Unified theory of the origins of erosive arthritis: conditioning as a protective/directing mechanism

[Guest guest]

J Rheumatol. 2003 Oct;30(10):2095-102.

Unified theory of the origins of erosive arthritis: conditioning as a

protective/directing mechanism?

Rothschild BM, Rothschild C, Helbling M.

Arthritis Center of Northeast Ohio, 5500 Market, Youngstown, OH 44512,

USA. bmr@...

OBJECTIVE: To validate the western Tennessee River limits of the

originally described rheumatoid arthritis (RA) catchment area and to

assess the possibility that absence of tuberculosis allowed the original

development of RA. The hypothesis that RA was related to tuberculosis

was once a driving force in treatment approach. RA initially was very

limited in geographic distribution, in contrast to tuberculosis.

Classical tubercular lesions were not observed in the rheumatoid

catchment area in ancient times. Similarities between clinical and

radiologic manifestations of spondyloarthropathy (SpA) and adjuvant

arthritis raised the possibility of a potential conditioning role for

occurrence of nonrheumatoid erosive arthritis. METHODS: Skeletal samples

from ancient RA catchment and non-catchment areas were compared for

frequency of tubercular-relatable pathologies. RESULTS:

Tubercular-relatable osseous pathologies were found only outside the

rheumatoid catchment area (p < 0.0001). The original RA catchment area

was confirmed not to extend beyond the western portion of the Tennessee

River.

CONCLUSION: There is an inverse relationship between occurrence of

tuberculosis and RA in the Archaic and Early Woodland periods of North

America. The virtually universal presence of tuberculosis in contiguous

Amerindian populations contrasts dramatically with its absence in the

ancient catchment area for RA. Conversely, SpA and tuberculosis do occur

in the same populations. Tuberculosis may represent a conditioning agent

for development of SpA, but at least potentially provides protection

against development of RA.

PMID: 14528501

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org