Juvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review

Jubran Alqanatish,1– 3 Banan Alsowailmi,1 Haneen Alfarhan,1 Albandari Alhamzah,1 Talal Alharbi1,2,4 1King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14611, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611, Saudi Arabia; 3Dep...

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Autores principales:	Alqanatish J, Alsowailmi B, Alfarhan H, Alhamzah A, Alharbi T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	hereditary hemochromatosis hfe gene arthritis deferasirox Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/904c7b033eef4d73b8f9ac2b76556c5d
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spelling	oai:doaj.org-article:904c7b033eef4d73b8f9ac2b76556c5d2021-12-02T15:19:13ZJuvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review1179-156Xhttps://doaj.org/article/904c7b033eef4d73b8f9ac2b76556c5d2021-01-01T00:00:00Zhttps://www.dovepress.com/juvenile-hemochromatosis-rheumatic-manifestations-of-2-sisters-respond-peer-reviewed-article-OARRRhttps://doaj.org/toc/1179-156XJubran Alqanatish,1– 3 Banan Alsowailmi,1 Haneen Alfarhan,1 Albandari Alhamzah,1 Talal Alharbi1,2,4 1King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14611, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611, Saudi Arabia; 3Department of Pediatrics, King Abdullah Specialist Children’s Hospital and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 4Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children’s Hospital and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaCorrespondence: Jubran AlqanatishKing Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), PO Box 22490, Riyadh 11426, Saudi ArabiaTel +966 118011111 Ext 53501Email qanatishj@ngha.med.saAbstract: Hereditary hemochromatosis (HH) is an inherited iron overload. The most common form of HH is type 1 hereditary hemochromatosis (HFE-related), which is associated with mutation of the HFE gene located on chromosome 6 and inherited in an autosomal recessive pattern. Type 2 hereditary hemochromatosis or juvenile hemochromatosis is less frequent autosomal recessive disease that results from mutations in the HJV gene on chromosome 1 (type2a) or the HAMP gene on chromosome19 (type2b). Mutation of type 2 transferrin receptor gene and mutation of the ferroportin gene result in hemochromatosis type 3 and hemochromatosis type 4, respectively. Juvenile hemochromatosis is characterized by an early onset of excess accumulation of iron in various organs. It could affect the liver, heart, pancreas and joints, resulting in arthropathy. Most juvenile hemochromatosis cases exhibit severe symptoms due to early onset. Cardiac and hypogonadism are the dominating features of the disease. Prevalence of arthropathy in juvenile hemochromatosis is higher than classic HH. Early diagnosis and intervention of juvenile hemochromatosis may prevent irreversible organ damage. The diagnosis can be made based on laboratory testing (of increased transferrin saturation, serum iron and ferritin levels), liver biopsy, imaging or genotype. According to international guidelines, treatment of HH is indicated when serum ferritin concentrations are above the upper limit of normal. We report two sisters who presented to the rheumatology clinic with arthralgia, which was subsequently found to have a homozygous mutation variant of unknown significance in the HFE2 gene: c.497A>G;p.(His166Arg) and has been treated with deferasirox (Exjade®). Musculoskeletal symptoms completely resolved in both patients in two months and remained so for one year on treatment.Keywords: hereditary hemochromatosis, HFE gene, arthritis, deferasiroxAlqanatish JAlsowailmi BAlfarhan HAlhamzah AAlharbi TDove Medical Pressarticlehereditary hemochromatosishfe genearthritisdeferasiroxDiseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol Volume 13, Pp 15-21 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hereditary hemochromatosis hfe gene arthritis deferasirox Diseases of the musculoskeletal system RC925-935
spellingShingle	hereditary hemochromatosis hfe gene arthritis deferasirox Diseases of the musculoskeletal system RC925-935 Alqanatish J Alsowailmi B Alfarhan H Alhamzah A Alharbi T Juvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review
description	Jubran Alqanatish,1– 3 Banan Alsowailmi,1 Haneen Alfarhan,1 Albandari Alhamzah,1 Talal Alharbi1,2,4 1King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14611, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611, Saudi Arabia; 3Department of Pediatrics, King Abdullah Specialist Children’s Hospital and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 4Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children’s Hospital and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaCorrespondence: Jubran AlqanatishKing Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), PO Box 22490, Riyadh 11426, Saudi ArabiaTel +966 118011111 Ext 53501Email qanatishj@ngha.med.saAbstract: Hereditary hemochromatosis (HH) is an inherited iron overload. The most common form of HH is type 1 hereditary hemochromatosis (HFE-related), which is associated with mutation of the HFE gene located on chromosome 6 and inherited in an autosomal recessive pattern. Type 2 hereditary hemochromatosis or juvenile hemochromatosis is less frequent autosomal recessive disease that results from mutations in the HJV gene on chromosome 1 (type2a) or the HAMP gene on chromosome19 (type2b). Mutation of type 2 transferrin receptor gene and mutation of the ferroportin gene result in hemochromatosis type 3 and hemochromatosis type 4, respectively. Juvenile hemochromatosis is characterized by an early onset of excess accumulation of iron in various organs. It could affect the liver, heart, pancreas and joints, resulting in arthropathy. Most juvenile hemochromatosis cases exhibit severe symptoms due to early onset. Cardiac and hypogonadism are the dominating features of the disease. Prevalence of arthropathy in juvenile hemochromatosis is higher than classic HH. Early diagnosis and intervention of juvenile hemochromatosis may prevent irreversible organ damage. The diagnosis can be made based on laboratory testing (of increased transferrin saturation, serum iron and ferritin levels), liver biopsy, imaging or genotype. According to international guidelines, treatment of HH is indicated when serum ferritin concentrations are above the upper limit of normal. We report two sisters who presented to the rheumatology clinic with arthralgia, which was subsequently found to have a homozygous mutation variant of unknown significance in the HFE2 gene: c.497A>G;p.(His166Arg) and has been treated with deferasirox (Exjade®). Musculoskeletal symptoms completely resolved in both patients in two months and remained so for one year on treatment.Keywords: hereditary hemochromatosis, HFE gene, arthritis, deferasirox
format	article
author	Alqanatish J Alsowailmi B Alfarhan H Alhamzah A Alharbi T
author_facet	Alqanatish J Alsowailmi B Alfarhan H Alhamzah A Alharbi T
author_sort	Alqanatish J
title	Juvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review
title_short	Juvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review
title_full	Juvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review
title_fullStr	Juvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review
title_full_unstemmed	Juvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review
title_sort	juvenile hemochromatosis: rheumatic manifestations of 2 sisters responding to deferasirox treatment. a case series and literature review
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/904c7b033eef4d73b8f9ac2b76556c5d
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Juvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review

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