Objective

The skeletal remains of a young individual (Guinigi US 1278) are described and a differential diagnosis is performed to determine the potential etiology of bone alterations.

Materials

Archaeological excavations conducted at the private funerary chapel of the upper class members of the Guinigi family (14th–17th centuries AD) of Lucca (Tuscany, central Italy) brought to light the fragmented human skeletal remains of a young individual (Guinigi US 1278) with pathological osseous modifications.

Methods

Morphological and radiological analyses were followed by differential diagnosis.

Results

Guinigi US 1278 was a non-adult aged 16–20 years, who exhibited florid skeletal alterations in the form of vertebral fusion and extensive subchondral bone changes of the small and large joints of the appendicular skeleton. The severity of the resorptive process in the peripheral joints, as well as vertebral fusion, indicates a long-standing inflammatory process.

Conclusions

The features and the distribution of the skeletal lesions of Guinigi US 1278 are highly consistent with a form of juvenile idiopathic arthritis (JIA), leading to irreversible phenomena such as subchondral erosive lesions and axial ankylosis, with impairment of the gait and neck movements.

Significance

While abundant clinical literature on JIA is available, paleopathological studies are scarce. The possible case of JIA from Lucca provides a direct opportunity to examine the chronic course of rheumatic disease in young individuals in the absence of appropriate medical therapies in the antiquity.

Suggestions for further research

Future molecular analyses might be able to identify specific alleles of the HLA region responsible for JIA subtypes.

中文翻译：

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文艺复兴时期卢卡（意大利中部托斯卡纳）一例可能的幼年特发性关节炎病例

客观的

描述了一个年轻个体 (Guinigi US 1278) 的骨骼残骸，并进行了鉴别诊断以确定骨骼改变的潜在病因。

材料

在卢卡（意大利中部托斯卡纳）的 Guinigi 家族（公元 14 世纪至 17 世纪）上层阶级成员的私人葬礼教堂进行的考古发掘揭示了一个年轻人（Guinigi US 1278）支离破碎的人类骨骼遗骸病理性骨改变。

方法

形态学和放射学分析后进行鉴别诊断。

结果

Guinigi US 1278 是一名 16-20 岁的非成人患者，他以椎体融合的形式表现出华丽的骨骼改变，以及附肢骨骼大小关节的广泛软骨下骨改变。外周关节吸收过程的严重程度以及椎体融合表明存在长期的炎症过程。

结论

Guinigi US 1278 骨骼病变的特征和分布与一种幼年特发性关节炎 (JIA) 高度一致，导致不可逆的现象，如软骨下糜烂性病变和轴向强直，以及步态和颈部运动受损。

意义

虽然有大量关于 JIA 的临床文献，但古病理学研究却很少。来自卢卡的可能的 JIA 病例提供了一个直接的机会，可以在古代没有适当的药物治疗的情况下检查年轻人风湿病的慢性病程。

进一步研究的建议

未来的分子分析可能能够识别出负责 JIA 亚型的 HLA 区域的特定等位基因。