Previous reports of juvenile idiopathic arthritis (JIA) depicted in paintings by Boticelli and Cavaggio1,2 portray single articular changes which, according to other authors, may represent pathology or reflect elements of the artist’s individual style3,4.
The Tate Britain museum, in London, UK, features the Portrait of Sir Francis Ford’s Children Giving a Coin to a Beggar Boy, circa 1793, by Sir William Beechey (Figure 1). Beechey was a portrait artist whose works were described by art critics of the era as “fixed and determinate, both in his colouring and outline … he never distorts his figures for the sake of extravagant attitude”5.
Portrait of Sir Francis Ford’s Children Giving a Coin to a Beggar Boy, by Sir William Beechey, circa 1793, is an early portrayal of juvenile idiopathic arthritis and may predate the first medical description. Photo: © Tate, London 2015.
The beggar boy is reaching for a coin while placing his walking stick into the bend of his right elbow. His hips are flexed because he is bending forward. There are flexion contractures of both knees and advanced bony deformities of the left midfoot in this young man.
Soft tissue swelling is apparent, anterior to the right ankle, consistent with synovitis. The synovitis and contractures explain his need for a walking stick.
His right upper extremity is held as in a sling, possibly due to the pain of ongoing inflammation in one of its joints. The multiple articular abnormalities in this portrait are clearly diagnostic of JIA, or possibly spondylitis. This differs from previous reports of other paintings, which portray only single articular changes1,2,3,4.
Acknowledgment
With thanks to Marilyn Krelenbaum, MSc, for her invaluable assistance with the research and submission of this paper.
