Book Review

Surgery for Rheumatoid Arthritis: A Comprehensive Team Approach

N Engl J Med 1993; 329:368July 29, 1993

Article

Surgery for Rheumatoid Arthritis: A Comprehensive Team Approach
Edited by Mack L. Clayton and Charley J. Smyth. 414 pp., illustrated. New York, Churchill Livingstone, 1992. $98. ISBN: 0-443-08217-0

The management of rheumatoid arthritis is imperfect and requires a firm understanding of both the medical and the surgical aspects of the disease. Surgery for Rheumatoid Arthritis attempts to describe the various surgical options, most of which have been developed within the past quarter of a century. Edited by two recognized leaders in their respective fields, the book is based on their more than 35 years of experience at the Denver Orthopedic Clinic: Dr. Smyth in rheumatology and Dr. Clayton in orthopedics. Other orthopedists in their group have written some of the chapters, but the style is uniform and consistent. The book is not intended to serve as a source book but, rather, to present the opinions of the authors about the selection, timing, and effectiveness of the various surgical procedures available for treating patients with rheumatoid arthritis.

The first few chapters review the basic pathophysiology of rheumatoid arthritis, its clinical manifestations, and pharmacologic therapy. This section is enriched by a historical discussion of the evolution of therapy for the disease. There follows a thorough discussion of the surgical principles of synovectomy, total-joint arthroplasty, and other procedures as they relate to the treatment of rheumatoid arthritis.

The major portion of the book is a joint-by-joint presentation of surgical options. Each chapter contains a historical review and a description of the fundamental surgical techniques. The authors then assume the demanding task of evaluating and commenting on the effectiveness of each operation and its effect on the patient as a whole. This is particularly difficult in a field in which there are few acceptable criteria for success or failure and in which one attempts to measure factors related to quality-of-life issues. The authors make an honest attempt to answer the salient questions, however, and state their opinions directly. In my own view, they do so with a high degree of accuracy. Case studies are used frequently to review basic principles and to present the multiple interrelations among factors in patient care. The illustrations and diagrams are superb, whereas the radiographs, although generally good, sometimes vary in quality.

The authors have succeeded in producing a highly readable and relatively short book. It should be useful to rheumatologists, orthopedists, and others heavily involved in the care of patients with rheumatoid arthritis. The authors have a well-founded confidence in their own judgments and espouse them effectively. Their opinions and concepts of total patient care distinguish this book from the traditional textbooks of orthopedics and rheumatology.

Ronald J. Anderson, M.D.
Brigham and Women's Hospital, Boston, MA 02115

Citing Articles (3)

Citing Articles

1. 1

   Jason R McCarthy, Farouc A Jaffer. (2011) The role of nanomedicine in the imaging and therapy of thrombosis. Nanomedicine 6:8, 1291-1293
   CrossRef

2. 2

   Adnan I. Qureshi. (2002) New Grading System for Angiographic Evaluation of Arterial Occlusions and Recanalization Response to Intra-arterial Thrombolysis in Acute Ischemic Stroke. Neurosurgery 50:6, 1405-1415
   CrossRef

3. 3

   Jeff Whittle, Chyongchiou Jeng Lin, Judith R. Lave, Michael J. Fine, Kristin M. Delaney, Dorothy Z. Joyce, Wanda W. Young, Wishwa N. Kapoor. (1998) Relationship of Provider Characteristics To Outcomes, Process, And Costs of Care for Community-Acquired Pneumonia. Medical Care 36:7, 977-987
   CrossRef