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The Spondylarthritides
  1. SIMON DONNELLY
  1. London

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    The Spondylarthritides. Edited by A Calin, J Taurog. (Pp 384; £65). Oxford: Oxford Medical, 1998. ISBN 0-19-262749-X.

    The past 20 years or more have witnessed major advances in the field of seronegative arthropathies including the remarkable association with HLA B27 and the recognition of psoriatic arthritis as a distinct entity separate from rheumatoid arthritis. The reader of this book is optimistic therefore that the pathogenesis of the spondylarthropathies is better understood including the role of enteric and urogenital organisms and that treatment strategies have significantly advanced. Does the book succeed in these areas?

    The strength of this book lies in the excellent chapters on the clinical aspects of these conditions. These sections have a fairly uniform structure with many including a historical reference and a discussion on differential diagnosis. The chapters are well written, up to date (referenced to 1997), and contain appropriate tables to summarise diagnostic criteria and clinical characteristics. Some chapters contain cross references and there is minimal repetition of tables or information.

    The chapter on the eye in spondlyarthritis is especially useful to practising rheumatologists and a similar section on the skin would be useful although this aspect is covered in some chapters.

    The inclusion of a chapter from the patient’s perspective is a novel approach, which is welcome as it provides a different emphasis and demonstrates the importance of support groups in any condition that is both chronic and debilitating.

    The section on pathogenesis and the aetiological role of HLA B27 is detailed but has no summary, which would benefit the reader unfamiliar with this work. It is generally accepted that HLA B27 is directly involved in the pathogenesis of ankylosing spondylitis in particular and its structure and method of antigen presentation have been clarified. However, the mechanism of HLA B27 in disease pathogenesis remains unresolved. Some new insights have arisen from the production of transgenic rat models that express HLA B27 or other animal models. These experiments are clearly presented and may provide answers regarding pathogenesis.

    In my opinion, the book contains an unnecessary emphasis on the views of some authors. This is exemplified in the introductory chapter including the superfluous discussion regarding terminology that favours a blanket term “spondylarthritides” for this group of conditions although other terms are subsequently used interchangeably throughout the text. The diagnostic criteria in the introduction also favours the authors’ approach and again in the chapter on disease outcome there is an emphasis on the Bath Indices of functional assessment, which have not yet been shown to be predictive of long term outcome. These are minor and personal criticisms that do not detract from the value of the book.

    All in all the clarity of the text makes this book excellent reading and an invaluable summary of the current state of knowledge in the field. The fact that the text serves to emphasise that the pathogenesis remains poorly understood and treatment options are limited and often inadequate will hopefully result in many more editions of this welcomed text.

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