This is a specifically designed textbook to aid medical students who often find rheumatology a bewildering specialty and to serve as a quick reference guide to those in their early postgraduate careers. The book is broken down into four main sections: specific conditions, investigations, pharmacology and approach to OSCE examinations with a useful breakdown to take a history or examine a patient with a musculoskeletal problem. Each condition is presented in a logical manner covering pathophysiology, epidemiology, clinical features, differential diagnoses, diagnostic investigations and management with useful diagrams and tables. A good range of rheumatological conditions are covered and as well as up to date information including NICE guidelines where available. Each chapter ends with self assessment questions to reinforce learning points.
Although the different conditions are laid out in a logical fashion, the main sections of the book could have been ordered better. Instead of diving straight into the different rheumatological conditions, it would have been better to start with history taking and examination of a patient with musculoskeletal problems. This section itself could also be expanded upon, since this is a rheumatology textbook it should cover all joint examinations instead of just focusing on the GALS screen and hand and wrist examination. It does provide though a link to a site to access demonstration videos of joint examinations however this did not work. Having the investigations and management chapters before the specific conditions section would make this section easier to follow without having to flick back and forth various chapters.
There are a few details that are incorrect. Firstly, IL-1 inhibitors are not licensed for the treatment of rheumatoid arthritis and are not part of NICE guidance. Secondly, following an EMA alert in 2014, strontium ranelate is only recommended in the management of post menopausal osteoporosis only if all other treatments have failed due to its cardiovascular risk, therefore it should not be included in the list of treatments. Lastly, there are no classification criteria for rheumatoid arthritis either the old 1987 ACR criteria or the newer 2010 ACR/EULAR criteria which is a shame as the faults of the old criteria could be explained and would then introduce the importance of early diagnosis and the need for updated classification criteria and the use of newer tests such as anti-CCP and musculoskeletal ultrasound.
The authors admit that this clinical text does not replace a more weighty textbook, but it is by and large a well presented book and although the flow of the book could be better the information is presented in a clear and concise manner. As a clinical handbook for medical students, it should have focussed more on clinical aspects by expanding more on taking a musculoskeletal history, joint examinations and formulating a diagnosis but it is up to date and information is laid out in such a fashion with bullet points and tables, along with self assessment questions. It would serve as a highly recommended revision aid for medical students but is probably pitched too low for those who are postgraduates.
Wing Hoi Yau Consultant Rheumatologist