Article Text

PDF

Vasculitis
  1. A Wiik

    Statistics from Altmetric.com

    Seventy contributors collaborated with the editors to produce this work on vasculitis and vasculopathies that may mimic inflammatory vessel diseases. The first four chapters deal with classification of vasculitic syndromes and basic scientific information on hypersensitivity, endothelial cell biology, and theories about the pathogenesis of vasculitis. The next seven chapters summarise the clinical manifestations that are common to vasculitides such as cutaneous and mucous membrane, ophthalmological, pulmonary, neurological, and renal manifestations as well as digital ischaemia. Imaging techniques used for the diagnosis of vasculitis are the subject of two chapters. All the vasculitic diseases and syndromes, as well as mimicking diseases and thrombotic syndromes, are then covered in 26 chapters. About half of the contributors are from the United States and the other half from Europe, Asia, the Middle East, and Africa. These authors cover the many specialties in internal medicine necessary to collaborate on the diagnostics of vasculitides such as rheumatology, radiology, immunology, dermatology, nephrology, pulmonology, and others.

    The target readership is doctors of many different disciplines, but the book may also be used by medical students who need more information than most ordinary textbooks can offer. The main emphasis has been placed on the various clinical syndromes and thus will be of long term interest to readers. Less importance has been given to the more theoretical topic of immunopathogenesis, mainly because such theories are constantly changing as cell biology and molecular biology techniques used for the study of patients give rise to many new data and ideas every day. Nevertheless, the chapters covering the more theoretical aspects of vasculitis contain most of the current theories about the immunopathogenesis and immunopathology for vasculitides.

    The general outline is logical, but the different chapters are very unevenly and differently structured, indicating that each author has been left the freedom to organise the individual chapter. Some chapters are nicely tabulated and have many good illustrations, although most of the pictures of clinical manifestations and histopathology are in black and white in the text. The editors have tried to compensate for this by adding 13 pages of full colour illustrations in the middle of the book. It would certainly have been preferable to place these full colour illustrations adjacent to the text where they belong. Most chapters have many references that will allow readers to find original information. The chapters covering strategies of diagnosing vasculitis within the spectrum of diseases in adults and children are somewhat difficult to read and contain only one algorithm to visualise a useful diagnostic approach. In addition, it is unfortunate that childhood vasculitides are classified differently from those of adult patients. There ought to be general agreement that the Churg-Strauss syndrome, Wegener's granulomatosis, and primary vasculitides of the central nervous system belong to small vessel vasculitides also in children. Tables to summarise diagnostic strategies would have made the chapters more readable. The chapters on imaging techniques are really excellent and well illustrated, and the epidemiology of the vasculitides is well covered. More illustrations would have added value to the chapter on assessment of disease activity and damage.

    It is impossible to avoid rather large overlaps between the different topics of the book, but this allows the reader to concentrate on a given topic and still get most of the necessary information in one chapter. There is a good index but many of the abbreviations used throughout have not been listed in the section on abbreviations at the beginning. Generally, the content is comprehensive and there are no major omissions. It is not quite obvious why polyarteritis nodosa is covered in the same chapter as microscopic polyangiitis, as these topics are clearly separated both in current publications and in the authorship of this chapter. The fact that both the pathogenesis and the treatment strategy are usually different would also indicate that separate chapters would have been more logical. In some of the illustrations detailing events in the pathogenesis of Wegener's granulomatosis a number of abbreviations have been used which are not explained to the reader. Treatment of this disease is well covered, although several of the more recent treatment modalities in use are not mentioned. The chapter on Behçet's disease is excellent, but the illustration of the geographical distribution of the disease cannot be read owing to the use of very similar grey scale spectra. A non-specialist reader will find the chapter on the immunogenetics of Behçet's disease very complicated. The difficult topic of central nervous system vasculitis is very explicit and clear considering the complexity of this clinically challenging diagnostic field. It is not quite clear why the antiphospholipid syndrome has been included in a book on vasculitis, but the topic is well covered and illustrated.

    The less well structured chapters and the slightly deficient illustrations and explanation of abbreviations may be because this is a first edition, but the book probably lives up to the expectations of the authors and the readership, and can fill a gap in the market.

    View Abstract

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.