Arthritis predicts advanced hepatic fibrosis in HFE haemochromatosis, finds study

By Melanie Hinze
The presence of arthritis in HFE haemochromatosis predicts advanced hepatic fibrosis, whereas its absence is linked to a low likelihood of advanced hepatic fibrosis, according to new research.

Published in Mayo Clinic Proceedings, the retrospective, cross-sectional analysis included 112 subjects with well-characterised HFE haemochromatosis and fibrosis validated by liver biopsy and biopsy-validated noninvasive biomarker indices. The subjects were recruited over 30 years, beginning in 1983.

In total, 19 subjects had advanced hepatic fibrosis, and 47 had haemochromatosis arthritis. Sixteen of the 19 (84%) patients with advanced hepatic fibrosis had arthritis, and 16 of the 47 (34%) patients with arthritis had advanced hepatic fibrosis. However, only three of 65 (5%) patients without arthritis had advanced hepatic fibrosis.

The study authors concluded that arthritis was significantly associated with the presence of advanced hepatic fibrosis, as determined by liver biopsy.

Lead authors of the research were Professor John Olynyk, Theme Lead for Health Research, Edith Cowan University, and Consultant Gastroenterologist & Hepatologist at Fiona Stanley Fremantle Hospital Group, Perth, and Professor Grant Ramm, Deputy Director of QIMR Berghofer Institute, Brisbane.

‘For GPs, the bottom line of this new research is that if patients with haemo­chromatosis don’t have arthritis, then they are at very low risk for having any liver disease at all,’ Professor Olynyk said.

‘So, you can just ask the patient to show you their hands and if there’s no arthritis, then there’s a 95% chance that they won’t have any significant liver disease,’ he said. ‘Then if their ferritin level is under 1000 mg/L, and there’s no arthritis, there’s almost no chance there would be any liver disease at all.’

The authors recommended that all subjects with HFE haemochromatosis who presented with arthritis be evaluated for the presence of advanced hepatic fibrosis using noninvasive biomarkers such as the AST-platelet-ratio index (APRI) or fibrosis-4 index, both validated as useful methods in HFE haemochromatosis.

‘The utility of arthritis in predicting advanced hepatic fibrosis in HFE haemochromatosis is novel, translating new knowledge into clinical practice,’ Professor Olynyk added.
Mayo Clin Proc 2022; doi: https://doi.org/10.1016/ j.mayocp.2022.02.017.