Rheumatology 2001; 40: 1073-1074
© 2001 British Society for Rheumatology
Letters to the Editor |
Reply to a letter by Inoue et al.
Northeastern Ohio Universities College of Medicine, 5500 Market Street, Youngstown, OH 44512, USA
SIR, The recent article by Inoue et al. [1] ambitiously attempts to draw conclusions as to the nature of large-joint osteoarthritis (OA) in antiquity. Suggesting that ‘reliable measures for the definition of OA have not been established’ they unfortunately premise diagnosis of OA solely on the basis of eburnation. That erroneous perspective is apparently derived [2] from a very flawed [3] text.
All eburnation represents is loss of joint cartilage, such that the component bones now abrade or ‘eburnate’. While eburnation may represent the final stage of OA (when cartilage has been worn away), it may complicate the spondyloarthropathy and other forms of arthritis known to exist in these populations. More importantly, the selected criteria are at variance with validated criteria developed by Altman et al. [4]. According to Altman et al. [4–6], osteophytes are the major skeletal identifiers for the presence of OA.
Inoue et al. [1] have identified remarkably important populations. They have determined that sufficient cartilage damage occurred to allow eburnation. Its aetiology, as yet, is undetermined. Is this the result of OA or the final stages of spondyloarthropathy or infectious arthritis (the forms of arthritis presumed to be most common in their populations) [7].
It will be intriguing to see these same populations analysed according to validated criteria, not only for OA, but also for spondyloarthropathy. Then, the true differences in patterns and frequencies of the diseases in hunter-gatherers and agriculturalists could be revealed.
Accepted 2 April 2001
References
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Inoue K, Hukuda S, Fardellon P et al. Prevalence of large-joint osteoarthritis in Asian and Caucasian skeletal populations. Rheumatology2001;40:70–3.
[Abstract/Free Full Text] - Rogers J, Dieppe P. A field guide to joint disease in archaeology. Chichester: John Wiley & Sons, 1994.
- Rothschild BM. Field guide to joint disease in archeology. Am J Phys Anthropol1996;101:299–301.
- Altman R, Alarcon G, Appelrouth D et al. Criteria for classification and reporting of osteoarthritis of the hand. Arthritis Rheum1990;33:1601–10.[Web of Science][Medline]
- Altman R, Alarcon G. Appelrouth D et al. Criteria for classification and reporting of osteoarthritis of the hip. Arthritis Rheum1991;34:505–14.[Web of Science][Medline]
- Altman R, Asch E, Bloch D et al. Criteria for classification and reporting of osteoarthritis of the knee. Arthritis Rheum1986;29:1039–49.[Web of Science][Medline]
- Rothschild BM, Martin L. Disease in the skeletal record. London: CRC Press, 1993.
Reply
Department of Orthopaedic Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga 520–2192, Japan
The letter from Dr Rothschild raises a conflicting opinion confirming that we currently lack established osteoarthritis (OA) criteria for paleopathological studies. Of no doubt, eburnation represents severe OA status. However, it is easily recognizable by researchers, providing reasonably comparable criteria. Our previous study reported the prevalence of severe OA as measured by the presence of eburnation.
The definition of OA in modern epidemiology is based on radiographic findings with or without symptomatology. In paleopathological studies, instead of the usual lack of information about cartilaginous tissue and symptomatology, researchers are able to observe fine and subtle findings on bony surfaces, such as osteophytes that cannot be detected by two-dimensional radiography. Therefore, whichever OA definition is chosen for skeletons, direct comparisons of prevalence between paleopathological and modern epidemiological studies are at present inappropriate.
Because inflammatory diseases of the joints have been one of our concerns in the past, we have observed all residual bones including those of spine, hand, and foot. The presence of erosions with or without bone formation and/or bony ankylosis was suggestive of inflammatory joint disease. In our experience, skeletons identified as having inflammatory arthritis rarely showed eburnation in a large joint. For example, in Asian samples, we identified 15 skeletons as having inflammatory arthritis; five with infectious arthritis, one probably with rheumatoid arthritis [1], one with gout [2], and eight with mono-/oligo-arthritis of undetermined diagnosis. Of these, only one skeleton showed eburnation in a large joint. In this skeleton, a male Chinese with an estimated age between 20 and 39 yr, bony ankylosis was seen in the right sacroiliac joint and right hip joint. The right hip was fused in an extremely flexed position with the right femur located in front of the abdomen. The contralateral left hip showed typical degenerative change, such as eburnation and marked osteophytes at both the acetabulum and femoral head. We assumed that OA of the left hip would have been related to the abnormal posture of the right hip. In view of the rarity of such a skeleton, we believe that the presence of inflammatory joint diseases in the study population had minimal influences on the results of our previous report.
References
- Inoue K, Hukuda S, Nakai M, Katayama K, Huang J. Erosive peripheral polyarthritis in ancient Japanese skeletons: a possible case of rheumatoid arthritis. Int J Osteoarchaeol1999;9:1–7.
- Inoue K, Hukuda S, Nakai M, Katayama K. Erosive arthritis of the foot with characteristic features of tophaceous gout in the Jomon skeletal population. Anthropol Sci1998;106:221–8.
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