Exploring "wear and tear" of joints and "muscle function" assumptions in skeletons with known occupation at death.

OBJECTIVES: Changes in the joints are believed to result from "wear and tear," a consequence of activity, as entheseal changes (EC) result from muscle use. However, clinical data showed that activity does not necessarily increase the likelihood of degenerative joint changes (DJC) and that exercise results in healthier joints. We tested whether individuals with continuous repetitive biomechanical efforts (Group 1) were more likely to exhibit EC and if occupations known to exert strenuous but discontinued efforts (Group 2) would more likely cause DJC. MATERIALS AND METHODS: Eighty-nine males with known occupations from Portuguese identified collections were used: shoemakers and carpenters (Group 1), workers (Group 2), and civil servants, and shop assistants as a control group. Major upper and lower limb joints and entheses sites were used. DJC and EC were tested between occupations - while controlling for age (overall approach) - and within occupation (occupation-specific approach). RESULTS: The overall approach showed that age - as a covariant - had a significant impact on DJC and EC development (p < 0.05), with occupation being non-significant (p > 0.05) despite the variability in the mean-values of lesions. The occupation-specific approach showed a significant variability of DJC and EC correlations, within and between occupations, with no clear trend of DJC and EC development according to occupation. DISCUSSION: The results showed that exploring overall patterns might conceal occupation-specific joint and muscle use, emphasizing age as a major contributor of changes; and that the occupation-specific approach highlighted particular aspects associated with occupations, allowing for a more informative assessment of strenuous repetitive or discontinuous activity-related technical gestures and their impact on skeletal biology.

Is it a cystic or a cyst-like condition? Discussing the etiology of an unusual large mandibular lesion in a Roman skeleton from Quinta da Torrinha/Quinta de Santo António (Almada, Portugal).

Cystic and cyst-like lesions of the jaw are a recurrent finding in routine dental radiography but not in paleopathology. This paper describes a large oval osteolytic cavity (23 × 14 mm) observed in the mandible of a middle-aged female unearthed from the Roman necropolis of Quinta da Torrinha/Quinta de Santo António (Almada, Portugal, 3rd-5th centuries AD). The lesion was located in the body of the mandible, inferior to the alveolus of the first left molar. The associated tooth exhibited a carious lesion that destroyed the tooth crown and exposed the pulp cavity. The osteolytic lesion presented inner smooth walls and sharped regular contours, surrounded by slight microporosity. Radiography revealed an unilocular lesion with well-defined contours and a thin opaque rim. The differential diagnosis considered several odontogenic and non-odontogenic conditions of the jaw. The size and shape of the cavity, the nature of its walls and contours, and the presence of a source of infection in the pulp is consistent with an odontogenic condition of inflammatory origin, probably a radicular cyst.

Can osteophytes be used as age at death estimators? Testing correlations in skeletonized human remains with known age-at-death.

Age-at-death estimation is one of the major challenges when establishing an adult skeleton biological profile. The presence of degenerative joint changes - e.g. osteophytes - has been regarded as a good postmaturity age indicator. This study assessed if a clear relationship between age and osteophytes exists. To accomplish this goal, a total of 16 joint surfaces, from the shoulder, elbow, wrist, hip, knee, and ankle, were examined in 604 adult individuals, of both sexes from two Portuguese Identified collections. Individuals had between 20 and 98 year old at death. Statistically significant results were found between age-at-death and degrees of severity of osteophytes throughout all the articular surfaces analyzed (p>0.001). However, the strength of the correlation varies from moderate to low in the majority of the joints, for both sexes. The only strong correlation effects (r=0.567 in females and r=0.552 in males) were found associated with the left and right glenoid cavity in females and males respectively. More noticeable changes were consistently found in association with older individuals (>62 years old). Results indicate that significant relationships exist between age and the presence of osteophytes in the joint margins. However, correlation effects were low to moderate in most cases, therefore the use of osteophytes to predict age-at-death is not without significant error of interpretation.

Is differential diagnosis attainable in disarticulated pathological bone remains? A case-study from a late 19th/early 20th century necropolis from Juncal (Porto de Mós, Portugal).

Differential diagnosis is a fundamental step in every palaeopathological study. It is a challenging exercise since many intrinsic and extrinsic factors may negatively impact the accurate interpretation of bone changes in human skeletal remains. Among these, the completeness and preservation of skeletal elements plays a significant role. This study aims to explore the limits of differential diagnosis in the analysis of disarticulated, fragmented bones. The sample consists of twelve adult bone fragments with noticeable changes. The remains were identified in a dis-articulated skeletal assemblage from the former necropolis of Juncal (Porto de Mós, Portugal), which probably closed in the late 19th century/early 20th century. They were analysed visually and with X-radiography, and the changes carefully described prior to differential diagnosis. Six bones presented signs of healed bone trauma and one showed features compatible with leg amputation. Periosteal reactions were observed in several bones, one of them resembling changes consistent with an overlying skin ulcer. Two bone fragments were identified as belonging to the same individual due to the matching bone changes. Despite the incomplete remains, a broader diagnosis was possible for most cases, which facilitated a discussion of health, medical and social care among the inhabitants of the region.

Exploring poverty: skeletal biology and documentary evidence in 19th-20th century Portugal.

BACKGROUND: The inference of the state of wealth or poverty from human skeletal remains is a difficult task, as the limited number of skeletal changes are mediated by numerous other physiological, biomechanical and pathological events. In recent years, identified skeletal collections have become valuable resources in enabling aetiologies of these changes to be understood while controlling for some known causative factors, e.g. age, sex and occupation. This has favoured more rigorous data analysis and interpretation. AIM: This study compares the presence of osteological makers of occupation - specifically degenerative joint changes (DJC) - between socio-economically framed occupational groups whilst controlling for age-at-death. MATERIALS AND METHODS: A total of 603 individuals were distributed into seven occupational groups used as a proxy for their socio-economic status. RESULTS: The results demonstrated that age was a contributing factor for DJC. Differences between occupational groups were only found for the hips, right shoulder and ankle. CONCLUSIONS: Differences found were not necessarily representative of low vs high socio-economic status. Furthermore, there are limitations associated with the use of occupation-at-death, based on documentary evidence, which does not necessarily reflect wealth-status.

A possible case of acquired syphilis at the former Royal Hospital of All-Saints (RHAS) in Lisbon, Portugal (18th century): a comparative methodological approach to differential diagnosis.

Between the years of 1999 and 2001, during the excavation of the Praça da Figueira (Lisbon, Portugal), several human osteological remains from various chronological periods were discovered. Amongst them several skeletons are known to be related with the Hospital Real de Todos-os-Santos (Royal Hospital of All Saints - RHAS), which had an important role. The hospital history begun in 1492 and ended in 1755 largely as a consequence of the Lisbon earthquake. Of the skeletons exhumed, one in particular, the adult female Sk. 1310 showed significant pathological changes. The bone lesions characterized by new bone deposition, with a symmetric and disseminate pattern, were found in the upper limbs, distal end of femurs and in tibia and fibula diaphyses. A bowing deformity with "sabre shape" morphology was also observed in the tibiae. The most striking lesions, characterized by healed nodular cavitations and similar to those of caries sicca, were recorded on the frontal bone. Considering the value of a complete description, as well as the application of multiple lines of enquiry for a reliable differential diagnosis, three distinct techniques were applied and compared: visual examination, imagiology and histology. The results showed that the macroscopic analysis coupled with conventional X-ray analysis were fundamental to obtain a possible diagnosis of acquired syphilis. In contrast, the CT-scan and the histological analyses were less informative. The application of a new scoring system also supports a diagnosis of acquired syphilis. This case-study constitutes the first evidence of syphilis associated with the RHAS, supporting historical data on the pivotal role that this hospital had on the treatment of several conditions, namely, syphilis.