Psoriasis and psoriatic arthropathy, historical aspects: part I.

Psoriasis was probably described no later than the first century AD, and the term was coined in the second century. However, a clear association between descriptions recognizable as psoriasis and articular symptoms began in the 19th century. This review was from the English-language, German, and French literature. The development of the differentiation of psoriatic arthritis from clinically similar symptoms, including relevant serologic and radiologic findings and therapeutics with a focus up to the 1960s and the recognition of the efficacy of methotrexate, is reported.

[The enterprising Irishman Bernard Connor (1666-1698)]. / Der unternehmungslustige Ire Bernard Connor (1666-1698).

In the thesis of the Irish physician Bernard Connor (1666-1698) from 1693 in Rheims he describes the torso of a man whose bones were joined together due to ankylosing spondylitis which is considered to be the first example of such skeletal findings. This communication must however be seen in connection with earlier and similar observations following soon after, which were published in the German and especially in the English literature. This further put into question the eponym of Strümpell-Marie-Bechterew disease commonly used in Germany for a long time. However, Bernard Connor was also a very interesting personality of the seventeenth century for other medical and historical reasons. With natural science oriented publications he attracted the opposition of the Clergy. In his 3-volume history of Poland where he worked for several months as the personal physician to King John III Sobieski, which was also published in German, he described very graphically not only the current political and social situation but also the medicine of the country which he found to be very backward. This stands in contrast to the exemplary achievements in rheumatology in Poland under European standards at the end of the twentieth century which are described and exemplified by some exceptional personalities.

A historical perspective of the spondyloarthritis.

PURPOSE OF REVIEW: The history of ankylosing spondylitis, the main representative of the spondyloarthritides, is dating back to several thousand years BC and recently proven for medieval skeleton by HLA-B27 typing with modern molecular techniques. In modern time, the history of spondyloarthritis (SpA) is characterized by fluctuation between lumping and splitting. Actually, the recent advent of new classification criteria demands to discuss the consequences and clinical implications in the historical context of the development of the concept of SpA including the controversy of lumping and splitting. RECENT FINDINGS: The new Assessment of SpondyloArthritis International Society classification criteria for axial and peripheral SpA are primarily developed to provide support for clinical trials with biologicals and other treatment modalities, which intend to cover the whole spectrum, especially early clinical manifestations of spondyloarthritides. New insights into genetics and the evolving etiological role of Chlamydia in SpA including the most recent finding of the effective combination antibiotic therapy are major advances in the evolving history of SpA. SUMMARY: The concept of SpA is well accepted for the classification, diagnosis, and therapeutic management of a high proportion of individuals with inflammatory rheumatic conditions. For further advances research technologies are now available to enlarge the current body of clinical, immunologic, and genetic studies using pivotal microbiologic research and new antimicrobial therapeutic strategies.

Did Sejong the Great have ankylosing spondylitis? The oldest documented case of ankylosing spondylitis.

AIM: Sejong the Great (May 7, 1397-March 30, 1450), a king during Korea's Choson Dynasty, is the most respected historical figure in South Korean society, and consequently, many studies have been conducted on his achievements and the disease he suffered. The dominant trend of scholarship claims that Sejong suffered from diabetic retinopathy. However, this interpretation has not been medically verified. The present analysis aimed to demonstrate that Sejong's is the oldest documented case of ankylosing spondylitis. METHODS: The Annals of the Choson Dynasty (hereafter, The Annals) are daily records of the king. The Annals were recorded for 472 years (1392-1865) and contain 49 646 667 Chinese characters. Records in The Annals on Sejong span 1418-1450; the present study author reviewed these records. RESULTS: Sejong's medical records are mentioned 40 times in the source text. The king first experienced musculoskeletal pain in his knee at the age of 22 years. Sejong's knee pain is mentioned 3 times, and his back pain, which he described as "stiff and immobile", is mentioned 6 times. He complained most frequently of ocular symptoms described as "prickly or tingling," which are mentioned 12 times. CONCLUSIONS: Based on the analysis of official documentation, the author argues that there is a high probability that Sejong suffered from ankylosing spondylitis, making this the oldest officially documented case of the disease.

Autoimmune joint diseases in Late Medieval skeletal sample from Croatia.

Analysis of 25 skeletons from Late Medieval cemetery Uzdolje-Grablje near Knin, Croatia, revealed three cases of systematic pathological changes to joints. Observed pathological lesions were examined macroscopically and radiologically and compared to the available paleopathological standards in order to formulate a differential diagnosis. In all three cases observed changes were most consistent with autoimmune joint diseases including ankylosing spondylitis, juvenile idiopathic arthritis and psoriatic arthritis. Based on published clinical studies, we suggest that the high prevalence of autoimmune diseases in our skeletal sample stems from the genetic basis of the autoimmunity, and that three individuals describe here are possibly closely related.

Ankylosing spondylitis: antiquity and differential diagnosis - a case study of a Bronze Age skeleton from Norabak, southeastern Armenia.

An excavation of a burial mound at Norabak site (Southeast Armenia) unearthed four burial chambers, the central one contained a single skeleton radiocarbon dated to about 1400-1200 BCE. The skeleton was observed to have a polyarticular erosive arthropathy, primarily affecting the spine, with diagnostic features of ankylosing spondylitis. The antiquity of ankylosing spondylitis is questioned in the literature, because there are few reliable and descriptive reports from prehistoric sites. Excellent preservation of the skeleton from Norabak made it possible to perform a detailed analysis of the pathologic changes and to support the diagnosis of ankylosing spondylitis in this 3000-years-old individual. Apart from the main pathology, the skeleton had a dens axis fracture of the C2 vertebra a few days before death, as well as a likely associated fracture of the C1 vertebra. This type of fracture has a high risk of displacement into the vertebral canal with severe neurological consequences. Thus, we were presented with an opportunity to reconstruct a possibly fatal event in the life of this individual. The described case provides further evidence that ankylosing spondylitis is a disease of fairly great antiquity.

The many ailments of Herman Melville (1819-91).

Herman Melville developed debilitating physical and psychiatric disorders in middle age after writing, perhaps, the greatest of American novels, Moby Dick. This article critically examines claims that Melville had bipolar affective disorder and alcoholism, and suggests he may also have suffered from post-traumatic stress disorder. Melville was active and vigorous in youth but in middle age he developed recurrent attacks of eye pain, photophobia and disabling low back pain. Melville's contemporaries usually attributed his physical problems to 'neurasthenia' and his biographers have often dismissed them as psychosomatic. However, Melville's clinical course, abnormally rigid posture, loss of 1(3/8) inches in height between the ages of 30 and 37, and a family history of rheumatological disease, suggest a diagnosis of ankylosing spondylitis.

A recording form for differential diagnosis of arthropathies.

The present study is focused on a group of arthropathies that may have very similar bone manifestations (rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis, osteoarthritis and diffuse idiopathic skeletal hyperostosis), which makes it more difficult to diagnose them in human remains from archaeological contexts. A stepwise recording form was designed in order to improve the identification and differential diagnosis of these pathological conditions in bone remains, particularly in joint manifestations of the spine, pelvis, hands, feet and other limb joints. This recording form was applied in the analysis of two medieval individuals from the Basque Country (Spain) who presented very severe arthropathic manifestations. The use of this recording form allowed the researchers the diagnosis of ankylosing spondylitis in one of them and diffuse idiopathic skeletal hyperostosis in the other.

"The Leeds Idea": an historical account of the spondarthritis concept.

In the 1960s, Professor Verna Wright became increasingly interested in possible relationships between certain seronegative "variants of rheumatoid arthritis", as they were then generally known. At the Rheumatism Research Unit, a department within the division of medicine at Leeds University, he gathered around him a succession of research workers, whom he inspired to study aspects of these relationships. The focus was on family studies, as it was thought that genetic factors could be important. The striking association previously noted between sacroiliitis or full-blown ankylosing spondylitis and several of these disorders to be studied - e.g., psoriatic arthritis, ulcerative colitis, and the arthritis associated with Crohn's disease - was to be central for each of these studies. As a provisional collective name for these possibly related conditions, the term "Spondarthritides" was chosen. These were the days before HLA B27, and so the research tools were simply clinical, radiological (for sacroiliitis) and serological (for rheumatoid factor). The research programme confirmed not only links between the primary disorders with ankylosing spondylitis, but also links between the disorders themselves. Over subsequent years, the spondarthritis concept (dubbed by some "The Leeds Idea") has gained further strength from HLA studies internationally. And membership of the group of conditions fulfilling spondarthritis criteria has grown substantially. It is hoped that this now consolidated framework of spondylitis-related entities will pave the way for further research, with exciting prospects of gene-based prevention and/or cure through the increasing sophistication of molecular biology.

Rich but poor: life in the Roman period with extreme rheumatoid arthritis.

In a Sidonian sarcophagus, from the Late Antique/early Christian period, skeletal remains of two persons were found. One of them, male, 30-50 years old, was found almost completely ankylosed, with highly osteoporotic bones and prominent erosion of joint surfaces. We diagnosed rheumatoid arthritis based on the eroded odontoid process, mandibular condyles, distal humerus, proximal and distal ulna, as well ankylosed hand and foot bones. Despite the fact that ankyloses of vertebrae and sacroiliac joint could point towards ankylosing spondylitis, the lack of typical vertebral ankyloses and new bone formation led to exclusion. In a practical sense, due to the advanced stage of the disease, the man was fixed in the supine position, on the left, with his head turned to the right. Apparently, he could not move and had problems with chewing and breathing. But, the high standard of provided healthcare probably enabled him to survive in advanced stages of the disease. This case shed light on the antiquity of the disease, its medical, and social context and provided the example of most extreme osteological changes reported in the paleopathological and medical literature.

[Cripples at the medieval hospital of Bátmonostor, Hungary--archeological findings]. / Egy magyarországi közepkori ispotály (Bátmonostor) beteganyaga az ásatási leletek tükrében.

Cripples from the medieval hospital of Bátmonostor, Hungary. People with disabilities were generally burdened with a painful fate in ancient times, however in the hospitals was no effective therapy. The hospital of Batmonostor was founded at late 13th century, The authors examine by morphological, radiological and histological methods 426 complete skeletons excavated from medieval (14th-15th century) cemetery of Bátmonostor (Hungary). Among them 30 cases (7.1%) of bony ankylosis, (24 cases on lower limb and 6 cases on upper limb) was found. Sacroiliac ankylosis 3 cases, Bechterew's spondylitis ankylopoetica 1 case was seen. Spondylitis tuberculosa and malum Potti 4 cases, and hunchback with other aetiology 2 cases was detected. Beside the cases with ankylosis severe posttraumatic osteomyelitis (7 cases), primary malignant bone tumors (2 cases) and an osteoplastic metastatic tumors (probably prostata carcinoma) was diagnosed. Paleopathologic study of the physically disabled may yield information and insight on the prevalence of crippling disorders. The authors hypothetize, that crippled persons lived in the hospital until their deaths.

Origins of spondyloarthropathy in Perissodactyla.

OBJECTIVE: Spondyloarthropathy has clearly been documented as not limited in occurrence to humans. Transmammalian in nature, it is of interest to understand the antiquity, and perhaps the origins, of this disorder in animal groups sufficiently represented in the skeletal record. METHODS: Fossil and recent skeletons of perissodactylae from North America were systematically examined to determine the occurrence and population frequency of spondyloarthropathy. RESULTS: Spondyloarthropathy was the most common form of arthritis recognized in the extant and fossil records. Common in extinct families such as Brontotheriidae and Chalicotheriidae, a progressive increase in the frequency of spondyloarthropathy was observed through geologic time in Equidae and Rhinocerotidae. CONCLUSION: Erosive arthritis of the spondyloarthropathy variety is now documented as not only persisting in Perissodactyla, but as actually increasing significantly in frequency (3-6 fold). Given the unusual evolutionary penetrance of this "disease," the possibility must be considered that its persistence provides evidence for some unknown benefit to the affected host.

Ankylosing spondylitis--the history of medical therapies.

This is a concise overview of the history of medical therapies for patients suffering from ankylosing spondylitis. Recent therapeutic advances are also summarised.

[Osteoarticular diseases from J.M. Charcot to the present time]. / Les affections ostéo-articulaires de J.M. Charcot à nos jours.

In foreign countries Charcot's main contribution in the field is known as Charcot's joint. A special paper is devoted to this topic by Dr Hubault in this issue of the Revue. It is perhaps less widely known that Charcot's thesis was devoted to rheumatoid arthritis and that he wrote also interesting observations on gout. Pierre Marie gave many famous contributions to bones and joints diseases. In 1886 he described acromegaly. In 1890 he described hypertrophic pulmonary osteoarthropathy which he correctly linked with lung diseases although some of the cases he had collected in the literature were instances of pachydermo-periostosis. In 1900 he gave a brilliant description of achondroplasia in 2 of his patients: Anatole and Claudius. On the 11th of February 1898 he reported 2 patients which were the basis of a historical description of ankylosing spondylitis, on which papers by Strümpell and von Bechterew had appeared in 1884 and 1893. The subsequent works at the Clinique des Maladies du Système Nerveux de la Salpêtrière on sciatica and herniated disks are related in Professor de Seze's paper in this issue of the Revue.

[Advanced-stage ankylosing spondylitis in a subject in the 8th century]. / Spondylarthrite ankylosante évoluée chez un sujet du VIIIe siècle.

Paleopathological study of an adult male skeleton, coming from a Hungarian archeological site from the 8th century, revealed lesions of the spine (ankylosing vertebral syndesmophytosis, costo-vertebral ankylosis, discal calcifications), of the sacro-iliacs (bilateral ankylosis) and several extraspinal changes (abnormalities of symphysis pubis, enthesopathies). Radiological and CT investigations confirmed the diagnosis of advanced stage ankylosing spondylitis.

Pierre Marie: gifted intellect, poor timing and unchecked emotionality.

Pierre Marie was a prominent member of the French neurological world of the early twentieth century. Having been trained by the celebrated physician, J-M Charcot, Marie remained influenced by his teacher throughout his career. Because of this influence, his career can be logically divided into three phases: first, the early years under the direct mentorship of Charcot (1878-1893); secondly, the aftermath of Charcot's death when Marie left his teacher's institution, the Salpêtrière hospital and established himself at the Bicêtre hospital in southern Paris (1893-1918); and finally, Marie's return to the Salpêtrière to assume the original Charcot chaired professorship, albeit as an aged man (1918-1925). This essay examines Marie's career with an emphasis on documentation of the combined attributes of a gifted intellect as well as a heated emotionality. In the context of his time, these elements prompted Marie to enter into controversies and medico-political battles that advanced neurological knowledge, but likely disadvantaged him in his career successes.