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Rheumatology guidebookA step-by-step guide to diagnosis and treatment. R. Ferrari J. Cash and P. Maddison. Oxford BIOS Scientific Publishers Ltd. 1996. 240 pp. Illustrated. Indexed. ╨Т╨И19.95

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therapy, adjuvant therapy, extracorporeal photochemotherapy,
and plasmapheresis, are extensively reviewed.
The editors have solicited an excellent group of authors, and this book will add significantly to the knowledge
base as a reference for students, residents, and clinicians who
treat patients with immunologic diseases.
Larry W. Moreland, MD
The University of Alabama at Birmingham
Rheumatology Guidebook A Step-by-step Guide to Diagnosis
and Treatment. R. Ferrnri, J. Cash, and P. Maddison. Oxford,
BIOS Scientific Publishers Ltd., 1996. 240 pp. Illustrated. Indtxed. f 19.95.
This book is well written, and the authors make a
concerted effort to emphasize the thinking process rheumatologists use when approaching diffuse pain, localized pain,
and then localized pain and swelling. They have constructed a
unifying diagnostic algorithm, and there is also an entire
section entitled “Outside the Algorithm” where they discuss
the more general topics of the painful back, the painful neck,
systemic sclerosis, inflammatory myopathies, vasculitis, reflex
sympathetic dystrophy, osteoporosis, and pediatric rheumatolow. Many of the specific diseases are followed by a short list of
“do’s and don’ts,” which are particularly insightful comments.
The book occasionally reads like an instruction manual, particularly as the authors refer to specific parts of the
algorithm (as in “now we can proceed as if the patient has
complained of localized pain . . .” or “you are traveling down
the algorithm towards the arthritis zone.”). 1 found this
directional style sometimes to be fun but sometimes to be
slightly patronizing. The introduction states that “Rheumatologists’ offices . . . are filled with straight-forward, misdiagnosed cases, that could have been avoided by the use of the
algorithm . . .” but that judgmental tone quickly fades in the
other chapters. The style is useful in conveying a sense of the
thought process often required to arrive at a specific rheumatologic diagnosis, and this is clearly the best quality of the
The illustrations are helpful but not attractive. The first
appendix has a rather simplistic list of “physiotherapy exercises”; the second appendix is a list of soft tissue inflammatory
disorders, all of which were covered previously in the text, and
the third appendix concerns joint aspiration and injection
techniques but does not include the anatomic information
necessary to perform such injections. The entire book is
referenced with only 5 very general textbook references.
One could quibble as to whether systemic lupus erythematosus belongs in a very general algorithm under the
heading “Localized Pain with No Joint Swelling.” Palindromic
arthritis is mentioned under the heading “Objective Joint
Swelling, Monoarticular, Brief Episode,” in a way that suggests
that its frequency might be more than some rheumatologists
actually see in their practice. The sections on regional examination are particularly well-written, although the inclusion of a
list of signs of malingering early in the section on examination
of the lumbar spine may be viewed as somewhat cynical. In the
section on the painful back there is a reference to Appendix 5,
and there is no such appendix. These issues do not detract
greatly from the book‘s many positive, strong points.
The book emphasizes diagnosis rather than treatment.
The approach is necessarily basic, and the flavor suggests that
the intended audience is nonrheumatologists. There is little
new information in the book, but this is not a criticism. The
information provided is very practical. I believe the book
would be most interesting for medical students, residents, and
general and family practitioners. The specifics of the process
that the authors as rheumatologists use to approach rheumatologic problems might be interesting for rheumatologists to
review, but there i s probably not enough detail, controversy, or
treatment specifics to make this a valuable addition to a
practicing rheumatologist’s library.
The title of the book emphasizes that it is a guide, and
I do think that the authors have accomplished their purpose,
particularly with regard to guiding readers to rheumatologic
diagnoses. The writing is clear, and the use of case scenarios is
also helpful. The clinical emphasis is very appealing. The lists
of “do’s and don’ts’’ are important and entertaining. For the
right reader at the right time, this will be a very pragmatic and
worthwhile book.
Marc D. Cohen, MD
Mayo Clinic
Jacksonville, FL
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1996, scientific, step, treatment, illustrated, maddison, guidebook, ferrara, ltd, cash, 240, guide, rheumatology, bios, indexes, и19, diagnosis, publisher, oxford
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