In 1509, Michelangelo was commissioned by Pope Julius II to paint Bible scenes on the ceiling of the Sistine Chapel in the Vatican. This physically demanding and difficult job would occupy him for 3 years. In a poem in 1510, he described his discomfort, lying on his back on a scaffold with dripping paint congealing on his face. Raphael, an artist who was 8 years younger than Michelangelo, was also in the Vatican at that time, painting a portrait of the Pope and also The School of Athens, which depicted a gathering of great Athenian philosophers; several of Raphael's contemporaries served as models (Fig. 1). The last figure, Heraclitus, the "gloomy philosopher", was added to this fresco soon after the first viewing of the Sistine Chapel ceiling in August 1511. All were astounded by this masterwork, including Raphael; as Espinel described, the figure in Raphael's painting had a strong resemblance to Michelangelo. The flexed right knee was knobby and swollen, suggesting the presence of an effusion and tophaceous deposits.[11,12] By contrast, other knees in the fresco appear normal. However, there is no confirmatory evidence that this figure in Raphael's fresco was truly Michelangelo, nor is there documentation that he was having a knee problem at that time.
"School of Athens" by Raphael (Vatican Palace). The Fresco shows philosophers and other notable persons in classical Athens. The seated figure in the left foreground, Heraclitus, is said to resemble Michelangelo. Nodularity seems to be present on his knees. Color online-figures is available at https://www.jclinrheum.com.
Michelangelo had 2 temporarily disabling illnesses in 1517 and 1518; their nature is largely unknown, although the first may have involved a leg injury. In 1525, he fell ill from "overexertion and cold rains" and later in the same year "was bothered by kidney stones". In 1531, he had considerable anxiety over a commission to create a tomb for Pope Julius II; he was working long hours, eating little, sleeping poorly, and losing weight. He feared that he might not have long to live. In 1540, he developed urinary problems again, with the passage of gravel and later of stones. His physician, Realdo Colombo, irrigated his bladder repeatedly and recommended that he drink mineral water from Viterbo. This is still marketed as "Fiuggi Water" and is said to dissolve uric acid stones among other benefits. Michelangelo attributed his recovery to these waters, but in 1549, he had another prolonged episode, starting with anuria, which was relieved after the passage of gravel.[2,8]
In 1555, Michelangelo wrote to a relative describing "…the cruelest pain I've had in one foot, which has prevented me from going out… They say it's a kind of gout."[8,9] In his later years, he became depressed because he was " …enfeebled like all old men from kidney trouble, the stone and the colic." In 1561, he complained of difficulty writing; it has been suggested that chronic gouty arthritis may have been responsible. However, a portrait of Michelangelo late in life shows a hand with changes in the first carpometacarpal joint, typical of osteoarthritis. In 1563, he wrote his last letter after working all day on the Rondanini Pieta. After sudden onset of fever, he began to fail; the 2 doctors in attendance administered crushed pearls in rosewater, often a treatment of last resort, but Michelangelo died on February 18, 1564, just short of his 89th birthday.
J Clin Rheumatol. 2015;21(7):364-367. © 2015 Lippincott Williams & Wilkins