A case of ankylosing spondylitis from the excavations at Kılıçlı Necropolis (Sinope, Northern Turkey) and its implications on the antiquity of the disease in Anatolia

Abstract

Ankylosing spondylitis (AS) is a chronic, inflammatory, and progressive rheumatic disease that is a member of a family of disease referred to as spondyloarthritis. Although the prevalence estimates of AS vary from 0.25% up to 4.5% in living human populations, the frequency of the disease in the past has not yet been determined. Some suspected AS cases have been reported only based on the vertebral ankyloses or fusions of sacroiliac joints dating from the Neolithic period to the Middle Ages among ancient Anatolian populations, but the AS diagnosis has not been definitively revealed in these cases. In this study, we aimed to identify an AS case that has AS‐originated pathological changes on a relatively well‐preserved middle‐aged male skeleton, recovered from the archaeological excavation of Kılıçlı Church, Sinope, Northern Turkey and dated to the 18–9th centuries. In addition, we made a differential diagnosis with other pathologies such as diffuse idiopathic skeletal hyperostosis, reactive arthritis, and psoriatic arthritis. In the specimen, there are four macroscopic features that are diagnostic of AS: (a) both sacroiliac joints were symmetrically obliterated, (b) spinal fusion was observed without skipping any vertebrae, (c) the spine has “bamboo spine” appearance, and (d) the vertebral syndesmophytes caused squaring of the vertebral bodies. We conclude that the Kılıçlı skeleton, one of the few archaeological specimens showing all symptoms of AS disease, is the first convincing case in Anatolia.

Prevalence of sacroiliac joint fusion in females and males depending on parity status

“…Furthermore, other types of pathologies that show ossification of ligaments and joints are also sexually dimorphic. Pathologies such as diffuse idiopathic skeletal hyperostosis (DISH) (Castells Navarro et al, 2022; Verlaan et al, 2007) and ankylosing spondylitis (AS) (Duyar, 2019) are more commonly found in males than females. Both DISH and AS include the ossification of spinal ligaments (Castells Navarro et al, 2022; Duyar, 2019), and AS specifically can impact the SI joints (Duyar, 2019; Šlaus et al, 2012).…”

Rheumatoid Arthritis: An Examination of Arthropathy in Antiquity

“…Spondyloarthropathies are distinguished from other arthropathies as they involve inflammation of the joints of the spine. Although the prevalence estimates of AS vary from 0.25 percent to 4.5 percent in living populations, the frequency of the disease in the past has not yet been determined (Duyar, 2019). This disease of unknown etiology affects males two to three times more than females (Rogers, 2000), with an age of onset between fifteen and thirty five years (Roberts and Manchester, 2005).…”

Amasya İnsanlarında (Roma Dönemi) Sağlık Yapısı

“…Bir eklemin kaynaşması ya da sertleşmesi sonucu hareket yeteneğinin ileri derecede kısıtlanmasına ankylosis denmektedir (Çırak ve Çırak, 2015). Ankilozan spondilit (AS) veya aksiyal spondiloartrit, spinal, sakroiliak ve periferik büyük eklemde bağ dokusu boyunca yayılan sistemik, ilerleyici ve bulaşıcı olmayan inflamatuar romatizmal bir hastalıktır (Duyar, 2019). Ankilozan spondilit seronegatif spondiloartrit (SpA) grubunda değerlendirilir.…”

“…Erkek:kadın oranı yaklaşık 5:1'dir ve başlangıçtaki en yüksek yaş 15-35 arasındadır (McVeigh vd., 2006). Prevalans tahminleri günümüz insan popülasyonlarında %0,25 ile %4,5 arasında değişmekle birlikte, geçmiş toplumlarda hastalığın sıklığı henüz belirlenmemiştir (Atamtürk vd., 2018;Duyar, 2019).…”