Now and then
Rheumatic disease and the Australian Aborigine
a University of
Adelaide, Australia, b Department of Immunology, Allergy and Arthritis,
Flinders Medical Centre, South Australia
Correspondence to: Professor P J Roberts-Thomson, Department of Immunology, Allergy and Arthritis, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia.
Accepted for publication 10 February 1999
OBJECTIVE
To document
the frequency and disease phenotype of various rheumatic diseases in
the Australian Aborigine.
METHODSA
comprehensive review was performed of the archaeological,
ethnohistorical, and contemporary literature relating to rheumatic diseases in these indigenous people.
RESULTSNo evidence
was found to suggest that rheumatoid arthritis (RA), ankylosing
spondylitis (AS), or gout occurred in Aborigines before or during the
early stages of white settlement of Australia. Part of the explanation
for the absence of these disorders in this indigenous group may relate
to the scarcity of predisposing genetic elements, for example, shared
rheumatoid epitope for RA, B27 antigen for AS. In contrast,
osteoarthritis appeared to be common particularly involving the
temporomandibular joint, right elbow and knees and, most probably, was
related to excessive joint loading in their hunter gatherer lifestyle.
Since white settlement, high frequency rates for rheumatic fever,
systemic lupus erythematosus, and pyogenic arthritis have been observed
and there are now scanty reports of the emergence of RA and gout in
these original Australians.
CONCLUSIONThe
occurrence and phenotype of various rheumatic disorders in Australian
Aborigines is distinctive but with recent changes in diet, lifestyle,
and continuing genetic admixture may be undergoing change. An
examination of rheumatic diseases in Australian Aborigines and its
changing phenotype may lead to a greater understanding of the
aetiopathogenesis of these disorders.
© 1999 by Annals of the Rheumatic Diseases
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Genetics
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Immunology (including allergy)
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Ankylosing spondylitis
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Degenerative joint disease
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