A case study of possible differential diagnoses of a medieval skeleton from Denmark: leprosy,ergotism, treponematosis,sarcoidosis or smallpox?

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the skeleton of a young woman, 20–25 years of age, which triggered the Danish palaeopathologist Vilhelm Møller‐Christensen's interest in leprosy. The skeleton was incomplete, but the majority of bones of the upper body, as well as the skull, were present. The pathological changes consisted of medullary and cortical lytic foci, periosteal reaction and enhanced cortical density. The lesions were most extensive on the left side, especially around the elbow, wrist and scapula. Treponematosis, leprosy, smallpox, ergotism, rheumatoid arthritis, tuberculosis and sarcoidosis are all reviewed with regard to bone and joint pathology and their likelihood of being the correct diagnosis. We concluded that the most plausible diagnosis is treponematosis, but neither sarcoidosis nor smallpox can be completely excluded. Copyright © 2007 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.     

An Unusual Erosive Arthropathy from Medieval England

In palaeopathology, diagnosis of skeletal disease is classically made with reference to changes wrought by known diseases in modern or recent cases. This report presents a skeleton from medieval England which shows a form of erosive arthropathy. A more precise diagnosis is problematic because the alterations appear inconsistent with any of the principle forms of erosive arthropathy in current clinical classification. The distribution of lesions in the axial and appendicular skeleton resembles that in seronegative spondyloarthropathies. The nature of the lesions however, which are almost entirely lytic and concentrated principally at synovial articulations rather than entheses, is inconsistent with seronegative spondyloarthropathies and is more consistent with pathophysiology of rheumatoid arthritis. These observations raise the possibility that the manifestations of erosive arthropathies may have altered over time and/or that our clinical understanding of the skeletal distribution of lesions in these diseases may be incomplete. These scenarios would have profound implications for our ability to identify the various forms of erosive arthritis in archaeological populations, but further work investigating erosive arthritis in patients, together with systematic studies of skeletal cases, would be required before firm conclusions can be made. Copyright © 2016 John Wiley & Sons, Ltd.     

Two Roman and medieval cases of symmetrical erosive polyarthropathy from Normandy: anatomico-pathological and radiological evidence for rheumatoid arthritis

With continued archaeological discoveries of skeletal remains in the USA and Europe, discussion of the possible aetiology for recognized cases of symmetrical erosive polyarthropathy include the spondylarthropathies and rheumatoid arthritis. One skeleton from the fourth century site of Lisieux and a second from the eleventh century site of Rouen are characterized by numerous symmetrical marginal erosions, primarily involving the metacarpophalangeal and proximal interphalangeal joints. Results of maroscopic, microscopic and radiological examination are highly suggestive of a modern-day diagnosis of rheumatoid arthritis. These data are consistent with the presence of rheumatoid arthritis before the onset of the fourteenth century. © 1997 John Wiley & Sons, Ltd.     

Antemortem pathological changes suggestive of reactive and degenerative arthritic disorders

The present case displays severe antemortem skeletal malformations suggestive of antemortem reactive arthritis (ReA), spondyloarthropathies and diffuse idiopathic skeletal hyperostosis (DISH). The ossified anterior longitudinal ligament on the right side of the thoracic vertebral bodies, with the presence of extraspinal enthesophytes, together indicates DISH. Fused lumbar vertebrae with costovertebral and sacroiliac joint fusion, combined with numerous large enthesophytes collectively suggest ankylosing spondylosis and ReA. Finally, some vertebrae showed evidence of age related osteoarthritis. However, the anatomical evidence for these conditions displays some inconsistencies with the known pathogenesis; therefore, a definitive account of this individual's antemortem condition remains uncertain. As no biological or medical information is known about the individual, skeletal morphology, irregular skeletal fusion and the presence of enthesophytes have been collectively used to propose the antemortem disorders that appear to have affected this individual's skeleton. Copyright © 2010 John Wiley & Sons, Ltd.     

Erosive peripheral polyarthritis in ancient Japanese skeletons: A possible case of rheumatoid arthritis

The antiquity of rheumatoid arthritis (RA) is still in dispute, due to the difficulty of conclusively differentiating peripheral polyarthritis, especially from spondyloarthropathy, in archaeological populations. In view of the importance of genetic factors in developing spondyloarthropathy and of the far lower prevalence of the disease in modern Japanese, a rarity of peripheral polyarthritis would be anticipated in the ancient Japanese population, given that RA had not been present there. One hundred and sixty adult Japanese skeletons of the late and final Jomon period (3400–2400 years bp ) were examined to find peripheral polyarthritis. There was one male skeleton with peripheral polyarthritis, showing marginal and surface erosions in the joints of the hands, feet, ankle and zygoapopheseal joints of the thoracic vertebrae. RA is suggested as the most probable cause of this pathology. This report raises the significance of further studies to consider whether more cases than anticipated exist in skeletal populations that would have been resistant to developing spondyloarthropathy. Copyright © 1999 John Wiley & Sons, Ltd.     

Spinal pathological findings in ancient Egyptians of the Greco‐Roman period living in Bahriyah Oasis

The spine can provide a large amount of information about an individual's physical condition and possible lifestyle through palaeopathological investigations. The aim of this research was to study spinal diseases among Greco‐Roman ancient Egyptians from Bahriyah Oasis, and to compare them with those from Giza of the Old Kingdom. The material used in the study included 809 single vertebrae and 77 adult sacra of ancient Egyptians from the Greco‐Roman period (332–30 BC) that were excavated from Bahriyah Oasis. The spinal elements were examined for pathological conditions, degenerative diseases, trauma, congenital abnormalities, infectious diseases and neoplasms. The most common lesions of the spine were those due to degenerative processes. The articular facets were more affected than the vertebral bodies. Compression fractures of the bodies, mostly due to osteoporosis, were found in 1.44% and 5.07% of thoracic and lumbar vertebrae respectively. The percentage of spina bifida occulta among ancient Egyptians from Bahriyah Oasis was 62.33%, while among those from Giza was only 3.33%. Few cases of lumbar spondylolysis and one case of DISH were recorded. No cases of infectious or neoplastic diseases were found. Copyright © 2008 John Wiley & Sons, Ltd.