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The Textbook of Rheumatology.
  1. CHRIS DEIGHTON,
  2. PHILIP PERKINS
  1. Rheumatology Unit, City Hospital, Hucknall Road, Nottingham NG5 1PB

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    The Textbook of Rheumatology. Edited by William N Kelley, et al. (Pp 1792; £179) Philadelphia, PA: WB Saunders, 1997. 5th ed. ISBN0-7216-5692-7.

    CMD was given the honour of reviewing the fourth edition of this encyclopaedic textbook (Ann Rheum Dis 1994;53:89). He had the following criticisms to make on that occasion:

    (1) Huge tomes go quickly out of date, particularly when CD roms and computer literature searches are readily available.

    (2) Some chapters were unpalatable to a wide rheumatology audience and there was unnecessary overlap between chapters.

    (3) Summaries, conclusions, tables instead of text, and diagrams and pictures were of remarkably variable prevalence between chapters.

    CMD has now been joined by PP to give a trainee’s perspective. Let us tell you about the significant changes from the fourth edition. The editors have brought in a host of new authors but this still remains a largely American textbook with only a hint of an international flavour.

    The highlights of the other changes are:

    (1) A new section on syndromes of impaired immune function.

    (2) A series of chapters under the heading of “Special issues of the rheumatic diseases”, which covers fibromyalgia, nutrition, and rheumatic diseases, psychosocial management of rheumatic diseases, rheumatic diseases in older patients, sports medicine and entrapment neuropathies.

    (3) An expanded section on evaluation of the patient aimed apparently at primary care physicians though covering incredible detail. Even our primary care colleagues with a major rheumatology interest would find this difficult to digest.

    (4) A new chapter on “Metabolic bone disease” that gives a useful update on osteoporosis.

    So are we any happier?

    (1) The problem of huge textbooks going out of date remains. Klippel and Dieppe’s textbook is now available on CD rom and we wonder how long it will take before Kelley is also available in a similar format. This would give us the opportunity for rapid searches as well as being able to download regular updates.

    (2) There has been an improvement in decreasing the overlap between chapters. When discussing complex interrelated systems, some overlap is inevitable.

    (3) There are more tables and diagrams. There also seems to be an increase in the number of useful conclusions to chapters as well as summaries of key points. This, however, remains variable between chapters. Some sections have long paragraphs of detailed information that we are sure would be more acceptable in table form. Overall, however, we feel that the new Kelley is more user friendly than the fourth edition.

    Every rheumatologist has their own favourite huge textbook and, of course, every self respecting rheumatology department should have up to date versions of all the major texts. Kelley remains the most encyclopaedic in our opinion, although we find Klippel and Dieppe’s textbook more user friendly. We shall therefore continue to use this as our first reference text, but on those occasions when it lets us down, Kelley is there as an excellent back up. We look forward to reviewing the sixth edition!

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