This book provides a comprehensive overview of the available biologic therapies whilst comparing them to standard disease modifying anti-rheumatic drugs, and discusses how best to determine which therapy is most appropriate for an individual patient in the framework of current guidelines. Biologics for the Treatment of Rheumatoid Arthritis is an up-to-date and concise practical guide to the latest therapeutic developments in this field. This book is an invaluable source of topical information for all rheumatologists and health care professionals treating patients with rheumatoid arthritis.

This practical text provides a clinical overview of the etiology, diagnosis and treatment for fibromyalgia. Current evidence-based treatments and guidelines are emphasized along with lifestyle modification suggestions for the patient. Also included is a review of current literature, research and emerging developments on this prevalent pain syndrome. A range of healthcare specialties, including pain management, rheumatology, neurology, internal medicine and family practice, will find this comprehensive guide to be a valuable resource to their routine treatment of fibromyalgia and improve patient's quality of life.

Understanding the key components of the diagnosis, assessment and management of inflammatory arthritis patients is essential to improving patient care. This book aims to cover these areas. It places inflammatory arthritis into a historical context; deals with the epidemiology, pathology, clinical assessment and investigation of inflammatory arthritis patients and provides a comprehensive overview of currently available treatment options. It provides insight into stratified medicine, an area of emerging importance in the management of heterogeneous diseases like RA. Finally, it provides an overview of what treatments strategies are in development.

This book is dedicated to our readers with the intention of providing an informative exposition of the myositis syndromes. It is also presented in the hope that perhaps it may serve to inspire and stimulate discussion and research into these disabling disorders. Included are descriptions of clinical features, differential diagnosis, pathogenetic mechanisms, and approaches to therapy. Current concepts of classi- cation and diagnostic techniques are also presented. The production staff at Humana Springer, especially Ms. F. Louie and Ms. C. Walsh, have been instrumental and invaluable in allowing this work to see the light of day. Above all, the scholarly essays of the contributing authors are acknowledged with gratitude. They have given this volume its character and existence. New York, NY Lawrence J. Kagen v Contents Preface ...v Contributors ...ix 1 Evaluation of the Patient ...1 Lawrence J. Kagen 2 Classification of Idiopathic Inflammatory Myopathies ...15 Frederick W. Miller 3 The Inflammatory Milieu: Cells and Cytokines...29 Ann M. Reed and Thomas A. Griffin 4 Juvenile Dermatomyositis: An Update on Clinical and Laboratory Findings ...55 Lauren M. Pachman 5 Inclusion Body Myositis ...87 Lawrence J. Kagen 6 The Role of Muscle Biopsy in the Diagnosis of Inflammatory Myopathy ...95 Sakir Humayun Gultekin 7 Electromyography ...1 1 1 Hans L. Carlson 8 Magnetic Resonance Imaging of Myopathies and Myositis ...127 Carolyn M. Sofka 9 Ultrasound in the Evaluation of the Inflammatory Myopathies ...147 Ronald S. Adler and Giovanna Garofalo vii viii Contents 10 Serological Findings ...165 Ira N.

With hundreds of question and answer items and bite-sized chunks of information that can be read and processed easily, reviewing for the pediatric board exams - or just brushing up in your spare time - has never been easier. Pediatric Tricky Topics, Volume 1: A Practically Painless Review includes review items in pediatric orthopedics, trauma, environmental medicine, toxicology, rheumatology, and neurology topics, among others. The Q&A format allows for self-testing or study with a partner or a group and is practical and accessible enough to dip into during a few minutes of downtime at the hospital or office, and as such it is suitable for those studying for the pediatric board exam, practicing physicians brushing up their skills, and any busy clinician who wants to learn more about these topics while on the go.

Systemic and nervous system vasculitides are a heterogeneous group of related disorders, each characterized by vascular inflammation such that they have the potential to cause serious morbidity and mortality if unrecognized and therefore untreated. Systemic vasculitis affect all populations and every nationality and walk-of-life, from childhood to older age. The first edition of The Vasculitides, published in 2014, met the urgent need for a clear, concise, and reliable textbook regarding the epidemiology, pathogenesis, clinical presentation, laboratory evaluation and management of these disorders, assembling participants of the 16th International Vasculitis and ANCA Workshop in Paris, France. Five years later, two subsequent meetings have taken place in London and Tokyo. Participants of the 19th International Vasculitis & ANCA Workshop will gather in April 2019 at the University of Pennsylvania for an exceptional venue to share translational scientific discoveries, data from clinical trials, and advances in the clinical assessment, pathophysiology, genetic biomarkers, standard-of-care, and novel therapies of vasculitis. The Workshop participants regathered to update the The Vasculitides, producing an even more cutting-edge two-volume set of books. This is the first book in the set, covering general considerations and systemic vasculitis.

Systemic and nervous system vasculitides are a heterogeneous group of related disorders, each characterized by vascular inflammation such that they have the potential to cause serious morbidity and mortality if unrecognized and therefore untreated. Systemic vasculitis affect all populations and every nationality and walk-of-life, from childhood to older age. The first edition of The Vasculitides, published in 2014, met the urgent need for a clear, concise, and reliable textbook regarding the epidemiology, pathogenesis, clinical presentation, laboratory evaluation and management of these disorders, assembling participants of the 16th International Vasculitis and ANCA Workshop in Paris, France. Five years later, two subsequent meetings have taken place in London and Tokyo. Participants of the 19th International Vasculitis & ANCA Workshop will gather in April 2019 at the University of Pennsylvania for an exceptional venue to share translational scientific discoveries, data from clinical trials, and advances in the clinical assessment, pathophysiology, genetic biomarkers, standard-of-care, and novel therapies of vasculitis. The Workshop participants regathered to update the The Vasculitides, producing an even more cutting-edge two-volume set of books. This is the second book in the set, covering vasculitis of the nervous system and treatments.

Rheumatologic diseases are highly associated with clinical symptoms of the skin, nails, and mucosal membranes. This book provides the practicing rheumatologist with a rapid, easy to consult reference to help interpret the nature of these cutaneous lesions and then quickly decide upon the appropriate follow-up tests. Utilizing an abundance of informative photographs, it contains all of the essential information needed for early diagnosis and treatment. This comprehensive guide properly orients the practitioner within the challenging world of rheumatologic disorders of the skin and gives insight into when consultation with a dermatologist is advisable.

Classification of the carpal injuries helps us to understand the relationship between them. The growing interest in this field has been advanced by recent imaging techniques. Therapeutic advice and treatment are still not completely defined, even by the most renowned specialists. There is still room for new concepts.

This book presents the essential anatomic and radiological data, discussing new and refined techniques of imaging such that readers may rely on their interpretation. The chapters on pathology are approached in a clinical context, accompanied by numerous diagrams and photographs, while the references, both classical and recent, are profuse. The result is a complete review of the subject, of interest to both the specialist and the non-specialist.

The physiology of man is a complex subject. Unfortunately the regulation of temperature in the human body is not always well explained in textbooks. Many conference proceedings on the subject have been produced that give excellent detail on research topics. However, the subject matter is rarely presented as a composite whole. New technology has broadened the scope of methods available for studying body temperature. Thermography in particular has made it possible to record in real time the temperature distribution of large areas of the body surface. Modem image processing methods permit dynamic studies to be carried out and detailed analyses made retrospectively-a tremendous advance over the complex and slow techniques formerly used by physiologists. Yet although the associa tion between disease and temperature is as old as medicine itself, beyond the implicit faith in the clinical mercury thermometer, other measuring techniques are finding a slow acceptance. This book is designed to put into perspective the critical factors that make up "body temperature. " Body temperature cannot be viewed as a static entity but rather must be seen as a dynamic process. An understanding of this phenomenon is important to all who use thermal imaging and measuring techniques in clinical medi cine. These methods have, in recent years, brought engineers, physi cists, technicians, and clinicians together. Inevitably, however, there v vi Preface are gaps and overlaps in technology and understanding.

As a phylogenetically old system complement is now regarded as a part of innate immunity. But it is much more than that. It bridges innate and adapted immunity, participates not only in host defense but also in many essential physiological processes, old and new diseases and adverse conditions. Indeed, complement became a term that almost defies categorization. What was for a long time a subject for a limited number of specialists has now moved into the mainstream of experimental and clinical immunology. In 1973 I visited the Basel Institute of Immunology and met its director, the eminent scientist and Nobel laureate Nils Jerne. When I entered his office he greeted me with the following words: "Complement, does that really exist?" I was never certain whether he wanted only to tease me or whether he sincerely believed that the complement system was an unimportant biological curiosity, a misstep of evolution. But, of course, missteps do not survive the evolutionary process. Little did I foresee the dramatic developments of recent years when Hans J. Muller-Eberhard and I started to unravel the specifics of the action of the cobra venom factor on the complement system in 1968 and defined a new pathway to its activation. An elucidation of the role of the system in diseases and its control for therapeutic reasons is now getting closer to actual realization in the clinic although many problems, in particular those of highly specificinhibition free of side effects, have still to be resolved."

Despite 50 years of antibiotics, infection remains a major source of both morbidity and mortality. Immunosuppression, either secondary to drugs in transplant recipients or secondary to HIV, has expanded the number of microorganisms that are known to be pathogenic in man. Imaging of infection has a vital role both in the initial diagnosis and in the continuing management of patients with infection or suspected infection. Functional imaging using nuclear medicine techniques has a unique role to play in identifying sites of infection in a wide range of patients with varying clinical conditions. This book, written by a series of experts not just in the fields of nuclear medicine but also infectious disease and radiology, discusses the role of nuclear medicine in three parts: a review of the pathophysiology of infection; a technical description of those nuclear medicine techniques which can be used in imaging infection; an extensive systematic review including thoracic, abdominal and orthopaedic infection as well as a special section on the acutely ill patient, the immunosuppressed patient and the patient with pyrexia of unknown origin. This book will be of interest to all clinicians looking after patients with infection and who need to use imaging techniques. It will also be of use to radiologists and nuclear medicine physicians who will be using these techniques clinically.

Leading clinicians and clinical researchers discuss in practical detail the newest treatments used in rheumatic diseases, emphasizing-without neglecting current standard treatments-those experimental therapies now undergoing clinical trials and poised for early introduction into the rheumatology armamentarium. The diseases and therapeutic regimes examined here range from rheumatoid arthritis and its treatment by gene therapy, to osteoarthritis and systemic autoimune diseases. Each chapter is organized so that the busy clinician can quickly obtain all the information needed optimal patient treatment. This includes an analysis of the pathogenic mechanisms that explain the molecular basis of the newer therapeutics, reviews of animal data and the results of clinical trials, and recommendations concerning use, side effects, and precautions.

Modern society is altering the lifestyle and longevity of its members much more quickly than evolutionary adaptation to these changes can take place. The problem of calcium deficiency in the population is compounded by the growing percentage of aged individuals with relatively fragile, less massive skeletons. Current-day civilizations are much more effective in prolonging human life in a state of relative debility than even a few decades ago. This reality is unlikely to change and mandates that we develop strategies to prevent aging-related diseases like osteoporosis before they become manifest. Osteoporosis: Genetics, Prevention and Treatment places emphasis on the (1) genetic predisposition, (2) early recognition and (3) prevention of osteoporosis. The intent is not to move the practitioner's attention away from intervention therapy of osteoporosis, but rather to expand their view of this disease as one beginning at birth and one in which susceptibility is manifest at the conclusion of adolescence, not at menopause. The book concludes with an informed view of the future in terms of the recognition, prevention and management of osteoporosis.

As it is quick, inexpensive, and non-invasive, ultrasound is the modality of choice for guidance of interventional procedures in the soft tissues. Furthermore, the rising mean age of the general population is being accompanied by increasing demand among patients for minimally invasive procedures to treat painful chronic and degenerative syndromes of the musculoskeletal system. This handbook is a clear, practical guide to ultrasound-guided minimally invasive treatments of musculoskeletal pain in the upper limb. Each chapter is clearly structured, with brief but comprehensive descriptions of the disease to be treated and of the materials and drugs needed. High-quality images and easy-to-follow schemes explain the best approach in each situation, and practical tips and tricks of value in daily clinical routine are provided.

Hughes Syndrome: The Antiphospholipid Syndrome, A Guide for Students provides an in-depth analysis into the main effects of Hughes Syndrome. In 1983, Dr Graham Hughes, and his team in London, described a syndrome and subsequently developed simple blood tests to diagnose the condition. This syndrome is characterised by thrombosis (both in limbs and internal organs), headaches, memory loss, strokes and, in pregnant women, placental clotting and recurrent miscarriage. The syndrome, now known worldwide as Hughes Syndrome, or the Antiphospholipid Syndrome, is common - being responsible for example, for up to 1 in 5 cases of young stroke and more importantly, it is treatable. Hughes Syndrome: The Antiphospholipid Syndrome, A Guide for Students details the effects of Hughes Syndrome on the major organs, making it a valuable reference tool for students in training.

Ankylosing spondylitis, the third most common form of chronic arthritis, is a systemic rheumatic disorder characterized by inflam mation of the axial skeleton (spine and sacroiliac joints), and a host of systemic manifestations. With comprehensive care, the vast majority of patients can lead full, productive lives. However, management can succeed only with patient education and exercise. Recent communication from my co-editor, Carson Dick, serves to remind me that there are several unresolved issues concerning drug therapy in ankylosing spondylitis. Clearly, in spite of my views, there are others who do not believe that the non-steroidal anti-inflammatory drugs (NSAIDs) alter favorably the course of disease and they must be administered for prolonged periods and in anti-inflammatry quan tities to be effective. I would agree with Carson Dick that aspirin and phenylbutazone are way down the list of drug priorities following the marketing of other NSAIDs that are effective and safer. I am grateful to my contributors to this volume, all recognized authorities on their particular topic. It has been a privilege col laborating with them on this particular volume. ABOUT THE EDITOR John J. Calabro, MD, is Professor of Medicine and Pediatrics at the University of Massachusetts Medical School and Director of Rheumatology at Saint Vincent Hospital, both in Worcester, Mas sachusetts, USA. He is the author of over 260 scientific articles, including several monographs and a book on arthritis for patients."

In recent years, the techniques of electron microscopy have developed so widely and rapidly that they now cover the fields of research once the unique ll:panage of sister research techniques such as biochemistry, physiology, immunology, X-ray diffraction, etc. It is now possible to reach molecular and submolecular levels, making this technique indispensable in every type of research. Electron microscopy alone often provides enough information to solve given problems. In the field of the connective tissue matrix, knowledge of the molecular structure of collagen, pro teoglycans and elastin and their interaction has been to a large extent elucidated by electron microscopy. The field over which electron microscopy ranges in the investigation of the connective tissue matrix is so wide that the aim of this volume is to collect the main ultrastructural acquisitions disseminated in various journals and monographs in one book. The intent ofthis volume is to: (a) integrate different and new microscopic methods and review the results of such an integrative approach; (b) present a comprehensive ultrastructural account of selected aspects of the field; (c) point out gaps or controversial topics in our knowledge; (d) outline pertinent future research and expansion of the subject.

Sparing of the growth plate is an early feature of diaphyseal and meta-diaphyseal osteosarcoma. Capitalising on this characteristic, Jose Canadell has developed an innovative technique to preserve the epiphysis while resecting primary bone malignancies lying adjacent to the growth plate of skeletally immature patients. Using external ? xation devices, controlled distraction of the epiphysis from the growth plate permits iatrogenic separation of the epiphysis from the affected region. Subsequent resection is enhanced by a safe distal margin and Canadell's local control rates attest to the success of the procedure as an oncologically sound technique. The Canadell technique has been developed through rigorous examination of the behaviour of osteosarcoma, as well as an interrogation of the best modalities for assessing tumour invasion of the growth plate. Combining an innovative treatment philosophy with a sound knowledge of the behaviour of osteosarcoma and basic bone and growth plate biology, as well as an extensive experience with ancillary investigations and adjuvant therapies, Canadell has developed a robust surgical technique for the management of a challenging tumour in selected patients. This book is the culmination of Canadell's endeavours over the last two decades. It traces the steps that he has taken to validate the safety and ef? cacy of the Canadell technique as we know it today.

Ankylosing Spondylitis in Clinical Practice is a concise, practical guide on the diagnosis and management of this debilitating condition. This book is aimed at clinicians who treat Ankylosing Spondylitis. It provides an authoritative, accessible guide to the diagnosis, management and treatment of ankylosing spondylitis.

It may have once been known as Disease of Kings, but gout is a growing problem for ordinary people around the world. This book brings together multinational expertise to draw out an understanding of this disease that will be useful for the academic, the clinician and indeed the sufferer of gout. Highlighting recent understandings of the genetic background to the condition, with detailed pathophysiology and epidemiology, this book brings together and illustrates the disease mechanisms that cause gout. There follows both an academic and practical appraisal of the dietary risk factors for the development of gout, and the cardiovascular associations that heighten morbidity. With state of the art imaging modalities, the process and sequelae of the disease is captured within the human body, describing in pictures the damage and effect that gout crystals can produce. That damage can be avoided however, if simple principles of treatment and lifestyle modifications are followed. Horizon scanning for yet more drugs to address this growing and unmet need is highlighted as new options that have either recently become available or will be accessible in the near future are explored. With the increasing incidence and prevalence of this condition we are all going to have greater exposure to gout. This book is a timely resource, written by experts, yet accessibly written for all, and certainly not just for kings.

Lupus is an extremely common, potentially treatable, disease of the immune system. It affects approximately 1 in 1000 women and is more common than diseases such as multiple sclerosis and leukaemia. Despite this, there is little information concerning the disease in contrast to other illnesses of similar prevalence.

Many people are unaware of the symptoms, treatment, and prevention of lupus. It is important that these topics are highlighted for many reasons. For example, a greater understanding of the symptoms of lupus will enable patients to recognise the symptoms earlier, and get treatment faster; before any serious damage is done. Similarly, awareness of preventative measures may reduce the number of cases of lupus that occur.

From a different perspective, it would be of great use to have an easily accessible source of information available to lupus patients that would highlight issues such as treatment options and sources of support.

In summary, although knowledge of lupus is growing, greater awareness of the disease amongst both patients and the general public is an issue that needs to be addressed.

A child with Duchenne Muscular Dystrophy (DMD) faces a childhood and adolescence with a disability that develops gradually. This book intends to expose the problems of children with DMD. The authors discuss situations related to the disease in an attempt to provide some quality and improvement of life for those affected since DMD is a degenerative disease which affects muscle. This book offers a historical study of muscular dystrophy. It also shows some profiles of excellent clinicians and scientists that have contributed to this book with a description of muscular dystrophy from the clinical picture, to the latest techniques in genetics. Also included in the chapters are resolutions of several approaches to DMD, like scales, in order to anticipate how to manage the disease. This book relates some techniques of moderate exercise, like Yoga and water exercises, that are compliable with some advantages in mobility. The book concludes with some current trends and what can be done in the future. This book can be a good read to everyone that is interested in DMD, and also for the ones who know or provide care for those with this terrible disease.