A case of erosive polyarthropathy has been discovered in a well preserved skeleton from the Medieval church of San Biagio in Cittiglio (Varese, northern Italy). Erosive marginal symmetrical lesions are present firstly in the metatarsophalangeal, metacarpophalangeal and interphalangeal joints of an adult male aged 55-75 years. Osteolytic changes, in the form of pocketed erosions, surface resorptions and pseudocyst formations, are also macroscopically observed on some carpal and tarsal bones and on several large peripheral joints, such as shoulders, elbow and hip. X-ray examination revealed a picture of diffuse juxta-articular osteopenia, associated with localized periarticular osteolysis and cortical thinning. The differential diagnosis comprises degenerative osteoarthritis, gout, other erosive arthropathies, in particular those belonging to the group of seronegative spondyloarthropathies, and rheumatoid arthritis. The skeletal distribution of lesions and their macroscopical and radiological appearance are highly suggestive of a case of rheumatoid arthritis. We also suggest the hypothesis of a remission phase of the disease, as demonstrated by the frequent presence of smoothed borders and sclerosed outline at X-ray. The present case is very significant as it enters into the debate upon the antiquity of the disease, representing an adjunctive evidence of the presence of rheumatoid arthritis in the Old World prior to the discovery of the Americas.
A probable case of rheumatoid arthritis from medieval northern Italy (12th-13th centuries)
Giuffra V;Fornaciari G;
2018-01-01
Abstract
A case of erosive polyarthropathy has been discovered in a well preserved skeleton from the Medieval church of San Biagio in Cittiglio (Varese, northern Italy). Erosive marginal symmetrical lesions are present firstly in the metatarsophalangeal, metacarpophalangeal and interphalangeal joints of an adult male aged 55-75 years. Osteolytic changes, in the form of pocketed erosions, surface resorptions and pseudocyst formations, are also macroscopically observed on some carpal and tarsal bones and on several large peripheral joints, such as shoulders, elbow and hip. X-ray examination revealed a picture of diffuse juxta-articular osteopenia, associated with localized periarticular osteolysis and cortical thinning. The differential diagnosis comprises degenerative osteoarthritis, gout, other erosive arthropathies, in particular those belonging to the group of seronegative spondyloarthropathies, and rheumatoid arthritis. The skeletal distribution of lesions and their macroscopical and radiological appearance are highly suggestive of a case of rheumatoid arthritis. We also suggest the hypothesis of a remission phase of the disease, as demonstrated by the frequent presence of smoothed borders and sclerosed outline at X-ray. The present case is very significant as it enters into the debate upon the antiquity of the disease, representing an adjunctive evidence of the presence of rheumatoid arthritis in the Old World prior to the discovery of the Americas.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
