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)
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.
Diffuse idiopathic skeletal hyperostosis: Diagnostic, clinical, and paleopathological considerations
Clinical Anatomy, 2016
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.
International Journal of Paleopathology, 2020
Objectives: To highlight conditions that may cause early-onset degenerative joint disease, and to assess the possible impact of such diseases upon everyday life. Material: Four adults aged under 50 years from a medieval skeletal collection of Prague (Czechia). Methods: Visual, osteometric, X-ray, and histological examinations, stable isotope analysis of bone collagen. Results: All four individuals showed multiple symmetrical degenerative changes, affecting the majority of joints of the postcranial skeleton. Associated dysplastic deformities were observed in all individuals, including bilateral hip dysplasia (n=1), flattening of the femoral condyles (n=3), and substantial deformation of the elbows (n=3). The diet of the affected individuals differed from the contemporary population sample. Conclusions: We propose the diagnosis of a mild form of skeletal dysplasia in these four individuals, with multiple epiphyseal dysplasia or type-II collagenopathy linked to premature osteoarthritis as the most probable causes. Significance: Combining the skeletal findings with information from the medical literature, this paper defines several characteristic traits which may assist with the diagnosis of skeletal dysplasia in the archaeological record. Limitations: As no genetic analysis was performed to confirm the possible kinship of the individuals, it is not possible to definitively assess whether the individuals suffered from the same hereditary condition or from different forms of skeletal dysplasia. Suggestions for Further Research: Further studies on premature osteoarthritis in archaeological skeletal series are needed to correct the underrepresentation of these mild forms of dysplasia in past populations.
"This paper reports on a case of massive hyperostotic alterations observed in the skeleton of an adult woman from the necropolis of Montescaglioso Belvedere (Basilicata, Southern Italy) attributed to the Enotrian culture and dated to the 6th century BC. Hyperostotic changes involve joints, the vertebral column, and the lower limbs. In particular, the large flowing ossification in both the thoracic (T6–T10) and lumbar (L2–L5) tracts, the sacralization of L5, accompanied by sacroiliac fusion on the left side, and the proliferative bone production on both the metaphyseal portion of the left tibia and the left third metatarsal are described. The vertebral antero-lateral ossification and the sacroiliac fusion support a diagnosis of diffuse idiopathic skeletal hyperostosis (DISH), while the flowing bone formation on the lower limbs supports a diagnosis of melorheostosis. The pathological conditions described here were already described in the literature, but this is the first reported case of the coexistence of DISH and the very rare melorheostosis. Furthermore, the skeleton from Montescaglioso Belvedere represents the first case of this disease described for ancient Europe, therefore adding a valuable contribution to the reconstruction of the antiquity and distribution of skeletal dysplasias."
Osteogenesis imperfecta in the archaeological record: An example from the Dakhleh Oasis, Egypt
The present study evaluates a fetal skeleton (B532) from the Romano-Byzantine period Kellis 2 cemetery (circa A.D. 50–A.D. 450), in the Dakhleh Oasis, Egypt. This skeleton displays abnormal skeletal characteristics consisting of severe bowing of the long bones. Differential diagnoses using macroscopic and radiographic analyses indicate that this individual’s pathological condition was caused by osteogenesis imperfecta (IO), possibly Type IIB/III, or Type IV OI, corroborating with characteristics reported in the clinical literature. Due to the severe bowing of the long bones, traditional aging methods could not be used for this individual. Baysian estimates of age indicate this individual was a fetus of approximately 38 weeks gestation. Although this condition has been diagnosed previously in the archeological literature, this burial represents the youngest aged example of osteogenesis imperfecta reported to date.
International Journal of Osteoarchaeology, 2020
Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory joint disease mainly characterised by the ossification of the right anterior longitudinal ligament and the presence of enthesopathies. Studies have shown that the disease typically affects males of advanced age. This is a case report of a female individual, aged between 40 and 60 years, dating to 1,472-1,635 AD and found in Eastern Germany. A differential diagnosis was completed following macroscopic examination and radio-graphic imaging of the affected bones. The results show several pathological features that resemble skeletal characteristics of DISH, besides other diseases. Therefore, we discuss DISH and provide a differential diagnosis of additional pathologies. Our case is particularly important because ancient female DISH cases are underrepresented and the burial location indicates a possible noble or monastic context, both linked with a lifestyle known to be related to DISH.