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Book Review Crystal–Induced Arthropathies, Gout, Pseudogout and Apatite-Associated Syndromes Robert L. Wortmann, H. Ralph Schumacher Jr, Michael A. Becker, Lawrence M. Ryan, editors, New York: Taylor & Francis Group, 2006, 427 pages, price US$217.00 Crystal-associated syndromes are common events in the emergency room and at rheumatology and orthopedic clinics. Often satisfying to treat because of the rapidity of clinical response, they are more often a challenge because of chronicity and progressive destruction, deformity, and disability. The editors of this volume, all respected clinician-scientists, along with 35 other experts in their fields, present historical reviews, prevalence, natural history, associated clinical conditions, epidemiology, clinical aspects, pathophysiology, diagnostic tools, biochemistry, pathology, and approaches to older established and newer therapies for gout (urate), pseudogout (calcium pyrophosphate dehydrate, CPPD), and basic calcium phosphate (BCP, calcium apatite) deposition diseases. The identification and association of urate crystals with acute arthritis is a recent (1960) event. The editors write that "much of the present understanding of these diseases is the result of observations that have occurred during the span of our careers." Population-based investigations suggest that the prevalence of gout is rising and that hyperuricemia is a strong, independent marker of mortality in coronary heart disease. Asymptomatic hyperuricemia and the concept of urate as a biomarker of endothelial dysfunction and vascular disease is intriguing although controversial. Prevalence data for CPPD and BCP deposition are derived from autopsy and radiographic reviews. The descriptions of the clinical aspects and genetics of the familial forms of crystal-associated arthropathies are interesting reading. The management of crystal-associated arthropathies includes chapters on colchicine, nonsteroidal antiinflammatory drugs, corticosteroids, uricosuric agents, xanthine oxidase inhibitors, uricase, and therapeutic strategies. The editors are to be congratulated on the presentation of this concise, in-depth, and current review. It is recommended reading for trainees and their mentors in rheumatology, orthopedic surgery, and physiatry, and others who have a particular interest in these common crystal-associated arthropathies. Joseph B. Houpt, MD, 49 Sunnydene Crescent, Toronto, ON, Canada M4N 3J5 |