Female with Ankylosing Spondylitis from the 7th–6th century BCE Lori Berd burial (Armenia)

Anahit Yu. Khudaverdyan; Seda H. Devejyan; Ruben H. Davtyan; Azat A. Yengibaryan; Arshak A. Hovhanesyan; Shota A. Vardanyan

doi:10.2478/anre-2021-0005

Authors

Anahit Yu. Khudaverdyan Institute of Archaeology and Ethnography, National Academy of Science, Yerevan, Republic of Armenia. 15 Charents st., 0025 Yerevan, RA
Seda H. Devejyan Institute of Archaeology and Ethnography, National Academy of Science, Yerevan, Republic of Armenia
Ruben H. Davtyan Max-Planck Institute for Social Anthropology, Germany
Azat A. Yengibaryan Department of Medical Biology, Mkhitar Heratsi State Medical University, Yerevan, Republic of Armenia
Arshak A. Hovhanesyan Armenia Republican Medical Center, Yerevan, Republic of Armenia
Shota A. Vardanyan Department of Forensic Medicine, Mkhitar Heratsi State Medical University, Yerevan, Republic of Armenia

DOI:

https://doi.org/10.2478/anre-2021-0005

Keywords:

Armenia, Lori Berd, Early Armenian Period, ankylosing spondylitis, traumas

Abstract

A female skeleton from the Lori Berd archaeological cemetery, located near the city of Stepanavan (Lori Province of Armenia) is described. Palaeopathological analysis revealed a variety pathology (ankylosis of the sacroiliac joints, ankylosis of the vertebrae, syndesmophytes, ankylosed of the costovertebral and costotransverse joint fusions, kyphosis, lordosis, fracture of the anterior inferior iliac spine and traumatic lesions). This paper reports a new case of ankylosing spondylitis in a skeleton and a differential diagnosis performed to determine the etiology of the condition. The vertebral bodies remodel and together with the associated syndesmophytes form a continuous, smooth bone surface that is sometimes referred to as “bamboo spine”. In this skeleton changes in the spine, ribs, the sacrum, acetabulum, head of the femur and greater trochanter, as well as the anterior inferior iliac spine are typical of ankylosing spondylitis in advanced stage. Addtionally, there were signs of a traumatic death with injuries sustained to the scapula and vertebra. Using osteological markers in combination with the reconstruction of the archaeological context, the burial pattern suggests that the pathology the female suffered was likely due to her physical deficiencies.

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References

AlQahtani SJ, Hector MP, Liversidge HM. 2010. Brief Communication: The London Atlas of Human Tooth Development and Eruption. Am J Phys Anthropol 42(3):481–90.
View in Google Scholar

Arriaza BT. 1993. Seronegative spondyloarthropathies and diffuse idiopathic skeletal hyperostosis in Ancient Northern Chile. Am J Phys Anthropol 91:263–78.
View in Google Scholar

Aufderheide AC, Rodriguez-Martin C. 1998. The Cambridge Encyclopedia of Human Paleopathology. United Kingdom, Cambridge: Cmabridge University Press.
View in Google Scholar

Baddoura R, Awada H, Okais J, Habis T, Attoui S, Abi SM. 1997. Validation of the European Spondylarthropathy Study Group and B. Amor criteria for spondylarthropathies in Lebanon. Revue du rhumatisme (English ed.) 64:459–64.
View in Google Scholar

Bass WM, Gregg JB, Provost PE. 1974. Ankylosing spondylitis (Marie Strumpel disease) in historic and prehistoric Northern Plains Indians. Plains Anthropol 19:303–5.
View in Google Scholar

Boylston A. 2004. Recording of weapon trauma. In: M Brickley, J McKinley, editors, Guidelines to the Standards for Recording Human Remains. Institute of field archaeologists paper No. 7. 40–2.
View in Google Scholar

Braund SM, James SMP. 1998. Quasi Homo: Distortion and contortion in Seneca’s Apocolocyntosis. Arethusa 31:285–311.
View in Google Scholar

Brandt J, Bollow M, Häberle J, Rudwaleit M, Eggens U, Distler A, Siaper J, Braun J. 1999. Studying patients with inflammatory back pain and arthritis of the lower limbs clinically and by magnetic resonance imaging: many, but not all patients with sacroiliitis have spondyloarthropathy. Rheumatology 38:831–6.
View in Google Scholar

Brown MA. 2008. Breakthroughs in genetic studies of ankylosing spondylitis. Rheumatology 47:132–7.
View in Google Scholar

Byers S. 2002. Introduction to forensic anthropology: a textbook. Boston.
View in Google Scholar

Buikstra JE, Ubelaker DH. 1994. Standards of data collection from human skeletal remains. Arkansas Archaeol. Survey Research Series. 44. Fayetteville.
View in Google Scholar

Cameron CM. 2008. Invisible citizens: captives and their consequences. Salt Lake City: The University of Utah Press.
View in Google Scholar

Cox M, Mays S. 2000. Human Osteology in Archaeology and Forensic Science. Cambridge: Cambridge University Press.
View in Google Scholar

Cruyssen BV, Munoz-Gomariz E, Font P, Mulero J, Vlam K de, Boonen A, Vazquez-Mellado J, Flores D, Vastesaeger N. 2010. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology 49:73–81.
View in Google Scholar

Çırak A, Çırak MT, Atasoy YS. 2013. İnsan iskelet kalıntılarında vertebral ankylosis: Tios iskeletleri üzerinde bir çalışma. Arkeometri Sonuçları Toplantısı 28:51–4.
View in Google Scholar

Devejyan SH. 1981. Lori-Berd. Vol. I. National Academy of Science of Armenia. Yerevan.
View in Google Scholar

Devejyan SH. 2006. Lori-Berd. Vol. II. National Academy of Science of Armenia. Yerevan.
View in Google Scholar

Denko CW, Malemud CJ. 2006. Body mass index and blood glucose: correlations with serum insulin, growth hormone, and insulinlike growth factor-1 levels in patients with diffuse idiopathic skeletal hyperostosis (DISH). Rheumatology International 26:292–7.
View in Google Scholar

DePauw K, Gavron S. 1995. Disability and Sport. USA: Human kinetics.
View in Google Scholar

Duyar I. 2019. A case of ankylosing spondylitis from the excavations at Kılıçlı Necropolis (Sinope, Northern Turkey) and its implications on the antiquity of the disease in Anatolia. Int J Osteoarchaeol 29:1100–8.
View in Google Scholar

Ethunandan M, Khosla N, Tilley E, Webb A. 2004. Melorheostosis involving the craniofacial skeleton. J Craniofac Surg 15:1062–5.
View in Google Scholar

Feldtkeller E, Lemmel EM, Russell AS. 2002. Ankylosing spondylitis in the pharaohs of ancient Egypt. Rheumatol Int 23:1–5.
View in Google Scholar

Falkenbach A, Franke A, Van der Linden S. 2003. Factors associated with body function and disability in patients with ankylosing spondylitis: a cross-sectional study. J Rheumatol 30:2186–92.
View in Google Scholar

Gran JT, Husby G, Hordvik M. 1985. Spinal ankylosing spondylitis: a variant form of ankylosing spondylitis or a distinct disease entity? Annals of the Rheumatic Diseases 44:368–71.
View in Google Scholar

Gómez Bellard F, Sánchez Sánchez JA. 1989. Spondylarthrite ankylosante: un cas complet. Int J Paleopathol 1:117–8.
View in Google Scholar

Healy PJ, Helliwell PS. 2005. Classification of the spondyloarthropathies. Curr Opin Rheumatol 17(4):395–9.
View in Google Scholar

Jimenea CV. 1979. Ankylosing Spondylitis. Henry Ford Hospital 27(1):10–3.
View in Google Scholar

Kalbermatten NT, Vock P, Rüfenacht D, Anderson SE. 2001. Progressive melorheostosis in the peripheral and axial skeleton with associated vascular malformations: imaging Wndings over three decades. Skeletal Radiol 30:48–52.
View in Google Scholar

Karapetian M, Mkrtchyan R, Simonyan H. 2019. Ankylosing spondylitis: antiquity and differential diagnosis – a case study of a Bronze Age skeleton from Norabak, southeastern Armenia. HoOMO 70/3:171–83.
View in Google Scholar

Kataria RK, Brent LH. 2004. Spondyloarthropathies. Am Fam Physician 69: 2853–2860.
View in Google Scholar

Khan MA, Van der Linden SM, Kushner I, Valkenburg HA, Cats A. 1985. Spondylitic disease without radiologic evidence of sacroiliitis in relatives of HLA B27 positive ankylosing spondylitis patients. Arthritis Rheum 28:40–3.
View in Google Scholar

Khudaverdyan A.Yu. 2005. Atlas of paleopatological findings in the territory of Armenia. Van Aryan, Yerevan.
View in Google Scholar

Khudaverdyan AYu. 2014. Ritual and ceremonial dismembering bones in a burials in Bronze and Iron centuries from Armenian Plateau. Journal of Antropologija 2(14):163–95.
View in Google Scholar

Khudaverdyan AYu, Devejyan S.H, Yeganyan LG. 2013. Methods of treating dead bodies at the sites of Shirakavan and Lory Berd (Armenia) (after paleoanthropological data). Bulletin of Archaeology, Anthropology and Ethnography 4(23):72–85.
View in Google Scholar

Khudaverdyan AYu, Devejyan SH, Vardanyan ShA, Yengibaryan AA. 2018. Extraordinary burials from Lori Berd monument: interpretation opportunities. Belgorod State University Scientific Bulletin 45(1):5–21.
View in Google Scholar

Khudaverdyan AYu, Devedjyan SH, Davtyan RH. 2019. Paleopathology Newsletter 188 (December):26–7.
View in Google Scholar

Klaus M, Novak M, Bavka M. 2012. Four cases of ankylosing spondylitis in medieval skeletal series from Croatia. Rheumatol Int 32:3985–92.
View in Google Scholar

Kidd KE. 1954. A note on the paleopathology of Ontario. Am J Phys Anthropol 12:610–5.
View in Google Scholar

Kiss C, O’Neill WO, Mituszova M, Szilágyi M, Donáth J, Poór G. 2002. Prevalence of diffuse idiopathic skeletal hyperostosis in Budapest, Hungary. Rheumatology 41:1335–6.
View in Google Scholar

Kramar C. 1982. A case of ankylosing spondylitis in mediaeval Geneva. International Journal of Skeletal Research 8:115–29.
View in Google Scholar

Lichtheim M. 1976. Ancient Egyptian Literature, Vol. II: The New Kingdom. University of California Press, Berkeley.
View in Google Scholar

Lovell NC. 1997. Trauma analysis in paleopathology. Yearbook of Physical Anthropology 40:139–70.
View in Google Scholar

Lukacs JR. 1989. Dental Paleopathology: Methods for Reconstructing Dietary Patterns. In: MY İşcan, and KAR Kennedy, editors, Reconstruction of Life from the Skeleton. Alan R. Liss, New York. 261–86.
View in Google Scholar

Mader R. 2003. Diffuse Idiopathic Skeletal Hyperostosis: a Distinct Clinical Entity. Israel Medical Association Journal 5:506–8.
View in Google Scholar

Martin DL, Harrod RP, Pérez VR. Editors. 2012. The bioarchaeology of violence. Gainesville: University Press of Florida.
View in Google Scholar

Martin-Dupont S, Cunha E, Rougé D, Crubézy E. 2006. Spondylarthropathy striking prevalence in a 19th–20th century Portuguese collection. Joint, Bone, Spine 73(3):303–10.
View in Google Scholar

Meindl RS, Lovejoy CO. 1985. Ectocranial suture closure: A revised method for the determination of skeletal age at death based on the lateral‐anterior sutures. Am J Phys Anthropol 68:57–66.
View in Google Scholar

Merbs CF. 1989. Trauma. In: MY ĺşcan, KAR Kennedy, editors, Reconstruction of Life from the Human Skeleton. New York: Alan R. Liss. 161–90.
View in Google Scholar

Minozzi S, Catalano P, Caldarini C, Fornaciari G. 2012. Palaeopathology of Human Remains from the Roman Imperial Age. Pathobiology 79:268–83.
View in Google Scholar

Morse D. 1969. Ancient disease in the Midwest. Illinois State Museum; Enlarged No. 15.
View in Google Scholar

Nassar J. 2010. A new case of ankylosing spondylitis affecting the skeleton of a deceased man placed on a funerary bed in Mari (Middle Euphrates, 2900 B.C.). Poster available at https://www.academia.edu/4941302/Nassar_J_2010_A_new_case_of_ankylosing_spondylitis_affecting_the_skeleton_of_a_deceased_man_placed_on_a_funerary_bed_in_Mari_Middle_Euphrates_2900_B_C_
View in Google Scholar

Olivieri I, D’Angelo S, Palazzi C, Padula A, Mader R, Khan MA. 2009. Diffuse idiopathic skeletal hyperostosis: Differentiation from ankylosing spondylitis. Curr Rheumatol Rep 11:321–8.
View in Google Scholar

Ortner DJ, Putschar WG. 1985. Identification of pathological conditions in human skeletal remains. Washington DC: Smithsonian Institution Press.
View in Google Scholar

Ortner DJ. 2003. Identification of pathological conditions in human skeletal remains. 2nd eition. San Diego: Academic Press.
View in Google Scholar

Özer D, Sevim A, Pehlevan C, Arman O, Gözlük P, Güleç E. 1999. Karagündüz kazısından çıkarılan iskeletlerin paleoantropolojik analizi. Arkeometri Sonuçları Toplantısı 14:75–96.
View in Google Scholar

Pálfi G, Panuel M, Gyetvai A, Molnár E, Bende L, Dutour O. 1996. Advanced-stage ankylosing spondylitis in a subject in the 8th century. J Radiol 77:283–5.
View in Google Scholar

Paparo F, Ravelli M, Semprini A, Camellino D, Garlaschi A, Cimmino MA, Rollandi GA, Leone A. 2014. Seronegative spondyloarthropathies: what radiologists should know. Journal of Radiology and Medicine Imaging 119:156–63.
View in Google Scholar

Pillai S, Littlejohn G. 2014. Metabolic factors in diffuse idiopathic skeletal hyperostosis a review of clinical data. Open Rheumatol J 8:116–28.
View in Google Scholar

Phenice TW. 1969. A newly developed visual method of sexing the os pubis. Am J Phys Anthropol 30:297–302.
View in Google Scholar

Resnick D. 1974. Patterns of peripheral joint disease in ankylosing spondylitis. Radiology 110 (3): 523–32.
View in Google Scholar

Resnick D. 1989. Inflammatory disorders of the vertebral column: Seronegative spondyloarthropathies, adult-onset rheumatoid arthritis, and juvenile chronic arthritis. Clinical Imaging 13(4):253–68.
View in Google Scholar

Resnick D, Niwayama G. 1988. Diagnosis of bone and joint disorders. 2nd edn. Philadelphia: Saunders.
View in Google Scholar

Roberts CA. 2000. Trauma in biocultural perspective: past present ad future work in Britain. In: M Cox, and S Mays, editors. Human osteology in archaeology and forensic science. London: Greenwich Medical Media. 337–56.
View in Google Scholar

Roberts C, Manchester K. 2005. The archaeology of disease. 3rd edn. Ithaca: Cornell University Press.
View in Google Scholar

Sahin S. 2019. Dilkaya (Orta Çağ) insanlarının sağlık yapısı. Antropoloji 37: 50–71.
View in Google Scholar

Sieper J, Poddubnyy D. 2017. Axial spondyloarthritis. Lancet 390:73–84.
View in Google Scholar

Singh R, Singh Z, Bala R, Rana P, Sangwan SS. 2010 An unusual case of sciatic neuropraxia due to melorheostosis. Jt. Bone Spine 77:614–5.
View in Google Scholar

Smith MJ. 2014. The war to begin all wars? contextualizing violence in neolithic britian. In: C Knüsel, MJ Smith, editors, The Routledge Handbook of the Bioarchaeology of Human Conflict. Abingdon: Routledge. 109–26.
View in Google Scholar

Snorrason ES. 1942. Rheumatism past and present. Canadian Medical Association Journal 46:589–94.
View in Google Scholar

Soker G, Bozkirli ED, Soker E, Gulek B, Arslan M, Memis D, Yilmaz C. 2016. Magnetic resonance imaging evaluation of shoulder joint in patients with early stage of ankylosing spondylitis: A casecontrol study. Diagn Interv Imaging 97:419–24.
View in Google Scholar

Soker G, Gulek B, Tufan MA, Soker E, Kelle OAB. 2014. Early diagnosis of hip joint involvement of ankylosing spondylitis using magnetic resonance imaging in the absence of clinical and x‐ray findings. Arch Rheumatol 29:99–104.
View in Google Scholar

Tang WM, Chiu KY. 2000. Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty 15:52–8.
View in Google Scholar

Timms AE, Crane AM, Sims AM, Cordell HJ, Bradbury LA, Abbott A, Coyne MRE, Beynon O, Herzberg I, Duff GW, Calin A, Cardon LR, Wordsworth BP, Brown MA. 2004. The interleukin 1 gene cluster contains a major susceptibility locus for ankylosing spondylitis. Am J Hum Genet 75:587–95.
View in Google Scholar

Trentin L. 2015. The Hunchback in Hellenistic and Roman Art. London.
View in Google Scholar

Trotter M, Gleser GC. 1958. A re-evaluation of estimation of stature based on measurements of stature taken during life and of long bones after death. Am J Phys Anthropol 16:79–123.
View in Google Scholar

Van der Linden S, Van der Heijde D. 2001. Spondyloarthropathies. Ankylosing spondylitis. In: S Ruddy, EJr Harris, and C Sledge, editors. Kelley’s textbook of rheumatology. 6th edition. Philadelphia: Saunders 1039–53.
View in Google Scholar

Waldron T. 2009. Paleopathology. Cambridge University Press.
View in Google Scholar

Walker PL. 2001. A bioarchaeological perspective on the history of violence. Annu Rev Anthropol 30:573–96.
View in Google Scholar