The History of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is today understood as a multifactorial disease. Though recent advances have been made concerning our understanding of the pathogenesis and aetiology of the disease, we still do not know specifically what causes RA and why some individuals and not others are prone to developing it. In addition, it is puzzling that RA evolved as a problem in the Western world only a little more than 200 years ago, even though evidence for RA was seen in skeletal remains from Indian dating from 4500 BC. Awareness of opportunities to treat RA effectively has grown, especially during the last decade where biological treatment alternatives have evolved. We also see now that the severity of RA is decreasing, and RA has become less frequent, reducing overall the considerable impact which RA has had on affected individuals and on society.

Archaeological Findings
The earliest appearance of RA was noted in remains of Indian skeletons dating from 4500 BC found in what is now known as Tennessee. Persistence of the disease in that region could be documented in several areas, as well as expansion into Ohio, first in a period about 1,000 years ago. As a consequence it seems possible that RA then spread to the Old World before it was again seen in the New World in 1785.¹ Rothschild has hypothesised how RA may have spread by migration from the original catchment area of RA into areas with French, English, Dutch and Spanish incursion. This hypothesis could explain how RA, initially geographically localised in an area protected from exploration, may have spread into the colonised New World and finally penetrated into the Old World in Europe.

For decades there has been a discussion as to whether RA is a disease with its origin in newer or older times. Those who claim that RA has not developed until recently have referred to the lack of evidence for it in the literature or written documentation, artwork or bones. While evidence of spondyloarthropathy in the Old World is abundant in the literature, evidence of RA in the pre-Columbian Old World has not been clearly documented.

The question when RA first manifested is relevant not only because of scientific relevance, but because it contributes to our perception of the disease in the context of our daily work or in a patient’s identity. Regarding research, epidemiology concerning the geographical spread of RA may point to the aetiology. If RA first evolved in the 19th century, this may have been caused by an environmental factor which did not exist earlier.