An Unusual Erosive Arthropathy from Medieval England

Abstract

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.

Utilization of validated criteria for diagnostic assessment in nonsynchronous, allopatric populations: Role in archeologic diagnosis of rheumatoid arthritis and differentially distinguishing it from mimics

“…Arcini has subsequently recanted her 1992 diagnosis, which had been based on the present of polyarticular disease, despite the pathology being limited to osteophytes. Ten cases, in which the presence of erosions was attributed to RA, were on the basis of differential diagnostic considerations limited to osteoarthritis or rheumatoid (Calgary, 1989; Campillo, 1990; Ciranni et al, 2002; Kilgore, 1989; Klepinger, 1979; Leden et al, 1988; Mays et al, 2017). An alternative diagnosis of AS was considered in four additional cases but discarded by those authors because of their perception was that AS could not be diagnosed in the absence of axial joint involvement (Arcini, 1992; Craps & Gowland, 2015).…”

“…Erosions were predominantly subchondral rather than marginal in distribution in 28 cases (Arcini, 1992; Bennike, 1985; Blondiaux et al, 1997; Campillo, 1990; Ciranni et al, 2002; Clavel et al, 1999; Craps & Gowland, 2015; Fontecchio et al, 2007; Hacking et al, 1994; Hagihara et al, 2015; Inoue et al, 1999; Kacki, 2013; Kilgore, 1989; Klepinger, 1979; Mant, 2014; May, 1897; Mays et al, 2017; Mckinnon et al, 2013; Rogers et al, 1981), four of which had sclerotic erosional margins (Inoue et al, 1999; Kilgore, 1989; Mckinnon et al, 2013; Rogers et al, 1981) and four of which had surface calcific deposits (Ciranni et al, 2002; Kilgore, 1989; Mckinnon et al, 2013). Fusion of appendicular joints was present in 25 individuals (Arcini, 1992; Blondiaux et al, 1997; Campillo, 1990; Ciranni et al, 2002; Clavel et al, 1999; Hacking et al, 1994; Hagihara et al, 2015; Inoue et al, 1999; Isidro et al, 2015; Kilgore, 1989; Kim et al, 2011; Leden et al, 1988; Macke & Macke‐Ribet, 1994; May, 1897; Ruffer, 1918; Šikanjić & Vlak, 2010; Steinbock, 1976; Tesi et al, 2019; Thould & Thould, 1983).…”

“…Support for the Old World hypothesis for its origin was predicated on observation of isolated pre‐Columbian cases of inflammatory arthritis attributed to RA (e.g., Blondiaux et al, 1997; Hagihara et al, 2015; Inoue et al, 1999; Isidro et al, 2015; Kilgore, 1989; Klepinger, 1979; Mays et al, 2017; Rogers et al, 1981). Some of those reports apparently related to lack of familiarity with other forms of inflammatory arthritis.…”

“…Disease origins have long been of interest, subjected to historical (e.g., literature), macroscopic, radiologic, histologic, and metabolic (e.g., DNA) analyses (e.g., Benton et al, 2021; Boni & Chhem, 2004; Rothschild & Martin, 2006; Schultz, 2011; Webb, 2015). While inflammatory arthritis has a deep history (Feldtkeller & Rothschild, 2016), that of what was now recognized specifically as RA has been controversial, with devouée committed to either New World (Rothschild & Woods, 1990a) or Old World origins (e.g., Blondiaux et al, 1997; Hagihara et al, 2015; Inoue et al, 1999; Isidro et al, 2015; Kilgore, 1989; Klepinger, 1979; Mays et al, 2017; Rogers et al, 1981). The maximal prevalence reported by those who accept possible occurrence of appendicular joint fusion in RA is 2% (Leden et al, 1988, 2012).…”

The Diagnostic Implications of Two Cases of Known Rheumatoid Arthritis from the CAL Milano Cemetery Skeletal Collection

“…Hence, both of these known cases showed the typical traits described in the clinical literature: erosive polyarticular symmetric lesions affecting the hand and wrist bones as well as other more distant joints (here, the elbows). These traits are recognized characteristics of RA (2,(7)(8)(9)15,18,19,21,23,24,27,28,38) and used in the differential diagnosis of previous studies (26,31,46,53,54). Moreover, they both lacked the same features that would have indicated other diseases included in the differential diagnosis: sacroiliac fusion, spinal fusion, asymmetric involvement, fibrocartilaginous entheses, oligoarthritis, DIP joints involvement, and bone debris.…”