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HFE genotyping demonstrates a significant incidence of hemochromatosis in undifferentiated arthritis

E. Cauza¹, U. Hanusch-Enserer¹, M. Etemad¹, M. Köller², K. Kostner³, P. Georg², A. Dunky¹, P. Ferenci⁴

¹Department of Internal Medicine V, Department of Rheumatology, Wilhelminenspital, Vienna; ²Department of Internal Medicine III, Department of Rheumatology and Metabolism, University of Vienna; ³Department of Internal Medicine I, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia; ⁴Department of Internal Medicine IV, Gastroenterology and Hepatology, University of Vienna, Vienna, Austria.

ABSTRACT
Objective
Hereditary hemochromatosis is a common autosomal recessive disorder of iron metabolism. Among Northern Europeans the carrier frequency is estimated to be 1 in 10, while up to 1 in 200 is affected by the disease. Arthropathy is one early clinical manifestation of this disease, but the articular features are often misdiagnosed. In this study the two frequent mutations of the HLA-linked hemochromatosis gene (HFE) were investigated in a rheumatology clinic population.

Methods
Two hundred and six consecutive patients (mean age 57.7 years; 38 male/168 female) attending a rheumatology clinic over a period of 14 months were screened for HFE mutations (C282Y and H63D). All standard diagnostic procedures were used to identify the aetiology of the arthropathy. Mutations were evaluated by separation on PAGE of digested PCR amplificates of DNA (by SnapI and Bcl-I, for C282Y and H63D, respectively) obtained from PBMCs.

Result
The C282Y and H63D allele frequencies were 4.5 and 12.8 in patients with rheumatic diseases. Five patients were homozygote for H63D (2.4%), and one for C282Y (0.5%). Five patients were compound heterozygous (2.4%). The observed C282Y allele frequency in rheumatic patients with undifferentiated arthritis was 12.9 and exceeded that of healthy subjects (p = 0.01).

Conclusions
Determination of the HFE genotype is clinically useful in patients with arthritis of unknown origin, to allow early diagnosis of hemochromatosis.

Key words
HFE mutation, C282Y, H63D, hereditary hemochromatosis, rheumatologic patient.

Please address correspondence to: Edmund Cauza, MD, Department of Internal Medicine V, Department of Rheumatology, Wilhelminenspital, Montleartstr. 37, A-1160 Vienna, Austria.