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Connective Tissue Diseases.
  1. NEIL McHUGH
  1. Bath

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    Connective Tissue Diseases. Edited by JJF Belch and RB Zurier. (Pp 392; £79.00.) Andover: Chapman and Hall, 1995. ISBN 0 412 48620 2.

    A potential problem in bringing connective tissue diseases under one heading is what we mean by the term and what to include. The editors have steered a safe route and included almost everything, although one could argue that osteoarthritis (which is not included) belongs as much as rheumatoid arthritis. In fact the latter is given a small chapter that seems rather incongruous in terms of its relative importance, and the management of important systemic manifestations such as Felty syndrome and rheumatoid vasculitis is barely touched upon. Osteoarthritis does get a mention under the molecular biology of inherited disorders of connective tissue—a rather curious chapter where there is a lot of valuable detail but lack of integration between the respective coauthors’ contributions. I liked the final section on future therapeutics which was imaginative and up to date and would not be out of place in many standard texts on inflammatory disorders.

    Most attention is given to “autoimmune” connective tissue disease if one is allowed to include systemic sclerosis under that term. Some chapters are more thorough than others, for instance polymyositis and dermatomyositis is comprehensive if not a bit wordy with 174 references, whereas scleroderma is understated and lacking a useful approach to diagnosis and management. Systemic lupus erythematosus is excellently covered, with about the right balance of clinical depth for a book of this size and contributes the most to a central panel of 11 colour plates. Otherwise chapters are well illustrated, including the two covering “primary” and “secondary” vasculitis respectively. The slightly arbitrary division between these two chapters does pose a few difficulties, which is almost inevitable in any attempt to carve up vasculitis. Microscopic polyangiitis is mentioned but not discussed and I would have liked to have seen a bit more on ANCA and its possible pathogenic significance. In contrast, the immunopathology of Sjögren syndrome is comprehensive yet the management section relatively brief. It seems that the interests of the contributors have been catered for in places at the expense of a more uniformly structured approach to each of the respective conditions that are covered.

    Having said all the above I liked the book, which sets out to inform physicians involved in the management of connective tissue disease. Anyone working full time in the area may pick up a few tips, but the real value may well be to those with more general interests, including physicians, medical trainees and students, scientists working in related research, and health professionals caring for patients with some of these complex multisystem disorders. The book is well referenced and indexed for the casual browser, which is necessary as some aspects are not covered in depth. There is a need for a book of this kind, but future editions may do well to concentrate even more on management issues of challenging clinical situations where there may be no help from evidence based medicine. Here a more personalised approach in some of the chapters would be very helpful and enhance the value of a book which otherwise is a welcome addition to the literature in this field.

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