Rheumatoid Arthritis: a bit of history

The first unequivocal publication in which it is possible to recognize the pathology we know today as Rheumatoid Arthritis (RA) is relatively recent and dates back to just over two centuries ago.

It was Augustin Jacob Landrè-Beauvais who spoke of it in his doctoral thesis.

A physician at the Salpêtrière Hospital in Paris, Augustin described in 1800 a rheumatic disease which he defined with the name of “primitive asthenic gout” but which was very different from gout: it mainly affected the female sex, was polyarticular, showed joint deformity and chronic progression .

Until then, gout seemed to be the best known joint disease and other diseases were often described in terms of analogy or difference from what could be considered as the prototype of rheumarthropathies.

Subsequently, Rheumatoid Arthritis was increasingly recognized and the first images also appeared as representations, demonstrating the typical deformities of the limbs.

In 1853 Jean-Martin Charcot, a French neurologist, reported nocturnal pain, confirming the onset of the small distal joints and described the alternation of acute and submissive phases. Charcot also documented the first epidemiological survey of the disease: it affected 5% of patients admitted to the Salpêtrière hospital in Paris and, confirming these data, proposed to eliminate the equivocal term “gout” and suggested the name of ” Primary chronic rheumatism ”which was to be adopted by medical literature until after the Second World War, when the Anglo-Saxon scientific culture took over.

After dusting off these initial considerations a little, it would seem that the first testimonies are even earlier and it may be interesting to go back and try to establish what was known about Rheumatoid Arthritis before 1800.

However, it is necessary to make a small introduction since the few citations that can be extrapolated from the medical literature leave many doubts due to their generic information.

There are also few references in ancient authors (Hippocrates, Areteo of Cappadocia and Sorano of Ephesus), only a few hints of rheumatological works by the English William Musgrave in the early eighteenth century [De Arthritide Symptomatica and De Arthritide Anomala] but nothing more.

Even in non-medical literature, Giuseppe Garibaldi and the painter Pierre Auguste Renoir should be mentioned among the historical figures who have suffered from this disease.

Giuseppe Garibaldi, defined as the commander of the most overwhelming military force in Italy, was born in Nice on 4 July 1807 into a family with a maritime tradition.

Upon returning from South American exile (1848), the Nice man brought with him an unparalleled experience as a guerrilla, the legendary red shirt (distinctive sign of Garibaldi and his volunteers), the reputation of being incorruptible and a REACTIVE ARTHRITIS that would accompany him for the rest of his days and for which, at the time, there were still no effective remedies.

When on June 2, 1882, in his beloved Caprera, he took his last breath, the doctor who examined his body noted: “… taking a look at the general’s hands and feet there was a very strong squeeze to the heart, so much so serious they were the deformations produced by arthritis. The upper phalanges of the fingers were shrunken, twisted, one overlapping the other … “.

However, even though his outward appearance was no longer that of a hero, and perhaps never was as he was rather short and stocky, his courage and lion spirit made him the leader we know today.

Rheumatoid arthritis suffered during the last 25 years of his life, the great French painter Pierre Auguste Renoir (1841-1919).

Behind the short and rapid strokes of color typical of the artist, he remains among the painters who symbolize the Impressionist current of the late nineteenth century but with a little hidden secret: Rheumatoid Arthritis.

A disabling disease then lacking an effective therapy, which for over twenty years severely deformed the artist’s hands, arms and shoulders, “giving him” in return an unmistakable style, made up of stains and shades of paint applied with short strokes and fast.

The aggressiveness of the symptoms forced him to adapt his way of painting to the pathology. Having the fingers of both hands folded back on themselves, he learned to grip and move the brush in jerks, holding it between index and middle fingers, in the first metacarpal space and, since his shoulders did not allow him to reach the highest part of the canvas, to to reach it he mounted special cylinders on the easel, on which the canvas could slide when necessary. Thus, despite the disease progressively eroding his joints, Renoir painted until his death.

Until about twenty years ago, however, paleopathological investigations had also given very poor results. The few other cases of possible AR, in fact, almost all date back to the 1980s.

At this point everything seemed to confirm the “recent” character of the disease, unless we think that it was present even before 1800, but segregated in some isolated area, and in any case foreign to the Old World (Europe-Asia-Africa).

In fact, one of the few and perhaps the safest paleopathological findings of relatively “certain” RA, as has just been reported, belonged to a pre-Columbian skeleton, found in Alaska. Starting from this hypothesis, the American rheumatologist Bruce Rothschild began a systematic research on all the material found in the necropolis and preserved in US museums. His team identified a consistent and growing number of skeletons, in which the presence of elements compatible with the diagnosis of RA could be documented.

Radio-carbon dating (dating method based on carbon atoms) then made it possible to establish that the most ancient finds dated back to about 4500 years ago.

At this point, nothing prevents us from hypothesizing that the disease “crossed” the Atlantic, to be “discovered”, as has been said before, in Paris in 1800.

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