Symmetrical erosive disease in archaic Indians: The origin of rheumatoid arthritis in the New World?

To evaluate and differentially diagnose erosive skeletal lesions located on multiple joints of an individual archaeologically recovered in 2017.

Skeletal remains of a well-preserved skeleton dating to the 12th–13th centuries from the medieval church of San Biagio in Cittiglio (Varese, northern Italy).

Macroscopic and radiographic imaging.

Erosive marginal symmetrical lesions are present on the metatarsophalangeal, metacarpophalangeal and interphalangeal joints of an adult male, aged 55–75 years. Osteolytic changes, in the form of pocket erosions, surface resorptions and pseudocyst formations, are also macroscopically observed on some carpal and tarsal bones and on several large peripheral joints.

A careful differential diagnosis of the lesions and their macroscopic and radiological appearance is suggestive of a case of rheumatoid arthritis-like polyarthropathy.

This case contributes to the debate regarding the antiquity of erosive polyarthropathies, providing additional evidence for the existence of these diseases in the Old World prior to the European discovery of the Americas.

Small sample size limits discussion of the scope of the disease in antiquity.

This case highlights the need for further macroscopic, radiographic, and biomolecular studies of pre-modern European skeletal samples to investigate the hypothesized pre-existence of these pathological conditions in Europe prior to 1492.

Rheumatoid arthritis (RA) is considered to be an uncommon condition in paleopathology, although several case studies have recently been published. These studies tend to focus on changes in the small joints of the hands and feet, which are the most diagnostic, though these skeletal elements are often poorly preserved in archaeological contexts. This study aims to highlight another common trait that has been observed in multiple cases of RA in the clinical and paleopathological record: erosive lesions on the proximal ulna. RA frequently affects the elbow in clinical cases, with erosions observable in the radial head, the proximal ulna, and the distal humerus, in the later stages of the disease. Lesions produced by RA in the proximal ulna demonstrate a remarkable consistency in appearance between paleopathological cases from different periods and places. Although overlooked, erosive lesions on the proximal ulna provide an important diagnostic indicator of RA and yields additional information concerning disease progression.

A skeleton from the Late Roman period, recovered in Amiens, northern France, exhibits multiple symmetrical marginal erosions, primarily involving the metacarpophalangeal and metatarsophalangeal joints. Other skeletal changes include erosions of several peripheral joints and some entheses, and severe osteoporosis. Macroscopic and radiological aspects of the lesions, as well as the absence of spinal and sacroiliac joints involvement, are consistent with a diagnosis of rheumatoid arthritis. Differential diagnosis includes other erosive arthropathies, in particular the diseases belonging to the spondyloarthropathy group. This case provides a new evidence of the presence of rheumatoid arthritis in Western Europe long before the colonisation of the Americas by Europeans.