Abstract
BACKGROUND AND AIMS: HFE hemochromatosis (HH) may cause arthritis, cirrhosis, and hepatocellular carcinoma (HCC). Cirrhosis is the main risk factor for HCC in HH. Arthritis is common in HH, strongly associated with cirrhosis and readily diagnosed. Thus, we evaluated whether arthritis might be of clinical utility in predicting the future risk of HCC in HH. METHODS: Two hundred four clinically well-characterized patients with HH were recruited between 1974 and 2013 and attended for regular follow-up at a single center over a median duration of 15.2 years. Clinical, biochemical, and cirrhosis status were recorded at diagnosis. The occurrence of HCC was defined as a documented diagnosis in the medical record. RESULTS: Ten of the 204 patients with HH developed HCC during a follow-up; 9 of these had recorded arthritis status. Seven of 88 patients with arthritis at diagnosis of HH subsequently developed HCC compared with 2 of 115 patients without arthritis (relative risk = 4.57, 95% confidence interval (CI) 1.11-19.07, P = .042). The sensitivity, specificity, positive predictive value, and negative predictive values were 78% (95% CI 45%-96%), 58% (95% CI 51%-64%), 8% (95% CI 4%-15%), and 98% (95% CI 93%-100%). Patients with arthritis and cirrhosis at diagnosis who went on to develop HCC had significantly higher alcohol consumption at baseline compared with those individuals who had arthritis and cirrhosis but did not progress to HCC (median 100 g/d vs 45 g/d, P = .0312). CONCLUSION: Arthritis combined with higher alcohol consumption at diagnosis of HH is associated with an increased risk of future development of HCC.