Hemochromatosis simulating rheumatoid arthritis: a case report

AbstractThis is a report of a patient who had a previous diagnosis of rheumatoid arthritis, non- erosive, rheumatoid factor negative, that despite the therapeutic approach presented pro- gressive worsening of the articular and general condition. After extensive research, she had a diagnosis of hemochromatosis. Joint symptoms are common manifestations in hemochromatosis. The arthropathy of hemochromatosis may resemble inflammatory ar- thropathy mimicking RA, particularly in the most common sites as 2nd and 3rd metacarpo- phalangeal. Radiologically are observed decreased joint space, subchondral sclerosis, cyst formation and chondrocalcinosis. Treatment with disease modifying drugs for rheumatoid arthritis tend to worsen the clinical picture, since the liver is the major site of deposition of iron in hemochromatosis and these medications are known to be hepatotoxic. Phlebotomy treatment for hemochromatosis is apparently ineffective in reversing the articular mani- festations, which requires the association with iron chelating drugs. Due to the apparent difficulty in differentiating between the two diseases, a screening profile of iron in patients with rheumatoid arthritis with atypical progression is necessary