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The Antiphospholipid Syndrome.
  1. MARCO GATTORNO
  1. 2nd Division of Paediatrics
  2. ‘G Gaslini’ Scientific Institute for Children
  3. Genoa Italy

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    The Antiphospholipid Syndrome. Edited by R A Asherson, R Cervera, J C Piette, Y Shoenfled. (Pp 330; £127). Boca Raton, USA: CRC Press, 1996. ISBN-0-8493-9423-6.

    During the past 12 years both clinicians and researchers involved in rheumatology, haematology, clinical immunology, and gynaecology have been inundated with hundreds of manuscripts regarding the so called antiphospholipid syndrome (APS).

    As a result of the spread of information about the pathogenesis and clinical aspect of antiphospholipid antibodies (APA) in humans, ‘non-professional APA readers’ have been often puzzled by APA characterisation, criteria for APS definition, reliability of assays for APA detection, and APS management.

    None the less, thanks to the growing number of clinical findings concerning APS, it has became apparent that understanding of this syndrome may be of interest to other medical specialties.

    Asherson and colleagues faced the difficult task of going through the great amount of information on APS and to present it in a systematic and didactic way.

    The book is homogeneously structured in three sections dealing with aetiopathogenic mechanisms of APS (section I), its clinical features and laboratory aspects (section II) and, finally, the new strategies for its management (section III).

    The choice to subdivide the three sections into short chapters written by a number of experienced European, American, and Israeli contributors has the undoubted advantage of allowing a detailed review of all the issues examined. Most of the chapters are referenced until 1994, and some to 1995.

    On the other hand, because of the number of contributors, repetition or overlap sometimes occur in the text, even if the structured format of each chapter leads to a final result that is pleasantly homogeneous.

    Most of the chapters (especially those on pathology and clinical manifestations) are beautifully illustrated with black and white and colour reproductions.

    The pathophysiological section benefits from the experience of the editor, Y Shoenfeld, and sheds light on the possible mechanisms of actions of APA. Because of the underlying ‘rheumatological cut’ of the book this section suffers from the lack of an ‘haematological perspective’ of APS pathogenesis. The same limitation occurs in the pages dedicated to the methods for detection of APA, especially when lupus anticoagulant is considered. This topic deserves a wider consideration in a separate chapter. The last chapter of the first section on the pathology of APS is remarkably well written and illustrated by J T Lie.

    The most fascinating part of the book is the clinical section, edited by R A Asherson and R Cervera. All the clinical manifestations possibly related with APA have been skilfully retrieved from the multitude of isolated case reports or small series of cases available in the medical literature. The final result is a truly complete and organic treatise of great usefulness for everyday clinical practice.

    In the last section of the book, edited by J C Piette, the (few) certainties and the (many) open questions on the management of the thrombotic event and on the possible prophylactic strategies to prevent fetal losses and thrombotic relapses are clearly outlined by the authors.

    Overall, the book represents for rheumatologist and haematologists a complete compendium of the state of the art of APS during the first 10 years of its existence or (better) ‘renaissance’. Moreover, thanks to the exhaustive clinical and therapeutic sections, it may be also considered as a good opportunity for clinicians and researchers from other specialties (paediatricians, gynaecologists, neurologists, dermatologists, nephrologists, ophthalmologists, cardiologists, pneumologists, and general practitioners) to face the ‘minefield’ of APS in a systematic and complete way.

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