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rheumatology. edited by rodney bluestone MB. Boston Houghton Mifflin Professional Publishers 1980. 527 Pages. Illustrated. Indexed. Contains Cme Post-Test

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110
neous nodules were demonstrated. Asymmetric swelling
and tenderness of the metacarpophalangeal and wrist
joints were present to a modest degree. Swelling involving mostly the superior and medial aspect of each
knee (more marked on the right) was obvious on inspection. Both knees were moderately warm and had a
fluid thrill, though the conventional bulge sign for fluid
was absent because of excessive fluid tension. However,
there was only a mild degree of pain at extreme flexion
and extension of the knees. Results of the rest of the examination were normal.
On aspiration, the right knee yielded 363 cc of
fluid and the left knee 110 cc. Both knees were then injected with 60 mg of Depo-medrol. The mucin clot was
fair and the synovial fluid white blood cell count (WBC)
was 3,600, with 52% neutrophils. Blood test results included normal WBC and hematocrit, ESR of 30 mm/
hour, normal chemistry, and negative rheumatoid factor
and antinuclear antibody.
LETTERS
The knee effusion recurred twice bilaterally in
the next 5 months, yielding less than 100 cc of fluid on
each occasion. The patient now remains fairly well on
Clinoril and gold therapy after 10 months of followup.
It is interesting that despite a huge effusion in
each knee, the patient’s symptoms were only modest,
and synovial fluid was only mildly inflammatory. A
large collection of fluid in any joint, however, is detrimental because of mechanical stress factors.
Although a huge effusion as in this patient is
amusing at best to most physicians, it would be interesting to know if any physician has aspirated by needle
a larger volume of fluid from any joint. Who knows,
someday this may find its place in the Guiness Book of
Records!
MUHAMMAD
YUNUS,MD
Peoria School of Medicine
Peoria, Illinois 61605
BOOK REVIEWS
Rheumatology. Edited by Rodney Bluestone, MB. Boston, Houghton MiffIin Professional Publishers, 1980. 527
pages. Illustrated. Indexed. Contains CME post-test.
The concept of producing a multi-author book in
rheumatology from a single medical center was pioneered by Mason and Currey in London, and Rodney
Bluestone, transplanted from there to Los Angeles, has
adopted the concept for these shores. It is a valid one, as
it allows the editor and his authors to meet frequently to
exchange opinions, permits the editor to browbeat slow
contributors, and above all, gives the feeling of cohesion
to the volume by taking away some of the uneveness
that characterizes books whose authors are geographically remote from each other.
The editor is known as a dynamic and gifted lecturer; his prose, in the many chapters he has contributed, is worthy of him. His opinions are as forcefully delivered as ever, and not everyone shares all of them (but
then, because rheumatology is a clinical science, there is
still considerable controversy about many opinions
firmly held by some and disputed by others). Several of
his authors are equally forceful and the book as a whole
is easy reading and stimulating even to the cognoscenti.
Identified as aiming at internists, this would be a
good initial textbook for both students and housestaff,
including fellows. A fairly good exposition of contemporary rheumatology, it provides a good introduction.
Case reports which amplify the various disease concepts
are graced by pertinent references. However, the chapters on the various diseases, approaches, concepts, and
treatments do not include references; instead some suggested readings are listed at the end of the chapter. Although most of these are aptly chosen and appropriate,
some are not, and better choices could have been substituted (for example, a book on the psychology of arthritis listed is probably the worst I have ever encountered). Unlike some other books purporting to explain
rheumatology to clinicians, this one actually does. I can
recall, while serving in the Armed Forces, attending lectures that told me more about the subject than I really
wanted to know; I have encountered many articles and
books since then that would fit that description; this
book does not.
Having complimented the volume thus far, let
me also mention its flaws. Rheumatology is not of much
use to a clinician attempting to make a diagnosis, and it
suffers from the same drawbacks as the encyclopedic
works it so frequently cites. This book discusses the various diseases and syndromes, but one must already
know which condition is present to refer to this volume
when confronted with a patient. Also, while the case report mentions it, involvement of proximal interphalangeal joints in interphalangeal osteoarthritis is not
cited in the text, a serious omission since this symptom
BOOK REVIEWS
111
is a frequent source of misdiagnosis. Thus, this work is
not problem-oriented. As a textbook, it is fine; as for
providing an answer to a clinical conundrum, it may not
suffice. The chapters on medical treatment can only
stimulate the reader to look up the compound he or she
wishes to use; they do not give enough information to
set up treatment programs. The discussion of psychology is somewhat too short and lacks comprehensiveness;
one is sorry to see that counseling of patients and families in a number of areas, including the social and sexual, gets short shrift. The suggested readings need better
proofreading and editing; sadly, Hollander is no longer
a coeditor of the textbook inherited by McCarty.
But overall, Rheumatology is an excellent book.
The discussions are comprehensible. Illustrations are
simple and add to the text. This volume would make a
good prize to give to an apt student.
GEORGEE. EHRLICH,
MD
Philadelphia, Pennsylvania
Nursing Rheumatic Disease. Margaret Elliott. New
York, Churchill Livingston, I 9 79. 186 pages. Illustrated.
Rheumatology is becoming an increasingly attractive subspecialty for nurses. Unfortunately, the
nursing literature is almost devoid of textbooks specifi-
cally related to the nursing care of patients with rheumatic disease. Thus, it is encouraging that a nursing text
devoted solely to this specialty area has been published.
In the preface, the author states that the book includes information regarding the most common forms
of the rheumatic diseases, in addition to particular aspects of nursing management. Approximately one-third
of the book is devoted to rheumatoid arthritis, with the
remaining chapters providing a more abbreviated overview of selected rheumatic disorders.
The format and content of the book are analogous to that of the Primer on the Rheumatic Diseases.
Although this abbreviated 186-page paperbound review
provides some medical perspective, the nursing implications are often superficial or even lacking. Even the bibliography is not oriented to nursing.
In summary, health professionals wanting an introduction and overview to the field may find this book
helpful. Both nurses in the field and nurses in general
want and need more depth and sophistication relative to
their role in this problematic area.
JOAND. SUTTON,
RN, MSN
Instructor in Medicine
Johns Hopkins University
School of Medicine
Baltimore, Maryland
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