Sclerosing Bone Dysplasia from 16th Century Sardinia (Italy): A Possible Case of Camurati–Engelmann Disease

The skeletal remains of a male aged 45–55 years displaying several bone anomalies were unearthed from the Alghero (Sardinia) plague cemetery ‘lo Quarter’, a burial site dating back to the 1582–1583 AD outbreak. The skeleton, whose stature is about 165 cm, presents a bilateral hyperostosis with increased diameter of the diaphyses of all the long bones of the upper and lower limbs; the metaphyses appear to be involved, while the epiphyses are spared. Marked thickening of the cranial vault is also evident. Radiological study showed irregular cortical thickening and massive endoperiosteal bone apposition; sclerotic changes are observed in the diaphysis of some metacarpals. Computed tomography (CT) cross sections of the long bones displayed a thickening of the cortical portion and endoperiosteal bone apposition. The individual was affected by a sclerosing bone dysplasia, a genetic disease characterized by increased bone density. In differential diagnosis, several sclerosing bone dysplasia, such as hyperostosis corticalis generalisata, craniodiaphyseal dysplasia, craniometadiaphyseal dysplasia, pachydermoperiostosis and Camurati–Engelmann disease, as well as other disorders characterized by sclerosing manifestations, such as Erdheim–Chester disease, mehloreostosis and skeletal fluorosis, need to be considered. The anomalies observed in skeleton 2179 fit with the features of Camurati–Engelmann disease, which is the most likely candidate for final diagnosis. It is highly challenging to evaluate how such a condition may have influenced the individual's lifestyle in terms of development, mobility and quality of life. This individual was probably symptomatic and must have experienced common clinical symptoms, such as pain in the limbs and fatigability. However, the strong development of the muscular insertions and the degenerative changes in the upper limbs suggest that the mobility problems should not have prevented him from reaching a mature age and from performing essential daily activities. The presented case is the unique paleopathological evidence of Camurati–Engelmann disease so far diagnosed. Copyright © 2015 John Wiley & Sons, Ltd.     

The chronology of epiphyseal union in the hand and foot from dry bone observations

Dry bone data for epiphyseal union at the hand and foot are scarce, incomplete or inexistent. This study documents the timing of fusion of secondary ossification centres at the hand and foot in a sample of known‐age human skeletons. The sample comprises 92 individuals (49 females and 43 males), between the ages of 9 and 22 years, from the identified skeletal collection curated at the National Museum of Natural History in Lisbon, Portugal. Epiphyseal union was recorded on the right and left side at the long bones of the hand (metacarpus and phalanges) and foot (metatarsus and phalanges), and also at the talus and calcaneus, using a three stage scheme (non‐fused; partially fused and completely fused). In the hand, intra‐observer agreement was 99% and inter‐observer agreement was 98%. In the foot, both intra‐ and inter‐observer agreement reached 100%. Lateral asymmetry was not significant and only 1.1% of the individuals in the sample were found to be asymmetric in the stage of epiphyseal fusion (1.8% in the hand and 0.3% in the foot). A minimum mean advancement of 1–2 years in females relative to males was observed. In the hand bones, epiphyseal union occurred between 12–18 years in females and 16–18 years in males. Comparatively, in the foot bones, epiphyseal union occurred slightly later, with the exception of the talus and calcaneus, which are the earliest bones to mature. Data in this study can be used to estimate the age of unidentified skeletal remains, either directly or by aiding in the modification of incomplete or imprecise data that have been collected over the years. Copyright © 2009 John Wiley & Sons, Ltd.     

Bone weight: new reference values based on a modern Portuguese identified skeletal collection

Skeletal weight and/or weight of the different bones of the human skeleton are currently used in a wide range of applications such as archaeological cremations and forensics. Still, few reference values are available that compare the mean weights for the different skeletal parts. In this paper we present new reference values for total skeletal weight, including the weight of the different skeletal bones based on a modern Portuguese Identified Skeletal Collection (CEI) curated in the Museum of Anthropology of the University of Coimbra (Portugal). The mean weight of the entire skeleton for the CEI pooled sample is 3323.8 ± 779.6 g. Sex and age differences were investigated. As expected, males display heavier bones, at a statistically significant level. The mean weight of the male skeletons is 3850 g, and 2797.6 g for the female sample. Age differences were found, especially for the female samples in the 29–39 versus 50–59 and/or >60 age groups, probably as a consequence of age‐related bone loss in post‐menopausal women. For the male sample, no clear age‐related trend was observed but for the unexpected result that the second highest bone weight recorded is in the oldest age group (>60 years). This could result from high mechanical loadings and thus greater bone robusticy and amount of cortical bone. The percentage of weight of the different parts of the skeleton was also calculated. These new values can be quite useful in the study of very fragmentary and/or commingled human remains, recovered from historic or forensic contexts, since the complete identification, by side, of the remains is not necessary. Copyright © 2008 John Wiley & Sons, Ltd.     

Subadult Age‐at‐Death Estimation From the Human Calcaneus

The estimation of age from subadult skeletal remains relies on the measurement of bones, which when unavailable or damaged hampers the ability to generate a reliable age estimate. The goal of this project was to demonstrate two methods for estimating age at death from the developing human calcaneus. These methods are generated from a sample of 32 European American and African American males and females with ages ranging from 1 to 19 years from the Hamann–Todd Collection. The first method was based on linear regression from two standard measurements of the calcaneus (maximum length and middle breadth); the second was based on transition analysis of fusion states of the calcaneal epiphysis. Results suggest that both methods perform well in estimating subadult age at death. Additional testing with larger contemporary samples would likely increase the accuracy of both methods. Copyright © 2011 John Wiley & Sons, Ltd.     

Age Estimation by Tympanic Bone Development in Foetal and Infant Skeletons

This article analyses age‐related changes in the development of the temporal bone in a sample of foetal and infant skeletons to contribute to the estimation of age by means of this skeletal element in bioarchaeological and forensic contexts. The sample was selected from a contemporary documented skeletal collection and is constituted by the temporal bones of individuals of both sexes (n = 37) with ages from 23 weeks of gestation up to 11 postnatal months. Different states of fusion of the tympanic ring and development of the tympanic plate were scored separately, and intra‐observer consistency was evaluated. Both documented chronological age and skeletal estimated age were examined in relation to successive stages of fusion and development in the pre‐ and postnatal periods. It was found that the state of fusion of the tympanic ring is especially useful in the discrimination of foetal and postnatal individuals, whereas the development of the tympanic plate is helpful in the differentiation of individuals from and below 3 postnatal months. Even though a certain degree of overlap between successive stages was observed, the fusion of the tympanic ring and the development of the tympanic plate constitute good indicators of age in foetal and infant skeletons. Copyright © 2015 John Wiley & Sons, Ltd.     

Adult scurvy in skeletal remains of late 19th century mineworkers in Kimberley,South Africa

Throughout history, scurvy has been a well‐known disease which develops due to restricted resources of fresh fruit and vegetables. The condition results from an extended limited intake of vitamin C. Although skeletal lesions associated with infantile scurvy have been well described by many authors, very little literature is available on adult scurvy and the resulting skeletal lesions. The purpose of this study was to investigate the skeletal remains of a 19th century mining population from Kimberley, South Africa, for any skeletal lesions that may be indicative of adult scurvy. Scurvy was well documented as being extremely prevalent in this population. The skeletal remains of 107 individuals, presumed to have died around 1898, were studied. The majority of these individuals were males between 19 and 45 years of age. It is likely that most individuals were migrant workers at the diamond mines. All bones were visually assessed for macroscopic indications of pathological bone alterations associated with healed scurvy. Bone samples were also taken from ambiguous lesions in order to perform histological investigations. Lesions indicative of possible healed adult scurvy were observed in 16 individuals. These lesions included bilateral ossified haematomas, osteoperiostitic bone changes and periodontal disease. Histological investigation confirmed the presence of ossified haematomas on the anterior tibiae of some individuals. Hospital records and historical documents describing the incidence of scurvy in the local hospitals and the daily diet of the black mine workers supported these findings. Copyright © 2009 John Wiley & Sons, Ltd.     

Skeletal remains of dogs unearthed from the Van‐Yoncatepe necropolises

A total of 15 dog skulls and a number of bones have been discovered in two burial chambers dating from 1,000 BC in the necropolises of the Van‐Yoncatepe Castle in eastern Turkey. The finds were a dog skeleton in burial chamber M5 and 14 dog skulls and plenty of bones in burial chamber M6. It was determined on examination that the skeleton found in burial chamber M5 was an 11–12‐year female dog, and that the skulls unearthed from burial chamber M6 belonged to dogs with an age range of seven to eight months to 12–13 years. In the latter chamber, however, except for one skull whose sex could not be determined, one was ascertained to belong to a female dog and the rest to males. Calculations of 20 different indices and ratios were made on the skulls. This showed that these skulls were of the dolichocephalic type. It was observed that there were signs of a widespread periodontal disease and alveolar recession. Enamel hypoplasia and abscess chambers detected on the teeth, and deformations observed in the hard palate were evidence enough to suggest that these were undernourished dogs. There were also some facial fractures, which were noticed to have occurred before death. On the other hand, examination carried out on the bones revealed that the dogs were of medium size, and that they were likely to have had a withers height of 50–55 cm. The data obtained from both the burial chambers brought to light the fact that these dogs were more of the hunting or working types. Copyright © 2002 John Wiley & Sons, Ltd.     

A possible case of spondyloarthropathy in a prehistoric Japanese skeleton

Palaeopathology helps to define the migration of past diseases. Genetic and environmental factors play a role in the development of spondyloarthropathy (SpA). We report skeletal remains with SpA from the Jomon period in Japan. The skeleton is of a female who died at a young adult age. The skeleton had characteristic features seen in SpA as follows: (1) polyarticular arthritis; (2) erosions accompanying some bone formation; (3) enthesial ossification; and (4) periostitis in lower long bones. The findings suggest that SpA was present in prehistoric Japan before contact with European civilisation, and the present example of SpA is the oldest in Asia and the Old World. Copyright © 2004 John Wiley & Sons, Ltd.     

‘Old wood’ effect in radiocarbon dating of prehistoric cremated bones?

Numerous reports of successful radiocarbon dating of cremated bones have emerged during the last decade. The success of radiocarbon dating cremated bones depends on the temperature during burning and the degree of recrystallisation of the inorganic bone matrix. During cremation bones undergo major morphological and mineralogical changes which have raised some interesting questions and discussion on the origin of the carbon source in archaeologically cremated bones. Recent laboratory experiments reveal that the properties of the combustion atmosphere play a significant role regarding the source carbon in cremated bones. Thus radiocarbon dating cremated bones is potentially dating the wood used for the cremation fire. Here we compare a high precision radiocarbon dated human bone with an associated dendrochronological age from an oak coffin. We find that the age discrepancy between the dendrochronological age and the cremated bone of 73 ± 26 ¹⁴C yr is best accounted for by the so called ‘old wood’ effect.     

Medieval Britain and Ireland in 1989

Abstract

CHILDHOOD IS A TIME of rapid biological growth and development, and a stage of the life course during which bodies are particularly sensitive to social and environmental stressors. As a consequence, events which may impact upon a child’s care and treatment can become physically embodied within their bones and teeth. The skeletal remains of children have been neglected within archaeological discourse until recently, but they are, in fact, a particularly important demographic for understanding the impact of social processes on past population health. This research examines the prevalence of skeletal disease in children (≤16 years) in Britain (England, Wales and Scotland) between ad 1000 and 1700. Data for a total of 4,626 children from 95 sites were collated from published and unpublished skeletal reports and analysed for evidence of skeletal changes reflecting disease. A biocultural approach was adopted in which the evidence was interpreted in relation to ecological, social, economic and environmental conditions. It was observed that childhood levels of skeletal stress did increase significantly after 1540. It was noted that during the Reformation sociocultural and economic factors added to stressors in the ecology of the medieval child. The effects of the Reformation were found to be the greatest aggravator in the rise of morbidity prevalence over seven centuries. Differences in morbidity patterns between non-adult age categories indicated that a state of ‘childhood’ existed until at least eleven years of age, after which there appears to have been a gradual transition into adolescence and adulthood.     

Dry-bone manifestations of rickets in infancy and early childhood

Rickets and osteomalacia are the subadult and adult expressions of a disease in which the underlying problem is a failure to mineralize bone protein (osteoid). The most common cause of this disease is a physiological deficiency in vitamin D. The associated problems include deformed bones and this condition is well known in pre-modern medical texts and documents as a fairly common cause of morbidity. Given these facts, it is surprising that the literature on palaeopathology provides very little evidence of this disease in archaeological human skeletal samples. The medieval sample (N=687) of human remains from Wharram Percy, North Yorkshire, England contains a remarkable subsample of eight burials in which a spectrum of pathological features is expressed. The subsample includes infants ranging in age from 3 to 18 months at the time of death. Ten abnormal bone features were identified in the subsample, including: (i) cranial vault porosity; (ii) orbital roof porosity; (iii) deformation of the mandibular ramus; (iv) deformation of arm bones; (v) deformation of leg bones; (vi) flared costo-chondral ends of ribs; (vii) irregular and porous cortex of the costo-chondral ends of the ribs; (viii) abnormality of the growth plates of long bones; (ix) irregular and porous surfaces of the metaphyseal cortex; (x) thickening of the long bones, particularly in the metaphyseal areas. Not all of these features were found in all of the cases. Nevertheless, the overall pattern of skeletal abnormality fits well with the anatomical and radiological conditions associated with rickets. © 1998 John Wiley & Sons, Ltd.     

A Probable Case of Acute Childhood Leukemia: Skeletal Involvement,Differential Diagnosis,and the Bioarchaeology of Cancer in South America

Cancer involves a complex spectrum of disease conditions. However, cancer has received relatively limited attention in paleopathology and bioarchaeology as it is infrequently encountered in the skeletal record, and its differential diagnosis in dry bone remains challenging. Of all neoplastic disorders, one of the most infrequently described forms in ancient skeletons is leukemia, or the myeloproliferative neoplasms of the reticuloendothelial system affecting bone marrow and blood. This case study describes and interprets a suite of lytic and proliferative lesions in the skeletal remains of an Early/Middle Colonial‐era child (ca. A.D. 1533–1620) excavated at the ruins of Eten, southwestern Lambayeque Valley Complex (north coast of Peru). A secondary burial contained the incomplete postcranial remains of a 5–6 year‐old child whose bones were characterized by abnormal porous loci in the right clavicle, scapulae, long bones of the upper limb, ribs, and thoracic and lumbar vertebrae. Additionally, fine areas of new bone formation were present on the clavicle and ribs. Multiple pathological conditions were evaluated in a differential diagnosis, including taphonomic changes and various bone resorbing and forming disorders. The lesions are most consistent with acute childhood leukemia and represent the first of its kind described in Andean South America. The identification of this condition helps focus research questions involving the bioarchaeology of cancer in the Andes, especially regarding the significance of neoplastic disorders in relation to the broader reconstruction of past human health in Peru. Copyright © 2014 John Wiley & Sons, Ltd.     

Evaluating human skeletal growth: An Anglo-Saxon example

Cross-sectional growth data were obtained from the skeletal remains of non-adults from the Raunds Anglo-Saxon site. Standard measurements of the diaphyseal lengths of the long bones of the upper and lower limbs and the maximum breadth of the ilium were recorded in order to construct skeletal growth profiles (SGP). In addition regression equations were used to estimate diaphyseal length from proximal and distal shaft widths, and epiphyseal breadth data for fragmentary remains. The skeletal measurements were then plotted against age estimates determined by the dental formation standards of Moorrees, Fanning and Hunt, and Anderson, Thompson and Popovich. The growth data were compared with sixth to seventh century German, ninth century Slavic and modern Caucasian data. With the exception of the ancient Slavic material, the Anglo-Saxon remains demonstrated the smallest rates of growth. Diaphyseal ageing curves derived from the Anglo-Saxon sample were tested for applicability on the non-adult cohorts of the Berinsfield and Exeter Anglo-Saxon/Early Medieval samples. Differences were observed between diaphyseal age as determined from the skeletal growth profiles for Raunds and calcification age assessed for individuals within the test samples. It is proposed that variation in long bone growth as well as dental age confounds consistent and reliable ageing of skeletal remains based on diaphyseal length. Assessment of changes in health and evaluation of methodological problems inherent to studies of skeletal growth from archaeological populations are discussed. Population comparisons for changes in general health are recommended over individual assessments.     

Ancient injury recidivism: an example from the Kerma period of ancient Nubia

A topical trend in clinical research has been the study of repeat trauma, referred to by clinicians as “injury recidivism,” which lends itself to the assessment of accumulated injuries among ancient people. The present investigation examined the healed injuries among two archaeological skeletal samples from the Kerma period (ca. 2500–1500 BC) of Sudanese Nubia. Both groups were known to have a high prevalence of multiple trauma—80% of 54 adults from the rural sites (O16 and P37) located near Dongola and 42% of 212 adults from the urban site of Kerma sustained nonfatal injuries. It was observed that a higher frequency of multi‐injured adults displayed one or more violence‐associated injury (cranial trauma, parry fracture). When all injuries were considered 38% of individuals with violence‐related injuries had other traumatic lesions in contrast to 22% of individuals who experienced injuries associated with accidental falls (e.g., Colles', Smiths', Galeazzi, and paired forearm fractures), although this difference was not significant. When only the skulls and long bones were evaluated 81% of adults with multiple injuries to these major bones bore one or more violence‐related injuries, while 60% of adults with single injuries sustained violence‐related injuries. Most individuals with multiple injuries were male and less than 35 years of age; there was no significant difference in the frequency of violence‐ or accident‐related multiple injury between the rural and urban communities. Although it cannot be established whether or not some of an individual's injuries were experienced during simultaneous or independent incidents, the pattern of multiple injury among these two ancient Nubian skeletal samples reflected the profile of injury recidivism observed by modern clinicians cross‐culturally. Copyright © 2002 John Wiley & Sons, Ltd.     

Differential diagnosis of cartilaginous dysplasia and probable Osgood–Schlatter's disease in a Mississippian individual from East Tennessee

This paper details the differential diagnosis of an adult female skeleton displaying features consistent with a cartilaginous dysplasia and Osgood–Schlatter's disease. This burial was excavated in 1940 from a Mississippian platform mound at the DeArmond site (40RE12) in Roane County, Tennessee as part of the Works Progress Administration (WPA) and Tennessee Valley Authority (TVA) archaeological investigations. The right humerus and left femur of this individual display traits consistent with achondroplasia, such as shortened length and normal width. However, the rest of the long bones display typical morphology. The affected humerus and femur are 82 mm and 58 mm shorter than their counterparts, respectively. This makes for obvious asymmetry. A review of the various cartilaginous dysplasias was undertaken to identify those conditions concordant with the differential manifestation of the long bone asymmetry. Morphological and radiographic analyses were used to rule out possible diagnoses. The most likely candidate is enchondromatosis out of the presented conditions, as it most commonly affects the long bones, does not affect every bone in the skeleton, and is asymmetrical in its manifestation. In addition to the cartilaginous dysplasia, both anterior proximal tibial metaphyses of this individual display defects that are roughly triangular with pitted, irregular floors. Osgood–Schlatter's disease is caused by repeated trauma to the tibial tuberosity during childhood. This individual would have walked with an obvious limp, and perhaps the added biomechanical stress on both quadriceps muscles as a result caused the injuries and resultant defects to its attachment points. Evidence of these conditions in an adult indicates that the Mississippian people in this community offered some sort of social support to differently‐abled individuals. Copyright © 2009 John Wiley & Sons, Ltd.     

The palaeopathology of a finger dislocation

The Ruffner collection, a Late Period (AD 500–1800), northern California skeletal sample, was analyzed for osteopathology. A probable fifth-finger dislocation of the right first and second phalanx was observed in a female aged 25–35 years at death. Traumatic adduction forced the second and third phalanges to slip laterally, upward and back about 10 mm, upon the dorsal surface of the first phalanx. Apparently, the medial collateral ligament of the interphalangeal joint was torn, making reduction impossible. As a result of the luxation, the flexor digitorum profundus slipped laterally and was fixed along the lateral surface of the distal end of the first phalanx. Over time, fusion of the joint restricted the flexion movement and left an abnormally aligned finger.     

Changes in survival of cattle (Bos taurus) during Medieval times in two Norwegian cities

Abstract

Bones (diaphyses) have epiphyses that fuse at a given age. This indicates if the animal was older or younger than the age of fusion for that specific epiphysis at death. In this short contribution, we present a new methodology to calculate survival/mortality of cattle on the basis of epiphysial fusion. We used cattle bones, excavated in two Norwegian cities, Oslo and Trondheim, to calculate survival and changes in mortality for cattle during the period from AD1000 to AD1624. This is based on standard logistic regression models, using a complementary log–log link and the log of age of fusion of the epiphyses as independent variable, an approach recognised as a ‘Weibull-model for current-status-data’. Mortality of cattle was higher in the city of Trondheim than in Oslo. For both cities the mortality of cattle decreased, and the life-span increased, during the period from the AD1000 until AD1350. In Oslo, mortality after 1350 was similar to that between 1150 and 1250, while in Trondheim, it was similar to the mortality in the period from 1250 to 1350. We have shown that mortality curves can be calculated using epiphysial fusion data, and using this approach have demonstrated a change in cattle mortality which corresponds to significant historic events during the medieval period.     

Is Unresolved Inflammatory Angiogenesis a Mechanism for the Delayed Development of Skeletal Lesions in Syphilis?

A recently described case of putative early tertiary syphilis in a young adult male from 6th century Anglo‐Saxon England exhibits a distinctive endocranial pathology. A case–control study using both clinical and archaeological materials was performed to investigate a possible association of the pathology with syphilis. Scanning electron microscopy and microcomputed tomography were used to image the syphilitic case and normal cranial material. Although the pathology does seem to have an association with syphilis (OR = 13.14), the sample size is small, and the authors caution against overinterpretation of the results. The study confirms observations by other authors suggesting the lesion has some association with a range of pathological conditions. Any association with syphilis seems to be restricted to the early tertiary stages and is possibly absent in the later stages of the disease. The morphological differences present in the samples observed by scanning electron microscopy and microcomputed tomography illustrate the abnormal nature of the vascularity within the syphilitic cranium. The widespread presence of similar lesions within other tubular bones leads the authors to propose hypothesis that unresolved angiogenesis is the underlying mechanism behind the skeletal changes in tertiary syphilis. This angiogenic model accounts for several diverse characteristics in the progression of skeletal disease resulting from infection by spirochetes of the Treponema pallidum family. Copyright © 2012 John Wiley & Sons, Ltd.     

Rickets in a High Social Class of Renaissance Italy: The Medici Children

Exploration of the Medici Chapels in the Basilica of San Lorenzo in Florence revealed the burials of nine juvenile members of the Medici family (16th–17th centuries). The estimated children's skeletal ages ranged from newborns to 5‐year‐olds, showing a series of bone abnormalities, in particular diffuse periosteal new bone and bowing of long bones. The comparable pathological lesions, including porosity evident on the skull, orbital roofs, costocondral ribs and growth plates between metaphyses and epiphyses, enlargement of metaphyses and sternal rib ends, and long bone bending, are interpreted as the skeletal manifestation of rickets. The diagnosis of a metabolic disease linked to vitamin D deficiency would appear to be unexpected for children brought up at the court of a Renaissance elite class family like the Medici of Florence. Analysis of the historical and social background is particularly helpful to understand the causes of the onset of the disease in this aristocratic group. Documentary sources, supported by ¹³C and ¹⁵N bone collagen analysis, attest that weaning of these children took place when they were around 2 years old. With a prolonged breast‐feeding and a delay in introducing solid food in the diet, vitamin D deficiency is expected to rise considerably, in particular if the other main risk factor, namely inadequate sunlight exposition, is associated with this human milk‐based diet. Copyright © 2013 John Wiley & Sons, Ltd.     

Possible rheumatoid arthritis found in the human skeleton collected from the tomb of Joseon Dynasty,Korea, dating back to the 1700s AD

We report a possible rheumatoid arthritis (RA) case found in a Korean Joseon Dynasty (1392–1910) tomb encapsulated by a lime‐soil mixture barrier (LSMB). The tomb is thought to have been constructed during the 1700s AD (1760 AD by carbon dating). In our anthropological examination, joint destruction, erosion or fusion (signs of polyarthritis) were identified mainly in the peripheral skeleton. Especially in both sides of the wrist bones, severe destruction/joint fusion possibly caused by polyarthritis was observed. A similar polyarthritis pattern also was seen in the right foot bones, even though we failed to confirm this symmetry due to the missing left foot bones. Despite these findings, signs suggestive of polyarthritis are very rarely seen in axial bones, even though bony fusions are found in the atlanto‐occipital joint or thoracic vertebrae (TV) 9–10. By the osteological signs observed in this case, the individual, a female, might have been suffering from a very late stage of RA and died in her 40s, even though other forms of chronic arthritis could not be ruled out completely. Though the current case could not provide evidence to decisively settle the debates on the antiquity of RA, our report could be a stepping stone for forthcoming studies on RA cases found in East Asian countries. Copyright © 2009 John Wiley & Sons, Ltd.