Bones of contention
Reproduced from Issue 104 of Arthritis Today
Dr Rogers examines one of the 3,000 skeletons in her collection
3,000 ancient skeletons are helping doctors find out more about the origins of arthritis. A special report looks at the groundbreaking work of Dr Juliet Rogers in Bristol.
There aren't many palaeopathologists in this country. And even fewer can claim to have 3,000 skeletons in their cupboard.
Dr Juliet Rogers can truthfully claim both. A leading palaeopathologist for the past 25 years (palaeopathology means a study of the diseases of the past), for the past decade or so she has been working closely with the 3,000 skeletons unearthed from a graveyard in Barton-on Humber, a small village in north Lincolnshire.
The bones date from the Anglo-Saxon period to the Industrial Revolution, and provide a fascinating glimpse of the lives of people in the north of England between the years 900 and 1850.
But unlike many of her archaeology colleagues, Dr Rogers' interest in the thousands of bones has a distinctly medical application. Carefully and painstakingly she and her team have been compiling reams of data in order to build up a picture of prevalence of arthritis and other rheumatic diseases in ancient times – with some surprising results.
Although she points out that she has yet to complete detailed analysis of the information she has collated, many of the work-in-progress results from the Palaeopathology Study Group she heads up – other members include arc luminary Professor Paul Dieppe and radiologist Dr Iain Watt – have been published in various journals and make for interesting reading.
For example, many of the 3,000 skeletons spanning the 950-year period showed evidence of osteoarthritis – around 17% of the adult population of the town. Dr Rogers also discovered 15 cases of Pagets Disease of bone, 12 cases of gout, and a similar number of inflammatory arthritis such as psoriatic and Reiter's Disease.
There were, however, very few cases of rheumatoid arthritis, which throws up all kinds of hypotheses about RA being a "new" disease, or at least more common than it used to be.
One of the objectives of the next three years will be to try to define the origins of RA, which might provide important clues as to the nature of any environmental trigger factors which might spark off the disease.
What the Barton-on-Humber skeletons show, and what many other similar but smaller collections of ancient skeletons have shown, is that osteoarthritis was the most common form of joint disease.
There is even evidence of OA in neolithic sites and in Egyptian mummies, and in Roman skeletons.
Patterns of OA have changed over the centuries. In pre-mediaeval times, people suffered from osteoarthritis of the hip more frequently than of the knee, a reversal of the current situation. Tibiofemoral knee OA common in modern times – and associated with risk factors from a modern lifestyle such as obesity and walking on hard surfaces – was uncommon in our ancestors.
Dr Rogers and Professor Dieppe believe this could mean that this form of OA of the knee has recent origins.
Juliet Rogers, now 57, trained and worked as a doctor, but during the time she took off to raise her young family, she became interested in the work of one of her husband's friends, an anthropologist.
Her interest in archeology grew – "because I was a medic I wanted to know about what all these changes in bones actually were" – and she achieved academic status in 1981. Her long-term collaborator Paul Dieppe helped her to get funding, and she has been working as one of the very few medical palaeopathologists in the country ever since.
Much of the Barton-on-Humber work has been very demanding in terms of the sheer numbers of bones and the amount of data amassed by each skeleton.
"The skeletons are sent to us and we lay them out in front of us, then they're assessed, for age and sex, and measured to work out stature and size," she explains. "We look at every single bone and joint, and write down the signs of pathological change. We have the data for every single joint and bone, so the data base is huge!"
Despite the importance of the work, Dr Rogers has struggled to get full-time funding to help the research reach its fruition. Fortunately, arc has now stepped in, providing a special three-year award of £162,459, which will keep her actively employed until she retires.
"I'm incredibly pleased about it, it's such a relief – my funding has been very hand to mouth until now," says Dr Rogers. While funding from English Heritage will enable her to complete her report on the Barton-on-Humber collection, arc grant will pay for the more specific technical analysis of the ancient bones.
Dr John Kirwan, a colleague of Dr Rogers at Bristol Royal Infirmary, believes her work is exciting, and highly relevant to the aims of arc.
"Because arthritis can leave signs in bones which lasts for centuries, we are finally in a position to go back and look at what happens, and see how patterns of arthritis change," he said. "Other people have looked at skeletons for similar purposes, but no-one else has such a huge collection of well-documented bones as Juliet. This is the only place in the world that is doing this kind of work."
Dr Rogers' final three years of in-depth analysis look likely to throw more light on the history of arthritis disorders in the UK. There seems little doubt that her work will contribute in no small way to both the medical and anthropological understanding of human disease in general, and arthritis in particular.
