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Giuffra V, Minozzi S, Aringhieri G, Campana S, Riccomi G. A case of secondary hypertrophic osteoarthropathy from medieval Tuscany (central Italy, 10th-12th centuries CE). Int J Paleopathol 2023; 43:51-57. [PMID: 37742426 DOI: 10.1016/j.ijpp.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES This study aims to provide a detailed evaluation of a case of secondary hypertrophic osteoarthropathy (HOA) and to explore insights into the presence and consequences of disease in medieval rural Italy. MATERIALS The skeleton of a male (US 4405) with an estimated age at death of 51-69 years excavated from the medieval rural site of Pieve di Pava (Siena, Italy). METHODS Macroscopic and radiological (x-ray, CT) analyses were performed. RESULTS Symmetrical extensive periosteal new bone formation on the diaphyseal and metaphyseal regions of this individual's long bones; the lower limbs were more extensively and severely affected than the upper limbs and the distal segments were more severely altered in comparison to the proximal ones. CONCLUSIONS The macroscopic and radiological features are highly consistent with a diagnosis of secondary HOA. SIGNIFICANCE The excellent state of preservation allowed the evaluation of rarely noted skeletal manifestations of HOA and provided insight into aspects of rural life in medieval Italy. LIMITATIONS Molecular analysis was not successful in sequencing the aDNA of tuberculosis, therefore the underlying primary cause of secondary HOA, whether pulmonary or extrapulmonary, remains obscure in this case. SUGGESTION FOR THE FUTURE RESEARCH It is advisable to regularly revisit the data available from osteoarchaeological collections in order to identify further cases of HOA, along with to further investigate the known cases to search for the underlying primary disease.
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Affiliation(s)
- Valentina Giuffra
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
| | - Simona Minozzi
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Giacomo Aringhieri
- Division of Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Stefano Campana
- Department of History and Cultural Heritage, University of Siena, Italy
| | - Giulia Riccomi
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
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Loyer J, Murphy E, Ruppe M, Moiseyev V, Khartanovich V, Zammit J, Rottier S, Potrakhov N, Bessonov V, Obodovskiy A. Co-morbidity with hypertrophic osteoarthropathy: A possible Iron Age Sarmatian case from the Volga steppe of Russia. Int J Paleopathol 2019; 24:66-78. [PMID: 30296644 DOI: 10.1016/j.ijpp.2018.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Hypertrophic osteoarthropathy (HOA) is a condition that can be inherited or acquired. It causes diffuse periosteal new bone formation on the long bones, with a predilection for the appendicular skeleton. When acquired, it is a nonspecific indicator of systemic disease that arises following a primary condition. This paper reviews the palaeopathological literature associated with this rare condition. It also describes the first possible case of co-morbidity associated with hypertrophic osteoarthropathy in an adult skeleton (cal. BC 170 - 1 cal. AD) from the mobile pastoralist Sarmatian culture of the Volga steppes of Russia. METHODS Macroscopic and radiological examination provide differential diagnoses of the lesions, while clinical and bioarchaeological analyses offer insights into the possible experience of disease and social implications of care among the nomadic populations of Iron Age Russia. RESULTS The analysis of Sk. 6524.102 displays lesions that may be due to both hypertrophic osteoarthropathy and osteomalacia. The man was physically impaired and his participation in physically challenging activities would have been limited. CONCLUSIONS The study stresses that co-morbidity is a key parameter when interpreting disease in past populations, particularly when the diagnosis involves hypertrophic osteoarthropathy. SIGNIFICANCE This is the first case of hypertrophic osteoarthropathy identified in Eurasian prehistoric populations. The research emphasises the significance of co-morbidity in the past. LIMITATIONS The diagnosis of co-morbid diseases in human remains is extremely complex and the conditions were identified as most probable by a process of elimination. SUGGESTIONS FOR FURTHER RESEARCH Further studies should be dedicated to understanding co-morbidity in the past.
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Affiliation(s)
- Jeanna Loyer
- Archaeology and Palaeoecology, School of Natural and Built Environment, Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK.
| | - Eileen Murphy
- Archaeology and Palaeoecology, School of Natural and Built Environment, Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK.
| | - Mary Ruppe
- Department of Medicine, Division of Endocrinology, Houston Methodist hospital, Houston, TX, 77030, United States.
| | - Vyacheslav Moiseyev
- Department of Physical Anthropology, Kunstkamera Museum, 24 Sredniy Prospekt, Vasilievsky Island St. Petersburg, Russia.
| | - Valery Khartanovich
- Department of Physical Anthropology, Kunstkamera Museum, 24 Sredniy Prospekt, Vasilievsky Island St. Petersburg, Russia.
| | - Jean Zammit
- TRACES UMR 5608 and ISTHIA, CNRS/EHESS, Université Toulouse Jean Jaurès, Maison de la Recherche 5, allée Antonio MACHADO 31058 Toulouse, Cedex 9, France.
| | - Stephane Rottier
- UMR 5199 PACEA, Université de Bordeaux, Bâtiment B8, Allée Geoffroy Saint Hilaire CS, 50023 33615 PESSAC CEDEX, France.
| | - Nikolay Potrakhov
- Department of Electronic Devices, St. Petersburg State Electrotechnical University «LETI», 5 Professora Popova street, St. Petersburg, Russia.
| | - Victor Bessonov
- Department of Electronic Devices, St. Petersburg State Electrotechnical University «LETI», 5 Professora Popova street, St. Petersburg, Russia.
| | - Anatoliy Obodovskiy
- Department of Electronic Devices, St. Petersburg State Electrotechnical University «LETI», 5 Professora Popova street, St. Petersburg, Russia.
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Flohr S, Jasch I, Langer A, Riesenberg M, Hahn J, Wisotzki A, Kierdorf H, Kierdorf U, Wahl J. Secondary hypertrophic osteoarthropathy in a male from the Early Medieval settlement of Lauchheim, Germany. Int J Paleopathol 2018; 20:72-79. [PMID: 29496219 DOI: 10.1016/j.ijpp.2017.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 06/08/2023]
Abstract
Hypertrophic osteoarthropathy (HOA) is rarely diagnosed in archaeological human skeletons. Here, we report on the well-preserved skeleton of a middle-adult man from the early Medieval settlement site of Lauchheim (Germany) that exhibits pronounced multi-layered shell-like periosteal new bone formation in a bilaterally symmetric fashion on the long bones, the skeletal elements of the pelvis and those of the pectoral girdle. In addition, the two distal phalanges recovered show signs of osteoclastic resorption on their distal tuberosities. The distribution and morphology of the observed lesions are consistent with a diagnosis of HOA. The adult age at death of the individual and the co-occurrence of "healed" and "active" lesions suggest a secondary form of HOA. Given that only skeletal remains were available for study, the underlying (pulmonary or non-pulmonary) primary disease cannot be definitively ascertained in the present case. No osseous changes were found on the ribs, but signs of osteoclastic resorption were observed on the dorsal surface of the sternal body, which might indicate a retrosternal or mediastinal location of the primary disease. Thus far, only a few archaeological case studies of secondary HOA reported signs of the presumed underlying primary disease, which was of a pulmonary nature in each of the individuals.
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Affiliation(s)
- Stefan Flohr
- University of Hildesheim, Department of Biology, Universitätsplatz 1, 31141, Hildesheim, Germany.
| | - Isabelle Jasch
- Eberhard Karls University Tübingen, Institute of Prehistory, Early History and Medieval Studies, Schloss Hohentübingen, Burgsteige 11, 72070, Tübingen, Germany
| | - Antje Langer
- Eberhard Karls University Tübingen, Institute of Prehistory, Early History and Medieval Studies, Schloss Hohentübingen, Burgsteige 11, 72070, Tübingen, Germany
| | - Martin Riesenberg
- Free University of Berlin, Institute of Prehistoric Archaeology, Fabeckstraße 23-25, 14195, Berlin, Germany
| | - Julia Hahn
- Eberhard Karls University Tübingen, Institute of Prehistory, Early History and Medieval Studies, Schloss Hohentübingen, Burgsteige 11, 72070, Tübingen, Germany
| | - Axel Wisotzki
- St Bernward's Hospital, Radiological Department, Treibestraße 9, 31134 Hildesheim, Germany
| | - Horst Kierdorf
- University of Hildesheim, Department of Biology, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Uwe Kierdorf
- University of Hildesheim, Department of Biology, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Joachim Wahl
- Landesamt für Denkmalpflege im Regierungspräsidium Stuttgart, Stromeyersdorfstraße 3, 78467, Konstanz, Germany; Eberhard Karls University Tübingen, Institute for Archaeological Science, Rümelinstraße 23, 72070, Tübingen, Germany
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Binder M, Saad M. Hypertrophic osteoarthropathy in a young adult male from Berber, Sudan (2nd-3rd century CE). Int J Paleopathol 2017; 18:52-62. [PMID: 28888393 DOI: 10.1016/j.ijpp.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/02/2017] [Accepted: 05/15/2017] [Indexed: 06/07/2023]
Abstract
Hypertrophic osteoarthropathy (HOA) is a pathological condition characterised by extensive periosteal new bone formation (NBF) on the diaphyses of the long bones, metacarpal and metatarsal bones. In modern clinical contexts, the secondary form of the disease is common and most often occurs secondary to intra-thoracic cancer and other forms of chronic pulmonary disease. Paleopathological evidence for HOA on the other hand has only occasionally been reported. Here we report a young adult male from the Meriotic cemetery at Berber in Sudan (2nd-3rd century CE) displaying widespread NBF on the diaphyses of the upper and lower limb bones, metacarpal and metatarsal bones, as well as the pelvis and scapulae. While several pathological conditions have to be considered as differential diagnostic options for NBF in the post-cranial skeleton, HOA is the most likely diagnosis, based on the distribution of the changes observed in this individual, as well as their macroscopic and radiographic characteristics. A chronic pulmonary condition as indicated by NBF on the visceral side of the ribs may represent the underlying cause for the HOA. This individual represents the first paleopathological case of HOA reported from an archaeological site in Africa.
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Affiliation(s)
- M Binder
- Austrian Archaeological Institute, Austrian Academy of Sciences, Franz Klein-Gasse 1, 1190 Vienna, Austria.
| | - M Saad
- National Corporation for Antiquities and Museums of Sudan, PO Box 178, Khartoum, Sudan
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Martinez-Lavin M. Exploring the Cause of the Most Ancient Clinical Sign of Medicine: Finger Clubbing. Semin Arthritis Rheum 2007; 36:380-5. [PMID: 17276498 DOI: 10.1016/j.semarthrit.2006.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Revised: 10/30/2006] [Accepted: 11/21/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Digital clubbing is regarded as the oldest clinical sign of medicine. The cause of this unique finger deformity has remained elusive throughout the centuries. For 3 decades our group has studied the etiology of this acropachy. This article reviews the current knowledge on the cause of digital clubbing. METHODS PubMed database (www.pubmed.gov) was accessed. In clinical queries/clinical study service we entered "clubbing" or "hypertrophic osteoarthropathy," choosing the "etiology" category with a "broad sensitive" search scope. The time span was from January 1975 to August 2006. Additionally, this article narrates the chronology of our research on the pathogenesis of clubbing. RESULTS The many dreadful internal illnesses associated with digital clubbing have in common enhanced platelet/endothelial cell activation. Emerging evidence suggests that, in hypoxic conditions with extrapulmonary shunting of blood, large megakaryocyte fragments fail to enter the pulmonary circulation. Instead they gain access to the systemic circulation impacting at the most distal sites, there releasing growth factors and thus inducing clubbing. In cases of lung cancer, the purported growth factor could gain direct entrance to the systemic circulation. Vascular endothelial growth factor (VEGF) may play a central role in the development of digital clubbing. It is a platelet-derived factor induced by hypoxia, and it is also abnormally produced by diverse malignant tumors fostering their uncontrolled growth. On the other hand VEGF produces vascular hyperplasia, edema, and fibroblast/osteoblast proliferation. Such are clubbing histologic characteristics. Enhanced VEGF expression has been reported in practically all internal illnesses associated with this type of finger deformity. Recent studies have demonstrated high circulating levels as well as increased local expression of VEGF in different groups of patients with digital clubbing. CONCLUSION Abnormal expression of VEGF may be the cause of digital clubbing.
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Affiliation(s)
- Manuel Martinez-Lavin
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, 14080 Mexico City, Mexico.
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Vasseur BG, Lerch P, Sage ML. Statue with clubbed feet: another reading. Ann Thorac Surg 2004; 77:756; author reply 756. [PMID: 14759491 DOI: 10.1016/s0003-4975(03)01410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Hypertrophic osteoarthropathy is one of the earliest recognized disease entities in the history of medicine. It has a peculiar periosteal proliferation distinctive from other bone diseases. In its advanced stage, it leaves an indelible mark on the skeleton. It has been recently shown that digital clubbing is accompanied by a bone remodeling process of the underlying phalanges. Thus, theoretically, this entity can be recognized in ancient human skeletal remains. We studied part of the collection of skeletal remains from pre-Hispanic Mesoamerica preserved at the National Museum of Anthropology of Mexico City. We examined 1000 specimens and found 2 skeletons with widespread, bilateral, symmetric periosteal proliferation of the tubular bones in addition to the bone remodeling changes of the distal phalanges. One of the specimens was from the Formative period (2000 B.C. to 100 A.D.). We conclude that hypertrophic osteoarthropathy can be recognized in ancient human skeletal remains and that this disease was present in Mesoamerica near the time of the original description of clubbing by Hippocrates about 2500 years ago.
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Affiliation(s)
- M Martínez-Lavín
- Rheumatology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico D.F., Mexico
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Johansen I, Nilsson F, Hansen BU. [The men behind the syndrome: Eugen Bamberger and Pierre Marie. They developed the theses of Hippocrates on lung disease as a cause of skeletal changes]. Lakartidningen 1992; 89:2519-20. [PMID: 1507984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- I Johansen
- Samtliga vid sektonen för reumatologi, medicinska kliniken, Centrallasarettet, Karlskrona
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Carcassi U. History of hypertrophic osteoarthropathy (HOA). Clin Exp Rheumatol 1992; 10 Suppl 7:3-7. [PMID: 1623670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hypertrophic osteoarthropathy (HOA) was first described in 1868 as "hyperostosis of the entire skeleton". It has also been mistaken for acromegaly. In 1887-1888 the first description was given of a dermatological disorder "cutis verticis girata" which coexisted with the peculiar bone anomalies of HOA. In 1890 HOA was named "osteoarthropatie hypertrophiante pneumique". Later a distinction was made between the rare idiopathic (or primary) form, also called "pachydermoperiostosis" and the more common secondary form due to concomitant disorders involving the lungs and pleura. The primary form usually develops shortly after puberty or during adolescence and has not been found associated with underlying disease. Secondary HOA was initially called "hypertrophic pulmonary osteoarthropathy" because it is frequently associated with various malignancies or chronic infections of the lung and pleura. Later, since the site of primary disease may be elsewhere, involving the gut and the cardiovascular, hepatobiliary and endocrine systems, this designation fell into disuse. In some cases of secondary HOA, the osteoarthropatic and facial skin changes subside after pneumonectomy or other procedures. A disease resembling human HOA has been also described in dogs.
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Menkes CJ, Lazareth JP. The contribution of French researchers to hypertrophic osteoarthropathy. Clin Exp Rheumatol 1992; 10 Suppl 7:9-11. [PMID: 1623679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C J Menkes
- Service de Rhumatologie A, Hôpital Cochin, Paris, France
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Barboriak PN, Neelon FA. Hippocratic nails. N C Med J 1988; 49:195. [PMID: 3287183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Affiliation(s)
- L Doyle
- Wythenshawe Hospital, Manchester
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Ryckewaert A, Naveau B. [Main contributions of Charcot and Pierre Marie to osteoarticular pathology]. Rev Rhum Mal Osteoartic 1984; 51:405-13. [PMID: 6387874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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