Paul Klee (1879-1940) as a tragic figure: What the artist learned from his illness.

Paul Klee was a major contributor to the development of modern European art. An ethnic German (although born in Switzerland) and a German citizen, he was persecuted by the Nazi government on political rather than racial grounds because of his allegedly "degenerate" artistic style. Dismissed from his teaching position, he emigrated to Switzerland in 1933; shortly afterward he became ill with systemic sclerosis and struggled with this condition for the remaining years of his life. Many publications have examined the effect of social rejection and illness on his art, but the present study considers the effect of these adversities on Klee's attitude toward his fellow humans. After being an extreme misanthrope in his early adult years, he developed an attitude of cosmic indifference toward humanity during the First World War, which he then maintained until the end of 1939. Although his rejection by Germany had been a significant emotional blow, it was the physical suffering caused by his illness that led him, at the end of his life, to show compassion toward the suffering of other individuals. In this he was like tragic figures such as King Lear who learned from their great misfortunes to value humanity.

SSc and the 2013 diagnostic criteria: the case of Paul Klee's manual pathology and dysgraphia.

The German-Swiss modernist painter Paul Klee (1879-1940) suffered in the final years of his life from a severe illness, diagnosed in 1936 as scleroderma, later renamed SSc. New classification criteria for this disease issued in 2013 now allow for a diagnosis to be confirmed. Important for this process, however, is the question of whether or not Klee's hands were affected by his illness. The morphology of the artist's hands and evidence of dysgraphic changes in his handwriting are reviewed as indications of his manual pathology. Despite his illness, Klee triumphed over his infirmity, simplifying his painting and drawing styles and substantially increasing his artistic output from 1936 until his death in 1940.

[History of systemic sclerosis]. / Historia de la esclerosis sistémica.

Systemic sclerosis (Scleroderma) is a generalized disease of the connective tissue, whose etiology is unknown, and which produces fibrosis and degenerative changes in the skin (scleroderma), synovial membrane, arterial vessels, skeletal muscle, and certain internal organs, especially the gastrointestinal tract, lung, heart, and kidney. Patients with cutaneous alterations, which could have been scleroderma cases, have been described since the most distant ancient times, and since the end of XIX century its recognition has been accurate. In the past century more precise diagnoses and treatments were possible because of the knowledge of its pathogenesis and its classification into clinic-serologic subgroups. We intend to recall the names and contributions of the doctors who collaborated with the advances throughout history.

Paul Klee's illness (systemic sclerosis) and artistic transfiguration.

Klee's symptoms, and the rapid progression of the illness, ending with his death after only 5 years, in all probability indicate the rarest but most serious form of scleroderma, known as diffuse systemic sclerosis. Although his skin and internal organs were heavily stricken by the illness, the artist's hands were fortunately spared. Thus he was able to draw and paint without hindrance to the end. Classified amongst diseases of the autoimmunity system, this form of sclerosis often has inexplicable causes. I believe, however, that the defamations suffered by Klee, his dismissal as professor of the Art Academy in Düsseldorf by the National Socialists, and the unintended isolation after his return to Berne were causative factors in the outbreak of the illness. Mentally and spiritually, the artist rose above his heavy bodily suffering. Constantly, his creativity remained vigorous. Although the greater part of Klee's works in his last years cannot be linked directly with his illness, careful viewing reveals a significant preoccupation with fate and illness. It is above all in his drawings, that were created like a diary, that the sorrows and troubles of the ill artist emerge: his fears, but also his hopes and finally his resignation to the illness, and his readiness for death. In undesired isolation, and in his own spiritual world, Paul Klee created with exemplary concentration, discipline and diligence a considerable number of late works, which differ from his early work and which deserve our full admiration. Reserved, quiet and kind, Paul Klee was nevertheless charismatic. And his art is poetic. Possessing a special aura, it can enchant those who surrender to it without any prejudice. Paul Klee has created an oeuvre that is unique, reflecting his character closely: a body of work that moves and stirs us by its deep humanity.

[A dermatologist and a rheumatologist define a syndrome. George Thibierge (1856-1926), Raymond J. Weissenbach (1885-1963)]. / Ein Dermatologe und ein Rheumatologe definieren ein Syndrom: Georges Thibierge (1856-1926), Raymond J. Weissenbach (1885-1963).

For decades, G. Thibierge and R.J. Weissenbach worked at the Hôpital St. Louis in Paris, one of the first and largest dermatological centers.In 1911 they described the occurrence of subcutaneous calcification in scleroderma patients, emphasizing that this was not a coincidental finding, but rather a causal link. Since then this syndrome has been given their names worldwide.Thibierge gave his attention solely to dermatology and venereology. Weissenbach initially concentrated on the overlapping areas between dermatology and rheumatology, such as gonococcal arthritis, joint disease in Lues and psoriatic arthritis. He later dealt with all areas of rheumatology, set up a large rheuma clinic at the hospital, wrote a series of authoritative books and a considerable number of individual papers. Thus he became a rheumatologist even before the specialty rheumatology existed.

[Could Aleijadinho have suffered from scleroderma]. / La malattia dell'Aleijadinho potrebbe essere stata una sclerodermia?

Rheumatic conditions have affected, among others, emperors, kings, politicians, religious personages and artists. Knowledge about their articular illnesses has increased with a multiplicity of source documents on these personalities: ancient texts, letters, drawings, paintings, sculptures, songs and pictures. Here the case of the most important Brazilian visual artist is described, namely the sculptor Aleijadinho (1730?-1814), who, besides suffering an extremely disability condition, did not give up performing artistic works throughout his whole life. This study proposes a discussion about the possibility that such an artist has presented a clinical profile of scleroderma.

Scleroderma: it has been a long hard journey.

Progress in the understanding of the aetiopathogenesis of scleroderma (systemic sclerosis) has been painfully slow and this has greatly impeded the application of specific disease modifying treatments. This article provides a brief historical overview of scleroderma (including the important Australian contribution of Dr Alfred Barnett and colleagues--see accompanying article in this issue on pages 513-18), highlights some recent pathogenic developments and summarises some exciting new therapies. Cautious optimism can now be offered to scleroderma sufferers.

Anti-scl-70.

OBJECTIVE: To develop an overview focusing on the utility of anti-Scl-70 autoantibody determinations in the rheumatic diseases. METHODS: Articles from electronic literature searches were retrieved, critiqued and data were extracted and pooled on anti-Scl-70 (topoisomerase I) in relation to history, optimal tests used for its detection, sensitivity, specificity, positive and negative likelihood ratios, indications, interpretation and pitfalls. RESULTS: Anti-Scl 70 antibodies are very useful in distinguishing systemic sclerosis (SSc) patients from healthy controls, from patients with other connective tissue diseases, and from unaffected family members. Among patients with SSc, anti-Scl-70 positivity is useful in predicting those at higher risk for diffuse cutaneous involvement and interstitial fibrosis/restrictive lung disease, though the latter has not been universally observed. Of the four different techniques notably immunodiffusion, immunoblotting, immunoprecipitation and enzyme-linked immunosorbent assay (ELISA) used to assay anti-Scl-70, immunodiffusion has been the most extensively validated. ELISAs are somewhat less specific than other techniques, especially in distinguishing SSc patients from those with other rheumatic diseases, though newer generation ELISAs have been developed to overcome the problem of low specificity inherent with the traditional techniques. As of yet, the need for serial testing of anti-Scl-70 has not been established. CONCLUSIONS: Evidence-based guidelines suggest that anti-Scl-70 antibodies are very useful in the diagnosis and clinical management of SSc patients and also to establish prognosis in these patients, particularly those with diffuse skin involvement.