Posts tagged arthritis

Ankylosing spondylitis in the wrists, forearms, and spinal column

Note the fused wrist bones in the arms, and the abnormal protuberances, fusions, and cavities in the spine.

Ankylosing spondylitis (also known as Bechterew’s disease) is an inflammatory spondyloarthropathy (arthritis affecting the spinal column), and its name comes from the Greek “ankylos-”, meaning “crooked”. Spondylitis can be broken down into “spondyl-” and “-itis”, which mean “spine” and “inflammation”, respectively.

Simply put, it’s a fusion of the joints in the axial skeleton (the spinal column, ribcage, and cervical collar), but there’s little else that’s simple about this condition. While it’s known to have a strong genetic predisposition and heritability, the exact triggers that begin the process of syndesmophytosis (literally "the process of abnormal binding together") which fuse bones together is not known.

While many of the genetic and immune factors in AS similar to those in rheumatoid arthritis, ankylosing spondylopathy has been differentiated from other RA conditions as early as the second century CE, by Galen. Because of its effect on the spinal column, AS has long been known as "bamboo spine".

Unfortunately, despite many treatments and therapies being available to counteract the effects of this autoimmune condition on the bones and organs, there is no cure.

Observations on the hip joint: to which are added … other similar complaints. Edward Ford, 1810.

Medieval Cures: Rheumatism

What you will need:

  • One domestic ass (donkey)
  • One knife

Directions:

  1. Slaughter donkey, discard head
  2. Skin donkey
  3. Wear full skin of donkey, ensuring pained joints are covered
  4. Wear skin no longer than one fortnight, do not wear skin after it putrefies, lest the stench and “bad air” invite plague

Fig 1. "Digitus Coeruleus" - “Blue finger”. Analogous to “club finger”, or clubbing of the fingernails, which often ends up with a blue tint at the end of the fingers. Many times clubbing develops in response to inadequate oxygenation of the blood, where there is either a problem in the heart or in the lungs (including the formerly ubiquitous TB), so the blue tint is not unexpected.
Fig 2. Onychomycosis - Fungal nail infection, often characterized by thickened, yellow, crumbly nails.
Fig 3. Onychia maligna - Severe inflammation and ulceration of the matrix and soft parts of the nail bed, accompanied by oozing lymph, purple-red hue surrounding ulcer, nail loss, and pain. Caused by mild trauma in debilitated or immunocompromised patients. Finger becomes bulbous and deformed if not treated. Was known to be caused by strumous or cachetic habits of the insane.
Fig 4. Onychia maligna - Similar to above, longer duration. Bulbous deformation of finger evident.
Fig 5. Arthritis urica Gichtknoten an Finger und Ellenbogen - Gouty arthritis, with gouty deposits in the fingers and elbow. Wow, is that ever some gout. 
Die Chiurgischen Krankheiten der Oberen Extremitatan. Paul Vogt, 1881.

Fig 1. "Digitus Coeruleus" - “Blue finger”. Analogous to “club finger”, or clubbing of the fingernails, which often ends up with a blue tint at the end of the fingers. Many times clubbing develops in response to inadequate oxygenation of the blood, where there is either a problem in the heart or in the lungs (including the formerly ubiquitous TB), so the blue tint is not unexpected.

Fig 2. Onychomycosis - Fungal nail infection, often characterized by thickened, yellow, crumbly nails.

Fig 3. Onychia maligna - Severe inflammation and ulceration of the matrix and soft parts of the nail bed, accompanied by oozing lymph, purple-red hue surrounding ulcer, nail loss, and pain. Caused by mild trauma in debilitated or immunocompromised patients. Finger becomes bulbous and deformed if not treated. Was known to be caused by strumous or cachetic habits of the insane.

Fig 4. Onychia maligna - Similar to above, longer duration. Bulbous deformation of finger evident.

Fig 5. Arthritis urica Gichtknoten an Finger und Ellenbogen - Gouty arthritis, with gouty deposits in the fingers and elbow. Wow, is that ever some gout. 

Die Chiurgischen Krankheiten der Oberen Extremitatan. Paul Vogt, 1881.

Gout has been known as “the disease of kings and the king of diseases” and “the rich man’s disease” since Ancient Greece

The first documentation of gout was in Egypt, in a description of an arthritic big toe with unique symptoms, around 2,600 BC.

Hippocrates knew of gout, and noted its absence in eunuchs and pre-menopausal women.

The realization that the urate crystals found in the urine and joints of gouty patients (first noted by Leeuwenhoek in 1679) was directly related to the symptoms caused wasn’t reached until Alfred Baring Garrod proposed the mechanism of pain in 1848.

Humans and other great apes lost the ability to produce uricase, which is part of the reason that we develop gout, and most other animals don’t…though if the ability to produce that enzyme is interfered with, gout CAN occur. Sue the Tyrannosaurus rex is thought to have been gouty, after all. It’s not known if some larger reptiles did not have the ability to produce uricase in general, or if Sue simply had a genetic defect.