The PRS News: Winter 2017
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Philip L. Cohen, MD

The art world considers RA a heavy metal-induced occupational hazard among painters. Here’s a quote: “Because the four artists (Renoir, Dufy, Rubens, Klee) with rheumatic disease used significantly more bright and clear colours than their contemporaries without rheumatic disease, they must have been more heavily exposed to pigments containing salts of heavy metals.  The use of white seems similar in both groups, so exposure to lead carbonate was probably much the same” (Pederson, Lancet June 4, 1988 (p. 1268). 

As rheumatologists, you probably find this risible, but the art community seems to take such explanations seriously.
My own interest in the subject came from an appreciation of Frederic E. Church, 19th century America’s greatest landscape painter. In an era before color photography, crowds marveled at the exotic landscapes he painted of far away places and of his own Hudson River valley. He gained fame and fortune exhibiting his paintings.

From about age 40, Church suffered from debilitating arthritis. I had the privilege of going through his letters and papers at the Olana State Historical Site near Hudson, NY. At Olana, overlooking the Hudson, Church built his remarkable Persian-style mansion. He continued to be productive despite increasing disability, and continued his extensive foreign travels. Often borne on a stretcher to spectacular natural sights, he made sketches that he transformed into great paintings when he returned home to Olana. Of his medical condition, we only know that he employed “rubbers” – masseurs – and that he was treated with “dry malt, pancreatin, and litheate of potassium”. Visitors to Olana often commented on his frailty and worsening arthritis.

From a letter by a friend: “to see that cunning hand gnarled, cracked, swollen, and shrunk out of all its beautiful shape with the Rheumatism which is eating him away, and slowly shutting him up in a living grave, is a pitiful and tragic sight.  He is just a knotted skeleton, all askew and covered with skin…”

Although I came across receipts for white lead used in home made paints, I hope my colleagues will agree that Church’s illness fits RA more closely than saturnine gout.  Its insidious onset, hand deformities, and debilitation are characteristic of RA. Like Renoir and Dufy, Church somehow continued to pain spectacular canvases despite severe hand deformities and dysmobility. Pharmacological relief was to come only after his death, in the form of aspirin, which benefited Renoir. The great Raoul Dufy, in the early 1950s, was one of the very first patients treated at the Mayo Clinic by Dr. Hench and colleagues with cortisone.
Rheumatic diseases are probably not more prevalent in painters. But I marvel at the mighty spirit of great artists who continued to create pictures of great beauty despite unallayed pain and deformity. They remind me of the many courageous patients I have known over the years who have achieved great things despite their chronic illnesses.

Cotopaxi.  Detroit Institute of Arts
Only one photograph of Church showing his hands exists: I have enlarged them so that his rheumatoid deformities can be seen. This was taken after about 20 years of disease. He may have developed amyloidosis, as his death certificate lists nephritis as the cause of death.

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Joyce C. Chang, MD
Sabrina Gmuca, MD
Paul A. Tsoukas, MD
Mugdha Agrawal, MD
Emily Keeler, DO
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