Reviewer: Dennis Keith Ledford, MD (University of South Florida Morsani College of Medicine)
Description: This is the third edition of this book, which has evolved from a handbook created for Canadian internal medicine residents in collaboration with the Canadian Rheumatology Association. The second edition was published with the name Canadian Clinician's Rheumatology Handbook in 2016 with an increased scope to assist clinicians in training and in practice. The third edition builds on this foundation with the addition of additional conditions and more recently recognized syndromes. The book is divided into six clinical sections rather than pathophysiologic divisions. These are: 1. common clinical presentations; 2. rheumatologic presentations in patients with pre-existing co-morbidities; 3. review of common lab tests; 4. review of therapeutic options with emphasis on the appropriate use of systemic glucocorticoids; 5. rheumatologic emergencies; 6. physical examination and joint injection techniques. The style is compact and concise, almost telegraphic, which facilitates rapid reading for point of care.
Purpose: Rheumatologic diseases are often not emphasized in general medical education but represent a sizeable portion of clinical medicine. This book is a handbook and not a textbook. The authors' intention, as stated in the preface, is to provide quick access at the point of patient care for diagnosis, assessment, and initial management of rheumatologic disorders. Pathophysiology and complex disease management are not discussed. The information is not of sufficient depth or detail for specialists other than fellows in training.
Audience: The audience is clinicians, particularly in internal medicine and family medicine as pediatric rheumatology is not discussed to any degree. The book is a point-of-care resource that provides relevant information for clinical decision making. In my opinion, medical students, residents, first-year rheumatology fellows, and physicians in general medicine will find the information useful. The authors are primarily practicing rheumatologists with academic affiliations. The information is relevant and accurate. Reviews have been provided by the Canadian Rheumatology Association. The editor, Dr. Lori Albert, is an academic rheumatologist at the Toronto Western Hospital, University Health Network, and an assistant professor in the clinical educator track. She has a long-term interest in clinical education at both the graduate and post-graduate levels. The handbook benefits from the diversity of authors and the educational experience of the editor.
Features: The handbook has a unique approach in that both the overall and individual chapter organization is clinically focused. Each chapter has "Key Points," which are practical; followed by "History" including key questions; focused "Physical Examination;" followed by "Key Laboratory Investigations;" then "Imaging;" and finally "Treatment Options" focusing on initial treatment. The emphasis is on "key," making the information very practical. The chapters on general rheumatologic pharmacologic therapy, physical examination, joint aspiration and injection techniques, and musculoskeletal imaging have retained the "Key Points" from prior editions but have deviated from the organization of the specific conditions. The book effectively uses tables and cartoon figures, but the quantity and quality of pictures is limited (with no color pictures provided). I was disappointed that there were no pictures of ultrasound imaging, an increasingly used bedside procedure, or MRI. I found the chapters on The Screening Musculoskeletal Examination, The Detailed Joint Examination, and Approach to Joint Aspiration and Injection to be particularly helpful. Personally, I will incorporate this information in my teaching rounds with house-staff and medical students. There is some redundancy as each chapter is able to stand alone and, therefore, examination and treatment points are repeated several times. I do not find this to be a distraction but complementary.
Assessment: This is a useful book that fills a need for a practical, quickly read, point-of-care resource. It is not as in-depth or complete but compares favorably with works such as the Oxford Handbook of Rheumatology, 4th Edition (Oxford University Press, 2018), Lange Current Diagnosis and Treatment in Rheumatology, 4th Edition (McGraw Hill, 2021), and the Washington Manual Rheumatology Subspecialty Consult, 3rd Edition (Wolters Kluwer, 2021). The book under review is short on pathophysiology, pediatric rheumatology, and evaluation of complex disorders such as vasculitis, but is long on practicality, ease of reading, and key points. The third edition adds considerably to the second, and thus justifies a new edition. The physical examination and joint injection chapters are especially useful.
