Recognition of hypertrophic osteoarthropathy in skeletal remains.

Objective: To characterize hypertrophic osteoarthropathy (HOA) in skeletons to allow its recognition in the archeologic record.

Methods: Individuals diagnosed in life with diseases known to cause HOA were examined from the Hamman-Todd, Grant, and Terry human skeletal collections. The latter consist of 5142 individuals who died in the early part of this century.

Inflammatory arthritis in large cats: an expanded spectrum of spondyloarthropathy.

Spondyloarthropathy was documented for the first time in 14 (3.7%) of 386 large cats, affecting eight species belonging to three genera. The limited distribution of joint erosions, associated with spine and sacroiliac joint pathology, was indistinguishable from that occurring in humans with spondyloarthropathy of the reactive type.

Antiquity of arthritis: spondyloarthropathy identified in the Paleocene of North America. off.

Objective: Determination of the antiquity of spondyloarthropathy by examining the fossil record.

Methods: Fossil collections from the Paleocene and Eocene of North America were systematically examined to determine the occurrence and population frequency of spondyloarthropathy.

Results: Spondyloarthropathy was present in three mammalian orders dated at 30 to 50 million years.

Dactylitis: implications for clinical practice.

Objectives: To assess the specificity of dactylitis for the diagnosis of spondyloarthropathy, sarcoidosis, and gout; and to characterize dactylitis specifically associated with gout.

Methods: Dactylitis was prospectively assessed among all individuals presenting to the Arthritis Center of Northeast Ohio from 1986 to 1996.

Results: Dactylitis was observed in 12% of individuals with spondyloarthropathy, 17% with sarcoidosis, and 5% with gout, but not in 96 patients with rheumatoid arthritis or in 2,434 patients with osteoarthritis, neck or back pain, or collagen vascular diseases.

Clues to recognition of fungal origin of lytic skeletal lesions.

The present study addresses the specificity of lytic osseous impact for distinguishing among metastatic cancer, tuberculosis, and fungal disease. Osseous impact is used in this manuscript as a convention to describe the macroscopic appearance of defleshed bones affected by the disease. Osseous changes in the skeleton of a 47-year-old black male, diagnosed in life as having blastomycosis, were characterized and compared to lytic lesions observed in ten individuals with tuberculosis and six with metastatic cancer in the Terry and Hamman-Todd Collections.

Clues potentially distinguishing lytic lesions of multiple myeloma from those of metastatic carcinoma.

This study was conducted to determine whether individual bony lesions are specific for recognizing multiple myeloma and thereby distinguish it from metastatic cancer and leukemia. The lytic skeletal lesions of multiple myeloma are characterized by sharply defined, spheroid lesions. They have smooth borders and effaced/erased trabeculae.

Porosity: a curiosity without diagnostic significance.

A controlled study of the relationship of two standard clinical indicators of osteoarthritis and porosity failed to demonstrate a relationship. Porosity appears to be a curiosity that has no clinical correlation and is not a sign of an identifiable rheumatologic disorder. It should be deleted as an identifier for osteoarthritis.

Microfoci of avascular necrosis in sickle cell anemia: pathophysiology of the dot dash pattern.

Objective: Definition of the nature of calcaneal "erosions" in sickle cell anemia.

Methods: Skeletons of individuals demonstrated to have had sickle cell anemia were examined for the presence of calcaneal surface discontinuity.

Results: Calcaneal and articular surface osseous microinfarction were identified macroscopically and confirmed radiologically by CT.

Should circulating anticoagulant [AKA anti-phospholipid] assays be a routine component of well-patient assessment?

Circulating anticoagulants are a major risk factor for thrombotic problems (eg, myocardial infarction, stroke) and pregnancy complications. The authors present a retrospective survey of anticardiolipin antibody and lupus anticoagulant in 200 consecutive patients presenting to their office.

Recognition of sickle cell anemia in skeletal remains of children.

The present study discusses in detail the osteological changes associated with sickle cell anemia in children and their importance in differential diagnosis. Posterior calcaneal and specific articular surface disruptive metacarpal lesions are diagnostic for sickle cell anemia. Calvarial thickening, tibial and femoral cortical bone thickening, and bowing are of more limited utility in differential diagnosis.

Two faces of "rheumatoid arthritis": type a versus type B disease.

Is rheumatoid arthritis one disease or a "catch-all" term for inflammatory arthritis that tends to spare axial joints? We have subdivided "rheumatoid arthritis," utilizing the criteria of periarticular osteopenia and marginally (distributed), symmetrical polyarticular erosions, in absence of axial (odontoid disease excepted) involvement as type A and presence of peripheral joint fusion and subchondral erosions as type B.Biomechanical analysis of axial joint sparing inflammatory arthritis also revealed the two distinct patterns. The low vibration/power cluster (type A) had symmetrical polyarticular marginal erosions, but no peripheral joint fusion.

Why do we fail in aging the skull from the sagittal suture?

The controversy over the reliability of ectocranial suture status (open vs. closed) as an age estimation stimulated the pursuit of Meindl and Lovejoy's suggestion (Meindl and Lovejoy [1985] Am. J.

The elusive petroexoccipital articulation.

In the present study, 1,869 skulls from the Hamann-Todd Collection were examined (macroscopically and by radiographs) for closure of the petroexoccipital articulation (jugular synchrondrosis). The results demonstrated the the petroexoccipital articulation underwent closure between 20 and 50 years of age in most human skulls evaluated. Approximately 7-10% of the human skulls underwent complete union of the petroexoccipital articulation before 20 years of age.

Recognition of leukemia in skeletal remains: report and comparison of two cases.

Recognition of disease in the archeologic record is facilitated by characterization of the skeletal impact of documented (in life) disease. The present study describes the osteological manifestations of leukemia as identified in the skeletons of two individuals diagnosed during life: a 3-year-old black girl with acute lymphocytic leukemia and a 60-year-old white male with acute myelogenous leukemia in the Hamann-Todd collection. Contrasting with the lack of specificity of radiologic findings, macroscopic skeletal changes appear sufficiently specific to allow distinguishing leukemia from other forms of cancer.

Identification of childhood arthritis in archaeological material: juvenile rheumatoid arthritis versus juvenile spondyloarthropathy.

The opportunity to examine the defleshed skeleton of an individual diagnosed in life (Hamann-Todd collection, individual 2036) afforded a unique opportunity to demonstrate the bone damage characteristic of at least one form of juvenile rheumatoid arthritis (JRA). Characteristics helpful for recognition of JRA in archaeological material include peripheral articular marginal and subchondral erosions, axial (e.g.

Naturally occurring inflammatory arthritis of the spondyloarthropathy variety in Cayo Santiago rhesus macaques (Macaca mulatta).

Objective: The establishment of an animal model is a major priority in the battle to control inflammatory arthritis. Exploration to date has not yet identified a viable model for rheumatoid arthritis (RA), while artificial (e.g.

Inflammatory arthritis in Pongo.

As the arboreal ape, Pongo, has an unusual ground ambulation adaptation, it was of interest to assess the impact of Pongo gait on patterns of arthritis. While osteoarthritis was not identified in Pongo, 11% of individual skeletons were afflicted with an inflammatory, erosive arthritis. The presence of sacroiliac involvement and the nature and distribution of erosive lesions allowed definitive diagnosis of spondyloarthropathy.