Juliet Rogers

Arthropathies in palaeopathology: The basis of classification according to most probable cause

Abstract A scheme is presented for the classification of joint changes seen in skeletal material according to their most probable cause. One of the critical factors in making this classification is the description of the pattern of pathological changes noted in the skeleton. It is important to consider the skeleton in its entirety, and a valid classification cannot be made from the examination of single sets of joints or single elements of the skeleton. The description of the pathology of a skeleton should include an account of the joints which are present and examined, those which are normal, as well as those which are abnormal. The classification of lesions in palaeopathological material must be securely grounded in modern clinical practice if useful comparisons are to be made between series and disease in modern populations. If this is not the case, there is a serious danger of over-interpretation and over-simplification.

Bone formers: osteophyte and enthesophyte formation are positively associated

OBJECTIVE To test the hypothesis that enthesophyte formation and osteophyte growth are positively associated and to look for associations between bone formation at different sites on the skeleton so that a simple measure of bone formation could be derived. METHODS Visual examination of 337 adult skeletons. All common sites of either enthesophyte or osteophyte formation were inspected by a single observer who graded bone formation at these sites on a 0-3 scale. The total score for each feature was divided by the number of sites examined to derive an enthesophyte and an osteophyte score. Cronbach’s α and principal components analysis were used to identify groupings. RESULTS Enthesophyte formation was associated with gender (M>F) and age. There was a positive correlation between enthesophytes and osteophytes (r = 0.65, 95% confidence interval, 0.58 to 0.71) which remained after correction for age and gender. Principal components analysis indicated four different groupings of enthesophyte formation. By choosing one site from each group a simple index of total skeletal bone formation could be derived. CONCLUSIONS Osteophytes and enthesophytes are associated, such that a proportion of the population can be classified as “bone formers”. Enthesophyte groupings provide some clues to aetiopathogenesis. Bone formation should be investigated as a possible determinant of the heterogeneity of outcome and of treatment responses in common musculoskeletal disorders.

Palaeopathology of spinal osteophytosis, vertebral ankylosis, ankylosing spondylitis, and vertebral hyperostosis.

Five hundred and sixty intact skeletons and several thousand disarticulated vertebrae have been examined with special reference to spinal fusion. In period they ranged from a 21st dynasty Egyptian mummy to a mid-19th century skeleton. Osteophytes were found in about half of the specimens, as reported previously. Fifteen skeletons with extensive blocks of spinal fusion were also identified. Sacroiliitis was present in two, but the asymmetrical spinal disease and peripheral joint changes suggested Reiters disease or psoriatic spondylitis rather than ankylosing spondylitis. The remaining 13 had typical features of Forrestiers disease, and extraspinal findings indicative of diffuse idiopathic skeletal hyperostosis (DISH) were also common. A review of the available literature suggests that many palaeopathological specimens previously reported as anklylosing spondylitis are examples of DISH or other seronegative spondylarthropathies. The antiquity and palaeopathology of AS needs reappraisal.

Radiographic assessment of the knee joint in osteoarthritis.

The development of radiographic systems for the grading of osteoarthritis requires knowledge of the reproducibility of their individual component features. This paper reports the reproducibility, both within and between observers, for five commonly used radiographic features of osteoarthritis in the tibiofemoral and patellofemoral compartments of the knee joint. The results suggest that assessments of joint space narrowing, osteophyte, and bony contour in the tibiofemoral compartments are more reproducible than those of sclerosis and cyst. Patellofemoral assessments, with the exception of osteophyte, are considerably less reproducible between observers than tibiofemoral assessments.

Medical History: Arthritis in Saxon and mediaeval skeletons

Examination of 400 Saxon, Romano-British, and mediaeval skeletons from seven archaeological excavations in the west of England showed an unexpectedly high incidence of osteoarthritis and osteophytosis. Three skeletons had evidence of an erosive peripheral arthritis—one with probable gout, one probable psoriatic arthropathy, and one with possible rheumatoid arthritis. The pattern and types of rheumatic disease, and the resultant disability, were apparently different. An exuberant form of large joint osteoarthritis was common and rheumatoid arthritis and similar diseases rare.

Comparison of visual and radiographic detection of bony changes at the knee joint.

Children with head injury can be managed by guidelines similar to those already used in adults, but to improve outcome even more patients should be investigated by computed tomography soon after injury. We therefore recommend that a patient with head injury who has either a persisting alteration in conscious level or a skull fracture should be investigated by computed tomography. The figure shows how this might be achieved through coordinated efforts by neurosurgical units and general hospitals with facilities for computed tomography. The box shows guidelines proposed as a basis for formulating new, locally agreed criteria for managing children and adults with head injuries.

Shape of the intercondylar notch of the human femur: a comparison of osteoarthritic and non-osteoarthritic bones from a skeletal sample

OBJECTIVES To compare objectively the shape of the intercondylar notch in human osteoarthritic and non-osteoarthritic femora. METHODS A sample of 96 human femora from a large skeletal population were selected for study. These femora included subjects with evidence of late stage osteoarthritis (that is, with eburnation present) and subjects with no such evidence. The distal end of the femur, viewed axially, was recorded with a video camera, and digitised computer images were produced. The outline of the intercondylar notch was extracted and represented mathematically as two functions. A functional principal components analysis was used to identify important modes of shape variation. These variations in shape were compared between eburnated and non-eburnated femora. RESULTS A statistically significant difference in the shape of the intercondylar notch was found between the two groups. The difference related mostly to the shape of the edge of the medial condyle: in the non-osteoarthritic group this tended to exhibit a concavity; in the osteoarthritic group it tended to be straight. CONCLUSIONS This observed difference may be a predisposing factor to the development of osteoarthritis. The morphology of the intercondylar notch is related to the functioning of and possible damage to the cruciate ligaments, and damage to the cruciate ligaments is a known risk factor for osteoarthritis. Alternatively, this difference may be due to bony remodelling secondary to the onset of osteoarthritis, perhaps in response to altered biomechanics.

The effects of dental wear on third molar eruption and on the curve of Spee in human archaeological dentitions.

The abrasiveness of food is a key determinant in the rate of physiological attrition (dental wear) in humans. With increasing food processing through time, the rate of physiological dental wear in human teeth has decreased markedly. Many consider such wear to be beneficial to oral health and that insufficient wear may result in impaction of the third molars. If enhanced extraoral food processing provides an evolutionary advantage, then it is possible that agenesis of the redundant third molar may follow. One of the aims here was to examine impaction and agenesis of the third molars in four populations of varying antiquity and hence varying dental-wear rates. Paradoxically, whilst there is a decrease in the rate of dental wear with modernity, there is also an increasing prevalence of advanced dental wear due to prolongation of the lifespan of the human dentition. As the effect of dental wear on the curve of Spee was unknown, a second aim was to examine it in an archaeological population with a high rate of dental wear. The results showed an increase in non-eruption and impaction of the third molars with modernity, but did not demonstrate a significant increase in the rate of agenesis. The time period over which impaction and agenesis could be discerned was of the order of 600 years and this may not be sufficient to observe adaptive changes at the genetic level in humans. In molar teeth there was no clear indication of maintenance of the curve of Spee with dental wear. This has potential implications on the design of prostheses for the worn dentition.

Infections in palaeopathology: the basis of classification according to most probable cause

Abstract A scheme is presented for the classification of the most common infectious diseases of bacterial origin seen in skeletal material according to their most probable cause. When using this classification, it is stressed that particular attention should be given to the pattern of the pathological changes observed; it is most important to consider the skeleton in its entirety. In the majority of cases it would be difficult to attempt a classification on incomplete skeletons or on single skeletal elements.

Skeletal palaeopathology and the rheumatic diseases: where are we now?

Many rheumatologists have an interest in the history of the rheumatic diseases. Sources of historical data include medical manuscripts, non-medical literature, art, and archaeological specimens such as mumnnmies and skeletons. Skeletal material is more commonly available than mummies and should provide valuable data on rheumatic diseases which leave imprints on bones. Over the last decade there have been an increasing number of publications on arthritis in skeletons; this article briefly reviews these reports and their contribution to rheumatology.