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.

Enfermedad de Forestier-Rotés Querol: un proceso continuo desde la Atenas de Pericles hasta el mundo de Almodóvar / Forestier-Rotés Querol disease: a continuous process from the Athens of Pericles to the world of Almodóvar

Se presentan 2 casos, separados por un intervalo de más de 2500 años, de Enfermedad de Forestier - Rotés-Querol, uno de ellos procedentes de un enterramiento de la Atenas de Pericles y el otro actual para ejemplificar su presencia continua en la historia de la patología humana. Se realiza una sucinta revisión histórica sobre su separación de las espondilopatías inflamatorias anquilosantes, se revisan sus posibles manifestaciones clínicas y radiológicas y se menciona su importante papel en el desarrollo de la última película de Pedro Almodóvar, Dolor y Gloria

We present two cases of Forestier-Rotés-Querol disease, separated by an interval of more than 2500 years, one of them coming from a burial in the Athens of Pericles and the other from the present. This exemplify its continuous presence in the history of human pathology. A brief historical review of their separation from ankylosing inflammatory spondylopathies is carried out their possible clinical and radiological manifestations are reviewed, and it is mentioned an important role in the development of the latest film by Pedro Almodóvar, Dolor y Gloria

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.

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.

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.

Inherited knee disorders in the Medici family.

Reconstructing a medical condition which was existent centuries ago is limited by the lack of contemporaneous evidence-based descriptions in the accounts given by physicians and other observers. Despite these limitations modern paleopathological evidence, supplemented by techniques of historical investigation, have led to the conclusion that males in the Medici family typically suffered from a complex clinical entity with a triple pathology of stenotic spinal ankylosis, recurrent peripheral joint disease and erythematous skin disease; the Medici Syndrome. Examination of the knee joint is illustrative of recurrent joint disease both in the primary and secondary lines of the family. Pictorial and sculptural representations, if used cautiously, can assist in this retrospective process. The six cases presented here illustrate the involvement of the knee joint where the joint destruction ultimately led to an ankylosis.

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.

The Medici syndrome: a medico-historical puzzle.

The historical significance of the Medici family of Florence is widely recognised, but the diseases which afflicted leading members of this family have only been scientifically studied in recent decades. Paleopathological findings on exhumed skeletons, supplemented by medical descriptions in historical documents, have permitted a retrospective diagnosis of a triple pathological syndrome in the senior branch of the Medici family. Peripheral joint and spinal conditions, with the presence of skin disease, are identified in several generations of the family in the 15th century and are presented as the 'Medici syndrome'. Radiological findings are compared with macro- and microscopical descriptions in the diagnosis of the peripheral joint disease and spinal ankylosis/stenosis within the syndrome.

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.

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.

"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.