InfernafionalJournaI of Osfeoarchaeology Voi I: 15 7-75.? (7997)

SHORT REPORT

Erosive Osteoarthritis in a Medieval Skeleton JULIET ROGERS', TONY WALDRON~ AND IAIN W A T ~ 'Department of Rheumatology, Bristol Royal Infirmary, Bristol BS2 8HW, UK; ' St Mary's Hospital, London W2 1NY and Institute of Archaeology, 31-34 Gordon Square, London WC1 H OPY, UK; and 3Department of Clinical Radiology, Bristol Royal Infirmary, BristolBS2 8HW, UK

ABSTRACT In human skeletons from archaeological sites, osteoarthritis is by far the most common disease found, but no case of erosive osteoarthritis has been described and we present here what we believe to be the first such case.

Keywords: Erosive, Osteoarthritis, Palaeopathology.

Case report

The skeleton

The skeleton that is the subject of this report came from a site in London, which can be dated to between the late fourteenth and early six- teenth centuries. It was that of an adult female but was very incomplete. All that remained was the distal left humerus, the left and right radius and ulna, all five lumbar vertebrae, the first sacral segment, part of the left ilium (including the auricular surface) and most of both hands. Obviously the body had been disturbed considerably after burial by subsequent intern- ments and it was extremely fortunate that the hands had survived virtually intact.

The lesions

Many of the joints of the carpus and hands were affected by erosive lesions (see Figure I). Those that affected the carpometacarpal joints and the metacarpophalangeal joints were marginal, but those involving the interphalangeal joints occupied a central position and there was, in addition, some proliferation of new bone around the joint margins. A small number of the phalanges showed expansion at their bases, especially the distal phalanx of the left thumb

and the middle phalanx of the second left finger. The left third proximal interphalangeal joint was ankylosed. There was some proliferation of new bone on the auricular surface of the left ilium and the left hand inferior facet joint of the fifth lumbar vertebra was eburnated. None of the other joints that survived showed any pathological changes.

Radiology

Radiologically the disease process affected mainly the proximal and distal interphalangeal joints; the metacarpophalangeal joints were almost completely normal. The predominant abnormality was ill-defined bone destruction arising principally from the articular surfaces of the phalanges. Most of the lesions were relative- ly well defined, although few were marginated. Proliferation of new bone visible on macroscopic examination was not a radiological feature. At least one proximal interphalangeal joint showed definite sound bony union with appreciable loss of bone substance of the middle phalanx. The bare areas of bone were largely intact. No periosteal new bone formation was present, nor was there evidence of phalangeal sclerosis.

Of the few carpal bones that remained, none was radiologically abnormal except for some

1047-482x/91/020151-03$05.00 @ 1991 by John Wiley & Sons, Ltd

Received 2 February 1991 Accepted 25 March 1991

152 J. Rogers, T. Waldron and 1. Watt

Figure 1. Radiograph of both hands of female medieval skeleton showing changes consistent with erosive osteoarthritis.

evidence of irregularity of the distal articular surface of the right scaphoid. There was one well-defined periarticular erosion at the base of the right fourth metacarpal.

Discussion

It is almost axiomatic in palaeopathology that the most interesting or important skeletons are never complete and so it is with this one. The presumptive diagnosis, therefore, had to be based on substantially less information than we would have liked but, nevertheless, the lesions found in the hands have many of the character- istics of erosive osteoarthritis, including their central position, their distribution, the presence of proliferative new bone and the presence of ankylosis. The finding of osteoarthritis else- where in the skeleton also lends support to this diagnosis.

Other conditions that need to be considered as an alternative diagnosis include rheumatoid arthritis, the sero-negative arthropathies and

gout. The changes in the sacroiliac joint orig- inally raised the possibility that this might be a sero-negative arthropathy,’ but the central position of the lesions in the hands argues strongly against this diagnosis. The central erosions, and the presence of proliferative new bone is against the idea that this is rheumatoid, and the position of the lesions similarly rules out gout.

The radiological features were felt to be consistent entirely with those previously des- cribed in erosive o~teoar thr i t i s .~’~ No feature was seen in the radiographs to suggest rheuma- toid disease or a sero-negative anthropathy, such as psoriasis. There were also no lesions centrally or in the bare areas to support a gouty diathesis.

The prevalence of erosive osteoarthritis in modern populations does not seem to be known with any certainty. Cobby et al .3 identified 24 cases amongst 500 patients with osteoarthritis, suggesting that it may comprise about 5 per cent of all osteoarthritis. We have examined well over 5000 skeletons from various sites in the UK

Erosive Osteoarthritis

from all periods from the Neolithic to the mid- nineteenth century, and although osteo- arthritis affects substantially more than a quarter of all adult skeletons this is the only one that in any way resembles erosive osteo- arthritis. Amongst the skeletons we have studied we have found a small number of cases that most resemble a sero-negative arthropathy, but none that satisfies the criteria for rheumatoid. These, admittedly rather crude data, might lead us to suppose that erosive osteoarthritis, like rheumatoid arthritis, was extremely uncommon in the past, certainly less common than the sero-negative arthropathies.

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References

Rogers, J., Waldron, T., Dieppe, P. and Watt, I. Arthropathies in palaeopathology: the basis of classification according to most probable cause. Journal of Archaeological Science, 1987; 14: 179-193. Utsinger, P. D., Resnick, D., Shapiro, R. F. and Wisner, K. B. Roentgenologic, immunologic and therapeutic study of erosive (inflammatory) osteoarthritis. Archiaes of Infernal Medicine, 1978;

Cobby, M., Cushnaghan, J., Creamer, P., Dieppe, P. and Watt, I. Erosive osteoarthritis: is it a separate disease entity? Clinical Radiology, 1990;

138: 693-697.

42: 258-263.