Background Rheumatoid arthritis (RA) was first described by Landré-Beauvais in Paris in 1800. Fifty years later 5% of all long-terms patients treated at the celebrated Paris teaching hospital Pitie-Salpetriere are documented to have had RA. European erosive RA is a contemporary disease as examinations of skeletal remains in Europe have demonstrated no evidence of erosive RA prior to 1800. This proliferation of RA reported only in Paris is likely to be due to specific environmental risk factors that became prevalent in 19th century Paris, but were unusual in the rest of Europe.
Objectives To explore why the first description of RA occurred in 19th century Paris and why an epidemic of RA ensued.
Methods A Pubmed and internet search was undertaken (up until March 2014) to determine risk factors that may account for the time and place of the first description of RA.
Result In 1800, Paris (Ville de Paris) was by far the most densely populated city in Europe with London a distant second (41086 vs 8137 inhabitants per square mile). Before 1800 only 3% of the world's population lived in cities. A body of research has identified very strong links to urbanisation and an increased risk of infectious diseases.
P. gingivalis is strongly linked to periodontitis and is commonly transmitted by close person to person contact. Periodontitis increases the risk of RA exclusively in non-smokers and is associated with anti-citrullinated α-enolase peptide-1 (CEP-1) positivity.
Bronchiectasis was first described in Paris by Laennec in 1819. Bronchiectasis is associated with elevated levels of anti-CEP-1 (9% of cases) (1). Studies have reported a prevalence of bronchiectasis in 25–30% of non-smoking seropositive RA. The majority of cases of bronchnfection with bacteria or viruses (tuberculosis, bacterial pneumonia, measles and Bordetella Pertussis). All these infections are more likely to have been more prevalent in the living conditions noted to exist in 19th century Paris.
Parisian culture was central to the introduction of smoking to Europe during the 17-19th century and Le Musée de fumeur in Paris chronicles this dubious contribution. Smoking has emerged in the medical literature as the most important environmental risk factor for the development of seropositive RA and is not associated with non-erosive seronegative RA.
Conclusion French rural depopulation resulted in 19th century Paris having the most overcrowded living conditions ever observed in Europe. Infection with P. gingivalis and organisms known to trigger bronchiectasis are likely to have greatly increased resulting in the emergence of seropositive RA in Parisian non-smokers in the early 19th century. The emergence of smoking at about the same time will have also contributed significantly to the epidemic of RA reported in 19th century Paris. Studies to determine if smoking, bronchiectasis and periodontitis are independent risk factors for seropositive RA should be undertaken. Lessons from history should always be sought.
Patients with bronchiectasis, with or without rheumatoid arthritis, have an elevated anti-citrullinated peptide antibodies (ACPA) response. Quirke AM, Perry E, Kelly C, de-Soyza A, Eggleton P, Hutchinson D, Venables P Ann Rheum Dis. 2014 Mar 1;73 Suppl 1:A71-2. doi: 10.1136/annrheumdis-2013-205124.163.
Disclosure of Interest None declared