The full content of Annals is available to subscribers

Subscribe/Learn More  >
History of Medicine |

Evidence of Hypertrophic Osteoarthropathy in Human Skeletal Remains from Pre-Hispanic Mesoamerica

Manuel Martinez-Lavin, MD; Josefina Mansilla, MD; Carlos Pineda, MD; Carmen Pijoan, PhD; and Patricia Ochoa, PhD
[+] Article, Author, and Disclosure Information

From Instituto Nacional de Cardiologa Ignacio Chavez and Institituto Nacional de Antropologa e Historia, Mexico City, Mexico. Requests for Reprints: Manuel Martnez-Lavn, MD, Rheumatology Department, Instituto Nacional de Cardiologa Ignacio Chavez, Juan Badiano #1, 14080 Mexico D.F., Mexico.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(3):238-241. doi:10.7326/0003-4819-120-3-199402010-00010
Text Size: A A A

Hypertrophic osteoarthropathy is one of the earliest recognized disease entities in the history of medicine. It has a peculiar periosteal proliferation distinctive from other bone diseases. In its advanced stage, it leaves an indelible mark on the skeleton. It has been recently shown that digital clubbing is accompanied by a bone remodeling process of the underlying phalanges. Thus, theoretically, this entity can be recognized in ancient human skeletal remains.

We studied part of the collection of skeletal remains from pre-Hispanic Mesoamerica preserved at the National Museum of Anthropology of Mexico City. We examined 1000 specimens and found 2 skeletons with widespread, bilateral, symmetric periosteal proliferation of the tubular bones in addition to the bone remodeling changes of the distal phalanges. One of the specimens was from the Formative period (2000 B.C. to 100 A.D.).

We conclude that hypertrophic osteoarthropathy can be recognized in ancient human skeletal remains and that this disease was present in Mesoamerica near the time of the original description of clubbing by Hippocrates about 2500 years ago.


Grahic Jump Location
Figure 1.

Radiographic periostosis. Anteroposterior views of tibias and fibulas of specimen 1 show a conspicuous thickening of the tibias with disappearance of their normal biconcave shape. Arrowheads point to the multilayered periosteal apposition. Advanced periostosis. A detailed view of the distal part of the left fibular of specimen 2 show an irregular shaggy cortex resembling tree bark ( ). Bone changes of digital clubbing. The first distal phalanx of the foot of specimen 2 ( ) with osteolysis and with remodeling of the tuft compared with the uniform contour of the first phalanx of a foot from the same archeologic source ( ).

Grahic Jump Location
Grahic Jump Location
Figure 2.
Ancient Mesoamerican illness.

Figurine from Jaina depicting a man with massive ascites and with eversion of the umbilicus. Chronic liver disease is a well-known cause of hypertrophic osteoarthropathy.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.