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Living with Arthritis. Tammi L. Schlotzhauer James L. McGuire. Baltimore Johns Hopkins University Press 1993. 216 pp. Illustrated. Indexed. 22.95

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enzyme-linked immunosorbent assay (ELISA) would be
helpful, since sera with precipitins virtually always have titers
in excess of 10’-fold over the limit of detection. The presence
of this level of binding over background is usually technically
straightforward, and the results produced are obvious.
We raise these issues since we realize how difficult it
is to define multiple precipitin lines, having originally described several of these systems in the 1960s and 1970s.
Indeed, it is because of such difficulties that we performed
the quantitative ELISAs to confirm our findings (see Table 3
of our article).
A final important difference: As stated in our paper,
every sample we tested was collected when the patient first
presented to the clinic, and none of the 6 patients with the
3-precipitin profile had previously been treated at presentation to the clinic. Aggressive therapy was required in each of
these 6 patients, and the precipitin profiles changed dramatically within 1 year with therapy. Two of these 6 patients lost
all 3 precipitins, 2 lost anti-nRNP, and 2 lost anti-Sm. Thus,
if we had not examined the first sample from the untreated
patients, we might have missed them all.
It is not clear from the data presented by Joseph et a1
if the samples tested for precipitin analysis were from
untreated patients. If not, as outlined above, the relevance of
their data to our findings would be in doubt. Also, though
perhaps not previously emphasized, we believe that any
prognostic value these observations may have is limited to
untreated patients at presentation.
G . A. McCarty, MD
King Faisal Specialist Hospital
Riyadh, Saudi Arabia
J. B. Harley, MD
M. Reichlin, MD
Oklahoma University Health Sciences Center
Oklahoma City, OK
Oxford Textbook of Rheumatology. Vols. 1 and 2. Edited by
P . J . Maddison, David A . Isenberg, Patricia Woo, and
David N . Glass. New York, Oxford University Press, 1993.
1,308 p p . Illustrated. Indexed. $210.00.
I liked this new textbook of rheumatology. The
number of textbooks is multiplying and the field is getting
quite congested; so much so that one would think that the
subspecialty’s star is in the ascendant. This book is mostly
authored by consultant rheumatologists from the United
Kingdom. As such, it has a slightly different tone from that
of the textbooks from the United States. The book is
practical, concise, and the emphasis is on the clinical.
However, the basic science material is adequately presented, and in a fashion that makes it approachable to the
non-research rheumatologist or fellow.
All of the standard clinical diseases are well presented, and there are some special chapters that are well
worth while. An entire section in the first volume is called
“Views from Different Perspectives” and brings together
such diverse topics as the subspecialty disciplines and rheumatic conditions, as well as pregnancy and psychiatric
considerations. It’s handy to have this approach when one is
searching for, say, an endocrine interaction in a rheumatic
disease. Some chapters may reflect the influence of this
textbook in the Commonwealth: it was intriguing to see an
entire chapter devoted to Brucella and another to the musculoskeletal manifestations of parasitic diseases.
The clinical discussions were candid and informal.
As I sat in my chair reading the book, I felt I was in the
presence of good, earnest doctors. The prose was clear, and
patient considerations were often emphasized.
There are always problems with multiauthored texts,
problems intrinsic to the effort to encompass an entire
subspecialty. Invariably compromises are made. Some chap-
ters are stronger than others. Rapidly changing basic science
is nearly out of date by the time of publication. The balance
between basic science and the practice of our art is difficult.
References were not always the ones I might have emphasized.
However, the focus of the textbook is uniform, the
attempt to be comprehensive succeeds, and the book is
portable without any prior weightlifting in the gym. The print
is clear, and the pictures are well reproduced and well
selected. If one had to purchase one textbook of rheumatology, this would probably be my choice.
Stuart B. Mushlin, MD
Stamford, CT
Living with Arthritis. Tammi L. Schlotzhauer, James L .
McGuire. Baltimore, Johns Hopkins UniversiQ Press, 1993.
216 pp. Illustrated. Indexed. $22.95.
This is a well-written, comprehensive book that will
be a valuable asset for many patients with rheumatoid
arthritis. Because of the detail and the level of writing, it will
appeal mostly to the well-educated, highly motivated patient. Sections on coping with rheumatoid arthritis, exercise
and rehabilitation, beyond medications, and practical matters are particularly well done and will make excellent
reading for those who want to learn more about their
There are several places where optimistic statements
about the outcome of rheumatoid arthritis are not supported
by facts. Specifically, the book states that: “Today, the odds
against becoming disabled are overwhelming in the patient’s
favor.” And again, when responding to whether or not an
individual patient will become disabled, it states that the
probability of this is “highly unlikely.” I think it is very
important to stress the positive aspects of treatment and
therapy, but to say that the odds are overwhelmingly against
somebody becoming disabled because of rheumatoid arthritis is clearly not supported by current data. Additionally,
there are some dogmatic statements that may cause some
concern for physicians caring for rheumatoid arthritis patients. One such statement is: “Never take more than one
NSAID at a time.” This may be a particular problem for
patients who are taking aspirin for heart disease, etc.
”& b39
3-2-95 T6
In summary, I believe this book is well-written and
will be a valuable resource for patients with rheumatoid
arthritis who are highly motivated to learn more about their
disease. I will recommend it with enthusiasm to my patients.
James R. O’Dell, MD
University of Nebraska Medical Center
Omaha, N E
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living, illustrated, university, hopkins, schlotzhauer, john, 216, 1993, tamm, mcguire, arthritis, indexes, baltimore, pres, james
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