A probable case of Legg-Calvé-Perthes disease in Warring States-era China

Testing the Digital Atlas of Ancient Rare Diseases (DAARD) using a new case of Legg-Calvé-Perthes disease from Early Byzantine (500-700 CE) Olympia, Greece

OBJECTIVE

The first case of Legg-Calvé-Perthes disease (LCPD) in Greece is presented. LCPD, a rare disease, is discussed using the Digital Atlas of Ancient Rare Diseases (DAARD), which tests the benefits of the database for diagnosing and contextualizing the new case with 42 archaeological cases of LCPD recorded in the DAARD.

MATERIALS

A 30-40-year-old, probable male individual was found at the archaeological site of Olympia, Greece, dating to 500-700 CE.

METHODS

Biological sex, age-at-death and pathological changes were investigated using macroscopic and osteometric methods. The DAARD provided the typical characteristics of LCPD.

RESULTS

Pathological changes in both hip joints without any other related changes in the skeleton corresponded to the skeletal features of LCPD. The DAARD produced 42 cases of LCPD, most of which from Europe, with a preference for male sex and unilateral involvement of the hip joint.

CONCLUSIONS

The DAARD aids in diagnosing rare diseases and interpreting new cases in the context of already known studies.

SIGNIFICANCE

This study shows that the DAARD has the potential to help researchers move beyond the level of single case studies and create a broader picture of the history of rare diseases.

LIMITATIONS

This paper focuses on the benefits of the DAARD in relation to LCPD but not all rare diseases have been included in the database.

SUGGESTIONS FOR FURTHER RESEARCH

More rare diseases from archaeological contexts should be added to the DAARD to create a base for the interpretation of their history and expand our understanding of rare diseases in the past.

Case study of Legg-Calvé-Perthes disease observed in Radom (Poland, 18th–19th century) with literature review

The aim of this study is to present the pathological lesions observed in a skeleton (male, about 35–38 years old) from Radom (Poland), dated to the 18th–19th century. Bone changes were observed in both femurs and both pelvic bones. The head of the femur is enlarged and deformed, described as “mushroom-shaped”, with areas of smooth cortex and cavities, or possible cystic residues. The neck of femur is short and thick. The bone shaft and distal epiphysis do not show any changes. The changes were also observed in both acetabularies of the hip joint (marginal bone formation, subchondral bone remodelling). Radiographic images show bilateral necrosis of the femoral head. There is a significant sclerotization of the femoral head, with a discrete visible crescent sign. These macroscopic and radiological changes match the symptoms associated with Legg-Calvé-Perthes disease. This is the first case of the disease described in bioarchaeological materials from Poland.

A case of septic arthritis of the hip in Central Plains, China, during the Western Han Dynasty (3rd century BCE-1st century CE)

OBJECTIVE

Septic arthritis is not commonly reported in paleopathology. This study aims to provide a differential diagnosis of septic arthritis by looking at a case from ancient China. We also aim to add to the current literature on septic arthritis in paleopathology.

MATERIALS

One adult male skeleton recovered from the Dapuzi Cemetery, Shaanxi, dating to the Western Han Dynasty (3rd century BCE-1st century CE).

METHODS

Macroscopic observations were conducted.

RESULTS

The lytic appearance and massive new bone formation on the left acetabulum of M142 are compatible with septic arthritis. The hip pathology greatly influenced his stature. The two femur shafts present different degrees of robusticity. He also showed severe osteoarthritis.

CONCLUSIONS

The individual suffered from septic arthritis of the hip, of unknown cause, for a long period, which greatly influenced his daily life. Complications included osteoarthritis, shortened stature, and difficulties in walking.

SIGNIFICANCE

This study offers a new case of septic arthritis and provides insight into the people who guarded the royal tombs in the West Han Dynasty.

LIMITATIONS

The skeleton is not well-preserved, limiting observations of bony changes to other areas of the body.

The role of case studies in recent paleopathological literature: An argument for continuing relevance

OBJECTIVE

To critically examine the role that case studies play in recent paleopathological literature, by evaluating their frequency of publication, academic impact, and the public engagement they generate.

MATERIALS

Articles published in International Journal of Paleopathology between 2011 and 2018 (N = 377).

METHODS

Articles were coded as case studies, population studies, methodological studies, or reviews. Case studies were coded as cultural practices, differential diagnosis, historical, or methodological/theoretical. We utilized bibliometric analysis to assess academic impact and altmetric analysis to evaluate public engagement.

RESULTS

Case studies continue to be the most frequently published, but least frequently cited, article type. There are no significant differences in public engagement data between article types. Methodological/theoretical case studies have the most academic impact. Differential diagnosis case studies have the least academic impact and generate the least public engagement.

CONCLUSIONS

The case study genre includes a variety of approaches, some of which hold significant potential for contributing to the discipline of paleopathology and beyond.

SIGNIFICANCE

This study updates Mays' (2012b) citation analysis, pioneers the use of altmetric data to analyze public engagement with paleopathological publications, and identifies less productive approaches and areas of heightened relevance in the case study genre.

LIMITATIONS

Publications in only one journal were analyzed. Only one source was utilized for citation data (Google Scholar) and one source for altmetric data (PlumX).

SUGGESTIONS FOR FUTURE RESEARCH

Expanding the granular analysis of case studies piloted here to additional journals and/or citation indexes to enlarge the sample size and provide keener insights.

Legg-Calvé-Perthes disease overview

Background

Legg–Calvé–Perthes Disease (LCPD) is a necrosis of the femoral head which affects the range of motion of the hips. Its incidence is variable, ranging from 0.4/100,000 to 29.0/ 100,000 children. Although LCPD was first described in the beginning of the past century, limited is known about its etiology. Our objective is to describe the main areas of interest in Legg–Calve–Perthes disease.

Methods

A review of the literature regarding LCPD etiology was performed, considering the following inclusion criteria: Studies reporting clinical or preclinical results. The research group carried out a filtered search on the PubMed and Science Direct databases. To maximize the suitability of the search results, we combined the terms ‘‘Perthes disease” OR “LCPD” OR “children avascular femoral head necrosis” with “diagnostic” OR “treatment” OR “etiology” as either key words or MeSH terms.

Results

In this article been described some areas of interest in LCPD, we include topics such as: history, incidence, pathogenesis, diagnosis, treatment and possible etiology, since LCPD has an unknown etiology.

Conclusions

This review suggests that LCPD has a multifactorial etiology where environmental, metabolic and genetic agents could be involved.

Towards a definition of Ancient Rare Diseases (ARD): Presenting a complex case of probable Legg-Calvé-Perthes Disease from the North Caucasian Bronze Age (2200-1650 cal BCE)

OBJECTIVE

This study discusses the challenges and possibilities of establishing a definition for Ancient Rare Diseases (ARD) in a probable case of Legg-Calvé-Perthes Disease (LCPD) from the Bronze Age cemetery Kudachurt 14, situated in the Northern Caucasus.

MATERIALS

We investigated the skeletal remains of a male aged 35-45 years at death. For comparison we examined other males buried at Kudachurt 14 (n = 24) and reviewed 22 LCPD cases from the paleopathological literature.

METHODS

We use macroscopic as well as osteometric examination methods and imaging techniques.

RESULTS

The morphology of the left hip joint corresponds to skeletal characteristics for LCPD. Co-occurring osteochondrosis dissecans, femoral anteversion, and atrophy of the left femoral shaft suggest a complex disease course.

CONCLUSIONS

Modern criteria of rare diseases applied on ancient skeletal remains are either non-transferable or require completion. We conclude that rarity is dynamic, etiological uncertainty has to be accepted, and the respective socioeconomic context is crucial. Degree of disability and level of sociomedical investment are not defining criteria for ARD.

SIGNIFICANCE

Dating 2200-1650 cal BCE, this study currently presents the earliest case of probable LCPD. This is the first attempt to transform modern characteristics of rare diseases for establishing a paleopathological concept of ARD.

LIMITATIONS

As this study is limited to LCPD, our conclusions are not directly applicable to other ARD in question.

SUGGESTIONS FOR FURTHER RESEARCH

More focused paleopathological research on skeletal populations from different cultures and time periods is needed, enabling an evolutionary perspective on the comparability of ancient, modern and future rare diseases.