Osteoarthritis historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou [2], Irfan Dotani [3]

Overview

Osteoarthritis / Osteoarthrosis (OA, also known as degenerative joint disease, degenerative arthritis, arthrosis or in more colloquial terms "wear and tear") is the most common form of arthritis, caused by wearing of the cartilage that covers and cushions joint spaces. As the cartilage wears away, the patient experiences pain with weight bearing. This word is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation. Inflammation, however, is not a common finding in this regard. OA possesses a great degree of variability in disease onset, progression, and severity. The earliest descriptions of OA were provided by Heberden and Haygarth in the 19th century. In the 1930s and 1940s, Dr. Stecher showed that there were two forms of OA: idiopathic and post-traumatic. In the 1950s, the links between Heberden’s nodes and large joint OA were revealed by Kellgren and Moore. In this regard, the first x-ray grading system for OA was developed by Jonas Kellgren and John Lawrence in the 1950s. Surgical management of OA was developed in the 1960s by Dr. Charnley and Dr. McKee [1] [2] [3].

Historical Perspective

According to the available pieces of evidence, osteoarthritis (OA) has been called by different terminologies: arthrosis deformans, osteoarthrosis-osteoarthritis, degenerative joint disease, Morbus (malum) coxae seniles[4]. Loss of cartilage associated with bone features (such as osteophytes and subchondral bone sclerosis) is common among all types of OA[5]. As mentioned before, this illness has been called by many names over the years, but none of them are entirely satisfactory for this condition. Despite the fact that the word "Osteoarthritis" is a misnomer because it implies a definite existence of an inflammatory process, it has been used for many decades in the English language and will probably continue to do so because of its well-known appeal compared to other more accurate terms of degenerative joint disease[4]. Osteoarthritis is considered a non-inflammatory disease of movable joints characterized by the possible formation of new bone at the articular surface and subchondral bone involvement with the abrasion and deterioration of involved articular cartilages [6][7].

The historical view of osteoarthritis from antiquity to the present year has a conventional perspective which can be found among paleopathological findings of skeletal discoveries. With no doubt, osteoarthritis can be called as a disease with the best paleopathology documents. For example, in a 200 million-year-old Dimetrodon Permian reptile recovered in Texas, USA there was an interesting piece of evidence of a compound fracture in its spine which was infected with pus formation. Moreover, the first polyarthritis in history was found on the posterity in the Mesozoic Platecarpus found in Kansas. All joints on the left hallux of this reptile had deformations, potentially caused by osteoarthritis. According to the microscopic evaluations of its bones, there was the common feature of increased vascular spaces with overgrowth of its articular margins which can be found in osteoarthritis pathology. Consequently, osteoarthritis can be called the oldest known disease on earth. On the other hand, osteoarthritis was found in the fossil of a Neanderthal man from La Chapelle-aux-Saints. In another piece of evidence, chronic osteoarthritis found in ancient Egypt with a history of older than 3000 years. Also, severe osteoarthritis of the hip in a Romano-Briton with a “lipped” acetabulum and deformation on the femoral head was also found in this regard. Among ancient Egyptian, Early Eskimo, Iron Age British, and American Indian populations, there is a strong correlation of evidence with the vertebral lipping limited to the lumbar region [8] .

Available visual arts in addition to historical pieces of evidence can be an important tool for paleopathological study in this regard. While searching for specific evidence for OA in history, some important data was found. Because painters are known to be good observers, they can transfer what they had seen from their society through their arts to us. From their drawings, they can help us find things that we cannot get from available skeletons. Here, we can find some impressive arts indicative of osteoarthritis during the ancient histories[9][10][11][12][13][14]:

I: In a Greek script from the late 14th century (kept in National Library, Paris), there is a Byzantine physician visiting a patient having a straight rigid spine with his hand stuck in a bent position (suggestive of spinal stenosis). We can conclude that the patient suffered from diffuse idiopathic spinal hyperostosis (DISH; Forestier disease).

I: In a Greek script from the late 14th century (kept in National Library, Paris), there is a Byzantine physician visiting a patient having a straight rigid spine with his hand stuck in a bent position (suggestive of spinal stenosis). We can conclude that the patient suffered from diffuse idiopathic spinal hyperostosis (DISH; Forestier disease)

.

II: In a great art by Jan Van Eyck (St. Bavo Cathedral, Ghent) about the St. John Baptist of the Adoration of the Lamb, we can see a typical Heberden node on his left thumb.

II: In a great art by Jan Van Eyck (St. Bavo Cathedral, Ghent) about the St. John Baptist of the Adoration of the Lamb, we can see a typical Heberden node on his left thumb.

III: Similar to the above-mentioned art, in another painting by different artist (Frans Hals) about the Portrait of Sara Andriesdr Hessix (Lisbon, Portugal), we can see a typical Heberden node on her both hands.

III: Similar to above-mentioned art, in another painting by a different artist (Frans Hals) about the Portrait of Sara Andriesdr Hessix (Lisbon, Portugal), we can see a typical Heberden node on her both hands.

IV: In a painting by George de la Tour ’s about the St. Hieronymus (as penitent), with a little care we can found Hallux valgus on his foot.

IV: In a painting by George de la Tour’s about the St. Hieronymus (as penitent), with a little care we can found Hallux valgus on his foot.

V: In another artwork by Diego Velasquez (1632) about the Jester “Don John of Austria”, the gesture of this indicative for genu valgum.

V: In another artwork by Diego Velasquez (1632) about the Jester “Don John of Austria”, the gesture of this indicative for genu valgum.

According to the ancient era, osteoarthritis is a common finding in Egyptian mummies and also in ancient skeletons found in England. There are strong pieces of evidence in ancient skeletons with osteoarthritis in their shoulders. Moreover, some degenerative changes in the lumbar spine were found. Historical evidence revealed that arthritis was considered to be clinical presentations of gout and there are some physical signs described by Hippocrates (460–375 BC), in this regard. There is a big question that despite the significant pieces of evidence of osteoarthritis in ancient skeletons, physicians did not recognize osteoarthritis until the 18th century. However, according to the book named, "The Biology of Degenerative Joint Disease", by Sokoloff in 1969, there are a number of pathological descriptions indicative of osteoarthritis.

In 1793, Sandiford of Leiden described osteoarthrosis of the hip.

In 1802, William Heberden in his book named "Commentaries on the History and Cure of Diseases" has described a disease which had no connection with gout. He also described the small nodes which later we know those nodes with his name.

In 1805, John Haygarth described polyarticular disease influencing the distal interphalangeal and other joints, resembling almost perfectly OA as seen in our present modern society.

In 1824, Bell, similar to Sandifort in 1793, had described osteoarthrosis of the hip.

In 1829, Benjamin C Brodie revealed a non-inflammatory erosion of articular cartilage peculiar to the elderly.

In 1831, Robert Adams distinguished osteoarthritis from polyarticular rheumatoid arthritis considering its localized character (also he even tried to use “partial” rheumatic arthritis name for osteoarthritis). This big step in differentiating OA from rheumatic arthritis had a huge acceptance in many parts of European scientist.

In 1835, J V Cruveilhier and Cruveilhier’s mentor Laennec (inventor of the stethoscope) were used the term "unsure" for defects in the articular cartilage of involved joints.

In 1835, Robert Smith named the degenerative joint disease as: "sui generis" and after that, he came with the description of "malum coxae senilis" related to the osteoarthritis of the hip.

In 1857, Schöman made monographs affirming Adams’ great work (in 1831) and published them were published 1857.

In 1859, Alfred Baring Garrod separated the osteoarthritis and rheumatic arthritis and he was the first one proposed the name rheumatic arthritis.

In 1869, Charcot and Virchow, known as the fathers of cellular pathology, used the term “arthritis deformans” for both osteoarthritis and rheumatic arthritis.

In 1889, John Kent Spender was the first one introduced the term osteoarthritis.

In 1890, AE Garrod was granted the current title of “osteoarthritis".

In 1895, (Soon after the introduction of X-rays as a great step in medicine by Wilhelm Konrad Röntgen), Joel E. Goldthwait were able to differentiate two main forms of arthritis: a) the “atrophic” type, which was found as polyarticular, in young population, and b) the “hypertrophic” type, non-polyarticular form occurred in fewer joints in young population. Then, hypertrophic arthritis and Atrophic arthritis were considered as osteoarthritis and rheumatic arthritis, respectively.

In 1908, Hoffa and Wollenberg Confirmed the work done by Joel E. Goldthwait.

In 1909, Nichols and Richardson Confirmed the work done by Joel E. Goldthwait.

In 1907, Albutt and Rolleston in a book named Albutt and Rolleston's System of Medicine describes both osteoarthritis and rheumatic arthritis separately with their own different special pathological specifications.

In 1910, Sir William Osler in his book "The Principles and Practise of Medicine" clearly worked on these two diseases and tried to differentiate them based on the clinical features and pathology.

In 1952, Kellgren and Moore connected the Heberden noduli to osteoarthritis, considering it as a primary generalized OA in order to differentiate it primary generalized OA from secondary OA.

In the 1950s and 1960s, Kellgren and Lawrence introduced a radiographic scoring system in grading OA.

In 1953, Collins described the possible association of age with the prognosis of trauma in pathological evaluations.

In 1970, Dick et al worked on the radionuclide studies evidence of synovial inflammation.

In 1982, Goldenberg et al worked on the histological evidence of synovial inflammation.

In 1989, Hans Valkenburg’s team worked on the descriptive epidemiology of osteoarthritis.

In 1997, Spector et al worked on the biochemical evidence of synovial inflammation.

In 2001, Sokoloff highlighted malum coxae senilis, hip osteoarthritis.

References

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