Henry Ford Hospital Medical

Dr. Conrad Lam Thoracic Surgery K-7

Arthritis: odern Concepts and Ancient Evidence

CURRENT CONCEPTS IN ARTHRITIS

Osteoarthritis Howard Duncan, MD

Ankylosing Spondylitis CaH ina V. Jimenea, MD

Gout and Pseudogout Gilbert B. Bluhm, MD

Rheumatoid Arthritis

Jeanne M. Riddle, PhD

Arthrit is: A Radiologic Overview Gordon H. Beute, MD

10

14

18

24

PALEOARTHRITIS WORKSHOP

The Search for "Ar thr i t i s " in Antiquity T. A. Reyman, MD

32

ARTHRITIS IN ANTIQUITY

Osteoarthritis in Prehistoric Turkey and Medieval Byzantium

J. Lawrence Angel, PhD

Biochemical Discovery of Homogentisic Acid Pigment in an Ochronotic Egyptian Mummy

Frederick F. Stenn, MD James W. Milgram, MD Sandra L. Lee, PhD Raymond J. Weigand, MS Arthur Veis, PhD Frank Rogers, MD

Hunter-Gatherer/ Agriculturalist Arthrit ic Patterns: A Preliminary Investigation

Robert B. Pickering, MA

38

44

50

Vol 27, N o l 1979

Continued on Back Cover

HENRY FORD HOSPITAL MEDICAL JOURNAL

Published quarterly by the Professional Staff ofthe Henry Ford Hospital

Vol 27, No 1 1979

EDITORIAL BOARD

John W, Rebuck, MD, PhD Editor

Gilbert B, Bluhm, MD Associate Editor

Joseph L. Ponka, M D Associate Editor

Wil l iam T Beher, PhD George C. Bower, MD Joseph C. Cerny, MD Howard Duncan, MD John H. Hageman, MD Raymond H. Kahn, PhD Michael Kleerekoper, M D Edward A. Krull, MD Paul D. Stein, MD D. Emerick Szilagyi, MD

Patricia L. Cornett, PhD Managing Editor

Robert H. Mohr Medical Art Director

Addresscommunicationsto: Editorial Office, 3029 Education and Research Center, Henry Ford Hospital, Detroit, M l 48202, Changeof address notices should be accompanied by an old address label.

Backcopiesof the lournal are available from Xerox LInlversity Microfilms, 300 N Zeeb Rd, Ann Arbor, M l 48106, as35 mm microfilms (Vols1-20)orasl6 mm films (Vols 19-present),

COPYRIGHT HENRY FORD HOSPITAL 1979

Arthritis: Modern Concepts and Ancient Evidence

Arthr i t i s means literally inflammation of a joint, but, by custom, this term is used in a general sense to cover a wide range of diseases, including some which are chiefly non­inflammatory in nature. Arthritis is the most common "dis­ease" reported in relics from the past, because specimens that survive from antiquity are chiefly bones. Soft tissues are rarely preserved unless the bodies are deliberately mum­mified by human art, fortuitously protected as in the peat bogs, or maintained by a desiccating climate. Since the major function of joints is movement, they are more suscep­tible to daily wear and tear than the nonmoving parts of the skeleton. The pattern of bony changes can sometimes be related to specific tasks within a given population or may simply reflect disease processes.

In view of the prevalence of so-called arthritis and the abundance of specimens from the past, it behooves the paleopathologist to give this area of study a high priority. The existing difficulty, however, is that archeologists and physi­cal anthropologists who find these specimens first and who mainly study ancient bodies are usually not trained in any depth in the field of pathology. On the other hand, patholo­gists and rheumatologists who have the necessary skills and experience to identify specific disease processes rarely, if ever, have the opportunity to examine this excavated mate­rial. To further complicate the situation, the etiologic mech­anisms of some major diseases ofthe joint are still unknown so thatthe progressive events of soft tissue and bonydamage remain puzzling even to those who spend a lifetime of study in this area.

For these reasons, it seemed to me that a comprehensive approach which combined the knowledge of practicing physicians and of students of the past might be fruitful. Dr. Jeanne M. Riddle and Dr. Howard Duncan, staff members of the Division of Rheumatology at Henry Ford Hospital, who are also members o f t h e Paleopathology Associat ion, agreed, and together we organized a symposium on the subject of arthritis in antiquity. Appropriate specialists from the Hospital staff were requested to present an overview of

current information on the majortypes of arthritis (Section I). Eve Cockburn and I organized the section on "Arthritis in Antiquity," which included paleopathologists and physical anthropologists, Henry Ford Hospital was most cooperative in hosting the symposium, which was held on September 23, 1978.

In addition, the Department of Orthopaedic Surgery atthe Hospital substituted the symposium for its weekly grand rounds, and everyone present benefited from their expertise as they participated in the different discussions. All told, roughly one hundred scientists attended, representing at least a dozen widely ranging disciplines.

A very important part of this symposium was the actual examination of ancient specimens by the modern special­ists. It is obviously importantto look at the best material that can be obtained, for one actual bone is worth a host of photographs. The paleopathologists and physical an­thropologists brought a variety of ancient bone specimens with them to the symposium, and Dr. Theodore A. Reyman organized the display. He also later collated the opinions of the specialists who examined this material (Section II).

The main purpose of the symposium was to clarify the diagnosis of those diseases found in ancient bodies and bony remains that are now lumped together under the general heading of "arthritis." We did not expect to find answers to all the existing questions, but it was hoped that at leastthe problems would be identified. How far this objec­tive was achieved can be seen in the subsequent pages of this issue.

— Aidan Cockburn, MD President, Paleopathology Association

ARTHRITIS: M O D E R N CONCEPTS A N D ANCIENT EVIDENCE

CURRENT CONCEPTS IN ARTHRITIS

Osteoar thr i t i s

Howard Duncan, MD

Anky los ing Spondyl i t is

Carlina V. jimenea, MD

Gou t and Pseudogout

C//6ert B. Bluhm, MD

Rheumato id Ar th r i t i s

yeanne M. Riddle, PhD

Ar th r i t i s : A Radiologic O v e r v i e w

Cordon H. Beute, MD

PALEOARTHRITIS W O R K S H O P

The Search fo r " A r t h r i t i s " in An t i qu i t y T. A. Reyman, MD

ARTHRITIS IN A N T I Q U I T Y

Osteoar thr i t i s in Prehistoric Turkey and

Med ieva l Byzant ium

/, Lawrence Angel, PhD

Biochemica l Discovery o f Homogent is ic Ac id Pigment in an O c h r o n o t i c Egyptian M u m m y

Frederick F. Stenn, MD james W. Milgram, MD Sandra L. Lee, PhD Raymond j. Weigand, MS Arthur Veis, PhD Frank Rogers, MD

Hunter -Gatherer / Agr icu l tura l is t A r th r i t i c

Patterns: A Pre l iminary Invest igat ion

Robert B. Pickering, MA

10

14

18

24

32

38

44

50

Vertebral Osteophytosis in D ickson M o u n d

Populat ions: A Biomechanica l

In terpre ta t ion 5 4

George A. Clark, BA lack A. Delmond, BA

Degenerat ive Joint Disease o f the Long Bones in Dickson Mounds 60

Debra L. Martin, MA George j. Armelagos, PhD lack R. King, BA

A Survey of Joint Disease at the Libben Site,

O t t awa County, O h i o 64

Marc A. Kelley, MA

Ar th r i t i s in D ry Bones: Diagnost ic Problems 68

Claire M. Cassidy, PhD

SYMPOSIUM S U M M A R Y

The Impact of Rheumat ic Disease on Society 70

james C, Leisen, MD Howard Duncan, MD

Ar th r i t i s , Anc ien t and M o d e r n : Guidel ines

fo r Field Workers 74

Aidan Cockburn, MD Howard Duncan, MD leanne M. Riddle, PhD

Guest Edi tors: Eve C o c k b u r n , M A (Oxon . )

H o w a r d D u n c a n , M D

Jeanne M . Riddle, PhD

1979 Vol 27, No 1

Paleopathology Association Monograph No. 3