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.

Fusion of cervical vertebrae from a basal archosauromorph from the Middle Triassic Denwa Formation, Satpura Gondwana Basin, India.

This report describes two adjacent, longitudinally-fused anterior cervical vertebrae from a basal archosauromorph. The specimen was collected from the Denwa Formation, Satpura Gondwana Basin, India. The differential diagnosis of the fusion includes genetic or environmentally-mediated congenital malformations, nonspecific spondyloarthopathy, and various infectious agents. These observations represent the first published recognition of archosauromorph vertebral pathology from specimens that were discovered in India. The observations affirm that basal archosauromorphs suffered from disorders that have been observed in later dinosaurs and modern-day vertebrates. Considering the process of orderly differential diagnosis is an important aspect of understanding lesions of ancient bones.

Correlation of Periodontal Disease With Inflammatory Arthritis in the Time Before Modern Medical Intervention.

BACKGROUND: Controversy exists regarding possible correlation of periodontal disease with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Confounding factors may relate to stringency of inflammatory disease diagnosis and the effect of therapeutic intervention for RA on periodontal disease. These factors are investigated in this study. METHODS: Forty-five individuals with documented RA (n = 15), spondyloarthropathy (n = 15), and calcium pyrophosphate deposition disease (CPPD) (n = 15), from the Hamann-Todd collection of human skeletons compiled from 1912 to 1938, and 15 individuals contemporarily incorporated in the collection were examined for tooth loss, cavity occurrence, average and maximum lingual and buccal depth of space between tooth and bone, periosteal reaction, serpentine bone resorption, abscess formation, and root penetration of the bone surface and analyzed by analysis of variance. RESULTS: Tooth loss was common, but actual number of teeth lost, cavity occurrence, average and maximum lingual and buccal depth of space between tooth and bone, periosteal reaction, serpentine grooving surrounding teeth (considered a sign of inflammation), abscess formation, and root exposure (penetration of bone surface) were indistinguishable among controls and individuals with RA, spondyloarthropathy, and CPPD. CONCLUSIONS: Although many factors can affect periodontal disease, presence of inflammatory arthritis does not appear to be one of them. The implication is that dental disease was common in the general population and not necessarily associated with arthritis, at least before the advent of modern rheumatologic medications. As specific diagnosis did not affect prevalence, perhaps current prevalence controversy may relate to current intervention, a subject for further study.

Spondylarthropathy striking prevalence in a 19th-20th century Portuguese collection.

UNLABELLED: The concept of spondylarthropathy (SPAP) covers a series of pathologies sharing a common genetic basis and infectious triggers. OBJECTIVES: To present and discuss the prevalence of SPAP in the Coimbra identified skeletal collection, a 19th-20th century Portuguese sample. MATERIALS AND METHODS: Each of the 505 individuals was macroscopically examined; each joint being assessed for degenerative, inflammatory, ankylosing, entesopathic, traumatic, congenital, infectious, or associated lesions. For the diagnosis of SPAP, besides the criteria proposed by Rogers and Rothschild, it was also applied a new set of criteria established by Martin-Dupont. Associated and differential diagnoses were also discussed. RESULTS: Using these latter criteria, SPAP was definitely diagnosed in 34 individuals (6.7%), mostly women and elderly individuals. Furthermore, SPAP was diagnosed as probable in 32 (6.3%) and could not be excluded in 98 skeletons (19.4%). Except for the third category, the results were close to those obtained when using the arguments of others authors. DISCUSSION: The specificity of each criterion is discussed, and the results are precautiously compared with other studies both from past and contemporary samples. Graduating the diagnosis as certain, probable or unexcluded, seems to us of interest, leading to etiological discussion as in clinical practice. CONCLUSION: The high prevalence of SPAP achieved for the Portuguese collection might be explained by high exposure to infectious triggers.