.

• Hemochromatosis, Front Range Gastroenterology Associates, P.C.  
  2030 Mountain View Avenue, Suite 300, Longmont, CO.  Basic statistics on HH.

• Hemochromatosis: Gastrointestinal Health Hemochromatosis, the most common genetic disease in the United States, results in iron overload and, if left untreated, severe organ damage. 

• Hemochromatosis: genetics helps to define a multifactorial disease 
  Clin Genet, 54(1):1-9 1998 Jul University of Washington, Seattle 98105 wburke@u.washington.edu  Early detection is desirable, because periodic phlebotomy provides effective treatment for iron overload and may prevent complications of the disorder.

• Hemochromatosis:  Genetics, Pathophysiology, Diagnosis and Treatment, "Introduction to Hemochromatosis"  Part I,  by Barton & Edwards.  Except from their book, [a pdf file] This is a large & excellent book covering all areas of hemochromatosis.  Published in 2000, $225.00

• Hemochromatosis:  Life Extension Foundation website.  Disease, Prevention & Treatment 3rd editon.  Dietary & Vitamin recommendations listed here including calcium for blocking of iron absorption.

• Hemochromatosis Special  American Liver Foundation newsletter,  ALF Progress, Vol. 21 No. 1, Summer 1999 The ALF newsletter created three scenarios based on the real life ethical, economic and medical quandaries posed by hemochromatosis, and asked three experts from divergent fields to respond with their opinions. The experts are: Bruce R. Bacon, MD [Director, Div. of Gastroenterology & Hepatology, Saint Louis University School of Medicine, St. Louis, M0]; medical ethicist Mark A. Rothstein, Esq. [Director, University of Houston Law Center, Health Law & Policy Institute, Houston, TX] and hemachromatosis patient Gayle Hoffman.

• Hepatic injury in chronic iron overload. Role of lipid peroxidation.   Chem Biol Interact. 1989 Bacon BR, Britton RS. Excess deposition of iron in the parenchymal tissues of several organs (e.g. liver, heart, pancreas, joints, endocrine glands) results in cell injury and functional insufficiency.

• Hereditary Hemochromatosis and Cancer risk:  More fuel to the fire?  Gastroenterology Vol. 121, No. 5, November 2001  Pg. 1253 [a pdf file]  These data suggest an involvement of iron in carcinogenesis even in heterozygotes for HFE mutations. 

• Hereditary Hemochromatosis--A Risk Factor for Cardiovascular Disease
  The HH mutation is a human genetic model of disturbed iron metabolism, which facilitates research to the mechanism of HH and iron involved in cardiovascular disease. We expect that in the near future, the mechanism of disturbed iron metabolism leading to cardiovascular disease in human will be better understood.

• Hereditary Hemochromatosis 
  CME Activity, Release Date: 2/28/2000 Expiration Date: 2/28/2002 From the February 2000 Issue of Physician Assistant  Objectives: After reading the article, the reader should be able to:
  1. describe the pathophysiology of hereditary hemochromatosis;
  2. recognize the clinical symptoms and signs of hereditary hemochromatosis;
  3. outline screening and evaluation testing; and
  4. provide accurate diagnosis, management, and treatment.

• Hereditary hemochromatosis: diagnosis and treatment in primary care Tenn Med 1999 Nov With early detection and treatment this can be a manageable chronic disease. If undetected, it is potentially fatal.

• Hereditary Hemochromatosis FamilyPractice.com  Robert B. Hash, MD, Department of Family Medicine, Mercer University School of Medicine, Macon, Ga. [J Am Board Fam Pract Dec. 2000] Considering the prevalence of the disease, it is important for physicians to consider it in the differential diagnosis when patients complain of the common signs and symptoms. For most patients hereditary hemochromatosis can be successfully treated in the physician's office. Early diagnosis and treatment, before signs of iron toxicity, if possible, can result in improved quality and quantity of life for many patients.

• Hereditary hemochromatosis: impact of molecular and iron-based testing on the diagnosis, treatment, and prevention of a common, chronic disease.  Arch Pathol Lab Med. 1999 Nov Press RD. Department of Pathology, Oregon Health Sciences University, Portland 97201, USA. pressr@ohsu.edu This direct HFE mutation test can now be used not only to confirm the diagnosis of HH in those with symptomatic disease, but also, perhaps more importantly, to detect those with presymptomatic iron overload in whom future disease manifestations may be prevented (with phlebotomy therapy).

• Hereditary hemochromatosis in children, adolescents, and young adults.  Am J Pediatr Hematol Oncol. 1988 Spring  Young individuals who should be screened for iron overload include patients with cardiac myopathies, hypogonadism, amenorrhea, loss of libido, diabetes mellitus, other endocrine disorders, cirrhosis of the liver, and arthritis, as well as the siblings, parents, and children of patients with hereditary hemochromatosis or iron loading of unknown cause.

• Hereditary hemochromatosis masquerading as rheumatoid arthritis
   Early erroneous diagnosis of rheumatic disease is common in subjects with arthropathy due to hereditary hemochromatosis Ann Ital Med Int 2001 Jan-Mar

• Hereditary hemochromatosis: Preventing chronic effects of this underdiagnosed disorder
  Sharon M. McDonnell, MD, MPH; David Witte, MD, PhD VOL 102 / NO 6 / DECEMBER 1997 / POSTGRADUATE MEDICINE.  In this article, Drs McDonnell and Witte discuss the diagnosis and management of this underrecognized problem as well as the various issues involved in screening. An illustrative case of hemochromatosis is also included.

• Hereditary hemochromatosis Rev Med Interne 2000 Nov  At present, any patient admitted with an isolated case of asthenia, or with arthralgia or hypertransaminasemia should be examined via transferrin-saturation testing: if the transferrin saturation coefficient is > 45%, then the presence of the C282Y mutation should be investigated to confirm the diagnosis of hemochromatosis. A liver biopsy is no longer necessary to establish the diagnosis.

• Hereditary Hemochromatosis Since Discovery of the HFE Gene  Clinical Chemistry 2001 [a pdf file] Includes an algorithm for screening and diagnosis of hemochromatosis. This review provides a comprehensive discussion of known mutations in the HFE gene and their phenotypic expression

• HFE gene and hereditary hemochromatosis: a HuGE review. Human Genome Epidemiology 
  Am J Epidemiol 2001 Aug 1

• HFE gene knockout produces mouse model of hereditary hemochromatosis Proc Natl Acad Sci U S A. 1998 Mar.  Xiao Yan Zhou, Shunji Tomatsu, Robert E. Fleming, Seppo Parkkila, Abdul Waheed, Jinxing Jiang, Ying Fei, Elizabeth M. Brunt, David A. Ruddy, Cynthia E. Prass, Randall C. Schatzman, Rosemary O'Neill, Robert S. Britton, Bruce R. Bacon, and William S. Sly  The knockout mouse model of HH will facilitate investigation into the pathogenesis of increased iron accumulation in HH and provide opportunities to evaluate therapeutic strategies for prevention or correction of iron overload.

• HFE gene mutations in patients with rheumatoid arthritis
  J Rheumatol 2000 Sep H63D mutation appears to play a role in pathogenesis of RA.

• HFE-PROTEIN IN HEREDITARY HEMOCHROMATOSIS
  Hereditary hemochromatosis is the most common known autosomal recessive disorder in Caucasians

• Hip arthropathy in genetic hemochromatosis. Radiographic and histologic features 
  In this study, hip radiographs of 112 patients with genetic hemochromatosis and arthritis were reviewed, and histologic examination of 2 femoral heads was performed.  Arthritis Rheum 1991 Mar

• Homozygosity for hemochromatosis: clinical manifestations.  Ann Intern Med. 1980 Oct; Diagnosis of asymptomatic hemochromatosis is important because organ damage may be prevented by early therapy.

• Idiopathic hemochromatosis presenting as amenorrhea and arthritis 
  Am J Med 1987 May A young woman with idiopathic hemochromatosis is described

• Investigating Anaemia and Iron Storage Disease
  Discussion of the different types of anemia, as well as the effects of iron overload.  

• Iron catalyzed oxidative damage, in spite of normal ferritin and transferrin saturation levels and its possible role in Werner's syndrome, Parkinson's disease, cancer, gout, rheumatoid arthritis, etc. Med Hypotheses 2000 Sep the disease is often overlooked by physicians, until several organs have been damaged permanently (heart, liver, brain, pancreas, kidneys, spleen, etc.). Moreover, since ferritin, transferrin saturation and hematocrit levels are not directly related to cellular iron levels, and since excess iron can wreak havoc in the cell, we can conclude that there is a need for a better way to evaluate intracellular iron levels and especially the intracellular free iron levels by a non-invasive technique.

• IRON DEPOSITION IN THE JOINTS OF CHILDREN WITH JUVENILE RHEUMATOID ARTHRITIS We adapted a machine called a gamma counter to measure the iron in eight patients' joints after giving them an iron isotope by vein.

• Iron is Hot:  An Update on the Pathophysiology of Hemochromatosis: Blood Journal Sept. 15, 1998  Genetic iron overload disorders are prevalent yet poorly understood. [A pdf file.]

• Iron Loading and Disease Surveillance
  Eugene D. Weinberg   Indiana University, Bloomington, Indiana   Emerging Infectious Diseases Journal, National Center for Infectious Diseases, Centers for Disease Control and Prevention. Excessive iron in specific tissues and cells (iron loading) promotes development of infection, neoplasia, cardiomyopathy, arthropathy, and various endocrine and possibly neurodegenerative disorders.
  

• Iron Overload Disease due to Hereditary Hemochromatosis  CDC website, National Center for Chronic Disease Prevention and Health Promotion.  Early detection and treatment for this genetic condition can lessen morbidity and mortality, and in some cases prevent the onset of disease. Therefore, early detection of hemochromatosis represents a major chronic disease prevention opportunity.

• Iron Overload Disorder Common and Increases Risk for Heart Attacks
  Full Health Nutrition Canada ArterialHealth e-News^© October 1999 A genetic defect that causes iron overload disease is the most common inherited disorder among whites, affecting one in 188 people of northern European descent.

• Iron Overload (Hemosiderosis; Hemochromatosis) The Merck Manual of Diagnosis and Therapy Section 11. Hematology And Oncology Chapter 128. Hemochromatosis is often diagnosed late in the course of disease after significant tissue injury is present because the clinical symptoms are insidious and the extent of organ involvement varies; thus, the full clinical picture evolves slowly

• Management of hereditary hemochromatosis. Blood Rev. 1994 Dec Phatak PD, Cappuccio JD. Early diagnosis and institution of phlebotomy treatments will prevent these manifestations and normalize life expectancy. Once organ damage is established many of the manifestations are irreversible. Since the early manifestations of the disease are subtle, a case can be made for routine screening.

• Management of hemochromatosis. Hemochromatosis Management Working Group.
  Ann Intern Med. 1998 Dec 1  Barton JC, McDonnell SM, Adams PC, Brissot P, Powell LW, Edwards CQ, Cook JD, Kowdley KV.  The complications of iron overload in hemochromatosis can be avoided by early diagnosis and appropriate management.

• Metabolic arthropathies 
  The clinical and radiologic presentations of the arthropathy of hemochromatosis have been extensively reviewed. Screening for the disease appears important, because it is the only way to prevent progressive worsening of organ involvement and arthropathy in particular. Curr Opin Rheumatol 1994 Jul.

• Molecular genetics of hemochromatosis Ann Endocrinol (Paris) 1999 Sep Hemochromatosis is a recessive disorder of iron metabolism characterized by progressive iron loading of parenchymal organs, which accounts for clinical complications such as cirrhosis, diabetes mellitus, cardiopathy, endocrine dysfunctions and arthropathy.

• Osteoporotic fractures: an unusual presentation of haemochromatosis. Bone. 1992; The association of haemochromatosis and osteoporosis is well established, but it is unclear whether this is due to iron overload, hypogonadism, liver disease, or diabetes mellitus. We describe a young eugonadal male patient with osteoporotic fractures as a presenting feature of haemochromatosis, suggesting that factors other than hypogonadism contribute to osteoporosis.

• Osteoporosis in hemochromatosis: iron excess, gonadal deficiency, or other factors? 
  OBJECTIVE: To define the prevalence, severity, type and pathogenesis of osteopenia in idiopathic hemochromatosis. Ann Intern Med 1989 Mar 15.

• Overview on Iron Overload and Hemochromatosis  CDC website, National Center for Chronic Disease Prevention and Health Promotion.  Early detection of hemochromatosis is essential because the disease’s potentially serious complications can be prevented by early therapy.

• Pathology Cases for Diagnosis: A 37 year old male is referred to the liver clinic for evaluation of abnormal liver related enzymes.  Includes pictures of biopsy slides. Case 96-19: Liver II Contributed by D. Robert Dufour, M.D., CAPT, MC, USNR-R Date Available: July 22, 1996 - December 31, 1996 

• Practice guideline development task force of the College of American Pathologists. Hereditary hemochromatosis.
  Witte DL, Crosby WH, Edwards CQ, Fairbanks VF, Mitros FA. College of American Pathologists Clin Chim Acta 1996 Feb. In view of the high prevalence in the American population (prevalence varies with ethnic background), the low cost of diagnosis and treatment, the efficacy of treatment if begun early, and, on the other hand, high costs and low success rate of late diagnosis and treatment, systematic screening for hemochromatosis is warranted for all persons over the age of 20 years.

• Preventing manifestations of hereditary haemochromatosis through population based screening.
  To evaluate the efficacy of identifying presymptomatic hereditary haemochromatosis through population based screening.  J Med Screen 1994 Jan

• Population screening in hereditary hemochromatosis   Annu Rev Public Health 2000

• Pseudogout, chondrocalcinosis and the early recognition of haemochromatosis 
  Ulster Med J 1992 Apr;61(1):119-23  No abstract available at this time.

• PubMed medline query: Many articles can be found here on arthritis, CPPD & HH.

• PULLING IRON OUT OF THE FIRE by Shelly Morrow.  This article appeared in the Sept/Oct 2000 issue of Arthritis Today, published by the Arthritis Foundation, Inc.

• Pyrophosphate Arthropathy in the Knees of Elderly Persons 
  Arch Intern Med, Volume 156(21).November 25, 1996 From the Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta.   Magnesium and iron influence crystal behavior, correlating with the known relationship of hypomagnesemia and hemochromatosis to PA, while disorders of calcium metabolism are also accompanied by PA.

• Radiological features of the visceral and skeletal involvement of hemochromatosis 
  European Radiology Abstract Volume 7 Issue 8 (1997) pp 1199-1206 Hemochromatosis arthropathy includes degenerative osteoarthritis and chondrocalcinosis.

• Reactive oxygen species and iron--a dangerous partnership in inflammation 
  We also consider the widening recognition of the importance of oxygen metabolites in hypoxia-reperfusion injury and disease of the skin and joint. Int J Biochem Cell Biol 1995 Feb

• Renal Transplantation and Evolution of Hemochromatosis:  A Clinical Case Report
  Despite being one of the world's most frequent autosomal recessive diseases, there are very few cases in the literature concerning hereditary hemochromatosis and renal transplantation. [a pdf file]

• Rheumatic manifestations of haemochromatosis
  Baillieres Clin Rheumatol 1991 Aug The characteristic histological changes are: abnormal amounts of iron deposits, little or no signs of synovial inflammation and CPPD deposition.

• Risk of disease in siblings of patients with hereditary hemochromatosis Digestion 2001

• Screening for genetic haemochromatosis in a rheumatology clinic
  Aust N Z J Med 1994 Feb The increased prevalence of GH in this group of patients with peripheral arthropathy provides an excellent justification for the routine screening of patients with peripheral arthritis for the exclusion of iron overload

• Screening for genetic haemochromatosis in blood samples with raised alanine aminotransferase
  Gut 2000;46:707-710 ( May )

• Screening for Iron Overload due to Hereditary Hemochromatosis 
   CDC website, Reyes, Michele, PhD and Muin J. Khoury, MD, PhD,  National Center for Chronic Disease Prevention and Health Promotion  Identifying people early with evidence of iron overload represents a major chronic disease prevention opportunity.

• Should all patients with diabetes mellitus be screened for hemochromatosis?   Department of Family Medicine University of California, Los Angeles 924 Westwood Blvd, Suite 650 Los Angeles, CA 90095-1628  West J Med 2002;176:110-114  Enhanced case finding becomes the first stage in a public health response when evidence has emerged for an effective early treatment of a disorder. It means the detection of HHC at the time of early symptoms, and it allows patients to benefit from early phlebotomy.  The implementation of this approach would include adding fasting serum transferrin saturation to the usual workup of patients with newly diagnosed diabetes mellitus, arthritis, and impotence.  The CDC recommends such iron-overload testing in anyone with possible symptoms of hemochromatosis, which includes patients with newly diagnosed diabetes mellitus.

• Spontaneous multiple vertebral fractures revealed primary haemochromatosis  
  We describe a male patient with osteoporotic fractures as a presenting feature of haemochromatosis  Osteoporos Int 1996

• The articular damage of hemochromatosis. A little known aspect Recenti Prog Med 1999 Apr The aim of this report is to underline that the patients with premature osteoarthritis or unexplained chondrocalcinosis must be screened for genetic haemochromatosis in order to formulate the correct diagnosis before the development of severe internal organ involvement.

• The effect of arthritis on the quality of life in hereditary hemochromatosis
  Although cirrhosis is the major factor affecting survival, arthritis is a prominent clinical factor affecting quality of life in hemochromatosis.  J Rheumatol 1996 Apr

• Too much iron can hurt joints, body organs 
  The Albuquerque Tribune. By John Crowe The Associated Press 1/11/00

• Unusual involvement of the feet in hemochromatosis  Foot Ankle 1984 Jan-Feb The arthropathy of hemochromatosis mimics aspects of both rheumatoid arthritis and degenerative joint disease.

• Use of HFE Mutation Analysis for Hereditary Hemochromatosis:  The Need for Physician Education in the Translation of Basic Science to Clinical Practice  Manish Kohli, MB, ChB, Steven A. Schichman, MD, PhD, Louis Fink, MD, Clive S. Zent, MB, BCh, Department of Internal Medicine, Division of Hematology/Oncology and the Department of Pathology, John L. McClellan Memorial Veteran's Hospital and University of Arkansas for Medical Sciences, Little Rock.  Southern Medical Journal

• Venesection therapy of insulin resistance-associated hepatic iron overload
  J Hepatol 2001 Sep The association of hepatic iron overload with metabolic disorders has been coined as the insulin resistance-associated hepatic iron overload syndrome (IR-HIO).

• Welcome to Joint Replacement Institute

Click on this link to read about HH. Discussion of a liver biopsy is also here: 

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