Diagnosing arthritis in the pharaohs of Ancient Egypt

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Mon Mar 04, 2019

The pharaohs are some of the most renowned rulers of the ancient world, and they still hold many secrets for modern archaeologists. One secret has been revealed through the mummies of these ancient rulers: that chronic inflammatory arthritis ran in families that included Ramesses the Great. Figuring out what kind can be something of a challenge, but it could be important for scientists who study how long these conditions have been around to determine their causes.

Arthritis that includes bony growth in the spinal area has been confirmed in Ramesses II (“the Great”) and his son Merneptah using advanced imaging techniques on their mummies. A similar case is also suspected in Pharaoh Amenhotep III, although he reigned in the dynasty before Ramesses II, as well as Ramesses III, from the dynasty after Ramesses II.

Amenhotep III reigned from the 1380s to the 1350s BCE, and his reign was marked by great prosperity and artistic development in Egypt. His non-arthritic son was the somewhat infamous Amenhotep IV, who tried to replace Egypt’s polytheistic religion with the worship of the god Aten.

Ramesses II ruled from around 1279 to 1213 BCE (66 years). He led a successful military campaign in Syria that brought peace between Egypt and the Hittites in what’s regarded as the first peace treaty. He also promoted great architectural works and lived to the remarkable age of 90 or 91. His son, Merneptah, was already an older man when he became pharaoh, and he ruled for around 10 years.

Ramesses III reigned from around 1186 to 1155 BCE (31 years), which, although not nearly as long as Ramesses II, was considered quite a long reign. During his rule, Egypt declined in power due to invasions and economic problems, and a conspiracy against him by a wife and son may have resulted in his death.

They come from very different backgrounds and time periods, but they were linked by one condition. What kind of arthritis did these pharaohs have? It was different from the kind that people get as they get older (this is osteoarthritis, caused by wear-and-tear on the joints). Some kinds of arthritis are caused when the body attacks itself and can strike at any age. At least, it’s certain that the pharaohs had one of these kinds.

For decades, it was held that several pharaohs had ankylosing spondylitis, a type of autoinflammatory arthritis that attacks the spine and causes bony growth and fusion of the vertebra (along with tendonitis, fatigue, and other not-so-fun symptoms that can’t be seen in a mummy). It proved that the disease was ancient in a way that other kinds of arthritis might not be. In fact, Ramesses II, even in his extraordinarily advanced age, had spinal discs that were thick and didn’t show signs of deterioration. This is probably because his disease added bone to them as he aged, instead of the usual breakdown that occurs over time. An ironic benefit of what must have been a painful disease.

More recently, though, scientists have reopened the case. The imaging techniques that were used to diagnose ankylosing spondylitis in the past are outdated today, and it turns out that the angles that were used don’t really prove much. Scientists now believe that these pharaohs had diffuse idiopathic skeletal hyperostosis (DISH). DISH also causes a lot of bony growth on the spine, and it doesn’t affect the lower spinal joints as much. This matches up with what’s seen in the mummies of Amenhotep III, Ramesses II, Merneptah, and Ramesses III. It also mostly strikes older men and runs in families, which fits the picture perfectly.

It’s not quite cut-and-dried, though. It’s also important to consider the fact that not all spondylitis affects the low back joints, so it still could be a type of spondylitis. Severe damage with spondylitis, like the changes seen in the mummies, is also found more commonly in men and is strongly associated with the gene HLA-B27. Did the pharaohs have that gene? The test hasn’t been run yet.

So what kind of arthritis did the pharaohs of Ancient Egypt have? Facts like this could hold important clues about the cause of diseases we still don’t really understand. If it was ankylosing spondylitis, it proves that the disease is ancient, not new as some scientists have proposed. It seems far more likely, however, that the pharaohs had DISH. Regardless, it shows that chronic illness can strike anyone at any time—even rulers who were the sons of their gods.

 

 

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2019 - Spring - Issue 6
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