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Infection and immunology in the rheumatic diseases. Dudley Dumond Editor. London Beadsworth 1976. 600 pages

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only a distinct form of a variety of mixed connective
tissue syndromes. In our opinion this term should be
used until another etiopathogenetic term is found. Other
proposed terms-Sharp
connectivitis, rheumatoid
lupus, and ENA syndrome-seem to be less suitable.
We hope that other interested rheumatologists will offer
their opinion on this issue in order to establish an easier
and more acceptable terminology.
Department of Rheumatology
University of Basel
CH-4055 Basel, Switzerland
amoris and genu remoris, such as the result of pleading
unsuccessfully for forgiveness while on one knee-genu
Division of Rheutnatology
Department of Medicine
Division of’ Orthopaedics
Departttient of Surgery
University of’ Texas Health Science Center
San Antonio. Texas
I . Sharp G C , lrvin WS, Tan EM, et al: Mixed connective
tissue disease. A n apparently distinct rheumatic disease
syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J Med 52:148-159, 1972
An Unusual Complication
of Genu Amoris
To the Editor:
Traumatic arthritis of the knee secondary to extraordinary athletic talents in love-making has been
coined genu amoris in a case report by Pinals (A&R
19:637-638, 1976). We report an unusual complicaton
of this entity. A 32-year-old woman was admitted to our
hospital for left knee pain and swelling of 4 days duration. Four weeks earlier she had been treated with benzathine penicillin for a positive VDRL in the local
health clinic and had been instructed not to have sexual
relations for an unspecified period of time. When she
violated these instructions, she was filled with remorse
and attempted to atone with vigorous prayer, which
included genuflexion and kneeling. Within 24 hours she
had developed swelling of her left prepatellar bursa with
minimal warmth and decreased flexion of the knee.
A work-up including pelvic examination with
gram strain and culture was completely negative. Fluid
aspirated from the painful area had a W BC count of 650
cells per cubic millimeter, was sterile, and did not contain crystals. The prepatellar bursitis revolved promptly
with heat and buffered aspirin.
Borrowing Pinals’s nomenclature, we feel that
this case could appropriately be termed genu remoris.
.4nd we suggest the possibility of sequelae t o genu
Arthritis and Rheumatism, Vol. 20, No. 3 (April 1977)
Infection and Immunology in the Rheumatic
Diseases. Dudley Dumond, Editor. London,
Beadsworth, 1976. 600 pages.
By editing Infection and Immunology in the Rheutnatic Diseases, Dr. Dumonde has done a major service
for those working in rheumatology, clinical immunology, and infectious diseases. This handsomely composed and printed volume of 600 pages comprises, in a
sense, the proceedings of a memorable symposium held
in London in 1974. However, because articles were submitted until the summer of 1975, the volume is quite
current. Seventy-nine research or review contributions,
seven edited discussions, and a WHO report are
grouped into five broad areas: immunologic response to
microbial infections; evidence associating various rheumatic diseases with infection; genetic and epidemiologic
considerations: immunopathologic mechanisms: and a
sometimes speculative, sometimes widely ranging section on future trends.
The signal strength of Infection and Immunology
is the comprehensive treatment of the subject of infectious processes in relation to rheumatic disease. Access to a sometimes otherwise difficult literature is afforded by authoritative contributions in this area. The
treatment allotted to the immunologic aspects of the
rheumatic diseases is rather more selective and limited,
and appropriately so.
The articles vary in perspective, some taking the
form of reviews, others covering new experimental find-
ings; still others vary from the carefully crafted historic
approach to the broadly visionary. The scientific quality
of the contributions is generally very high, although in a
few isolated places one might wish for slightly ,more
rigor. The discussion sections provide an intellectual
buffet of varied composition and character, spiced by
occasional deep insights and generalizations. They are
particularly valuable in providing a perspective of each
subject area. A useful feature of the book is the detailed
author and subject index.
Infection and Immunology in the Rheumatic Diseuses is important and timely. As a reference and as a
source of stimulation, it is very much the sort of book
one would like to have on one’s own library shelves.
The Rockefeller University
New York. New York
Gout and Uric Acid Metabolism. John H . Talbott, M . D., and Tsai-Fan Yu, M . D. New York,
Stratton Intercontinental Medical Book Corporation, 1976. 320 pages. Price: $34.00.
Gout and Hyperuricemia. James B. Wyngaarden, M.D., and William N . Kelley, M . D . New
York, Grune & Stratton. 1976. 512 pages.
Price: $39.50.
I t seems paradoxical to suggest that a few of the
frustrations begot by a swelling medical journalism
should be relieved by the near-simultaneous publication
of two authoritative books on gout. The major investigations in gout have probably been completed, and
some now await a place in histories of the type that
embellish both books. As is possible with few medical
texts, these answer most of the important questions
relating to their subject matter. Examples of unanswered
questions form the basis for an epilogue in Gout and
Uric Acid Metabolism.
Arthritis and Rheumatism, Vol. 20, No. 3 (April 1977)
As symbols of the conquest of gout, both are
exemplary. Total praise is a tight and unfamiliar corner,
but Wyngaarden and Kelley may merit total praise for
theirs, an outgrowth of their admirable chapter on “The
Metabolic Basis of Inherited Disorders.”
Gout and Hyperuricemia, which deals also with
hypouricemia, reads well, the authors’ verbal and scientific skills being equally noteworthy. It is well organized
and comprehensive, with chapters varying from “Hyperuricemia in Filipinos, Micronesians, and Polynesians”
to “Prognosis in Gout.”
Clinical features of gout are dealt with as expertly
as are the physiology and biochemistry of purine compounds and the pathophysiology of primary and secondary hyperuricemia. The case histories are interesting
and systematically instructive. Suggestions for treatment
of gout and hyperuricemia, including the recognition
and management of renal failure, are likely to be helpful
t o all physicians, including those with an established
interest in gout. Wyngaarden and Kelley use their material no more than that of others, filling their book with
a,ppealing details made possible by discernment and a
thorough search of the literature. Although the authors
are generous in quoting others, they seem to do sofat
times without attribution.
Dr. Yu has joined Dr. Talbott in revising his
book, enriching it with knowledge gained froni a lifelong study of gout attested to by 49 or more (of 1010)
references to papers she wrote with colleagues. Adding
considerably to the scope of Gout and Uric Acid Metabolism, Dr. Seegmiller has written a chapter on “Intermediary Purine Metabolism and Its Regulation,” which
is informed by his own pacemaking investigations.
The illustrations and photographs that enliven
this work are valuable, particularly those in “History”
and “Diagnosis.” With one or two exceptions, those in
the section on differential diagnosis were particularly
edifying, though surely the cystic, fused carpal bones in
the X-ray film of a wrist in Fig. 153 are more compatible
with the “RA” for which the patient was treated than
with Paget’s disease, which was “confirmed” by biopsy.
University of Alabama in Birmingham
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london, dudley, 1976, beadsworth, 600, rheumatic, editor, dumont, disease, infectious, immunologic, page
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