By Dr Ananya Mandal, MD
Arthritis and diseases of the joints have been plaguing mankind since ancient times. In around 1500 BC the Ebers Papyrus described a condition that is similar to rheumatoid arthritis. This is probably the first reference to this disease.
There is evidence of rheumatoid arthritis in the Egyptian mummies as found in several studies. G. Elliot in his studies found that rheumatoid arthritis was a prevalent disease among Egyptians.
In the Indian literature, Charak Samhita (written in around 300 – 200 BC) also described a condition that describes pain, joint swelling and loss of joint mobility and function. Hippocrates described arthritis in general in 400 BC. He however did not describe specific types of arthritis. Galen between 129 and 216 AD introduced the term rheumatismus.
Paracelsus (1493-1511) suggested that substances that could not be passed in urine got stored and collected in the body especially in the joints and this caused arthritis. Ayurveda in ancient Indian medicine also considered arthritis as one of the Vata. Practitioners attributed rheumatic disorders to humors (rheuma).
Thomas Sydenham first described a disabling form of chronic arthritis that was described later by Beauvais in 1880. Brodie went on to show the progressive nature of this disease and found how rheumatoid arthritis affected the tendon sheaths and sacs of synovium in the joints. He found how there was synovial inflammation or synovitis and cartilage damage associated with rheumatoid arthritis.
History of the terms rheumatoid arthritis, rheumatology and rheumatologist
A B Garrod in 1858 named the disease rheumatoid arthritis replacing the old terms arthritis deformans and rheumatic gout. He is thus credited to make a distinction between rheumatoid arthritis and osteoarthritis and gout.
Appearance of rheumatoid arthritis affected joints was first described by Bannatyne (1896). It was in 1940 that Camroe coined the term rheumatologist and the term rheumatology was coined by Hollander in 1949.
In 1932 the International Committee on Rheumatism was formed. It later became American Rheumatism Association and then American College of Rheumatology.
History of treatment of rheumatoid arthritis
In the olden days treatments for rheumatoid arthritis included bloodletting and leeching. In the Far East developed practises of acupuncture, acupressure, moxibustion (use of heat), cupping etc. were used.
After several failed treatments that did not improve the condition of the patients, came the use of heavy metals in treatment of many diseases including rheumatoid arthritis. Gold, bismuth, arsenic and copper salts were used with varying rates of success. Gold however has shown success over years of use and is still a part of Disease Modifying Antirheumatic drugs (DMARDs). DMARDs are widely used in treatment of Rheumatoid arthritis.
History of pain relief
Pain relief was achieved using plant extracts of Willow bark and leaves. These contained salicin. Hippocrates, Galen used Willow extracts to treat pain of rheumatoid arthritis and other forms of arthritis.
In 1929 Leroux identifies Salicylic acid as the active substance that eased pain. In 1853, acetyl salicylic acid (aspirin) was synthesized by Gerhardt. Thereafter beginning with phenylbutazone in 1949 several other non steroidal anti-inflammatiory agents came into being.
History of Disease Modifying Anti-rheumatic drugs (DMARDs)
Payne in 1895 was the first to suggest the use of quinine to treat lupus erythematosus and rheumatic diseases. In 1957 Baguall used chloroquine and now hydroxychloroquine is still part of the DMARDs.
In 1940’s sulphasalazine was developed as an anti-inflammatory and still forms part of DMARDs. In 1949 Philip Hench and Edward Kendall first showed the successful use of cortisone in autoimmune diseases including rheumatoid arthritis.
Methotrexate was first synthesized in 1950’s as a folate antogonist to treat leukaemia. It was not until 1980’s that the role of methotrexate in rheumatoid arthritis was discovered. It still forms part of the DMARDs.
Monocyte derived tumour necrosis (TNF) factor was first identified for its role in the pathogenesis of rheumatoid arthritis in 1975. In 1993 Anti-TNF antibodies were shown to be effective in the treatment of patients with rheumatoid arthritis.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)