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Controversies in Rheumatology. Edited by D A Isenberg and L B Tucker. (Pp 180; £49.95). London: Martin Dunitz, 1997. ISBN 1-85317-395-9.
It has been said of cardiology that no medical discipline enjoys such a wealth of high quality data, which in turn are routinely ignored in practice. Rheumatology can be considered the opposite. As a group, we tend to enthusiastically accept preliminary and incomplete data as definitive. The pathogenesis of this optimism is our difficulty as a discipline (largely because of economics) of developing and realising the appropriate definitive clinical trials. This multiauthored text features 15 short reviews by true experts in diverse areas of clinical rheumatology where the core issues are important but where the crucial data are lacking and where reasonable differences in opinion can be easily supported.
Subjects run a diverse gamut from our incomplete understanding of the pathogenesis of growth retardation in juvenile chronic arthritis to a review of the increasing doubtful role of heat-shock proteins in joint inflammation. Each essay is tersely and elegantly presented with economical use of tables and comparatively short and highly focused bibliographies. The editors are to be commended for having effectively enforced reasonable uniformity of style and scientific depth. The net result is an immensely readable and generally well done book.
The weaknesses of the text are its relative superficiality and the diversity of its chosen subjects. Regarding superficiality, we are told that pain is the commonest complaint of rheumatology patients and that antibodies are immunoglobulin molecules. Regarding diversity, topics in addition to those mentioned above include the role of HLA-DRB1 in rheumatoid arthritis, the role of gastroprotective agents in practice, the appropriate use of methotrexate and the newer investigational monoclonal antibodies in rheumatoid management, the epidemiology of systemic lupus erythematosus in Africa, the role of Klebsiella in ankylosing spondylitis, as well as clinical treatises on issues of diagnosis and management of systemic lupus erythematosus, so called ‘mixed connective tissue disease’, and childhood rheumatological disorders. The editorial goal was eclecticism, the result is one of diffuseness.
There is little new or insightful information for the authors’ peer group of focused researchers. I would recommend the text to the senior trainees or junior faculty members seeking to identify an area of research focus and/or to the clinical generalist as a time efficient mode of catching up with selected changing subject areas.
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