Utilization of validated criteria for diagnostic assessment in nonsynchronous, allopatric populations: Role in archeologic diagnosis of rheumatoid arthritis and differentially distinguishing it from mimics

Abstract

AbstractThe origin of rheumatoid arthritis (RA) has been controversial, with devouée committed to either New World or Old World origins. Support for the latter was predicated on observation of isolated Old World pre‐Columbian cases of inflammatory arthritis. The hypothesis is that spectral assessment of disease characteristics can determine the likelihood that pre‐Columbian Old World claims are validly attributed to RA. Do they represent spectrum outliers or do they have a different etiology (e.g., spondyloarthropathy)? The published literature was surveyed for reports alleging pre‐Columbian, Old World cases of RA. The disease characteristics in published reports claiming presence of pre‐Columbian RA were analyzed. Spectrum of disease (manifestations as population phenomenon) was utilized to assess likelihood diagnoses, when only isolated cases are recognized. None of the accessible 41 reported cases, with adequate information to allow assessment, described/illustrated individuals with the polyarticular, marginally distributed erosions in the absence of peri‐erosional sclerosis, reactive new bone formation, or ankyloses/fusion that is typical of RA. The findings in 90% of reports were actually classic for spondyloarthropathy. The probability of valid diagnosis of RA among individuals with subchondral erosions was less than 0.0001; individuals with joint fusion/ankyloses, <0.0001; and individuals with axial joint disease, 0.0002. Observation only of outliers, without other individuals (in the same sample/population) representing the spectrum of disease that characterizes RA, provided a spectral pattern incompatible with that diagnosis. The role of spectral patterns was supported as an effective tool for generating confidence in paleopathological diagnoses. Additionally, confidently identified pre‐Columbian Old World RA removes the objection to its suggested New World Origin.