RHEUMATOLOGY HIGHLIGHTS 2001–2002. Edited by P. Bacon. £15.00. Health Press, Oxford, UK, 2002. 92 pages. ISBN: 1-903-73414-2

R. A. Luqmani

Rheumatology Highlights attempts to do the impossible, which is to summarize a vast body of work relating to advances in understanding rheumatic diseases. The reviews in this book concentrate predominantly on inflammation and infection. It is difficult to review what is already a series of expert reviews.

The section on early arthritis concentrates on the more recent findings; that inflammatory synovitis is, in fact, much more aggressive than we originally thought, with evidence of bone oedema appearing within the first 4 weeks of symptoms with presumed progression to bone erosion. This evidence is being used as the basis for more aggressive therapy and there is some debate as to how effective early use of our current interventions might actually be. The persistence of inflammation in rheumatoid synovitis is discussed in relation to the role of fibroblasts, which may orchestrate some of the persisting inflammation. Infection remains an important trigger factor for arthritis, both direct infection and reactive arthritis. The interplay between persistent microbial infection and activation of the immune system is discussed. A new classification system is described for the anti-phospholipid syndrome and some advances in our understanding of its genetic basis are reviewed. Management still remains uncertain although there is a study underway to address the role of prophylactic anticoagulant therapy. The assays for ß2-glycoprotein I (ß2GPI) dependent anti-cardiolipin antibodies are now more reliable. The relationship between anti-phospholipid syndrome and atherosclerosis is becoming more apparent.

The relationship between cardiovascular events and rheumatic diseases is further discussed in systemic lupus erythematosus (SLE) with a review of the current data, particularly from the Toronto Group. The common difficulties of managing SLE with drugs that might exacerbate atherosclerosis are discussed. The cardiovascular mortality and morbidity in rheumatoid disease is becoming more apparent following on from the SLE data with significant risks associated with rheumatoid disease itself. These are demonstrated by subclinical evidence on myocardial perfusion imaging using single photon emission computed tomography (SPECT) as well as the clinical observations of an increased prevalence of ischaemic heart disease at a younger age, in patients with rheumatoid disease. It seems that the role of the rheumatologist is changing to embrace the management of cardiovascular risk factors in our patients.

The systemic vasculitides are reviewed and the important role of disease assessment and the need for large multi-centre trials is discussed. Long-term cyclophosphamide offers no significant benefit in terms of disease control and may confer considerable toxicity. Accurate disease assessment provides better opportunities for planning appropriate therapies and minimizing toxicity. The use of methotrexate as an alternative to cyclophosphamide in Wegener's granulomatosis is discussed. In Behçet's syndrome, central nervous system and pulmonary involvement with aneurysms and haemorrhage are discussed. The genetic basis for Behçet's remains uncertain, but there may be a link with familial Mediterranean fever.

Overall, the highlights provide short but informative overviews of quite a wide range of topics and are well worth reading to whet your appetite for in-depth reviews of the literature.





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