Book Review

Adolescent Rheumatology

N Engl J Med 2008; 359:1298September 18, 2008

Article

Adolescent Rheumatology
Edited by Janet E. McDonagh and Patience H. White. 439 pp., illustrated. New York, Informa Healthcare, 2008. $229.95. ISBN: 978-0-8493-9890-2

Pediatric rheumatology has a quality that sets it apart from other pediatric subspecialties. In some respects, this quality is determined by the limited number of board-certified practitioners caring for an ever-growing number of children with autoimmune disease, musculoskeletal dysfunction, and difficult-to-interpret laboratory data. As diagnostic studies, medical interventions, and even the nature of youth itself have become more complex, it is important to acknowledge that adolescence is not just an age but a stage. Half the world's population is younger than 25 years of age, and the prevalence of musculoskeletal disease alone accounts for more than one fifth of the cases of chronic illness in American youth. On the basis of this information, it is easy to understand how the burden of care may fall on providers who do not have expertise in adolescent medicine, pediatric rheumatology, or the more intricate and complex arena in which these disciplines merge. Adolescent Rheumatology spans the globe, with an anthology of material designed to promote an understanding of this unique specialty to anyone who provides care for adolescents with common disorders, such as conventional knee pain, or more complicated, multisystem diseases. The book makes it clear that not only is a child not a small adult, but an adolescent is not just a big child.

The adult rheumatologist using this book will be best served by reviewing the chapters that address issues specific to adolescent patients: interview technique, the developmental importance of self-image, risk-taking behavior, and the medical consequences of noncompliance versus the achievement of a mutual understanding that promotes treatment adherence. These are patients with greater psychodynamic vulnerabilities than adults — patients who are subject to conditions that further delay their goals of independence and self-determination.

Although the adolescent subspecialist may be in sync with the inner programming of a 15-year-old's brain, the general pediatrician may not. The book gives pediatricians the tools they need to recognize and differentiate a given complex of symptoms. The chapters on specific rheumatic disease will also be of interest to pediatricians for the attention paid to conditions most prevalent during this stage of development, as well as to the psychosocial ramifications of these conditions. Practitioners of adolescent medicine will appreciate the inclusion of discussions of chronic pain syndromes, mechanically caused musculoskeletal disease, and back pain in addition to the standard bearers of pediatric texts — systemic lupus erythematosus and juvenile chronic arthritis.

Pediatric rheumatologists, like myself, will benefit from the reviews of medical processes that intersect and amalgamate the rheumatic diseases but will also find themselves nodding affirmatively while reading the discussions of how to incorporate the methods recommended to improve the delivery and quality of adolescent health care. I was rewarded with concrete strategies on how to manage the parents of these complicated patients and how to help emerging adults transition into their new medical and psychosocial world — this being my struggle as much as theirs.

All members of the health care team who support young people with rheumatic disease — including physical and occupational therapists, nurse specialists, orthopedists, psychologists, social workers, and even the adolescent patients themselves and their families — will find value in at least portions of, if not all of, the material presented by the expert panel of authors. I recommend reading the last chapter first. Entitled “Young People Have the Last Word,” it consists of a series of vignettes written by adolescents with rheumatic disease. As one 16-year-old girl writes in a poem, “Speak to us so we know you care / Not about us as if we're not there.” It is a very powerful message.

Herbert Lazarus, M.D.
New York University School of Medicine, New York, NY 10016
herbert.lazarus@med.nyu.edu