Exploring an Explorer's Illness: (continued)

UT Arthritis Expert Re-Examines Death of Christopher Columbus

By Meredith Raine

However, based on the limited medical information, Dr. Arnett says reactive arthritis seems the more likely cause of the mariner's disease. A severe form of reactive arthritis could explain his crippling relapses, bleeding eyes, and periods of blindness — signs of conjunctivitis and anterior uveitis.

Dr. Arnett believes Columbus may have been genetically predisposed to his illness. He had all the features of someone of Northern European descent. He was tall and had fair skin and blue eyes. "He certainly was a candidate for having the HLA-B27 gene."

The HLA-B27 gene would have made him more susceptible to reactive arthritis, which results from an infection a patient can get when he ingests tainted food or contracts a sexually-transmitted disease. About 75 percent of patients with reactive arthritis have this special genetic marker.

Conditions on the ship were ripe for food poisoning, and Dr. Arnett believes this was the most feasible mechanism for contracting reactive arthritis.

"We have no evidence that Columbus was anything but moral," Dr. Arnett says. "Had Columbus consorted with the natives, rumors would likely have appeared and there would have been a public outcry in Spain. There is no reason to think he had a sexuallytransmitted disease."

Without treatment, in 60 percent of cases, patients recover from reactive arthritis within three to 12 months. Thirty percent will have a relapse, perhaps due to re-infection.

In rare instances, the bacterial infection settles permanently in the joints, causing 10 percent of patients to have progressive, disabling disease. Columbus was one such patient, Dr. Arnett theorizes.

"Most people don't realize that Columbus died a crippled man," Dr. Arnett says. "He was bedridden. He was in so much pain he couldn't write or stand. He was very sick."

Reactive arthritis can ultimately cause heart and renal failure. While it is unclear how Columbus died, Dr. Arnett says, it is realistic to hypothesize that complications associated with reactive arthritis killed him.

Like Columbus, the disease itself has an interesting history. In 1818, Dr. Benjamin Brodie, a famous physician, first described the three components of reactive arthritis – conjunctivitis (eye inflammation), arthritis, and urethritis (urinary tract inflammation).

It wasn't until 1916 that the disease got recognition and a name, Reiter's syndrome. Dr. Hans Reiter, a German military physician, described the disease in a World War I soldier who developed reactive arthritis after a bout of shigellosis, a type of food poisoning.

Dr. Arnett says reactive arthritis used to be the most prevalent form of arthritis in young men. That all changed with the AIDS epidemic. As condom-use increased in the 1980s, the incidence of reactive arthritis dropped sevenfold.

"Now we only see a few cases a year," Dr. Arnett says. "It's very rare."

If Columbus were alive today, Dr. Arnett says he would prescribe him etanercept or another tumor necrosis factor (TNF) blocker. These are relatively new medications that block activity of TNF, a major cause of inflammation in joints.

"I just saw a man not long ago who got food poisoning in another country," Dr. Arnett says. "He had reactive arthritis really bad, and after getting a TNF blocker, his symptoms disappeared within 24 hours. He took the drug for four months, and now he is disease-free. Columbus should have been on one of these drugs. Who knows? It could have changed history."