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Biology of the synovial joint.
  1. P SIMKIN
  1. Division of Rheumatology, University of Washington, Seattle

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    Biology of the synovial joint. Eds C W Archer, B Caterson, M Benjamin, J R Ralphs. (Pp 443; £70.) Amsterdam: Harwood Academic Publishers, 1999. ISBN 90-5702-327-X.

    Biology of the Synovial Joint grew out of a symposium held during the summer of 1996 at the University of Wales in Cardiff. The editors convened that meeting in the “belief that joints need to be seen as whole organs”, and the contributors were chosen to provide expert perspectives on each of the major articular tissues. For this volume, the same authors were asked to review their topics to provide “a useful source of reference for anyone interested in the biology of joints”. This is an ambitious goal but in many respects they have succeeded admirably. One example, of many that might have been cited, is a nice review of the structure and mechanisms of entheses. Many rheumatologists who see enthesopathies often, have not thought much about the unique stresses that affect these hard/soft tissue interfaces, the special adaptations found there, and the possible significance of these features in the pathogenesis of common rheumatic diseases. Similarly, the biochemical parallels between the matrices of the synovium and of articular cartilage deserve careful consideration by students of synovitis. Those intrigued by such interrelations of structure and disease will find many other useful starting points.

    “Biology”encompasses a panoply of perspectives and many biologists will be disappointed in the attention paid to their viewpoints. It is surprising, for instance, that there is so little information about subchondral bone or about the unique system of lubrication that makes synovial joints such effective mechanical bearings. Less surprisingly, perhaps, this book avoids almost all of the foci of research interest that dominate most rheumatological meetings and journals. Those seeking information on molecular genetics of rheumatic disease and cellular and molecular mechanisms of arthritis will have to look elsewhere.

    For matters of structure, however, this book is a useful, though somewhat uneven, reference. Havelka and Horn, for instance, make generous use of illustrations to draw attention to the tidemark of articular cartilage, and review effectively the little that is known about this seemingly important interface. Another important chapter, by contrast, includes no illustrations. There is one reference in a discussion of clinical problems of the shoulder but 176 in a review of the collagens of cartilage. Unfortunately, none of the references is more recent than 1997. Given the structural focus of the book, this lack of timeliness is less of a problem than it would be in covering “hotter” areas of science. It is an obvious concern, however, in discussions of more active research areas such as strategies for repair of damaged articular cartilage.

    This volume, though uneven, has many strengths. It is particularly recommended for rheumatologists who would like to shore up their foundation knowledge of the structure and mechanics of articular tissues.

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