The relationshˆip between the rheumatologic diseases, rheumatoid arthritis (RA) and osteoarthritis (OA), is based on common physiopathogenic mechanisms and correlations of their mutual presentation1,2. We discuss the historical association between these 2 conditions through the analysis of European artwork from as early as the 15th century.
Diego Rodríguez de Silva y Velázquez (1599–1660) was one of the most important painters of the Spanish Golden Age, and the leading artist in the court of King Philip IV. He was an individualistic artist of the contemporary Baroque period and was important as a portrait artist.
In addition to numerous renditions of scenes of historical and cultural significance, in 1618 Velázquez painted one of his most notable compositions of his early period in Madrid, Old Woman Frying Eggs (oil on canvas, 100.5 × 119.5 cm; Figure 1), now held at the National Gallery of Scotland in Edinburgh. The presence of trapeziometacarpal OA in both hands of the old woman with more advanced rizarthrosis on the left hand was described in 19923. We discuss the subject of the painting with a diagnostic eye and suggest that the woman also had RA. Our diagnosis of the woman in this historical painting supports a longtime and persistent association between these 2 disorders.
Diego Velázquez (1599–1660). An Old Woman Cooking Eggs, 1618. Oil on canvas, 100.5 × 119.5 cm. Collection: Scottish National Gallery. Purchased with the aid of the Art Fund and a Treasury Grant 1955. Republished with permission.
Looking at the woman’s features, we focus our attention on the anatomic disruptions of the right hand, holding a wooden spoon. The hand presents a prominent second metacarpophalangeal (MCP) joint and possible subluxation of the MCP joints associated with ulnar deviation of the third and fourth fingers, suggestive of an RA-forced functional alteration, indicated by the way she holds the spoon.
Historically, the medical description of RA was attributed to the French physician Dr. Augustin Jacob Landré-Beauvais (1772–1840) in 1800 under the name of aesthetic gout and renamed properly as RA by British rheumatologist Sir Alfred Baring Garrod in 1859. Its presence was recognized in other artwork such as the Jan van Eyck portrait of John IV, Duke of Brabant, dated 1441, and paintings by Jacob Jordaens (1593–1678)4. Velázquez’s portfolio suggests the existence of RA prior to the classical diagnostic paper of Landré-Beauvais5. Notably, the described association between RA and OA demands a new look at these retroactive diagnoses of OA that could also include RA4.
