CLINICAL PRACTICE IN RHEUMATOLOGY. Maurice Barry. Springer Verlag, London. 110 pages. ISBN 1 852 33719 2.

I. Haq

Musculoskeletal problems are extremely prevalent in the community, and it is important that doctors are competent in assessment of the musculoskeletal system. Medical school training is variable, and many doctors do not feel confident about managing such patients. The aim of this book is to provide an introduction to rheumatology for students, junior doctors, primary care practitioners and allied health professionals.

There is an interesting note to the reader at the start of the book, highlighting the fact that chronic musculoskeletal pain is often associated with psychosocial distress and that recognizing this, together with reassurance where appropriate, can benefit the doctor and the patient. This is something that I emphasize in my teaching and is an excellent mission statement!

The format of the book is as easy-to-read bullet points. History taking and examination are covered first, including the GALS (gait, arms, legs, spine) screen. A very useful section covers presenting symptoms and their differential diagnoses. There is sensible advice on when to use imaging, how often to see patients and when to admit. Local guidelines could be added in here if necessary.

Drug therapy in rheumatology is well covered, with practical details on choice of analgesia and use and monitoring of DMARDs, including new biological therapies. The use of DMARDs in pregnancy and breast feeding is a valuable inclusion. There is a small section on joint injection, which may have benefited from illustrations, although the aim of the book is not to teach injections to doctors unfamiliar with rheumatology. The essential roles of the multidisciplinary team are summarized—an area that some students and doctors may know little about.

The book then moves on to discuss the various rheumatological disorders, starting with soft tissue problems, which are very common and are seen by all medical practitioners. Included in this part of the book is a synopsis of autoantibodies. This is well written but may have been better in a stand-alone section earlier in the book, as this is often a confusing area for the non-specialist. Finally there is a small reading list and a more extensive list of web-based resources.

This book is well written, concise and easy to read. It provides an excellent practical introduction to the specialty for students and doctors alike. Its strengths lie in that it provides a combination of symptom- and disease-specific information, with emphasis on the importance of addressing psychosocial and physical problems. I would recommend it to all students, house officers, senior house officers (especially those working towards the MRCP examination) and general medical specialist registrars. General practitioners will also find this a quick reference book to have on their surgery desks.

The author has declared no conflicts of interest.





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