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Joint cartilage degradationbasic and clinical aspects. Edited by J. Frederick Woessner Jr. and David S. Howell. New York Marcel Dekker 1993. 576 pp. illustrated. indexed. 175.00

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Mechanics of Human Joints: Physiology, Pathophysiology,
and Treatment. Edited by Verna Wright and Eric L. Radin.
New York, Marcel Dekker, 1993. 480 p p . Illustrated. Indexed. $185.00.
The title of this text, emphasizing mechanics, belies the
broad range of information provided, which melds knowledge
of joint biomechanics with physiology, pathophysiology, and
treatment. The text is divided into 5 parts: Physiology of
Joints; Mechanics; Neurophysiology; Pathophysiology ; and
Treatment. Chapter 1, Biology of Joints, provides an important background overview. Its author has played a leadership role in this area of investigation, and the chapter could
readily have been expanded to include more details of his
Chapters in the section on Mechanics review joint
anatomy related to function; mechanics of gait; synovial
fluid; human joint lubrication; ligament reconstruction with
specific reference to the anterior cruciate ligament of the
knee; joint stiffness; and muscle physiology and electromyography. Information relative to anterior cruciate ligament
reconstruction is of particular value, given the frequency of
this disorder and the interest in this entity in the orthopedic
Chapter 10, concerning the Intervertebral Disc, is
clearly written and nicely illustrated; this chapter could also
have been further expanded by the author, who has played a
significant role in our understanding of this disease process.
The chapter on the effect of vibration, with its unfamiliar
terminology and mathematical equations, will be difficult for
the average reader. Dr. Radin’s chapter about Osteoarthrosis represents only a precis of his many contributions to our
understanding of this disease state. The following chapter,
on Mechanically Induced Periarticular and Neuromuscular
Problems, covers the topics of low back pain, ruptured
muscles and tendons, bursitis and tendinitis, carpal and
tarsal tunnel syndromes, tom menisci, and chondromalacia
of the patella-a formidable task! Chapter 15, Physiologically Based Treatments, is limited primarily to therapeutic
approaches using osteotomy, interrelating the indications
and results of such surgery to biomechanical concepts.
This text will be of value to individuals interested in
relating bioengineering principles to normal and abnormal
joint function. This book by two senior editors who have
contributed significantly to research in this area represents
an important addition to the limited number of textbooks
available to the researcher or clinician attempting to understand the interrelationships of joint biomechanics and physiology.
Roland W. Moskowitz, MD
Case Western Reserve University
Cleveland, OH
Joint Cartilage Degradation: Basic and Clinical Aspects. Edited by J . Frederick Woessner, Jr. and David S . Howell.
New York, Marcel Dekker, 1993. 576 p p . Illustrated. Indexed. $1 75.00.
It was not too many years ago that interest in
cartilage was so limited that comprehensive reviews would
have filled at most one or two chapters rather than an entire
text. Fortunately, increased research with larger numbers of
investigators interested in the field, and expansion of sophisticated techniques to study cartilage have provided extensive information concerning not only biochemistry and physiology, but also molecular biology and cartilage immunology.
(Given the anatomically “protected position” of cartilage, a
role for immunologic processes in joint breakdown was considered unlikely, if not outright heresy!) This text by Drs.
Woessner and Howell, acknowledged leaders in cartilage research, represents an attractive volume for investigators and
clinicians already expert in the field; in addition, it will be of
value to clinicians and researchers who wish to upgrade their
knowledge not only of cartilage, but of osteoarthritis, which is
particularly addressed.
The editors have recruited an outstanding group of
contributing authors, all of whom are recognized for their
leadership roles in cartilage investigation. Although the book
reviews both basic and clinical aspects of joint breakdown,
the weight of the discussions is directed toward fundamental
mechanisms. Accordingly, the book will be of somewhat
limited interest to the general clinician, but of significant
value to rheumatologists and orthopedists hoping to develop
an understanding of fundamental cartilage disease processes. Individuals interested in specific pharmaceutical
approaches to osteoarthritis disease management will find
the book’s contents exceedingly informative.
The first 6 chapters of the book discuss cartilage
structure and function, including chondrocyte and matrix
components. A chapter on growth plate structure and function, included in these discussions, will be of somewhat less
interest to the general rheumatologist. Chapters 7 and 8
discuss the role of endogenous proteinases, and physical and
mechanical agents in matrix degradation. Crystal deposition,
which has both primary and secondary relationships to
cartilage breakdown, is discussed in detail by leading investigators. Later chapters discuss mechanisms of evaluating
cartilage breakdown and the use of in vitro models for
cartilage study. These latter are particularly important since
they provide an opportunity for study of cartilage biochemistry and pathophysiology with diminished use of animal
models. Nevertheless, the use of animal models in the study
of any disease remains vital as a natural step in controlled
sequential analysis of biochemical and physiologic processes.
Clinical correlations provided in later chapters include pathologic cartilage degradation; immune responses to
cartilage proteoglycans in inflammatory models in human
disease; pharmacologic control of cartilage degeneration in
osteoarthritis; and modulation of cartilage degradation in
arthritic diseases by therapeutic agents. The final chapter,
Prospects for Medical Intervention and Cartilage Repair,
whets the appetite for future specific therapeutic approaches; unfortunately, the answer remains elusive.
Although there are a number of textbooks which
contain various components of information similar to that in
this volume, consolidation of these various topics into one
area is a special strength of the book. The chapters are
well-referenced with up-to-date sources. Chapter 12, on
78 1
Degradation of Articular Cartilage and Culture: Regulatory
Factors, gets the award for most references-569!!
As in any text with multiple authors, a certain
amount of reduplication is unavoidable. Chapter 18, on
Modulation of Cartilage Degradation, primarily discusses
rheumatoid arthritis; although excellently written, it is somewhat out of sync with the remainder of the text. Chapter 17,
Pharmacological Control of Cartilage Degradation in Osteoarthritis, is an up-to-date review of so-called “diseasemodifying agents” in osteoarthritis; it will be a useful
resource for investigators interested in specific therapeutic
This book, although moderately expensive, deserves
a place on the shelf of anyone interested in cartilage and
Roland W. Moskowitz, MD
Case Western Reserve University
Cleveland, OH
Arthritis and Related Affections: Clinic, Pathology, and Treatment. Arnold Soren. Berlin, Springer-Verlag, 1992. 456 p p .
Illustrated. Indexed. $198.00.
I love this book, in large part because I don’t agree
with everything in it but value the approach of a long-term
observer and original thinker about the joint. The book is
designed as a comprehensive arthritis text which also covers
clinical and radiographic features, but it is clear that the keen
interest of this orthopedist has been the pathology of joint
disease. Dr. Soren tackles concepts like post-traumatic
synovitis, liposynovitis, and intermittent hydrarthrosis (for
which he provides some support for allergic mechanisms in
some cases), as well as the standard rheumatic diseases. He
provides us impressions, but not yet the systematic studies
that will be needed.
An extensive list of 1,825 references includes many
not found in standard texts. Clear strengths are the nurnerous gross and histologic illustrations, although it is frustrating that the legends often do not identify the disease and one
must scan back through the text.
There is a lot to quibble with but also to be stimulated
by. One case is described as chronic knee arthritis secondary
to untreated gonorrhea persisting for more than 25 years.
One would like more information on such a case.
Discussion of pathology is mostly based on gross
examination and light microscopic material, with very little
electron microscopy, immunocytochemistry, or use of
other, newer techniques.
Dr. Soren has been an innovator in attempting to
codify histologic diagnosis. His earlier work has stimulated
several groups now attempting to improve prognostication
and to understand mechanisms involved in the synovitis of
rheumatoid and other diseases. Although this work is mentioned, it unfortunately is not expanded on in this text.
Arthritis and Related Affections will not be competition for standard textbooks but will be a treasured part of
my library. These pathologic descriptions and references can
be a useful starting point and a source of ideas for someone
about to investigate the articular aspects of a disease.
H. Ralph Schumacher, Jr., MD
Hospital of the University of Pennsylvania and Veterans
Affairs Medical Center
Philadelphia, P A
Taking Control of Arthritis. Fred G . Kantrowitz. New York,
Harper Perennial, 1991. 246 p p . Indexed. $10.00.
In the course of providing care to patients and
lecturing about arthritis, rheumatologists and other health
professionals encounter questions that are asked repeatedly
over the years. Our answers to these questions evolve with
time, as we gain further experience and integrate new
knowledge and perspectives about the rheumatic diseases.
In Taking Control of Arthritis, Dr. Kantrowitz provides his
thoughtful responses to such questions. Most rheumatologists would accept his information as consistent with current
concepts. The exercise of comparing his answers with our
own can potentially refine and improve the important role we
play in patient education.
Inquiring patients want to become more knowledgeable about their diseases and options for treatment. Patient
education supplied in the office or clinic by the health team
of physicians, nurses, and occupational and physical therapists can be supplemented with recommended reading. An
office or clinic lending library or reference list for patients
should include this book. Studying Dr. Kantrowitz’s answers to questions is likely to reinforce and expand what the
patient and family have learned from the rheumatology
team. New or contradictory information may stimulate important new questions for discussion at the next office visit.
The format of the book (questions followed by answers that may run several paragraphs) may make it difficult
for the reader to find organized information about specific
diseases, but the book is well indexed. For example, there is
no chapter on rheumatoid arthritis (other informational
books serve that purpose), but the index contains about 30
topics listed under “rheumatoid arthritis.”
Frequent references to well-known athletes and entertainers and their experiences with rheumatic disease add
to the interest of the book and make it more readable.
Chapters such as “Taking Control-Ways to Help Yourself’ and “Taking Charge of Your Attitude” contain strong
messages reinforced by inspirational anecdotes about respected public figures.
My father, who has longstanding rheumatoid arthritis
and osteoarthritis, now with successful bilateral knee replacements, found the book easily understandable and recommended the book for patients either early or far along in
the course of their disease. From this book, family members
of arthritis patients can also gain helpful perspectives about
arthritis and the feelings involved in coping with chronic
Larry G. Anderson, MD
Maine Medical Center
Portland, ME
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