The physiopathology of osteoarthritis: Paleopathological implications of non-articular lesions from a modern surgical sample

OBJECTIVES

This research focused on osteoarthritis (OA) lesions on modern patients to 1) identify consistently observed lesions not included within current paleopathological measures of OA, 2) assess the correspondence of bone and cartilage lesions with clinical OA diagnostic criteria, and 3) discuss the correspondence of bone lesions with sources of pain reported in clinical literature.

MATERIALS

Tibial plateaus from 62 patients undergoing total knee replacement surgery due to OA were examined.

METHODS

Plateaus were scored for several non-standard OA criteria, including non-articular and X-ray visible lesions and pre-maceration cartilage lesions, as well as articular surface criteria standard in paleopathology.

RESULTS

Proliferative bone in the intercondylar region was present in 95 % of specimens, while areas of dense trabecular bone and lytic defects, both on the inferior side of the plateaus, were present in 98 % and 83 %, respectively.

CONCLUSIONS

The inferior lytic defects may be physical evidence of bone marrow lesions (BML), a clinical OA indicator visible via MRI. Previous research has linked BML to pain, inflammation, and ligament pathology. The latter conditions have also been associated with intercondylar enthesophytes and third intercondylar tubercle of Parsons (TITP), both of which were observed in the intercondylar regions.

SIGNIFICANCE

Several non-articular lesions not currently included in paleopathological measures of OA were consistently observed.

SUGGESTIONS FOR FUTURE RESEARCH

A similar analysis of a control sample of non-OA tibial plateaus would better contextualize these results.

LIMITATIONS

The sample's high average age (65.8 years) and severe OA stage may hamper generalizability to archaeological collections.

Diverse perspectives on interdisciplinarity from Members of the College of the Royal Society of Canada

Various multiple-disciplinary terms and concepts (although most commonly “interdisciplinarity,” which is used herein) are used to frame education, scholarship, research, and interactions within and outside academia. In principle, the premise of interdisciplinarity may appear to have many strengths; yet, the extent to which interdisciplinarity is embraced by the current generation of academics, the benefits and risks for doing so, and the barriers and facilitators to achieving interdisciplinarity, represent inherent challenges. Much has been written on the topic of interdisciplinarity, but to our knowledge there have been few attempts to consider and present diverse perspectives from scholars, artists, and scientists in a cohesive manner. As a team of 57 members from the Canadian College of New Scholars, Artists, and Scientists of the Royal Society of Canada (the College) who self-identify as being engaged or interested in interdisciplinarity, we provide diverse intellectual, cultural, and social perspectives. The goal of this paper is to share our collective wisdom on this topic with the broader community and to stimulate discourse and debate on the merits and challenges associated with interdisciplinarity. Perhaps the clearest message emerging from this exercise is that working across established boundaries of scholarly communities is rewarding, necessary, and is more likely to result in impact. However, there are barriers that limit the ease with which this can occur (e.g., lack of institutional structures and funding to facilitate cross-disciplinary exploration). Occasionally, there can be significant risk associated with doing interdisciplinary work (e.g., lack of adequate measurement or recognition of work by disciplinary peers). Solving many of the world’s complex and pressing problems (e.g., climate change, sustainable agriculture, the burden of chronic disease, and aging populations) demands thinking and working across long-standing, but in some ways restrictive, academic boundaries. Academic institutions and key support structures, especially funding bodies, will play an important role in helping to realize what is readily apparent to all who contributed to this paper—that interdisciplinarity is essential for solving complex problems; it is the new norm. Failure to empower and encourage those doing this research will serve as a great impediment to training, knowledge, and addressing societal issues.

An innovative method to visualise mastoiditis using a hand-held X-ray system

OBJECTIVE

We explore the utility of using a hand-held X-ray system to diagnose mastoiditis in archaeological populations.

MATERIALS

A sample (n = 56) of hunter-fisher-gatherers from the Early Neolithic (8,000-7,000/6,800 cal. BP) Cis-Baikal cemetery of Shamanka II (Russia) were examined.

METHODS

Images were taken medio-laterally, approximately 90° to a sensor temporarily affixed to the lateral surface of the mastoid process. Digital radiographs were analysed for signs of mastoiditis occurring pre- and/or post-puberty.

RESULTS

Two thirds of individuals (39/56) exhibited evidence of mastoiditis. Chronic mastoiditis and chronic sinusitis co-occurred in 61.5% (24/39) of observable individuals.

CONCLUSIONS

This method was found to be an effective, convenient, and versatile non-destructive alternative to sectioning and traditional radiographic imaging.

SIGNIFICANCE

This is the first project to adapt a hand-held X-ray system for imaging and diagnosis of mastoiditis and this approach encourages future analyses of this infection.

LIMITATIONS

The cost of the imaging system is limiting and there are few comparative images taken in the same plane.

SUGGESTIONS FOR FURTHER RESEARCH

Further research should create a larger catalogue of comparative radiographs and assess the diagnostic potential of imaging the mastoid process to rather than imaging the entire pneumatized portion of the temporal bone.

Paleopathological description and diagnosis of metastatic carcinoma in an Early Bronze Age (4588+34 Cal. BP) forager from the Cis-Baikal region of Eastern Siberia

Extensive osteolytic and osteoblastic lesions were observed on the skeletal remains of an adult male excavated from an Early Bronze Age cemetery dated to 4556+32 years BP, located in the Cis-Baikal region of Siberia (Russian Federation). Lytic lesions ranged in size from several mm to over 60 mm in diameter and had irregular, moth-eaten borders. Many of these lesions destroyed trabecular bone, though a hollowed shell of cortical bone often remained observable. Radiographic analysis revealed numerous lytic lesions within trabecular bone that had not yet affected the cortex. Blastic lesions were identified as spiculated lines, bands, or nodules of mostly immature (woven) bone formed at irregular intervals. Anatomical elements with the greatest involvement included those of the axial skeleton (skull, vertebrae, sacrum, ribs, and sternum) as well as proximal appendicular elements (ossa coxae, proximal femora, clavicles, scapulae, and proximal humeri). Osteocoalescence of destructive foci was observed on the ilium and frontal bone, with the largest lesion found on the right ilium. Differential diagnoses include metastatic carcinoma, mycotic infections, tuberculosis, Langerhan's cell histiocytosis, and multiple myeloma. Based on lesion appearance and distribution, age and sex of the individual, as well as pathogen endemism, the most likely diagnostic option for this set of lesions is metastatic carcinoma. The age and sex of this individual and appearance of the lesions may reflect carcinoma of the lung or, possibly, prostate. This represents one of the earliest cases of metastatic carcinoma worldwide and the oldest case documented thus far from Northeast Asia.

Lower limb activity in the Cis-Baikal: entheseal changes among middle Holocene Siberian foragers

Lower limb entheseal changes are evaluated in order to reconstruct activity levels and more fully understand cultural and behavioral variation among the middle Holocene (ca. 9,000-3,000 years BP) foragers of Siberia's Cis-Baikal region. The four cemetery samples examined span a period of diachronic change characterized by an 800- to 1,000-year discontinuity in the use of formal cemeteries in the region. Two of the cemetery samples represent the early Neolithic Kitoi culture, dating from 8,000 to 7,000/6800 cal. BP; the other two represent the late Neolithic-early Bronze Age Isakovo-Serovo-Glazkovo (ISG) cultural complex, dating from 6,000/5,800 to 4,000 cal. BP. Findings suggest a dynamic pattern of cultural variability in the Cis-Baikal, with spatial distribution (i.e., site location within particular microregions) appearing to be just as important a factor as cultural/temporal affiliation in explaining intersample differences in entheseal morphology. In addition, intrasample comparisons reveal increasing sexual disparity with advancing age at death, emphasizing the influence of sex-related activities on lower limb entheseal changes. Finally, results from the separate fibrous and fibrocartilaginous datasets appear to be largely congruous, implying that activity patterns in the Cis-Baikal may have similar effects on the morphology of both types of entheses.

Dental health indicators of hunter–gatherer adaptation and cultural change in Siberia's Cis-Baikal

This investigation of the Cis-Baikal dental record focuses on health and lifestyle reconstruction of the region's mid-Holocene foragers, with particular interest in an apparent fifth millennium BC biocultural hiatus. The four cemetery populations considered represent two distinct biological and cultural groups separated by an apparent 700-year hiatus: the late Mesolithic-early Neolithic Kitoi culture (6800-4900 BC) and the middle Neolithic-early Bronze Age Serovo-Glaskovo cultural complex (4200-1000 BC). Research focuses on the frequency and severity of seven dental health indicators: enamel hypoplasia, caries, alveolar defects, periodontitis, antemortem tooth loss, dental calculus, and dental attrition. Together, these seven indicators provide a basis not only for better understanding mid-Holocene lifeways in the Cis-Baikal but also for independently assessing the relative effectiveness of the different adaptive strategies employed by pre- and posthiatus peoples. Results reveal some discrepancies between the Kitoi and Serovo-Glaskovo, specifically in their relative vulnerability to physiological stress, providing evidence to support previous interpretations of their distinct adaptive regimes (namely the narrower resource base and decreased mobility of the former). Results also suggest that some of the differences observed among the four sites may reflect geographical or environmental factors rather than simply cultural ones. However, despite these distinctions, the overriding trend appears to be one of general continuity, social equality, and good health among all mid-Holocene occupants of the Cis-Baikal, pre- and posthiatus alike.

Osteoarthritis in Siberia's Cis-Baikal: Skeletal indicators of hunter-gatherer adaptation and cultural change

This examination of osteoarthritis in Siberia's Cis-Baikal region focuses on the reconstruction of mid-Holocene mobility and activity patterns with particular interest in an alleged fifth millennium BC biocultural hiatus. Five cemetery populations--two representing the pre-hiatus Kitoi culture (6800-4900 BC) and three the post-hiatus Serovo-Glaskovo (4200-1000 BC)-are considered. The objective is to investigate osteoarthritic prevalence and distribution (patterning) within and among these populations in order to reconstruct mobility and activity patterns among the Cis-Baikal foragers, and to test for possible disparities that may reflect differing adaptive strategies. The data reveal that levels of activity remained relatively constant throughout the mid-Holocene but that mobility and specific activity patterns did not. Although results are consistent with the current understanding of distinct Kitoi and Serovo-Glaskovo subsistence regimes, specifically the lower residential mobility and narrower resource base of the former, they also draw attention to adaptive characteristics shared by all occupants of the Cis-Baikal.