A case of hypertrophic osteoarthropathy (HOA) in a female burial from the Cathedral hill necropolis in Vyazma (late 13th c. ad)

The necropolis at the Cathedral Hill in Vyazma is mainly dated to the late 13th c. AD, and likely contains burials of the citizens of a high social status. A complete and well-preserved skeleton of a 35-40 year old female was excavated from Burial 15 of the necropolis. Almost all the bones of both upper and lower limbs were deformed due to excessive deposits of bone (periostitis) in the diaphyseal and metaphyseal areas. A combination of macroscopic and radiological - x-ray and microfocus computed tomography - has revealed that the lesions were likely manifestations of the Pierre-Marie-Bamberger syndrome, or secondary hypertrophic osteoarthropathy (HOA). This bone pathology accompanies some chronic diseases of the lungs and pleura (including benign and malignant tumors, tuberculous lesions, etc.), mediastinum and heart, and also, less frequently, other organs and systems. The exact disease that caused the observed bone lesions cannot be determined due to the absence of soft tissues. However, a detailed description of the skeletal manifestation of this pathology, in our opinion, can facilitate the detection and interpretation of periostitis of this type and localization in archeological remains of varying preservation and completeness. Noteworthy, this syndrome is, in 80% of clinical cases, associated with various lung diseases.