"This splendid volume is easily understandable, uses real-life situations as examples and is far more up-to-the-minute than other such books. From sexuality to surgery, it offers practical and science-based advice."--Charles M. Plotz, M.D., Editor-in-Chief, Rheuma21st.com

Your complete guide to understanding and living well with rheumatoid arthritis

If you or someone close to you suffers from rheumatoid arthritis (RA), this book is a powerful tool you don’t want to be without. Two of the authors are physicians at the Hospital for Special Surgery, one of the nation’s oldest and best orthopedic research hospitals. Its purpose is to arm you with the information you need to take charge of your disease management and work with your doctors to develop a treatment program that’s right for your lifestyle and life goals.

In plain English, the authors demystify rheumatoid arthritis–its causes, progression, and various effects on the human body–and decode the often perplexing language that doctors use to describe RA and its diagnosis and treatment. They explain the various treatment and pain management options available to you and ways to discuss them with your doctor. The authors also include the true stories of RA patients whose tales offer encouragement and powerful insights for dealing with the difficult psychological and lifestyle issues RA sufferers face. Their expert advice and guidance covers a range of topics of vital concern to people affected by RA, including:

• Old, new, and emerging drug therapies, including gold, corticosteroids, and immunosuppressants
• Analgesics and anti-inflammatories
• Alternative treatment strategies
• Nutrition, diet, and exercise for RA
• Vitamins and supplements, including glucosamine and Evening Primrose oil
• Managing crucial lifestyle issues such as sports, travel, and sex
• Pregnancy and RA
• Alleviating depression and pain
• Surgical options, including joint replacement therapy

Vasculitis (inflammation of the blood vessels) occurs during injury and also as a response to many diseases, particulary those that are rheumatological in nature. This account begins with the classification and histology of these conditions, and then considers the pathology, diagnosis, and treatment. An important aspect is the extensive coverage given to childhood conditions.

Section A: Methods of Autoantibody Detection This Section provides well structured protocols for autoantibody detection. Step-by-step procedures are accompanied by explanatory notes and comments, clear diagrams, line illustrations and excellent photo illustrations. Extensive literature references lead the way to further background information. The methods presented were validated by more than 40 leading laboratories active in sera analysis, which indicates that these methods have been found to be practically useful and lead to consistent inter-laboratory results: consensus in autoantibody detection. Section B: Autoantigens This Section contains the first compilation of full, detailed information on autoantigens related to important autoimmune diseases. The chapters are all structured according to an easy-reference fixed template structure: specific detection methods, cellular localization, biochemical characteristics, function, cDNA and derived amino acid sequence, gene structure, B- and T-cell epitopes and lists of published monoclonal antibodies. The text is greatly enhanced by many beautiful schematic figures and photo illustrations. As in Section A, extensive literature references are provided. The information for this section was brought together by leading experts in their fields. This Manual is an ideal text and reference book for bench scientists working in the field of autoimmunity, but also for rheumatologists, general (internal medicine) physicians or clinical immunologists caring for patients with autoimmune disorders.

Relieve your Muscle Pain in Seconds You're now only 90 seconds away from getting rid of many of your muscle pains, completely drug free If you suffer from back pain, tennis or golfer's elbow, head or neck pain, wrist pain, shin splints, carpal tunnel syndrome, or many other common muscle aches, Dr. Dale Anderson's innovative ""Fold and Hold"" technique can help ""Fold and Hold"" combines simple, safe, biomechanical self-treatment with the natural healing powers of the human body. The result is muscle pain relief in 90 seconds. Here are just a few of the benefits:
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Presents a sampling of new and novel approaches to the amelioration of musculoskeletal disease pathology, emphasizing prevention and therapy. Where applicable, these new technologies are focused on their application to human autoimmune diseases, but the volume mainly discusses and details the use of

The review articles in this book discuss vasculitis and rheumatic diseases that are encountered in clinical neurology. Tables, graphs and a comprehensive bibliography make it possible to find information quickly about the immunological aspects that are increasingly important in daily neurological practice. Specifically, the clinician will find information about giant-cell arteritis, granulomatous arteritis, isolated angitis of the CNS and lupus arythematosus.

Rheumatoid arthritis demands intensive interdisciplinary cooperation between the orthopaedic surgeon and internist, and this monograph provides all the information necessary for the specialist dealing with inflammatory changes of the hip joint in rheumatoid arthritis. The reaction of the joint to rheumatoid arthritis is generally uniform, but the diagnoses may vary. For this reason, particular attention is paid to the differential diagnosis of the chronic inflammatory changes at the hip joint. The course of the disease is outlined, so that varying treatment approaches can be understood. The book describes the medical and the physical treatment of the hip joint, including discussion of the mechanisms of action and side effects that may occur. The options for conservative orthopedic treatment and for operative intervention are carefully considered. The broad spectrum of treatment principles, courses of action and results that are discussed will aid every physician interested in the rheumatoid hip.

The so-called 'connective tissue disorders' hold a particular fascination to both the rheumatologist and the dermatologist, and the diagnosis of, sometimes subtle, changes in the skin can often be difficult. This book aims to give a succinctaccount ofcutaneous manifestations of the major connective tissue diseases, including the cutaneous side effects of anti-rheumatic therapy, and the main diagnostic and prognostic features and guides to their management. Although the book is intended primarily for dermatologists and rheumatologists, it will also be of value to general physicians and general practitioners. We would like to express our thanks to our colleagues in the Medical Photography Department at the Royal United Hospital, Bath, especially Tim Browne and AnnabelHancock, and to Hilary Woolf for painstakingly typing the manuscript. We would like also to thank the following who have generously allowed us to reproduce their clinical and pathological photographs. Dr T. I. MacLeod (Figs. 2.2, 2.6, 3.1, 5.7, 7.2, 9.20, 11.6(b)); Dr S. O'Loughlin (Figs 3.2(b) and (e)); Dr R. S-H. Tan (Figs 3.4, 11.6(a)); Dr C. T. C. Kennedy (Figs 3.6, 4.1, 6.14); Dr T. Provost (Fig. 3.12(a)); Dr R.

The main research described in this book is concerned with assessing the interrelationship of psychological adjustment, compliance with medical advice and use of unorthodox treatments in a sample of rheumatoid arthritic out-patients. Basically this research is comprised of four components: two pilot studies; the development and postal administration of an illness knowledge assessment questionnaire; and a 'follow-up' correlational study. pilot study 1, which involved interviews with 18 patients, was a 'question seeking' study - the aim being to develop research questions of relevance to the Subject sample. The findings of this study suggested that poor illness knowledge and consequent misconceptions was contributing to psychological distress and affecting health behaviour among patients. In pilot study 2 a sample of 17 patients were questioned in detail - but using open-ended questions - about their understanding of their condition and treatment. The results of this study supported the impression gained in pilot study 1, that patients were typically ill-informed about their illness and tended, in the absence of correct information, to overestimate "the risks associated with rheumatoid arthritis and underestimate the value of treatments.

This selection of MCQs in rheumatology is largely aimed at MRCP candidates but some will be difficult for established rheumatologists and some will be possible for enthusiastic medical students. The format of the questions largely follows that used in the MRCP Part I examination with a few exceptions employing diagrams and assertion/reason questions (these are explained on p. vi). No gui dance on scoring is included since we feel that if an honest attempt is made at answering the question then the process is, in itself. educa tional. Some of the answers have been determined only after consider able discussion between us and as far as possible we have attempted to convey the views expressed in accepted British texts. Where answers seem contentious an appropriate reference has been given. Similarly the layout of the chapters largely follows that adopted by standard text books although the basic sciences have been incorpor ated within the individual chapters. We wish to thank Mrs. Dora Smith for typing and re-typing the manuscript according to the foibles of three different authors. Leeds, October 1988 P. S. Helliwell H. A. Bird V. Wright Assertion/Reason Questions These questions consist of two statements. The first statement is numbered 1 and the second is numbered 2. For example: 1. A positive family history of ankylosing spondylitis (AS) is often found in patients with this disease. 2. There is an increased incidence of HLA-B27 antigen in patients with AS."

Langzeitergebnisse sind die Basis jeder medizinischen Behandlung und Weiterentwicklung von Therapiemodalitaten. Dies gilt in der Kinderorthopadie in besonderem Masse. Es ist die vordringliche Aufgabe des Behandlers, Wachstums- und Reifungsprozesse zu beurteilen und wenn notwendig zum richtigen Zeitpunkt lenkend und korrigierend einzugreifen. Ein solcher Eingriff kann eine wichtige Weichenstellung zu einer normalen Entwicklung oder aber im ungunstigen Fall bleibender lebenslanger Behinderung sein. Wir leben in einer Zeit stetiger Veranderungen mit taglichen Neuerungen und Fortschritten in der Medizin. Bei aller Euphorie ist jedoch festzuhalten, dass viele neue Methoden ihre Evaluierung durch den Faktor Zeit noch nicht bestanden haben. Die dargestellten Spatergebnisse belegen u. a. den Vorteil, dass durch den Zeitfaktor die subjektive Sicht des initialen Behandlers meist ausgeschaltet war. Langzeitergebnisse sind daher fur die heute so haufig geforderte Evidenz-basierte Medizin von Bedeutung."

This volume reviews the state-of-the-art in osteoarthritis. The pathogenetic roles of mechanical, systemic and inflammatory factors and the importance of neurogenic factors in pain management and in the causes of disease are considered. Of particular value is the review of the implications of pathogenetic mechanisms in future modes of management. The concept of "activated arthrosis" is given special attention. Finally, controversial issues and new areas for investigation are discussed. The book will help the clinician and the investigator consider the importance of addressing different phases and subtypes of osteoarthritis in planning treatment.

Das Spektrum der in den westlichen Industrienationen filhren- den Krankheiten und der darauf basierenden Thdesursachen hat sich in den letzten J ahrzehnten gewandelt. Wahrend frliher die Infektionskrankheiten und speziell die Thberkulose den hochsten Todeszoll forderten, sind in den Jahrzehnten nach dem zweiten Weltkrieg mit steigendem Wohlstand die Herz- und GefaBkrankheiten an die erste Stelle gerlickt. Trotz gewis- ser Erfolge in der Pravention in einigen Uindern wie z. B. in den USA, Kanada, Australien; aber auch in einigen Gebieten West- europas, in denen die Zahl der tOdlichen Hirnschlage und Herzinfarkte inzwischen wieder rlicklaufig ist, wird die Spit- zenposition in der Todesursachenstatistik hier auch weiterhin von diesen Krankheiten eingenommen. In anderen Uindern wie z. B. in Osteuropanehmen die Erkrankungsraten weiter zu. Wenn man sich fragt, was getan werden kann, urn weitere Er- fqlge auf diesem Gebiet zu erzielen, dann ist ein Blick in die Lander des Fernen Ostens hilfreich. In der Volksrepublik Chi- na undin J apanliegt die Sterblichkeit an koronarer Herzkrank- heit bzw. an Herzinfarkten flinf- bis zehnmal niedriger als in der Bundesrepublik Deutschland. Arteriosklerotische Durch- blutungsstorungen der unteren Extremitaten, auch diabeti- sche GefaBerkrankungen kommen dort kaum vor. Vergleicht man die Lebensweise der Bevolkerung in diesen Uindern mit den Verhaltnissen in den westlichen Industriena- tionen, so fallenerhebliche Unterschiedeinder Ernahrungauf. Wahrend in China Fleisch und Molkereiprodukte in deutlich geringeren Mengen als bei uns verzehrt werden, besteht der Hauptanteil der Ernahrung aus einer an pflanzlichem EiweiB und Schlackenstoffen reichen Kost.

The second volume of "Osteologia" - the proceedings of the annual meetings of the German Society for Osteology - differs from the first one in two ways. In contrast to the preceding one this issue is written in English. There had been good reasons for this decision but there had been equally good arguments against it by some board members. We therefore consider this to be a trial. Being aware of the difficulties to prepare a book not in one's mother tongue the editors only made minor corrections of the authors' con tributions. Having published with the first proceedings an overview of the various fields of research on osteology in our country, the conference of the German Society for Osteology now deals with special subjects and so will this conference report. The main heading of this book being "Generalized bone diseases." One chapter will deal with new developments in the field of osteology and another presents unusual cases presented at the meeting. Our hopes are that the efforts of the German Society for Osteology, the local organizers and the editors will find some acknowledgement. Our thanks are due to the authors for their contributions as well as to the publishing house."

I am proud that this study of the hand appears in the series Exercises in Radiological Diagnosis founded by A. WACKEN HEIM. From time eternal, man has tried to explain the numerous configurations and lines of the hand in order to reveal the true character of a person and to display his life. The importance of the symbolism of the hand is reflected in its role in the cultural life of the old world. Therefore, it is not astanishing that the first book about the hand, by Johannes Hartlieb, was devoted to Chiromancy, and that it was so successful that it went through four editions since the second half of the fifteenth century. When Wilhelm Rontgen in 1895 asked his wife to lay her hand on a photographic plate covered with black paper and exposed it to the radiation he had just discovered, it marked the beginning of radiology. Today the study of the hand concerns only 2%-4% of the activity of radiology. It nevertheless reveals an amazing quantity and variety of pathology. That is the reason for this work. - The authors wishes to thank his friends Y. DIRHEIMER, rheumatolog1st, J. C. DoscH, traumatologist, and G. Fou CHER, surgeon, who provided some of the material for the illustrations. P. BouRJAT VII Contents Part One: Iconography . . . . . . . . . . . . . . . . 1 Part Two: Commentary with Corresponding Schemata 117 Subject Index . . . . . . . . . . . . . . . . . . 203 . . ."

This book is about the drugs used in the treatment and management of rheumatic disorders. The term 'therapeutics' used in the title is intended to mirror the relevance of drugs in the widest sense of the word. Thus, general principles underlying pharmaceutical and pharmacological study have been included together with more clinical matters concerned with applying specific rheumatic problems. The need for another work on rheumatological drugs in itself, as opposed to the different approach intended, was prompted by the ever continuing and bewildering plethora of antirheumatic drugs flooding the market at present. We believe that such a burgeoning of new preparations is welcome in an era when in general there are still no 'cures' available. Moreover, we also feel that a continued update of this rapidly advancing field is essential, not only for its own sake, but also to place it in perspective with itself and with neighbouring fields.

Dimethylsulfoxid (DMSO) istalsSubstanzkeine Unbekannte: seitJahrzehntenwird es als Lt!sungsmittel fUr bestimmte organische Verbindungen in der chemischen Industrie benutzt. Erst in den letzten Jahren ist DMSO als Arzneimittel (wieder) entdeckt worden. Nachdem erste Versuche bald nach dem 2. Weltkrieg mit unzureichend reinem DMSO aufgrund ihrer Nebenwirkungen eingestellt wurden, begann die systemati- scheUntersuchungvonDMSO spaternochmals- mitderhochgereinigtenSubstanz. Aufgrund der Vorgeschichte - in den USA war DMSO zeitweise unter dubiosen Umstanden in Verkehr gebracht worden - galt es, vieI MiBtrauen und Vorurteile abzubauen. Heute, nach zahlreichen toxikologischen Untersuchungen und jahrelangen Erfah- rungen am Menschen kann diese Substanz als ausreichendsicherbetrachtetwerden. In der Bundesrepublik Deutschland gehOrt das DMSO-haltige Dolobene Gel heute zu den fUhrenden Externa im Sport- und Rheumabereich. Diewissenschaftlicheund klinische Erforschung von DMSO und seinen Kombinationen zusammenzufassen und anzuregen, warZieldiesesWorkshops. Heutekonnenwirsagen, daB dieErwar- tungen weit ubertroffen wurden, daB bereits Neuentwicklungen auf der Basis von DMSO in der klinischen Prufung sind. BesondererDankgilt allen Tagungsteilnehmern, besonders aber den beiden Vorsit- zenden, Herrn Dr. Jacob und Herrn Herschler, Portland (USA) sowie Frau Bauer, Frau Eckleund Herrn Dr. Rubsamen von der Abt. Med.-Wiss. undHerrnWandals Organisationsleiter. Blaubeuren, im September 1985 Dr. med. Michael Herschel (LeiterBereich Medizin, Merckle GmbH) Preface Physicalpaincanbeaseriousburden,andreliefofincapacitatingpainmustbeviewed as a great blessing; any degree ofreliefcontributes to the overall quality oflife.

"Rheumatic Disease" is the second monograph in a new series on management and treatment in major clinical subspecialties and patient groups. Further volumes will be published over the next few years. Each book is complete in its own right. The whole series, however, has been prepared to fill a gap, perceived by the publisher, myself and the volume authors, between standard text books of medicine and therapeutics and research reviews, sympo sia' and original articles in specialist fields. Each volume aims to provide a concise, up to date account of treatment in its subject area with particular reference to drug therapy. Wherever pos sible, authorship has been undertaken by practising clinicians who themselves have training and experience in clinical pharma cology. The volumes are intended to be guides to treatment, to assist in the choice of drug and other treatment and to provide easy references to drug interactions and adverse reactions. The aims of the series should be upheld by this volume on "Rheumatic Disease." The book has been prepared in Glasgow and Newcastle. The authors, Drs. Hilary Capell, Terry Daymond and Carson Dick, are not only respected clinicians and rheumato logists but have wide clinical and research experience in the clinical pharmacology of antirheumatic drugs and therapeutic management of connective tissue disease and other areas of rheumatology. This volume combines practical pragmatic man agement with new concepts in drug treatment."

In general, existing texts concerned with rheumatic With regard to the general plan of the book, the therapy have either been addressed to specific aspects of chapters are largely self-contained and can be read in treatment or have formed only part of more general any order. However, it is recommended that the 'in textbooks. This book has therefore been written to fulfil troductory' chapters (Chapters I, 2, and 4) should be a need for a convenient and comprehensive distillation read before those succeeding them. If a more circuitous route is preferred each chapter is supplied with a list of of material covering the various treatment entities, the contents and a summary to aid swift appraisal. A interrelationships between them, and the wide potential generous system of cross-references and some repetition for their application. of salient points are also intended to help the reader who A further need for such a book stems from the fact uses the book as a reference source. A summary of the that approaches to treatment and their associated whole book is given in the last chapter (Section 12. 10) research reports have continued to grow at a high rate in and contains conclusions about the present status of the recent years. This is particularly so in relation to drug various approaches to therapy, together with suggestions therapy, and the task of reviewing this massive literature about the future.

In the Middle Eastern states, in the developing countries of Southeast Asia and Africa with their vast populations, in the poverty-stricken Central and South American lands, and in other underprivileged parts of the world, rheumatic heart disease is a major problem with a high morbidity and mortality. In these areas the disease frequently attacks children, in whom the course is much more malignant than in adults. This re sults in severe pathologic changes in the cardiac valves from an early age. Stenosis of the mitral valve is one of the more common lesions, and closed mitral commissurotomy is often carried out in children. Furthermore, mitral insufficiency, aortic insufficiency, and tricuspid valve pathology may cause such life-threatening hemodynamic effects as to require valve replacement, usually electively, or even occaSionally, as an emergency. This differs from experience in the affluent sections of the population in the developed countries where severe rheumatic valvular pathology in children is uncommon, and sur gery for the advanced form of the disease is limited to adults. Recent progress in diagnostic methods, great advances in surgical skill, and the de velopment of improved valvular prostheses encourage the application of valvular sur gery - so successfully carried out in adults - to children. Such surgery is being under taken with increasing frequency, and the long-term results are encouraging. It was therefore considered important to collect the considerable but scattered information on the subject and to present it in monograph fOml."

In numerous puplications the results of synovectomy have been written about where either one or another viewpoint have been examined. In this publication, the attempt is made to collect as many parameters as possible so as to get a most objective picture of the therapeutic worth by studying 100 knee and 370 finger synovectomies. During the survey, among other points, the following important aspects were taken under consideration: The operative results were not evaluated by the operating surgeon, but by a rheumatologist who was not on the clinic staff. As is well known, it is difficult to evaluate the X-ray picture objectively, since very often "subjective impressions" prevail. Gschwend succeeded in setting up - mainly for the synovectomized finger joints - a comprehensive point system, so as not to leave the evaluation to chance. Besides the purely local joint condition, an internal rheumatological status, at the time of the operation and the follow-up examinations, with corresponding laboratory tests, was carried out and included in the evaluation. Finally, it should be pointed out that this is a long term study of 5 years, with various controls made in between. The examination of so-called control groups, for the present study, seems to us to be highly problematic and of little value for a statement. Essentially, only the local condition with respect to pain and swellings im proves, while the general activity of the inflammatory process as also the mobility and deformity of the synovectomized joints will only be somewhat influenced.

For more than 30 years, the highly regarded Secrets Series (R) has provided students and practitioners in all areas of health care with concise, focused, and engaging resources for quick reference and exam review. Rheumatology Secrets, 4th Edition, features the Secrets' popular question-and-answer format that also includes lists, tables, pearls, memory aids, and an easy-to-read style - making inquiry, reference, and review quick, easy, and enjoyable. The proven Secrets Series (R) format gives you the most return for your time - succinct, easy to read, engaging, and highly effective. Fully revised and updated throughout, including protocols and guidelines that are continuously evolving and that increasingly dictate best practices. Practical coverage of basic immunology and pathophysiology, important disease manifestations, and clinical management issues related to common and uncommon rheumatic disorders. Top 100 Secrets and Key Points boxes provide a fast overview of the secrets you must know for success in practice and on exams. Features bulleted lists, mnemonics, practical tips from leaders in the field - all providing a concise overview of important board-relevant content. Keeps you up to date with new techniques and technologies, as well as changing treatment options and drug information. Portable size makes it easy to carry with you for quick reference or review anywhere, anytime. Helps ensure mastery of the material with 100 board-style questions available online that provide effective review and quick practice for your exams. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.