Rembrandt's Maria Bockenolle has a butterfly rash and digital deformities: overlapping syndrome of rheumatoid arthritis and systemic lupus erythematosus.
Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are the most common autoimmune disorders, although they each have very different pathophysiology. In general, RA is considered to be a Th1-mediated disease, while SLE is a Th2-mediated disease. Thus, their overlapping, in so called "rhupus", is a rare condition. In Rembrandt van Rijn's (1606-1669) portrait of the middle-aged Maria Bockenolle, we have what may be the earliest depiction of a case of rhupus syndrome: the coexistence of a butterfly rash and digital deformities. This suggests the possible historical importance of an RA epidemic which took place in the early 17th century.
Hayakawa
Satoshi
S
Division of Infectious Disease Control and Clinical Immunology, Nihon University Medical Research Institute, 30-1 Ohyaguchi-kamimachi, Itabashiku, Tokyo 173-8610, Japan. satoshih@med.nihon-u.ac.jp <satoshih@med.nihon-u.ac.jp>
Komine-Aizawa
Shihoko
S
Osaka
Shunzo
S
Iida
Toshihiro
T
Hayakawa
Junko
J
Nishinarita
Susumu
S
Nemoto
Norimichi
N
D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D005260:Female; D049670:History, 17th Century; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D008512:Medicine in the Arts; D009426:Netherlands; D010151:Paintings; D011173:Portraits as Topic / Q000266:history*; D013577:Syndrome