An Unusual Erosive Arthropathy from Medieval England

In palaeopathology, diagnosis of skeletal disease is classically made with reference to changes wrought by known diseases in modern or recent cases. This report presents a skeleton from medieval England which shows a form of erosive arthropathy. A more precise diagnosis is problematic because the alterations appear inconsistent with any of the principle forms of erosive arthropathy in current clinical classification. The distribution of lesions in the axial and appendicular skeleton resembles that in seronegative spondyloarthropathies. The nature of the lesions however, which are almost entirely lytic and concentrated principally at synovial articulations rather than entheses, is inconsistent with seronegative spondyloarthropathies and is more consistent with pathophysiology of rheumatoid arthritis. These observations raise the possibility that the manifestations of erosive arthropathies may have altered over time and/or that our clinical understanding of the skeletal distribution of lesions in these diseases may be incomplete. These scenarios would have profound implications for our ability to identify the various forms of erosive arthritis in archaeological populations, but further work investigating erosive arthritis in patients, together with systematic studies of skeletal cases, would be required before firm conclusions can be made. Copyright © 2016 John Wiley & Sons, Ltd.