Textbook of Rheumatology

This work has a representative sampling of the major rheumatologic disturbances-their etiology, treatment, post-followup, nutritional implications and implications forconventional medicinal preparations and alternative medicine.For instance, the rendition on low back pain is excellent."During any month, 32-37% of the population will suffer from lowback pain for a period longer than 24 hours." The cause oflow back pain has many factors; namely, smoking, body vibration,job stress, sedentary jobs, static posture and strenuous movements. Low back pain is the most common cause of disability in workers under 45 years of age. Higher levels of exercise andtargeted physical therapy protect against low back pain.Three major types of forces in the lumbar spine can causenerve injury leading to pain; namely, stretch, compression andvibration. "Increased tension increases intrafascicular pressure and decreases cross-sectional area in the nerve. This interfereswith blood flow, causing venule stasis at 8% stretch and total ischemia at 15% stretch." A decrease in cross-sectional areamakes sense in engineering because the increased length anddecreasing elasticity will cause the nerve to be significantlydistorted . As a result of the distortion, the cross-sectionalarea will represent an exaggerated multi-dimensional geometryhaving a smaller cross-sectional area. The discussion onspinal stenosis explains the rationale for compression of nerveroots. There is an excellent workup for low back pain.Lumbago has a dull and low back pain component. The herniateddisk has an electric-knife-like stabbing pain. Spinal stenosishas aching and burning in the thighs. Metastases has seriousand unrelenting pain. Ankylosing Spondylitis has insidiousonset of pain, uveitis and sometimes aortic insufficiency.The epidural abscess has sharp and severe bilateral buttockand leg pain. There is an excellent section on nutrition andrheumatic diseases. The late Paleolithic diet consists of34% protein and 21% fats; whereas, the American diet consists of12% protein and 42% fats or twice the Paleolithic dietarycontent of fats. A number of vitamins benefit patientswith rheumatologic diseases; namely, beta-carotene, Vit E,Vit C, Vit D, Zinc, Selenium, Cu and Fe to compensate foriron deficiency anemia. Linoleic acids, Omega 3 and Omega 6fatty acids have been found to be essential in the diet.For the arthritic diseases, "Vegetarian diets, when supplemented with sufficient proteins, vitamins and minerals , can result in amodest improvement in pain and stiffness."There is an excellent section on acupuncture. The authors state:"Because the most obvious application of acupuncture to patientswith arthritis or fibromyalgia is to relieve pain, there has been significant research over the past 20 years on the mechanisms in Western terms that might explain the relief ofpain by acupuncture needles. With the discovery of naturalhuman opiates, many different studies have shown that reductionin pain may result fr

Kelley's et. al., Textbook of Rheumatology has been considered the Bible of Rheumatology ever since its 1st edition. The 5th edition still lays claim to that honour. However, the appearance of Klippel and Dieppe's Rheumatology has effectively relegated it to a second place. Kelley's is lucid and far-reaching into areas of Rheumatology, but it is more concise, less illustrative, and harder to digest than Klippel's. Moreover, the tendency to have the same editors and authors write chapters throughout the history of the book has made the book rather stagnant, with few differences between the 4th and 5th edition. The book is rather ethnocentric in concentrating on research done in USA, largely ignoring research (and authors) from other parts of the world, while Klippel's is more cosmopolitan and has more global representation in authorship and content. For example, in the chapter on Rheumatoid Arthritis in Kelley's, it is held that the occurrence of the disease is constant in different areas of the world, while Klippel's points to evidence to the opposite of that statement. Still, Kelley's is a very useful reference textbook for the specialist rheumatologist who knows quite a bit about his subject, less so for the beginning fellow.