Psoriatic arthritis in a fifth-century Judean Desert monastery

Psoriatic arthritis is a greatly underreported seronegative erosive arthropathy, due to the ambiguous lesions it leaves on bone in all but the most severe cases. For a confident diagnosis of psoriatic arthritis to be made, sacroiliac and intervertebral joint fusion must be present together with erosive lesions of the peripheral skeleton including most especially the terminal interphalangeal joints. In modern times it is only a small percentage of cases who experience such debilitating disease, which may explain who so few cases of psoriatic arthritis can confidently be identified from past populations. This report describes this pathological condition as observed in the comingled skeletal remains of nine males and one female from the tomb of Paulus in the Byzantine Monastery of Martyrius, in the Judean Desert. Visual study was complemented using radiographic techniques along with scanning electron microscopy. Two adult males show characteristic lesions of psoriatic arthritis, demonstrating the form known as arthritis mutilans. A third individual shows less widespread erosive lesions which may signify a pauciarticular example of psoriatic arthritis, as is true of most cases in modern times, or the remains may represent Reiter's disease. During the Byzantine period the earlier practise of expelling those with disfiguring diseases (biblical leprosy) evolved into a philanthropic, caring philosophy where the sick were housed and fed out of charity, often within monasteries. The presence of these cases of psoriatic arthritis within such a Judean Desert monastery confirms earlier suggestions that psoriasis was one of the diseases included by those in the ancient eastern Mediterranean under the umbrella term of biblical leprosy.