Arthritis Expert Re-Examines Death of Christopher Columbus
In 1492, Columbus sailed the ocean blue. His destination was the East Indies, but he inadvertently docked on New World soil, going down in history as the famed explorer who discovered America.
A rheumatologist at The University of Texas Medical School at Houston believes that what immediately followed this historical event may have ultimately led to Columbus' demise.
Based on clues dotted throughout historical documents, Frank Arnett, M.D., professor of internal medicine and holder of the Elizabeth Bidgood Chair in Rheumatology, has deduced that Columbus most likely developed a progressively debilitating form of arthritis upon his return home from that maiden voyage.
The University of Maryland School of Medicine invited Arnett to review Columbus' symptoms and propose theories about his illness and death during its annual historical clinicopathological conference. Last May, he presented his findings there and at the UT Medical School.
Before Columbus' death almost 500 years ago, his symptoms were described as gout. A more plausible diagnosis, Arnett said, is reactive arthritis - a potentially crippling disease that wouldn't be described for centuries to come.
From the time Columbus was in his 40s until he died just short of his 55 th birthday, he suffered from relapsing arthritis that began in lower extremities and became progressively disabling. He also had an old wound that reopened.
Other recurring symptoms were bleeding eyes and periods of blindness. Arnett said these conditions were key to his differential diagnosis that Columbus had reactive arthritis, also known at Reiter's syndrome.
There is evidence Columbus may have even had a fused spine, a symptom of ankylosing spondylitis, which is a cousin of reactive arthritis.
Arnett theorizes that bouts of food poisoning and a gene that would have made him susceptible to this now-rare form of arthritis most likely triggered Columbus' skin ulceration and inflammation of the joints and eyes.
Based on the known symptoms, Arnett used process of elimination in an attempt to unravel the mystery of Columbus' disease.
Columbus didn't fit the classic description of someone with gout, Arnett said. He was not portly. Rather he was fit and muscular. Columbus also wasn't known to imbibe in alcohol or rich foods.
Stereotypical gout profile aside, even if Columbus had been genetically predisposed to gout, his symptoms didn't match the disease. Gout attacks commonly last seven to 10 days before joint pain and swelling subside. "The durations of Columbus' attacks were simply too long to be gout," Arnett said.
For the same reason, Columbus couldn't have suffered rheumatic fever, Arnett said. At times, Columbus was bedridden for months. On one voyage, sailors had to construct shelter for him on the poop deck because he was so sick. With rheumatic fever, he would have recovered within a matter of weeks.
Arnett ruled out rheumatoid arthritis because it appears the arthritis didn't cripple Columbus' hands until the end of his battle with disease, which rendered him unable to write. Rheumatoid arthritis would have affected his hands much earlier, Arnett said.
The bleeding eyes and re-opened wound could have been signs of scurvy, a deficiency of vitamin C, Arnett said, but the length of Columbus' four voyages to the New World didn't match up with scurvy's 100-day rule. Sailors at sea for at least 100 days were at risk for scurvy, but Columbus' voyages never lasted longer than two months.
Columbus could have had Behcet's syndrome, a chronic condition that causes mouth ulcers, eye inflammation, skin problems and arthritis.
However, based on the limited medical information, Arnett said reactive arthritis seems the more likely cause of the mariner's disease. A severe form of reactive arthritis could explain his crippling relapses, bleeding eyes and periods of blindness - signs of conjunctivitis and anterior uveitis.
Arnett believes Columbus may have been genetically predisposed to his illness. He had all the features of someone of Northern European descent. He was tall and had fair skin and blue eyes. "He certainly was a candidate for having the HLA-B27 gene."
The HLA-B27 gene would have made him more susceptible to reactive arthritis, which results from an infection a patient can get when he ingests tainted food or contracts a sexually-transmitted disease. About 75 percent of patients with reactive arthritis have this special genetic marker.
Conditions on the ship were ripe for food poisoning, and Arnett believes this was the most feasible mechanism for contracting reactive arthritis.
"We have no evidence that Columbus was anything but moral," Arnett said. "Had Columbus consorted with the natives, rumors would likely have appeared and there would have been a public outcry in Spain. There is no reason to think he had a sexually-transmitted disease."
Without treatment, in 60 percent of cases, patients recover from reactive arthritis within three to 12 months. Thirty percent will have a relapse, perhaps due to re-infection.
In rare instances, the bacterial infection settles permanently in the joints, causing 10 percent of patients to have progressive, disabling disease. Columbus was one such patient, Arnett theorizes.
"Most people don't realize that Columbus died a crippled man," Arnett said. "He was bedridden. He was in so much pain he couldn't write or stand. He was very sick."
Reactive arthritis can ultimately cause heart and renal failure. While it is unclear how Columbus died, Arnett said, it is realistic to hypothesize that complications associated with reactive arthritis killed him.
Like Columbus, the disease itself has an interesting history. In 1818, Dr. Benjamin Brodie, a famous clinician, first described the three components of reactive arthritis - conjunctivitis (eye inflammation), arthritis and urethritis (urinary tract inflammation).
It wasn't until 1916 that the disease got recognition and a name, Reiter's syndrome. Dr. Hans Reiter, a German military clinician, described the disease in a World War I soldier who developed reactive arthritis after a bout of shigellosis, a type of food poisoning.
Arnett said reactive arthritis used to be the most prevalent form of arthritis is young men. That all changed with the AIDS epidemic. As condom-use increased in the 1980s, the incidence of reactive arthritis dropped seven-fold.
"Now we only see a few cases a year," Arnett said. "It's very rare."
If Columbus was alive today, Arnett said he would prescribe him etanercept or another tumor necrosis factor (TNF) blocker. These are relatively new medications that block activity of TNF, a major cause of inflammation in joints.
"I just saw a man not long ago who got food poisoning in another country," Arnett said. "He had reactive arthritis really bad, and after getting a TNF blocker, his symptoms disappeared within 24 hours. He took the drug for four months, and now he is disease-free. Columbus should have been on one of these drugs. Who knows? It could have changed history."