Interleukin-1 receptor antagonist in refractory haemochromatosis-related arthritis of the hands

1-3 This arthropathy, which may seriously affect quality of life, was reported to occur in 20%-50% of HH patients with articular complaints and can coexist with calcium pyrophosphate deposition. 4-6 Hand arthropathy is not alleviated by phlebotomy, and in a few patients, disease is refractory or intolerant to standard treatments such as non-steroidal anti-inflammatory drugs (NSAIDs), low-dose colchicine or analgesics. [...]these patients remain without adequate treatment. In vitro, iron complexes decrease proteoglycan synthesis and could induce lipid peroxidation in chondrocytes, which may contribute to cartilage catabolism. 3 In addition, accumulation of ferritin in synovial fibroblasts could be pro-inflammatory; indeed, in some tissue, ferritin was a potent and rapid inducer of IL-1 gene expression. 3 In HH patients, anakinra, which inhibits both IL-1α and IL-1β, could reduce neutrophilic infiltration, a characteristic of HH arthropathy 8 and could act by decreasing inflammation related to CPP crystals. 9 10 Our cases suggest that IL-1 blockade could be a promising approach for treating HH-related arthritis.