This multi-author text provides a unique mixture of insights into current management across the spectrum of rheumatic diseases. I found the book extremely accessible. It is divided into three main therapy sectionsrheumatoid arthritis (RA), osteoarthritis (OA) and connective tissue diseases. There is also an extensive section on gene therapy. The RA and OA sections start with background chapters, which include useful information on topics ranging from pharmacogenetics to regulatory issues surrounding OA drugs. Therapy chapters are generally comprehensive, well referenced and up to date with a smattering of references from 2000 in several chapters. Many, but unfortunately not all, chapters finish with a useful section devoted to Current recommendations. Amongst the connective tissue diseases, entire chapters focus on, for example, inflammatory myopathies or Sjögren's syndrome, and this generally results in a comprehensive summary of current treatment recommendations both for the disease in general and for specific complications.
As the title suggests, the emphasis is on developing rather than established treatments. For RA, for example, there are discussions of biological therapies, leflunomide and COX-2 antagonists, but traditional disease-modifying anti-rheumatic drugs (DMARDs) are mentioned only in the context of combination therapy, and physical approaches to therapy not at all. There are also useful chapters on experimental therapies that may or may not ultimately reach the clinic. It was refreshing to find an entire section devoted to the rapidly expanding area of therapies for OA.
As with any multi-author text there was some variability in quality and also some inconsistency. Thus, in the context of OA, intra-articular steroids are said to be virtually devoid of side-effects. A more tempered view is provided in the equivalent RA section. Neither offers advice as to what constitutes a reasonable frequency of administration. Many chapters adopt a critical, evidence-based approach whereas others provide more of a personal commentary. Clearly the former is more useful.
There is a sizeable section devoted to gene therapy. Very few examples of gene therapy have reached the clinic or even phase I/II studies and so this section is of less practical use. These chapters provide an indication of the immense potential of gene therapy, as well as additional pathogenetic and mechanistic information that is not covered in other chapters, for example on cell signalling and apoptosis.
Organizationally, I have a few minor criticisms. There are inexplicably two chapters on non-steroidal anti-inflammatory drugs (NSAIDs), which include much repetitive information. A (brief) chapter on psoriatic arthritis is included under systemic autoimmune diseases in a completely different section to spondyloarthropathies. One chapter (17) is entirely out of place in the book.
Overall, this is a book that manages to bring together and summarize an enormous volume of information across a spectrum of diseases in a largely readable form. It would be useful as a reference book in any department's library and should remain so for at least a few years. It is also an accessible read, however, for the individual with a specific interest in rheumatic disease therapy. I have two minor suggestions for any future editions. First, because there is considerable discussion of experimental therapies, it is not always clear when the drugs under discussion hold specific licences. Second, in this day and age, it might be advisable for authors to declare potential conflicts of interest.