NOW AND THEN Rheumatic disease and the Australian Aborigine
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چکیده
Objective—To document the frequency and disease phenotype of various rheumatic diseases in the Australian Aborigine. Methods—A comprehensive review was performed of the archaeological, ethnohistorical, and contemporary literature relating to rheumatic diseases in these indigenous people. Results—No 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. Conclusion—The 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. (Ann Rheum Dis 1999;58:266–270) Ancestors of Australian Aborigines migrated to Sahul (continental land mass of Australia and New Guinea) 40–60 000 years before present and have continued to occupy the land to the present time. From a biological perspective the subsequent cultural and biological evolution of these isolated people in their unique environment can be viewed as an excellent opportunity to examine diVerences in disease expression in comparison with racial groups in other lands. If diVerences are observed they may provide clues to the aetioipathogenesis of these disorders. However, before examining the prevalence and phenotype of rheumatic diseases in the Australian Aborigines we need to acknowledge recent changes in genetic and environmental influences. Up until white settlement the Australian Aborigines were considered to be genetically a fairly homogenous race but with some striking and distinctive regional variations particularly involving those HLA class II genes involved in immune responses. 2 For example, in Aboriginal groups from diVerent geographical regions, alleles with an apparent local origin accounts for 20–30% of the DRB1 gene frequencies. Furthermore, these indigenous people lived a hunter/gatherer lifestyle rich in cultural traditions but with little variation in their regional environmental influences. However, since settlement racial intermarriages have occurred with a mixture of white, Asian, Polynesian and Melanesian genes. In addition, there have been dramatic environmental changes including changes in diet and nutrition, lifestyle and exposure to various new infectious, chemical and toxic agents, etc. Thus today, tragically, the Australian Aborigines are characterised with high levels of obesity, diabetes, hypertension, chronic renal disease, hepatitis B, alcoholism, chronic unemployment, and suicide. It is important therefore to recognise that changes in disease prevalence or phenotype over the past 200 years may reflect these influences and that contemporary observations may not necessary reflect the situation before white settlement. It should also be noted that rheumatic disease prevalence and perhaps phenotype may also change over time, for example, the probable increased prevalence of rheumatoid arthritis (RA) in the past 200 years. Sources of information The Australian Aborigines while rich in oral tradition have no written language and hence their own historical record from these people with regard to rheumatic diseases is not available. We must therefore seek other sources for this information. These alternative sources can be listed as (1) archaeological, (2) ethnographical/historical, (3) contemporary. Archaeological evidence of rheumatic disease is obtained from the examination of skeletal material obtained from aboriginal burial grounds or elsewhere and this study constitutes Ann Rheum Dis 1999;58:266–270 266 University of Adelaide, Australia
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تاریخ انتشار 1999