Comment on: Hereditary hemochromatosis arthropathy and Doppler ultrasound findings of synovitis

Sir, I read with interest the letter to the editor by Okeet al. [1] ‘Hereditary hemochromatosis arthropathy and Doppler ultrasound findings of synovitis’. The authors reported two interesting cases of patients with hereditary haemochromatosis that were found to have increased Doppler signal on US examination due to synovitis [1]. A possible explanation of their observation is the presence of calcium pyrophosphate dihydrate crystal deposition disease (CPPD), which has been strongly associated with haemochromatosis [2,3]. A previous study demonstrated that 66% of patients with CPPD had sonographic hypervascularization of degree 2 or higher in their joints (increased Doppler signal), consistent with active synovitis [4]. Although the radiographs did not reveal chondrocalcinosis, neither US showed hyperechoic rounded amorphous spots, imaging findings that often are seen in CPPD, but their absence does not exclude the disease [5]. On this basis, I believe that the main cause of active inflammatory arthritis in haemochromatosis is coexistent CPPD.
Source: Rheumatology - Category: Rheumatology Source Type: research