Imaging Beams Into Rheumatic Diseases of the Ancient Past

November 11, 2014

"Paleoradiology" has now disputed claims that ankylosing spondylitis plagued some royal Egyptians in antiquity. This is the latest of several revelations about the provenance of some rheumatic conditions, based on imaging of ancient remains.

What was the mummy's real curse? Researchers using computed tomography (CT) for late-day diagnosis report that, in the case of several mummified human remains in Egypt, it was not (as previously thought) ankylosing spondylitis – disputing, in the process, the claimed antiquity of that condition.

“Ankylosing spondylitis was long believed to be a disease that occurred in antiquity, mostly based on its diagnosis in the Ancient Egyptian subjects, specifically diagnosis using x-rays of the mummies dated to 18th-19th dynasties,” says author Sahar N. Saleem MD, a radiology professor at the Kasr Al Ainy Faculty of Medicine in Cairo, whose team used CT to dispute earlier claims that several ancient Egyptian mummies had ankylosing spondylitis.1 In 13 royal mummies, they discovered diffuse idiopathic skeletal hypertosis (DISH), a degenerative disorder.2

“This study proved that 13 of the studied mummies dated to 18th-early 20th dynasties did not have ankylosing spondylitis disease,” Saleem told Rheumatology Network.

The majority of ancient remains are discovered as skeletons that are amenable to physical exam, so imaging plays a lesser role. But “mummies are a unique form of remains with preserved soft tissue covering the skeleton,” Saleem points out, making them suitable for imaging exams.

Over the past decade, imaging-based studies have revealed new information about musculoskeletal diseases in other ancient remains.

With x-ray, mammography, and whole-body CT, investigators uncovered rheumatoid arthritis (RA) in a 16th century mummy known as the “Braids Lady” of Arezzo.3

They report several features of RA, including large erosions of the metacarpophalangeal joints, volar metacarpophalangeal subluxation of the third and fourth fingers, and lateral deviation of all fingers.

Other researchers identified chondrocalcinosis on x-rays done in the mummified remains of the 190-year-old “Soap Lady.”4

In 2012, CT studies of mummies from the Capuchin Catacombs of Palermo, Sicily revealed that 37.5% of the adult male mummies had herniation pits that match currently accepted imaging characteristics of early osteoarathritis (OA), validating the antiquity of a common modern "curse".5

Benign herniation pits of the femoral neck are seen on CT as “round to oval subcortical/subchondral lesions at the anterior femoral neck, which is clearly demarcated by an encircling sclerotic margin,” the investigators explain.
They suggest that other researchers keep an eye out for this potential precursor to OA.

“OA of the hip joint is a very common observation in paleopathology and the discussed clinical relevance of [herniation pits] should also be addressed in paleoradiology,” they explain.


 

References:


1. Feldtkeller E, Lemmel EM, Russell AS. Ankylosing spondylitis in the pharaohs on ancient Egypt. Rheumatol Int. (2003) 23:1-5.
2. Saleem SN, Hawass Z. Ankylosing spondylitis or diffuse idiopathic skeletal hypertosis (DISH) in Royal Egyptian mummies of 18th-20th Dynasties? CT and archaeology studies. Arthritis Rheumatol. (2014) doi:10.1002/art.38864.
3. Ciranni R, Garbini F, Meri E, et al. The “Braids Lady” of Arezzo: a case of rheumatoid arthritis in a 16th century mummy. Clin Exp Rheumatol. (2002) 20:745-752.
4. Dorwart BB. Chondrocalcinosis in a 180-year-old cadaver. J Clin Rheumatol. (2005) 11:172-174.
5. Panzer S, Piombino-Mascali D, Zink AR. Herniation pits in human mummies: A CT investigation in the Capuchin Catacombs of Palermo, Sicily. PLoS One. (2012) doi: 10.1371/journal.pone.0036537

 

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