Northeastern Ohio Universities College of Medicine, 5500 Market, Youngstown, OH 44512, USA
Correspondence to: bmr{at}neoucom.edu
SIR, Appelboom [1] suggests artistic rendition of rheumatoid arthritis by Rubens, predicated upon identification of swan-neck deformity and metacarpophalangeal and proximal interphalangeal joint swelling. While I did not recognize a swan's neck deformity in The Three Graces, the proximal and distal interphalangeal joint swelling in The Miracle of St Ignatius of Loyola is impressive. The prominent nodular appearance of those interphalangeal joints seems, however, more in keeping with a diagnosis of severe osteoarthritis of the hands. I was unable to determine whether apparent slight metacarpophalangeal joint swelling might simply be a visual artefact related to positioning of the hand.
The real challenge, however, is distinguishing substance and style [2, 3]. Do the renditions of Rubens accurately depict disease phenomena (as Appelboom suggested for The Three Graces in 1987) [4] or are they simply stylistic, as suggested by Louie's analysis of the work of Renoir [3]? The conference that Appelboom chaired in 1987 provided great insights to the difficulties of distinguishing style and substance and did much to advance perspectives of this problem [4].
Leonardo da Vinci is perhaps considered one of the most accurate illustrators of his time. His depictions of an in situ fetus in RL19101r, K/P 197v from the Royal Collection (also known as Illuminismo) provides important insight [5]. The apparent metacarpophalangeal joint and irregular finger swelling must be stylistic, as actual fetal disease of this nature is unknown. If some of Leonardo's renditions are stylistic, how can the work of other artists be confidently attributed? As Appelboom noted, confident historical documentation is obtained from examination of the skeleton [1]. Such analysis documented rheumatoid arthritis as a North American disease with only relatively late penetrance into Europe [6, 7]. Appelboom's appropriate placement of a question mark at the end of the title of his article [1] highlights his attention to the stylesubstance question.
The author has declared no conflicts of interest.
References
|