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.

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.

Prehistoric juvenile rheumatoid arthritis in a precontact Louisiana native population reconsidered.

Descriptions of skeletal pathological conditions evident in the prehistoric Tchefuncte adolescent 16ST1-14883b are clarified. The basis is reaffirmed for assigning to the described pathological conditions a diagnostic perspective of juvenile rheumatoid arthritis or juvenile Lyme disease--a disease that mimics juvenile rheumatoid arthritis in its arthritic presentation--rather than of assigning them as representative of juvenile onset ankylosing spondylitis or other juvenile spondyloarthropathies. A hypothesis (Lewis [1994] Am. J. Phys. Anthropol. 93:455-475) is restated that 1) the spirochete Borrelia burgdorferi was the infectious agent responsible for prevalence of adult rheumatoid arthritis in prehistoric southeastern Native American populations, 2) that B. burgdorferi is a possible cause of the arthritis evident in individual 16ST1-14883b, and 3) that antibodies to B. burgdorferi provided partial immunity to the related spirochete Treponema pallidum for the 16ST1 precontact Tchefuncte population from Louisiana, protecting them from severe treponemal response. Given the probable widespread existence of Ixodid tick vectors for B. burgdorferi in prehistoric North America, coupled with the existence of treponematosis, it follows that the transition of Native American hunting-gathering economies to more sedentary economies would predictably be linked to an increased incidence of treponematosis due to the loss of benefits of the above-stated partial immunity. In other words, as prehistoric Native American exposure to tick vectors for B. burgdorferi decreased, susceptibility to treponematosis increased. Inferences regarding biological controls interacting with and influencing prehistoric Native American migration patterns are suggested from the link of B. burgdorferi to an Ixodid tick common to northeast Asia.

[Correct and incorrect paths in the history of ankylosing spondylitis]. / Wege und Irrwege in der Geschichte der Spondylitis ankylosans.

This article retraces the history of ankylosing spondylitis. While the first part takes into consideration the paleopathological aspects of illness, the second part retains the main stages of the research on the subject from the 16th to the 19th century. This part refers to B.O. Connor, who in 1694 was the first to give a complete description of a characteristic skeleton. This part also mentions Benjamin Brodie who in 1850 wrote the first complete clinical description and Charles Fagge who in his work was the first to combine clinical and anatomical elements. The scientific discussion at the end of the 19th century between Adolf Strümpell. Wladimir von Bechterew and Pierre Marie is also part of this paragraph. The last part shows the important discoveries of the 20th century, specially useful for a better understanding of the pathogenesis of the disease.

Rheumatic diseases in Neolithic and Medieval populations of western Switzerland.

An investigation of three groups from ancient populations (Neolithic, Early Middle Ages, Middle Ages) was performed on 273 adult skeletons. Despite unequal preservation of the remains, a study of a series of large joints and spinal segments permitted some conclusions: rheumatoid arthritis, ankylosing spondylitis, and osteoarthrosis of large joints (hip, knee, shoulder) were not found. The main findings were: osteoarthrosis in spinal zygapophyseal joints (particularly at cervical level); intervertebral osteochondrosis (particularly at the cervical and lumbar levels); Schmorl's nodes (particularly at the thoracic and lumbar levels); enthesopathic osteophytes (particularly in the spine, iliac crest, patella, and calcaneus). Such deformities seemed more frequent in the Middle Ages than in the Neolithic period.

Paleopathologic evidence for the evolution of rheumatoid arthritis.

A human skeleton recovered from a Sicilian archaeological site and dating from the Hellenistic period (330-210 B.C.) presents a pathological pattern suggesting a transition between ankylosing spondylitis and rheumatoid arthritis, providing evidence in support of the hypothesis that rheumatoid arthritis may have recently evolved out of ankylosing spondylitis.