Possible case of rheumatoid arthritis from Sudanese Nubia

Abstract

Due to its apparent absence in archaeologically derived skeletons, rheumatoid arthritis (RA) has generally been believed to be of fairly recent origin. A growing body of evidence now demonstrates that erosive lesions typical of RA are present in archaeological populations and that the antiquity of RA may be greater than previously expected. In support of this argument, a case of erosive arthritis is reported in a skeleton from Kulubnarti, Republic of the Sudan (c. 700-1450 A.D.). Lytic, erosive lesions and subchondral cysts are present bilaterally in the carpal and metacarpal joints of a female skeleton with an estimated age at death of 50+ years. These lesions are typical of those seen in clinically diagnosed rheumatoid patients. While their expression and distribution are highly suggestive of RA, interpretation must be made with due consideration for problems of differential diagnosis of this disease in archaeological material.

Spondyloarthropathy identified as the etiology of Nubian erosive arthritis

“…Presence of subchondral as well as marginal erosions, characteristic of spondyloarthropathy (Rothschild and Woods, 1991a), was observed both in this study and that of Kilgore (1989). Lack of periarticular loss of bony density in this study and that of Kilgore (1989) is also characteristic of spondyloarthropathy (Bywaters, Rothschild and Woods, 1991a,b).…”

“…Lack of periarticular loss of bony density in this study and that of Kilgore (1989) is also characteristic of spondyloarthropathy (Bywaters, Rothschild and Woods, 1991a,b). The observed prominent remodeling of erosion margins in both studies is probably responsible for the X-ray density findings, characteristic of spondyloarthropathy (Rothschild and Woods, l989, 1991a).…”

“…(Since a 30-50% change in bone density is required (Resnick and Niwayama,l988) for radiologic recognition, perilesional bone reaction in rheumatoid arthritis is below that threshold.) Sclerotic reactive bone noted here and in Kilgore (1989) is notably absent at the borders of rheumatoid erosions (Bogoch et al,l988;Katz,l989;McCarty,l989;Ropes et al,l958;Rothschild,l982;Rothschild et al,l988;Woods and Rothschild,l988). The perilesional bone (around the erosions) was actually increased in density in both studies, as expected in spondyloarthropathy, but incompatible with a diagnosis of rheumatoid arthritis.…”

Genetic Predisposition to Rheumatoid Arthritis in a Tuscan (Italy) Ancient Human Remain

“…Its existence in the Old World is difficult to date because of the lack of ancient remains (3), nevertheless numerous literary and pictorial descriptions of peripheral joint changes resembling those of RA can undoubtedly be taken into consideration (3)(4)(5)(6). Furthermore, the discovery of a female mummy under the floors of the church of San Francesco in Arezzo (Italy) in 1996, may shed further light on this puzzle.…”

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

“…It begins as a synovial inflammation, firstly affecting the joints of the hands or feet, and progressing to cartilage or bone erosions (Fontecchio et al, 2007). Even though RA is a disease that can be diagnosed by cross-referencing clinical, laboratory and radiological findings, various bony changes such as erosion, joint destruction and joint space narrowing have been regarded as significant signs of RA in archaeologically collected samples (Kilgore, 1989;Rothschild & Woods, 1990;Blondiaux et al, 1997). Of course, even though the polymorphic HLA-DRB1 locus was recently suggested to be a useful tool for identifying RA in ancient bones (Fontecchio et al, 2007;Leden et al, 2008), osteoarchaeological examination remains an effective method as well.…”