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Book Reviews
Arthritis and Allied Conditions. A Textbook of Rheumatology, 14th Edition. William J Koopman, Editor. Philadelphia: Lippincott, Williams and Wilkins, 2001. Volumes I and II, 2848 pages, price $299.00 U.S. What started as a single authored edition in 1940 (Bernard I. Comroe), later edited by Joseph Lee Hollander, and then Daniel J. McCarty and collaborators, now has 190 contributing authors in 2 large volumes. My first purchase, the 6th edition, (Hollander, 1960) was read and reread cover-to-cover as befits a good textbook. The present 14th edition has 131 stand-alone chapters, each expansively documented and extensively referenced. I could pick up and read comfortably my 6th edition. Volume I of this 14th edition is 7 lb 8 oz, (3.45 kg), volume II is 6 lb 9 oz, (3.9 kg) both quite heavy to hold. The job of a textbook editor surely is daunting. Remarkable advances to the study and treatment of rheumatic diseases occur steadily in the 4-5 years between editions. Many chapters from previous editions have undergone extensive revision. This edition has 7 chapters addressing new topics and 37 chapters authored by new contributors. The first 665 pages deal with the scientific basis for the study of rheumatic diseases, and the next 400 on therapeutic approaches. This is followed by 1700 pages dealing with inflammatory and connective tissue disorders, other miscellaneous rheumatic diseases, regional disorders of joints, osteoarthritis, metabolic bone and joint diseases, and infectious arthritis. There are many stellar chapters, well written and easy to understand, such as "The Epidemiology of Rheumatic Diseases" and "Clinical Evaluation in Rheumatic Diseases" (which more appropriately should be titled "Anti-Rheumatic Drug Trial Design"). Other examples of chapter content include the structure of the joint and its constituent molecules, the inflammatory response and effective pathways, proteoglycans, apoptosis, cytokines, immune complexes, nitric oxide, and eicosanoids. Several chapters document the molecular basis of immunoglobulin and T cell receptor diversity, the cellular basis of the inflammatory response, and the importance of the HLA complex in the pathogenesis of rheumatic diseases. There is documentation of many new therapeutic modalities, biologic agents, immunomodulatory agents, gene therapy and bone marrow transplantation, COX-Z, and the role of bacteria in the pathogenesis of rheumatic disease. A real disappointment, however is the poor reproduction of radiographs. Trainees in rheumatology, a specialty that prides itself on the ability to interpret bone and joint radiographs, will have to look elsewhere for their education in musculoskeletal radiology. Line drawings are good. Histological specimens are poorly reproduced, difficult to interpret and are poorly labeled. As an example, Figure 122.6, "The histology of major metabolic bone diseases", is reproduced in black and white and yet the caption describes bright red, dark red and yellow (paratrabecular, trabecular and marrow). The excellent chapter on inflammatory myopathies is weakened by the absence of any meaningful description of electromyography. One contributing author claims that electrodiagnostic tests are the "gold standard" for carpal tunnel syndrome and yet there is no description of these neurophysiological tests. This stands in marked contrast to the 36 pages on magnetic resonance imaging and 90 pages on surgery. Both these chapters contain redundant and extraneous material. Joe Hollander, planning for his 6th edition, claimed that " The effort has been to obtain an outstanding contributor on each subject, not necessarily chosen for the neutrality of his point of view." With above reservations aside, I believe that Koopman for this 14th edition has been as focused and just as successful. These reference volumes are recommended for the excellence of the written material. It is hoped that in later editions more care is given to editing histology and radiograph reproduction. JOSEPH B. HOUPT, MD, FRCPC, Toronto, ON Canada. Primary Care Rheumatology Edward D. Harris, MD, and Mark C. Genovese, MD, editors. Philadelphia: WB Saunders Company, 2000, (Harcourt Health Sciences), 413 pages, price $52.00 US It is always very difficult for me to say, especially in view of the growing knowledge in rheumatology, how much one should expect the primary care physician to know about musculoskeletal system disease. This 413 page text contains information delivered in 3 parts: "General Approach to Musculoskeletal Disroders," "Approach to the Patient with Musculoskeletal Pain," and "Recognition and Management of Patients with Specific Rheumatologic Problems." The authors represent different disciplines of medicine and many of them are well known experts in their fields. This book contains very well organized algorithms and tables, with information that would be useful for any physician involved in the management of musculoskeletal disorders. Many radiographs and graphic presentations of diagnostic tests are featured. A section entitled "Aspiration and Injection of Joints and Soft Tissues" describes indications and techniques of aspiration and injection of joints. I would like to see a notation that only experienced operators should be involved in this form of therapy and that prior training should be considered essential. A section "Pain - Its Origin, Consequences and Management" is very interesting but probably a little too complicated for the everyday clinical use of this book. Some recommendations for the management of chronic pain are consistent with the American College of Rheumatology guidelines, but not necessarily in accord with the consensus among Canadian rheumatologists (e.g., acetaminophen as the drug of choice for relieving mild to moderate musculoskeletal pain and considering nonsteroidal antiinflammatory drugs treatment only). In Part I, Chapter 9, "Drugs that Relieve Pain and Inflammation," oral gold and d-penicillamine are described among other effective and quite acceptable medications such as hydroxychloroquine, sulfasalazine, and methotrexate. Some information on the efficacy of those drugs in the treatment of rheumatoid arthritis would be useful to the reader. In the Appendix, the "Protocols for the Medical Management of Musculoskeletal Complaints" are not going to be easily followed by the primary care physician, especially when higher than average dosing is advised, (i.e., hydroxychloroquine, 600 mg per day). It is quite useful to have geriatric medicine covered as well as musculoskeletal diseases of children. I found quite interesting the sections dealing with musculoskeletal problems involving orthopedic surgeons, as well as primary care physicians and dermatologists. In summary, this text contains very solid basic information about musculoskeletal disorders but not necessarily for the primary care physician. This will be an excellent review for rheumatologists, orthopedic surgeons, and medical residents in training. I expect that there is a significant amount of knowledge in this book that is beyond the scope of the primary care physician, but it can always serve as a useful reference book. Finally, but maybe not so important, it is good value for the money. WOJCIECH P. OLSZYNSKI, MD, PhD, FRCPC, Clinical Professor of Medicine, University of Saskatchewan, Rheumatology Associates, Saskatoon SK S7K 046 Canada.
Textbook of the Autoimmune Diseases Robert G. Lahita, Nicholas Chiorazzi, Westley H. Reeves, editors, Philadelphia: Lippincott Williams and Wilkins, 2000, 912 pages, price $169 US This textbook was written to present rheumatologists and other specialists managing autoimmune diseases with authoritative and up-to-date information on the basic science and clinical aspects of these disorders. The book is divided in 3 sections dealing with the basic mechanisms of the immune system, autoimmune diseases of organ systems, and disorders of unknown etiology, among which are the autoimmune connective tissue diseases. Included are other interesting topics such as chapters on how to interpret autoimmune tests and environmental autoimmunity. The level of language used in the basic sciences section makes it easy to understand for someone who is not familiar with basic immunology. This review of knowledge is systematic and complete. The second part of this section succinctly presents the pathogenesis of autoimmune diseases. The third section, which concerns most of the connective tissue diseases and systemic autoimmune diseases that are of interest for rheumatologists, is concisely presented in short chapters with many summarizing tables that can be useful for quick reference. In the section entitled "Possible Autoimmune Syndromes", I was disappointed, as a rheumatologist, to see that a full chapter had been devoted to fibromyalgia. This disorder definitively does not have an autoimmune basis and does not justify provision of this space in the book. Black and white pictures are not always graphically interesting but they are clear and efficiently supportive of the text. There is an interesting section of color plates. This textbook presents a summary of knowledge on the pathogenesis of autoimmune diseases and an interesting and practical overview of clinical aspects of these disorders. The price is not high considering the amount of information it contains and it would certainly be a good acquisition for a rheumatologist. PIERRE DAGENAIS, MD, PhD, FRCPC, Hôpital Maisonneuve-Rosemont, Montréal, PQ H1T 2M4, Canada. Rheumatoid Arthritis J.J. Goronzy and C.M. Weyand, editors. Basel: Karger, 2001, 282 pages, price $170.50 US This multi-authored volume is the third in a series on current directions in autoimmunity. It focuses exclusively on rheumatoid arthritis (RA) and addresses both genetic and immunobiology themes in the pathogenesis of the disease. The first 3 contributions cover the genetics of RA as well as the structural basis for the HLA-DR association of RA. The subsequent sections are devoted to immunologic aspects of RA pathogenesis. The role of T cells is explored by 2 different investigators, and leukocyte homing to the synovium is examined by another. There are 2 sections that review the role of molecular mimicry, in RA and Lyme arthritis. The role of the unique synovial microenvironment in rheumatoid synovitis is examined through reviews of lymphoid microstructures and the regulation of apoptosis (programmed cell death) in synovial fibroblasts. The contribution of cytokines to RA pathogenesis is dealt with by 2 investigators, one focusing primarily on tumor necrosis factor-a and interleukin 1 (IL-1) and the other on IL-15. Finally, the role of biologic therapy in the treatment of RA is addressed. The editors of this volume, Goronzy and Weyand, with their own expertise and research focus in RA pathogenesis, have put together a comprehensive review of the basic mechanisms in RA. Although some aspects of disease pathogenesis are not covered, the selection of articles and organization of topics flow well, and address some major issues in understanding the evolution of rheumatoid synovitis. The contributions are all well written, each having a helpful introduction to the topic and clear text that is not overly scientific. Thus, for most sections, the information is accessible to clinicians. That being said, there is an assumption that the reader has an elementary understanding of immunobiology and genetics. This volume will be valuable for anyone with an interest in genetics and basic mechanisms in RA pathogenesis. It is an excellent resource for clinical trainees in rheumatology, rheumatologists with an interest in biologic therapies, or investigators studying RA or other autoimmune diseases. LORI J. ALBERT, MD, FRCPC, University Health Network, The Toronto Western Hospital, Toronto, ON M5T 2S8, Canada. Muscle Pain: Understanding Its Nature, Diagnosis and Treatment S. Mense, D.G.Simons, I.J. Russell, editors. Hagerstown, MD: Lippincott Williams and Wilkins, 2001, 385 pages, price $54.05 US This text is a comprehensive overview of the biology and clinical features of muscle pain. The 3 authors are recognized authorities in this field and have made many contributions to the topic of muscle pain over the years. The authors' stated purpose in producing this book was "to present an overview of the clinical diseases and syndromes associated with muscle pain and to combine the clinical view with new concepts based on neuroanatomic and electrophysiologic research." The first 7 chapters deal with the neurobiology of muscle pain including local and spinal mechanisms as well as central modifying mechanisms. Each chapter focuses on different aspects of biology and how the basic science relates to various clinical features such as local muscle disorders, neuropathic muscle pain, and various referred pain syndromes. The authors point out frequently that many traditional concepts of pain mechanisms are unsupported by research based evidence and are only unconvincing theories. A recurring comment in this text is that investigators who seek to understand pain mechanisms often overlook the concept of myofascial pain. The largest chapter addresses the subject of myofascial pain and gives a detailed discussion of current understanding, clinical features, and management strategies of this common problem. The final chapter is an up-to-date review of fibromyalgia with several pages outlining the disturbed physiology that underlies this disorder. The author discusses various treatment strategies for fibromyalgia. In summary, this is an excellent book. It is well written, has excellent illustrations, and includes a large up-to-date reference base. I would highly recommend this text as a resource for physicians who treat pain disorders. W. JOHN REYNOLDS, MD, PRCPC, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada.
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