Adolescent Rheumatology

(Martin Dunitz) Univ. College, London, UK. Analyzes the impact of rheumatological disorders in adolescence. Addresses topics on joint development, infection and arthritis, myositis, pain syndromes, nutrition, rehabilitation, and more. For practitioners. Halftone and color illustrations.

This book brings together two disciplines -- rheumatology and adolescent medicine -- in an authoritative yet practical fashion. It is short by today's standards, only 18 chapters and 349 text pages, but it covers several topics not available in either of the two standard U.S. textbooks on pediatric rheumatology (James T. Cassidy and Ross E. Petty. Textbook of Pediatric Rheumatology. 3rd edition. Philadelphia: W.B. Saunders, 1995; and Jerry C. Jacobs. Pediatric Rheumatology for the Practitioner. 2nd edition. New York: Springer-Verlag, 1993). The editors, one from the United Kingdom and one from the United States, have chosen 30 contributors from both sides of the Atlantic, but the style, spelling, and the disease nomenclature make the book distinctly British. The writing is concise, the figures and photos (many in color) excellent, and the bibliography extensive.

The introductory chapter on joint development is a brief overview of structure, growth, and developmental abnormalities of the synovial joints. It is a good overview but does not fit well with the rest of the book, which emphasizes the clinical, emotional, and school- and work-related problems faced by the adolescent with a chronic rheumatic syndrome.

The strength of the book lies in the nine chapters on special needs and challenges for teenagers with arthritis and their doctors, including those related to recreation, nutrition, sexuality, medical and surgical rehabilitation, educational and vocational planning, and leaving home. The problems are thoughtfully identified and discussed, and specific suggestions are provided, often including checklists for implementation.

The middle eight chapters cover the major rheumatic disorders but do so in considerably less detail than the above-mentioned textbooks. Some illnesses, such as mixed connective-tissue disease, diabetic cheiroarthropathy, and the CREST syndrome (calcinosis cutis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia), are not covered at all, whereas others, such as Sjogren's syndrome and Kawasaki's disease, are covered in a cursory fashion. Treatment is mentioned but without much detail with respect to drug doses, side effects, and alternative drugs. Thus, this book cannot be considered definitive.

The chapter on pain syndromes by David Sherry is an exception. He discusses the commonality of fibromyalgia, reflex sympathetic dystrophy, causalgia, and psychogenic muscle pain; provides many clues to the diagnosis; and gives much common-sense advice concerning management. He also covers the differential diagnosis, something missing from many of the other disease-oriented chapters.

In sum, this book is an excellent supplement to standard textbooks on pediatric rheumatology. It is a must for health care professionals who deal with teenagers who have a rheumatologic disorder.

Reviewed by E. Richard Stiehm, M.D.
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