Clinical and imaging features of haemochromatosis arthropathy: a systematic literature review and meta-analysis to inform the development of EULAR classification criteria.

OBJECTIVES

The objective of this study was to summarise the clinical and imaging features of haemochromatosis arthropathy (HA) to inform the development of the European Alliance of Associations for Rheumatology classification criteria for HA.

METHODS

We performed a systematic literature review by searching Medline (PubMed and Ovid), Cochrane Library and Embase, and conference abstracts. Various MeSH terms were used to reduce the search to the essential articles. We included original articles describing clinical and/or imaging features of HA, with no restrictions on language or year of publication. We conducted meta-analyses and calculated the pooled prevalence of individual features using a random intercept logistic regression model in R.

RESULTS

A total of 2473 articles were screened, of which 81 were selected for full-text review, and 36 were finally included for data extraction. The most prevalent clinical characteristic was limited range of motion in metacarpophalangeal joints (MCP) 2 and 3 (MCP2/3: 0.62 [0.35-0.83]), bony enlargement (MCP2/3: 0.48 [0.09-0.90]), and joint pain (MCP2/3: 0.41 [0.22-0.63]). Radiographically MCP joints 2 and 3 showed the highest prevalence of subchondral cysts (MCP2: 0.52 [0.37-0.66]; MCP3: 0.52 [0.37-0.66]), joint space narrowing (MCP2: 0.62 [0.43-0.77]; MCP3: 0.62 [0.44-0.78]), and osteophytes (MCP2: 0.49 [0.30-0.68]; MCP3: 0.52 [0.33-0.71]). Chondrocalcinosis prevailed in the knee (0.29 [0.17-0.45]) and subchondral sclerosis in the hip, with >60% (0.61 [0.03-0.99]).

CONCLUSIONS

Our systematic literature review identified characteristic clinical and imaging patterns of HA joint involvement. However, due to the high heterogeneity and low number of studies suitable for analysis, the meaningfulness of the data is limited.