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Oxford Textbook of Rheumatology.
  1. Edgbaston, Birmingham

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    Oxford Textbook of Rheumatology. 2nd ed. Edited by P J Maddison, D A Isenberg, P Woo, D N Glass. (Pp 2208; £195). Oxford: Oxford Medical, 1998. ISBN 0-19-262697-3.

    First time around, I must confess to having purchased “The Other” rheumatological tome—that is, Klippel and Dieppe (KD), attracted by its user friendliness and liberal use of eye catching coloured diagrams, tables, and photographs in contrast with the more monochrome first edition of the Oxford Textbook of Rheumatology (OTR). It was therefore with interest that I agreed to review the second edition of the OTR to see whether I would change my allegiance!

    The two main differences from the first edition, immediately evident from even the most cursory of glances of the textbook are as follows:

    (1) The second edition of the OTR is dramatically more colourful with numerous colour photographs. Furthermore, the tables and line diagrams have improved both quantitatively and qualitatively as well as acquiring colour themselves, somewhat reminiscent in appearance and style of KD (fig 1). An infectious side effect of healthy competition, I suspect! This is most obvious in such chapters as “The skin”, which is now very visual, having previously only had a few photographs in a section distant from the actual text. The chapter on the eye has similarly benefited from colour processing as has the chapter on rehabilitation of children, which is now a sheer delight to read.

    Figure 1

    Representative page from the Oxford Textbook of Rheumatology (p1742).

    (2) The cushingoid-like weight gain! The 57% increase in pages is approaching the number that requires a government health warning for all those readers with weak backs and/or biceps musculature! The third edition is likely to require a tripartite division.

    The comprehensive text and liberal use of illustration will, without doubt, meet the needs of, and attract a wide target audience, defined by the editors as “trainees, full-time clinicians and academic rheumatologists.” There is a happy, balanced marriage between the scientific and clinical components of the text, with the complicated aspects of each explained with welcome clarity. An evidence-based approach is frequently used with summary tables of the available evidence from trials and studies accompanied by more extensive referencing than in the first edition. There are no major omissions, with this edition seeing the welcome arrival of several new chapters including psychological issues in rheumatic diseases, outcome assessment, sports injuries, osteomyelitis, the neurophysiology of pain, and a much improved, well illustrated chapter on injection therapy.

    Most of the disease specific chapters in volume 2 have a similar structure, for example, epidemiology, clinical features, etc, which is particularly useful and educational for those in training. The “Practical Problem” sections of KD however have no equivalent in the OTR and may represent an area worthy of thought for the next edition, useful for both trainees and trainers alike. Most chapters do however have “Points to Remember” lists. These are sadly not universal.

    Fairburn and Kidd, when reviewing the first edition of OTR (Ann Rheum Dis 1995;54:23–4), commented that the placing of the chapter on rehabilitation at the end of the book may reinforce the inferiority of rehabilitation as an aspect of rheumatological care, especially to the younger, less experienced readership. Sadly, both rehabilitation chapters (adult and children) remain at the end of the book and are not actually cross referenced in some of the relevant specific disease chapters, for example, rheumatoid arthritis, systemic onset and pauciarticular juvenile chronic arthritis.

    There are some potentially confusing chapter arrangements, for example, rheumatoid factor positive polyarthritis is included under the heading of rheumatoid arthritis and although it is similar to adult rheumatoid arthritis, some may think it preferable to be seen as distinct from adult rheumatoid arthritis in view of the differences in general management of childhood arthritides.

    Overlap and repetition is almost unavoidable in such large textbooks with multi-authorship. Cross referencing is prevalent but not universal (see above). There are some minor areas of overlap, for example, role of diet in inflammatory arthritis (sections 1.3.6 and 3.5.3) but perhaps the most obvious major area is the overlap and repetition in the regional problems. Whereas the regional upper limb problem section ( includes anatomy and clinical aspects, the soft tissue rheumatism chapter includes pathogenesis as well as the same clinical aspects. My personal opinion is that in this most important area for the “jobbing rheumatologist”, the division is to the detriment of the impact of this section of the text. KD certainly wins hands down for its regional pain section in comparison in this regard.

    In my reviewing process, I tried to think of some practical questions for which a clinician may use the book as a source for quick reference. Useful summary algorithms/sections were readily available for most conditions. Similarly, a useful algorithm is given for management of septic arthritis in childhood though not for adulthood. The algorithm for management of rheumatoid arthritis unfortunately is somewhat confusing (and incomplete in my copy), compounded by the fact that the order of drugs discussed in the algorithm, table, and text is inconsistent.

    This second edition therefore now compares well with the competitors, having been significantly improved upon the previous edition. The competition between the large rheumatology tomes is obviously proving beneficial and long may it continue—it is the readership who will benefit. As my nearest university library has neither the first or second edition of either the OTR or KD, I would recommend all libraries to have both. I wonder when the CD-ROM of this edition is planned!

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