Ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis in Royal Egyptian mummies of the 18th-20th dynasties? Comment on the article by Saleem and Hawass. (original) (raw)
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DISH or Ankylosing spondylitis in Royal Ancient Egyptian mummies of New Kingdom_Saleem and Hawass
2015
We aimed to study the computed tomography (CT) scans of the royal Ancient Egyptian mummies dated to the eighteenth to early twentieth Dynasties for the claimed diagnoses of Ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) and to correlate the findings with the archaeology literature. Methods: We studied the CT images of thirteen royal Ancient Egyptian mummies (1492-1153 BC) for ankylosing spondylitis and DISH diseases. We correlated the findings with the archaeology literature. Results: CT findings excluded the diagnosis of ankylosing spondylitis based on absence of sacroiliac joints erosions, or fusion of the facet joints. Four mummies fulfilled the diagnostic criteria of DISH: Amenhotep III (18th Dynasty), Ramesses II, his son Merenptah, and Ramesses III (19th to early 20th Dynasties). Diagnosis of DISH, a commonly asymptomatic disease of the old age, in the four Pharaohs concord the longevity and active life styles that they have lived. Conclusion: CT findings excluded the diagnosis of ankylosing spondylitis in the studied royal Ancient Egyptian mummies and questioned the antiquity of the disease. CT features of DISH in this ancient period were similar to those commonly seen in modern populations and likely they will be in the future. Affection of Ramesses II and his son Merenptah supports familial clustering of DISH. The process of mummification may induce changes in the spine that should be considered during investigations of mummy diseases.
Diffuse Idiopathis Skeletal Hyperostisis (DISH) in a Mummy from the Theban Necropolis
JHIE 4, 2021: 115-122, 2021
The vertebral pathological condition known as Diffuse Idiopathic Skeletal Hyperostosis (DISH) has infrequently been reported convincingly in ancient Egyptian human remains. Here we describe and illustrate a near textbook example in a partial adult torso identified as Mummy 10 from the forecourt of TT 66-Saff Tomb 1, with a probable date in the Third Intermediate Period (TIP). It was found during excavations on the hill of Sheikh c Abd ᾽el-Qurna, in the elite necropolis of the New Kingdom, in close proximity to the Temple of Hātshepsūt at Deir ᾽el-Bahri, across the Nile from Luxor, Egypt. Utilising macroscopic observation, the individual in question exhibits a flowing «melted wax» type ossification along the right anterolateral side of the vertebral column extending from the second through the eleventh thoracic vertebrae (T2-T11). Gross observation suggests open intervertebral disc spaces with no sign of syndesmophytes. Such pathological changes appear consistent with the skeletal manifestations of DISH and rule out Ankylosing Spondylitis as a possible aetiology.
AbstrAct: The paper reports on a collective burial from a 13th c. AD cist grave in Attica, Greece. The grave was located inside a basilica and held the remains of at least ten adults. Bone representation analysis showed secondary manipulation of previous deceased including long bone selection for reburial in the same grave and/or bones transported from a different burial place. Paleopathological analysis used macroscopy and radiology, and revealed several lesions on the axial and appendicular skeleton expressed mainly by spinal ligament ossification and multiple peripheral enthesopathies. Individuation of the remains pointed to a middle-aged male with DISH, a condition often correlated to high social rank. Byzantine period is marked by increasing development and prosperity in Greece including among others the creation of many local monastic centers. Although the precise social and professional profile of these individuals cannot be revealed, the combined investigation of skeletal and archaeological evidence suggests that the grave gathered the remains of individuals belonging to an upper class social group.
Shanidar 1: A case of hyperostotic disease (DISH) in the middle paleolithic
American Journal of Physical Anthropology, 1992
The Shanidar 1 Neandertal partial skeleton presents osteophytic lesions on its vertebrae and appendicular skeleton which appear independent of the multiple traumatic and degenerative joint disease lesions on the individual. In particular, the large flowing osteophyte on the L3 body, a smaller one on the L5 body, and enthesopathic osteophytes on both calcaneal tuberosities, both patellae and the left ulnar olecranon, support a diagnosis of hyperostotic disease (DISH). The diagnosis is supported by small enthesopathic osteophytes on the preserved femoral greater trochanter and scapular corocoid process. This diagnosis would make it the oldest hominid specimen clearly presenting this systemic condition. © 1992 Wiley-Liss, Inc.
The Orthopedic Diseases of Ancient Egypt
The Anatomical Record, 2015
Background: CT scanning of ancient human remains has the potential to provide insights into health and diseases. While Egyptian mummies have undergone CT scans in prior studies, a systematic survey of the orthopedic conditions afflicting a group of these ancient individuals has never been carried out. Methods: We performed whole body CT scanning on 52 ancient Egyptian mummies using technique comparable to that of medical imaging. All of the large joints and the spine were systematically examined and osteoarthritic (OA) changes were scored 0-4 using Kellgren and Lawrence classification. Results: The cruciate ligaments and menisci could be identified frequently. There were much more frequent OA changes in the spine (25 mummies) than in the large joints (15 cases of acromioclavicular and/or glenohumeral joint OA changes, five involvement of the ankle, one in the elbow, four in the knee, and one in the hip). There were six cases of scoliosis. Individual mummies had the following conditions: juvenile aseptic necrosis of the hip (Perthes disease), stage 4 osteochondritis dissecans of the knee, vertebral compression frac-
International Journal of Osteoarchaeology, 2019
Ankylosing spondylitis (AS) is a chronic, inflammatory, and progressive rheumatic disease that is a member of a family of disease referred to as spondyloarthritis. Although the prevalence estimates of AS vary from 0.25% up to 4.5% in living human populations, the frequency of the disease in the past has not yet been determined. Some suspected AS cases have been reported only based on the vertebral ankyloses or fusions of sacroiliac joints dating from the Neolithic period to the Middle Ages among ancient Anatolian populations, but the AS diagnosis has not been definitively revealed in these cases. In this study, we aimed to identify an AS case that has AS-originated pathological changes on a relatively well-preserved middle-aged male skeleton, recovered from the archaeological excavation of Kılıçlı Church, Sinope, Northern Turkey and dated to the 18-9th centuries. In addition, we made a differential diagnosis with other pathologies such as diffuse idiopathic skeletal hyperostosis, reactive arthritis, and psoriatic arthritis. In the specimen, there are four macroscopic features that are diagnostic of AS: (a) both sacroiliac joints were symmetrically obliterated, (b) spinal fusion was observed without skipping any vertebrae, (c) the spine has "bamboo spine" appearance, and (d) the vertebral syndesmophytes caused squaring of the vertebral bodies. We conclude that the Kılıçlı skeleton, one of the few archaeological specimens showing all symptoms of AS disease, is the first convincing case in Anatolia.
International Journal of Osteoarchaeology, 2019
Ankylosing spondylitis (AS) is a chronic, inflammatory, and progressive rheumatic disease that is a member of a family of disease referred to as spondyloarthritis. Although the prevalence estimates of AS vary from 0.25% up to 4.5% in living human populations , the frequency of the disease in the past has not yet been determined. Some suspected AS cases have been reported only based on the vertebral ankyloses or fusions of sacroiliac joints dating from the Neolithic period to the Middle Ages among ancient Anatolian populations, but the AS diagnosis has not been definitively revealed in these cases. In this study, we aimed to identify an AS case that has AS-originated pathological changes on a relatively well-preserved middle-aged male skeleton, recovered from the archaeological excavation of Kılıçlı Church, Sinope, Northern Turkey and dated to the 18-9th centuries. In addition, we made a differential diagnosis with other pathologies such as diffuse idiopathic skeletal hyperostosis, reactive arthritis, and psoriatic arthritis. In the specimen, there are four macroscopic features that are diagnostic of AS: (a) both sacroiliac joints were symmetrically obliterated, (b) spinal fusion was observed without skipping any vertebrae, (c) the spine has "bamboo spine" appearance, and (d) the vertebral syndesmophytes caused squaring of the vertebral bodies. We conclude that the Kılıçlı skeleton, one of the few archaeological specimens showing all symptoms of AS disease, is the first convincing case in Anatolia.
Diffuse idiopathic skeletal hyperostosis: diagnosis and importance in paleopathology
Diffuse idiopathic skeletal hyperostosis is a disease primarily affecting the spine. However, it is also associated with the ossification/calcification of tendon, ligament and capsule insertions (entheses) occurring at multiple peripheral sites. The etiology of the condition is unknown, as the name suggests (diffuse idiopathic skeletal hyperostosis), although some correlations with diabetes mellitus, obesity and age have been noted. Clinical diagnostic criteria have been adapted for paleopathological assessment of archeological skeletal remains, revealing some interesting patterns between monastic and lay populations; showing a higher incidence of DISH amongst individuals buried in monastic cemeteries. Although fascinating, the mechanisms behind this difference in prevalence are still not fully understood and have been attributed to the relatively richer diets of the monks and priests. The development of diagnostic criteria where earlier cases of DISH can be identified as well as a better understanding of its causes are paramount to the prevention of this potentially debilitating condition and perhaps this is where paleopathologists can assist. The use of dry bone rather than living patients for detailed assessment means that paleopathologists are less restricted by the techniques they can use in their investigations and the conditions occurrence in various archeological assemblages can provide interesting insights into its etiology.