Rheumatoid arthritis is a chronic, systemic, inflammatory condition that starts from a synovitis, leading to diffuse erosions in the marginal area of joints and finally conducting to joints deformity and bone ends destruction. The aetiology of the disease is unknown but multiple genetic and environmental factors have been linked to its development. According to clinical studies, the 10-30% of cases undergoes to healing of the lesions and spontaneous remission of the disease. Today's approach to inflammatory diseases is conditioned by the early diagnosis, thanks to the evolution of the analyses and diagnostic methods and by the mitigation of drug therapies. In the past, the remission was entrusted just by the individual’s immune resistance. A case of erosive polyarthropathy has been discovered in an elderly male individual recovered from the medieval cemetery of San Biagio in Cittiglio (northern Italy). The well preserved skeleton was recovered in the external area in front of the church access and, according to the archaeological stratigraphy, it dates back to a period between the 12th and the 13th century. The bone elements, undergone to macroscopic and microscopic analysis, exhibit several erosive lesions with symmetrical distribution, affecting firstly the appendicular skeleton of the little joints of hands and feet and other larger joints, such as the shoulder, elbow and hip. The bony tissue involved by the erosions is the so-called “bare area”, in the marginal region of the joints, where is found the synovium membrane-lined bone. The diagnosis of this erosive polyarthritis is complicated by the mild expression of the lesions and by the presence of a subtle sclerotic border to some erosions observed radiographically. Then, a careful differential diagnosis was necessary to clarify the etiology of the polyarthropathy; the skeletal distribution of the lesions and their macroscopic and radiological appearance are suggestive of a case of rheumatoid arthritis-like polyarthropathy. A hypothetical remission phase of the disease, as demonstrated by the frequent presence of smoothed borders and sclerosed margins on radiographic images, is also suggested. Co-existence of diffuse marginal lipping, joints degeneration and severe areas of eburnation, is also recorded, suggesting a co-morbidity of the erosive condition with Osteoarthritis, which is compatible with the advanced age of the individual. With this medieval case, we present a new evidence of the existence of erosive arthritis and, specifically, of rheumatoid arthritis-like polyarthropathy in Europe before the discovery of the Americas, entering into the long debate about the antiquity of the disease that, firstly, was considered as originated in the New World and subsequently spread to the Old World. On the basis of this and other already published cases, rheumatoid arthritis seems to have been present in Europe more anciently than was previously thought.
Un nuovo caso Medievale di una forma di poli-artropatia erosiva conforme all’artite reumatoide dal cimitero di San Biagio in Cittiglio (nord-Italia)
GIUFFRA V;FORNACIARI G;
2019-01-01
Abstract
Rheumatoid arthritis is a chronic, systemic, inflammatory condition that starts from a synovitis, leading to diffuse erosions in the marginal area of joints and finally conducting to joints deformity and bone ends destruction. The aetiology of the disease is unknown but multiple genetic and environmental factors have been linked to its development. According to clinical studies, the 10-30% of cases undergoes to healing of the lesions and spontaneous remission of the disease. Today's approach to inflammatory diseases is conditioned by the early diagnosis, thanks to the evolution of the analyses and diagnostic methods and by the mitigation of drug therapies. In the past, the remission was entrusted just by the individual’s immune resistance. A case of erosive polyarthropathy has been discovered in an elderly male individual recovered from the medieval cemetery of San Biagio in Cittiglio (northern Italy). The well preserved skeleton was recovered in the external area in front of the church access and, according to the archaeological stratigraphy, it dates back to a period between the 12th and the 13th century. The bone elements, undergone to macroscopic and microscopic analysis, exhibit several erosive lesions with symmetrical distribution, affecting firstly the appendicular skeleton of the little joints of hands and feet and other larger joints, such as the shoulder, elbow and hip. The bony tissue involved by the erosions is the so-called “bare area”, in the marginal region of the joints, where is found the synovium membrane-lined bone. The diagnosis of this erosive polyarthritis is complicated by the mild expression of the lesions and by the presence of a subtle sclerotic border to some erosions observed radiographically. Then, a careful differential diagnosis was necessary to clarify the etiology of the polyarthropathy; the skeletal distribution of the lesions and their macroscopic and radiological appearance are suggestive of a case of rheumatoid arthritis-like polyarthropathy. A hypothetical remission phase of the disease, as demonstrated by the frequent presence of smoothed borders and sclerosed margins on radiographic images, is also suggested. Co-existence of diffuse marginal lipping, joints degeneration and severe areas of eburnation, is also recorded, suggesting a co-morbidity of the erosive condition with Osteoarthritis, which is compatible with the advanced age of the individual. With this medieval case, we present a new evidence of the existence of erosive arthritis and, specifically, of rheumatoid arthritis-like polyarthropathy in Europe before the discovery of the Americas, entering into the long debate about the antiquity of the disease that, firstly, was considered as originated in the New World and subsequently spread to the Old World. On the basis of this and other already published cases, rheumatoid arthritis seems to have been present in Europe more anciently than was previously thought.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
