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Systemic autoimmunity. Immunology Series Volume 54. Edited by Pierluigi E. Bigazzi and Morris Reichlin. New York Marcel Dekker 1991. 300 pp. Illustrated. Indexed. 149.50

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BOOK REVIEWS
Handbook of Drug Therapy in Rheumatic Diseases. Joseph G.
Hardin, Jr., Gesina L . Longenecker. Boston, Little Brown,
& C o . , 1992. 256 p p . Illustrated. Indexed. $29.50.
This is a conveniently sized handbook apparently
targeted for practical use in the treatment of patients. It is
divided into sections according to the conventional groupings of drugs (nonsteroidal antiinflammatory drugs
[NSAIDs], corticosteroids, slow-acting antirheumatic drugs
[SAARDs], and drugs for gout); it also includes a section on
specific therapy for the more common rheumatic diseases.
The book is adequately, though not exhaustively, indexed.
The handbook has some real and gratifying
strengths. Specifically, it presents an an up-to-date overview
of knowledge about the mechanism(s) of action of the
antirheumatic drugs in a clear, concise way, without venturing into speculation. The discussion of rheumatoid arthritis
(RA) treatment is quite good, although it does not mention
the current controversy about inverting the RA treatment
pyramid. Unlike many other publications, this book addresses the financial burden involved with antirheumatic
drug therapy (particularly with respect to the SAARDs).
As RA is the prototypic rheumatic disease, its treatment is carefully and completely outlined. The book is less
specific, helpful, and comprehensive in describing treatment
of other rheumatic diseases (e.g., Raynaud's phenomenon,
other connective tissue diseases, and degenerative joint
disease). While an explanation for this shortcoming may be
that less good data are available, the contrast with the
thoroughness of the coverage of RA is nevertheless evident.
Furthermore, the discussion on adverse reactions to
NSAIDs could have benefited from more data and more
emphasis on how to avoid adverse reactions (and how to
treat them if they occur).
Overall, I believe Handbook of' Drug Thercrpy in
Rheumatic Diseases has a place in the early teaching about
the treatment of rheumatic diseases, with the clear understanding that it represents the beginning, not the middle or
end, of the curriculum.
Daniel E. Furst, MD
Virginia Mason Research Center
Seattle, WA
Systemic Autoimmunity. Immunology Series, Volume 54.
Edited by Pierluigi E. Bigazzi and Morris Reichlin. Neu,
York, Marcel Dekker, 1991. 300 p p . Illustrated. Indexed.
$149.50.
Autoimmune diseases have historically been classified as systemic or organ specific, according to the pattern of
pathologic involvement. While this distinction retains its
clinical utility, its relevance for understanding disease pathogenesis has diminished. Indeed, research on most autoimmune diseases, irrespective of classification, is now being
approached using a remarkably coherent set of experimental
paradigms. To review this research as it applies to the
Arthritis and Rheumatism, Vol. 35, No. 10 (October 1992)
connective tissue diseases, Drs. Pierluigi E. Bigazzi and
Morris Reichlin have assembled Systemic Autoimmunity.
The volume provides detailed descriptions of immunologic
features of diseases such as systemic lupus erythematosus,
Sjogren's syndrome, and polymyositis; these diseases are
denoted as systemic autoimmune diseases, in contrast to
neurologic and endocrine diseases, which are considered
organ specific.
The book consists of 10 chapters, 5 on pathogenesis
and 5 on specific diseases, all written by leaders in the field.
The focus is primarily on autoantibodies and the role of
genes of the HLA complex in determining their expression
and specificity. The discussion of clinical issues is more
limited, although relevant material for the practitioner is
included in each chapter. The chapters on the specific
diseases are, in general, outstanding, and contain a wealth of
useful information on clinical immunology, as well as comprehensive reference lists.
Although the chapters on pathogenesis are expertly
written, as a group they are perhaps less successful. This
situation reflects problems in distilling, from the large and
emerging body of literature on autoimmunity, the most
relevant material for presentation. Thus, topics such as
pathways of B and T cell activation, T cell receptor utilization, and murine autoimmunity would have all benefited
from more extensive coverage. Since no single volume can
encompass all facets of this dynamic field, these considerations in no way diminish appreciation for this scholarly and
carefully crafted work. Systemic Autoimmunity can be recommended for clinicians as well as researchers interested in
the most recent information on autoantibody responses in
the connective tissue diseases. The purchase price, however. may limit its acquisition for personal libraries.
David S. Pisetsky, MD, PhD
Department of Veterans Affairs, Medical Center
Durhmm. NC
Receptors of Inflammatory Cells: Structure-Function Relationships. Cellular and Molecular Mechanisms of Inflarnmation. Volume I . Edited by Charles G. Cochrane and Michael
A . Girnbrone. San Diego, Academic Press, 1990. 255 p p .
Illustrcited. Indexed. $49.95.
Inflammation is fundamental to defense mechanisms
of higher organisms and is a hallmark of many diseases that
affect humans. Understanding the basic mechanisms of the
inflammatory process is therefore an important goal in both
basic biology and applied medicine. At the cellular level,
each phase of inflammation, such as the recruitment of
inflammatory cells and their activation, with subsequent
elaboration of various mediators, involves interaction between specific ligands and their cognate receptors. Recent
advances in biochemistry and molecular biology have resulted in a profusion of literature on basic mechanisms of
ligand-receptor interactions. The first volume of the series
Cellular and Molecular Mechanisms of Inflammation brings
together these latest advances with specific relevance to
inflammation.
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morris, series, illustrated, bigazzi, systemic, dekker, autoimmunity, immunologic, new, 1991, volume, 300, marcel, pierluigi, york, reichlin, edited, indexes, 149
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