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Seronegative Polyarthritis. Verna Wright and John H. Moll. Amsterdam and New York North Holland Press 1976 488 Pages. Price65.50

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398
BOOK REVIEWS
Rheumatism in Populations. J . S . Lawrence.
London, William Heinemann Medical Books,
1977. 572 pages.
Dr. John Lawrence has devoted much of his career to the investigation of rheumatism in populations,
and the publication of this lengthy and detailed monograph will undoubtedly be remembered as a milestone in
documenting knowledge of the epidemiology of rheumatic diseases. Lawrence’s work has always been characterized by a meticulous approach, and this thoroughness is very evident in his book.
The monograph has many strengths: the discussions of rheumatic complaints, disc disease, osteoarthritis, rheumatoid arthritis are all very strong. The
description of benign polyarthritis is particularly interesting, since many of these cases never come to the
attention of the consultant. The review of the rarer
forms of rheumatic diseases such as lupus and Reiter’s
syndrome is hampered by the paucity of data, yet Lawrence discusses what information is available with considerable expertise. He includes a few chapters which
perhaps are of less interest to the rheumatologists, including one on bone disease and another on congenital
and acquired deformities. The chapter on occupational
aspects of rheumatic disease is unique and highly detailed. I found particularly interesting the descriptions
of the peculiar forms of traumatic arthritis that occur in
certain occupational groups such as cotton spinners.
One of the best aspects of the book is the extensive use
of figures and tables. The radiographic reproductions
are excellent, and the documentation is superb with
citation to some 2500 references, which cover the field
up to the end of 1973.
One can certainly find minor errors in the text.
For example, on page 375 the author cites Emmerson’s
pedigree of gout and familial hyperuricemia. Lawrence
fails to note that Emmerson later discovered that the
hyperuricemia in this family resulted from chronic lead
poisoning from a single source (Emmerson BT, Aust
A n n Med 12:310-324, 1963). This is an interesting example of the still unresolved problem of nature and
nurture. Likewise, in the chapter on gout Lawrence
minimally describes the role of obesity in gout, which he
attributes to inheritance. A few pages later he does cite
studies of Popert and Hewitt indicating that much of the
hyperuricemia in populations may be due to dietary
indiscretion. I feel that gluttony plays a larger role in
gout, but this is barely discussed. In the discussion of
Arthritis and Rheumatism, Vol. 21, No. 3 (April 1978)
lupus erythematosus, Lawrence does note that the incidence of lupus is increasing, however, he fails to offer
any explanation. This perhaps should not be a criticism
since no one else has an adequate explanation. A small
number of the citations are irritating in that the reader
cannot verify them. They are references to discussions,
government documents, and meetings. When one considers the size of the bibliography, the fact that a few of
the references are out of alphabetical order and a few
have insufficient citations does not detract from the
value of this immense and otherwise accurate bibliography.
Lawrence’s essay is the best available summary
of the epidemiology of rheumatic diseases. It carefully
reviews all of the literature available on this subject and
presents the results in a very readable and unbiased
fashion. As such this book will probably remain the
standard source of information on the epidemiology of
rheumatic diseases for many years to come. I would
certainly recommend the book very highly to any fellow,
practicing rheumatologist, or other scientist interested
in the study of rheumatism in populations.
WILLIAM
M. O’BRIEN,M.D.
Projessor of Internal Medicine
University of Virginia School of Medicine
Charlottesville, Virginia
Seronegative Polyarthritis. Verna Wright and
John H . Moll. Amsterdam and New York,
North Holland Press, 1976, 488 pages. Price:
$65.50.
Professors Verna Wright and John Moll have
masterfully authored a textbook on the seronegative
variants which provides its readers with a lucid and
concise compendium of recent investigation into mechanisms and relationships of the spondyloarthropathies.
More important, they enable us to follow the lengthy,
sometimes frayed, clinical threads that represent years
of rigorous clinical study that have recently been woven
into one multicolored fabric. This work forms the basis
for understanding the clinical spectrum of the seronegative variants and their association with the histocompatibility system.
The condensation of historic, diagnostic, and
therapeutic facts presented in its 488 pages is impressive.
There are chapters on the individual variants including
ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, the arthritides of entropathic bowel disease,
Whipple’s disease, Behcet’s syndrome, and Still’s disease. Also included are more general essays on the
“meaning of seronegativity and seropositivity,” the concept of seronegative spondarthritides, and chapters on
therapeutics (including physical measures) and the histocompatibility system. The appendices that accompany
the individual chapters are noteworthy. They contain
summaries of clinical measurements, techniques, diagnostic criteria, population studies, and historical vignettes, such as an extract from the manuscript Sur la
Spondylose Rhizotnelique by Pierre Marie. Although
these materials are important and add to the book’s
value, they would have disrupted the fluid presentation
of the respective chapters. Overall, it is a well orchestrated and highly readable monograph.
There is the occasional obvious error in the text
and tables, such as table 4.9 where the ratio of male to
females in psoriatic arthritis is given as 1 : 1.04, while the
totals in the series referenced yields 1 : 1.4. However,
these errors are few, and the presentation is authoritative and accurate.
The cost of Seronegative Polyarthritis ($65 .OO,
U.S.) initially seemed high, but after serious appraisal of
the contents, it appears more reasonable. The book is
destined to become a classic point of origin and departure for interested students and investigators of these
diseases. All rheumatologists should consider purchasing the text since it is one of the rare reference books
that should be read cover to cover. But this is too
narrow a commendation. All physicians should have
access to a copy and become aware of its riches. It
belongs in every general medical library.
One suggestion to Doctors Wright and Moll:
consider a biennial supplement, addressing the many
advances in this exploding field which could not be
included in a hard-bound edition by virtue of the time
constraints of writing such an encyclopedic text. The
numerical indexing of the chapters and subheadings
would readily lend itself to such an endeavor.
THOMAS
C . NAMEY,
M.D.
Division of Clinical Immunology and
Rheumatology
University of Alabama in Birmingham
Birmingham, Alabama 35294
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1976, wright, holland, 488, price65, new, page, john, york, north, molly, amsterdam, seronegative, polyarthritis, vern, pres
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