Abstract
In ‘Preface’, the authors explain the need for such a book and their perspective for choosing the chapter subjects. They state how this book is different from most books in medicine and its subspecialities that are organised according to diseases. However, in real life, for example, in exit examinations or in clinical practice, trainee or trained physicians are confronted with patients who present with symptoms and signs and occasionally with some laboratory/imaging investigations. How does a physician learn to analyse the problem with which the patients approach the physician? The editors mention two distinct approaches for learning to analyse the clinical issue at hand when the patient presents in the clinic. They cite a common method of ‘case-based learning’ where a real or hypothetical patient is presented and discussed. Most such examples talk about some uncommon presentations of common diseases. The editors state a second and less-travelled path they have taken for structuring their book that identifies the clinical scenario as seen in the clinic, followed by a proposed way forward to make a diagnosis towards appropriate treatment. Starting with common scenarios of mono-, oligo-/pauci- or polyarticular joint pains, the chapters take up more challenging scenarios, for example, additional clinical features appearing on the background of an established disease on treatment, such as the appearance of ‘chest pain’, ‘ascites’ or ‘seizures’, as well as dryness in mouth/eyes (many other issues) in such a patient. What would be the roadmap for tackling such a patient? The editors also bring in an increasingly common recent scenario where patients come and dump stacks of investigation reports, including a variety of imaging and other investigations, asking why such-and-such test report is out-of-range! This is a refreshing new approach to learning and understanding clinical medicine, including rheumatology, probably best suited to those who have already completed their internal medicine/paediatric postgraduation. A few specific examples would help! Patients with shoulder pain are common in our clinic. Most of them are diagnosed rheumatic disease patients under treatment in our clinic, but on a particular visit, they complain of shoulder pain. What to do and how to proceed scientifically to reach the correct diagnosis and treatment for this new complaint? This book would help you. This is just one example. The book has a number of such scenarios, for example, the appearance of Raynaud’s phenomenon, palpable purpura, seizures, serositis, sexual dysfunction, peripheral gangrene, onset of an ear problem and so on. The layout with clear photographs, tables, flowcharts, textboxes and tables makes it easy to read and quick checklist. How to satisfy a patient who got some irrelevant ‘unwisely chosen’ tests or a ‘full body check-up including laboratory tests’ done where 10% of the tests were returned with questionable positivity? This book provides a clear understanding of such tests and how to interpret them to be able to answer such questions with evidence base.
I would like to see a few more chapters added to the next edition of this book. For example, a woman in her middle 50s was seen a few days ago with 9 years of well-controlled rheumatoid arthritis who woke up at 2
Any multi-author book will have certain issues, and this book is no exception. There would always be some disagreements among clinicians in approaching a given problem. Occasionally, there could be actual mistakes that become habits for us clinicians. An example in this book is the definition of ‘oligo-/pauci-arthritis’; in one chapter, it is correctly mentioned as ‘2, 3 or 4’ joints, while in another chapter, it is mentioned ‘less than 4 joints is pauci-arthritis and more than that is polyarthritis’! Then, how about those with four affected joints? But, overall, this is a minor issue.
Finally, for me, reviewing a book has many good things about it. To name a few, one gets the book without having to pay for it! If it is a multi-author book, then one learns about the special expertise of many colleagues one meets in meetings and conferences without knowing their real academic strength. Of course, one will learn about certain areas that have not been paid attention to in the past.
I would strongly recommend this compact, hardbound small book to the bookshelf of practicing rheumatologist.