Until recently it was believed Ramesses II, aka “the great” or Ozy to his friends, and various members of his family suffered from the debilitating autoimmune disease ankylosing spondylitis (AS).
Authors of a 2002 study analysed Ramesses II's mummy, as well as those of his son Merenptah and cousin Amenhotep II, who was the seventh pharaoh of the 18th dynasty, and detected joint inflammation that is characteristic of AS in each set of ancient remains.
AS would have been a problem as, although pharmacists may have stocked opioid pain remedies 3,000 years ago, not even the most forward thinking ancient chemist had access to the modern mAbs used to slow disease progression.
Denial
But was the 2002 x-ray-based diagnosis correct?
No according to Sahar Saleem from the Kasr Al Ainy Faculty of Medicine in Cairo and Egyptologist Zahi Hawass, who suggest in a new study that the pharaohs were actually suffering from a degenerative condition called diffuse idiopathic skeletal hyperostosis (DISH).
Like AS sufferers, people with DISH have reduced mobility, pain and stiffness in the upper back as a result of swelling and inflammation caused by the disease.
However, as Saleem and Hawass point out, although the three mummies studied in 2002 showed signs of inflammation, none showed any evidence of joint erosion which is a key characteristic of AS but absent in DISH.
Saleem and Hawass reanalysed the original mummies as well as ten others using computed tomography – basically a computerised x-ray analysis technique capable of generating a 3D image – and found that most had intact joints in the lower back and pelvic area.
They also found no fusion in the sacroiliac and facet joints of the spine, both of which are found in AS but not in DISH.
Saleem and Hawass concluded that: "CT findings excluded the diagnosis of ankylosing spondylitis in the studied royal Ancient Egyptian mummies and questioned the antiquity of the disease.
"CT features of DISH in this ancient period were similar to those commonly seen in modern populations and likely they will be in the future."
Value of the findings
Clearly, news of the likely misdiagnosis is of little use to a man who has been dead for 3,000 years, but such studies do have a point according to Dr Saleem.
“The mummies of Ancient Egypt offer a wealth of information regarding the history of disease. In studying these ancient remains we may be able to uncover the pathway of diseases—like ankylosing spondylitis or DISH—and how they might impact modern populations.”
The findings also cast doubt on the belief that Ankylosing spondylitis is a disease of antiquity according to the authors, who suggest a reanalysis with this in mind could aid the development of new treatments.
Paper ref: “Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis (DISH) in Royal Egyptian Mummies of 18th-20th Dynasties? CT and Archaeology Studies.”
Sahar N Saleem and Zahi Hawass. Arthritis & Rheumatology; Published Online: October 20, 2014 (DOI: 10.1002/art.38864).