The "Braids Lady" of Arezzo: a case of rheumatoid arthritis in a 16th century mummy.
OBJECTIVE
To diagnose a probable case of rheumatoid arthritis in a mummified female body from the 16th century and to backdate the first clinical diagnosis, entering the diatribe regarding the ancientness of the disease.


METHODS
Image techniques such as normal X-ray, X-ray by mammography, total body CT and high resolution CT were used. Microscopic examination by stereomicroscopy was performed. Samples of tissue were submitted to histology. These data and the review of past literary references, of artistic representations and of paleopathological cases provided an interesting contribution to reconstruct the history of the disease.


RESULTS
The body of the "Braids Lady" showed all the "stigmata" of the disease. The left hand revealed large erosions of the metacarpophalangeal joints of both the third and the fourth fingers, volar metacarpophalangeal subluxation of both the third and the fourth fingers and lateral deviation of all the fingers. The carpus showed some minute and marginal erosions of the bones. The bases of the first phalanges were slightly flared. The toes showed partially overlapped fibular deflection. CT evidenced subluxations of the joints. The body showed no involvement of sacroiliac articulation.


CONCLUSIONS
The "Braids Lady" was affected by rheumatoid arthritis. A large number of features typical of the disease were recorded. Differential diagnosis supported the findings. The death of the lady was established at the end of 16th century, namely 200 years before the first clinical diagnosis worked out by Landré Beauvais in the early 1800s.
Ciranni
R
R
Department of Oncology, Division of Pathology, Section of Paleopathology, University of Pisa, via Roma no. 57, 56126 Pisa, Italy. r.ciranni@do.med.unipi.it
Garbini
F
F
Neri
E
E
Melai
L
L
Giusti
L
L
Fornaciari
G
G
D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000266:history*; D001175:Arthrography; D005260:Female; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000266:history / Q000473:pathology; D006227:Hand Deformities, Acquired / Q000000981:diagnostic imaging / Q000266:history / Q000473:pathology; D049669:History, 16th Century; D006801:Humans; D007558:Italy; D016916:Joint Deformities, Acquired / Q000000981:diagnostic imaging / Q000266:history / Q000473:pathology; D007596:Joints / Q000473:pathology; D008327:Mammography; D008875:Middle Aged; D009106:Mummies / Q000000981:diagnostic imaging / Q000266:history* / Q000473:pathology; D014057:Tomography, X-Ray Computed