Arthralgia With a Tan

🗒️ Question 

A 62 year old male presents to the clinic with complaints of persistent fatigue, joint pain in his hands and knees and a decreased libido over the past year. He also reports occasional abdominal discomfort and has noticed his skin becoming slightly darker. His past medical history includes type 2 diabetes mellitus and hypertension, managed with metformin and amlodipine. On examination, he has hepatomegaly.

His blood tests show:

• Haemoglobin: 14.2 g/dL (13.5-17.5 g/dL)

• White cell count: 6.8 × 10^9/L (4.0-11.0 × 10^9/L)

• Platelets: 215 × 10^9/L (150-400 × 10^9/L)

• Serum ferritin: 950 µg/L (30-300 µg/L)

• Transferrin saturation: 60% (20-50%)

• ALT: 50 U/L (10-40 U/L)

• AST: 45 U/L (10-40 U/L)

• TSH: 2.2 mIU/L (0.4-4.0 mIU/L)

• Glucose: 8.2 mmol/L (3.9-5.6 mmol/L)

Which of the following is the most appropriate initial management for this patient?

(A) Venesection
(B) Iron chelation therapy
(C) Ursodeoxycholic acid
(D) Liver transplant
(E) Methotrexate