A case of secondary hypertrophic osteoarthropathy from medieval Tuscany (central Italy, 10th-12th centuries CE)

Objectives: This study aims to provide a detailed evaluation of a case of secondary hypertrophic osteoarthropathy (HOA) and to explore insights into the presence and consequences of disease in medieval rural Italy. Materials: The skeleton of a male (US 4405) with an estimated age at death of 51–69 years excavated from the medieval rural site of Pieve di Pava (Siena, Italy). Methods: Macroscopic and radiological (x-ray, CT) analyses were performed. Results: Symmetrical extensive periosteal new bone formation on the diaphyseal and metaphyseal regions of this individual’s long bones; the lower limbs were more extensively and severely affected than the upper limbs and the distal segments were more severely altered in comparison to the proximal ones. Conclusions: The macroscopic and radiological features are highly consistent with a diagnosis of secondary HOA. Significance: The excellent state of preservation allowed the evaluation of rarely noted skeletal manifestations of HOA and provided insight into aspects of rural life in medieval Italy. Limitations: Molecular analysis was not successful in sequencing the aDNA of tuberculosis, therefore the underlying primary cause of secondary HOA, whether pulmonary or extrapulmonary, remains obscure in this case. Suggestion for the future research: It is advisable to regularly revisit the data available from osteoarchaeological collections in order to identify further cases of HOA, along with to further investigate the known cases to search for the underlying primary disease.