The History of Rheumatoid Arthritis

I’ve heard people blame RA on our modern world. These folks would like us to believe that modern processed foods, pollution and modern lifestyles are at fault. That is simply not true; rheumatoid arthritis has been around for centuries. We can’t blame it on the modern world.

Although the earliest known appearance of RA was noted in skeletal remains of Indians from 4500 BC found in what is now known as Tennessee, we don’t find documented evidence until much later.

The first written reference to arthritis sounds very similar to what we now know as rheumatoid arthritis. In 123 AD a text from India called Caraka Samhita describes a disease where swollen, painful joints initially strike the hands and feet, then spread to the body, causing loss of appetite, and occasionally fever.

In 1591 Guillaume de Baillou, the French physician and Dean of the University of Paris medical faculty writes one of the first books on arthritis. In this book he uses the term rheumatism to describe a condition characterized by inflammation, soreness, stiffness in the muscles, and pain in and around the joints. He writes, “The whole body hurts, in some the face is flushed; pain is most severe around the joints, so that the slightest movement of the foot, hand, or finger causes a cry of pain…At night…the pain becomes more serious and the patient cannot sleep.” Could this be a combination of RA and fibromyalgia?

In 1680 they begin treating rheumatism with a Peruvian bark, which contains the anti-malarial agent, quinine. In modern times we treat it with an anti-malarial, Hydroxychloroquine Sulfate, better known as Plaquenil. Then in 1763, they had another weapon to fight rheumatism, Willow bark. Willow bark contains salicylate, the active ingredient in aspirin.

It wasn’t until 1859 that the disease earned a proper name. Sir Alfred Garrod, the London physician, coins the clinical term ‘rheumatoid arthritis’ and the first reference is made in medical literature.

Now that the disease had a name, things really started to roll. In 1893 the surgeon W. A. Lane developed a system of carbon steel screws and plates that made internal repair of bones and joints possible, and joint replacement surgery began.

The Bayer Company took the Willow bark treatment on step further in 1897, manufacturing acetylsalicylic acid, better known as aspirin. It quickly gains worldwide recognition in the treatment of pain and rheumatic disorders, becoming the standard treatment. In 1929, another new drug emerges; periodic injections of gold salts are first used to relieve muscle pain.

1939 brought the first autoimmune theory into the picture. Sir McFarlane Burnet, head of the Research Institute of Melbourne, Australia decides that autoimmunity, the process by which the body’s defense system malfunctions and attacks its own tissues, causes many arthritis conditions. This theory holds true today.

The development of x-rays in 1895, the surgical pin in 1907 and the ball and cup artificial hip joint in 1931 lead to the formation of the American Academy of Orthopaedic Surgeons in 1933. The first total hip replacement is performed in 1938 by surgeons in England.

In 1941 RA becomes official, the American Rheumatism Association officially recognizes rheumatoid arthritis as a distinct disorder and in 1946 the American Committee to Control Rheumatism is founded in Philadelphia, officially announcing the modern American field of rheumatology. The Arthritis Foundation came shortly after, established in 1948.

1948 also brings us two important discoveries. Drs. Philip Hench and E.C. Kendall discover the therapeutic anti-inflammatory effects of steroid hormones. This milestone will win them the Nobel Prize. Almost equally important, the antibody known as the rheumatoid factor is isolated in the blood of people with rheumatoid arthritis. The Rose-Waaler diagnostic test, that employs this factor, is devised.

The year 1955 begins the love-hate relationship many of us know so well. Prednisone, a synthetic derivative of cortisone, is introduced and it rapidly becomes the most widely used oral corticosteroid medication.

Over the next half of a century, many new treatments and surgeries fall into to place; joint replacements are perfected, new drugs are developed. And many of us are diagnosed with that same disease found in Indians from 4500 BC. So the next time someone tells you that RA is caused by the evils of the modern world, you’ll know the truth.

References:
IntelliHealth Arthritis Timeline
Arthritis Today, January – February 2000, Though the Years, an Arthritis Timeline