Textbook of Orthopaedic Medicine

Soft-tissue rheumatism is common, and we are all familiar with and often quote figures for days of work lost because of its various forms. Nevertheless, understanding of the causes and treatment of the various types of soft-tissue rheumatism is very limited. This is a field that James Cyriax has made his own and likes to term 'orthopaedic medicine'. In this new and enlarged volume of his textbook he explains that his approach is as the physician counterpart of the orthopaedic surgeon. He describes the diagnosis and assessment of numerous syndromes and dwells in detail on the clinical history and physical examination. In general, x-rays and other objective tests such as blood tests are of little value. The physician 'must take great pains to be right, for contrary evidence is often not available to bring an error to his notice'. However, this is the nub of the problem. Without support from pathological studies there is generally no consensus view about these syndromes. Equally, the management of them is described in rather a didactic fashion, yet we lack knowledge of their natural histories and remission rates and controlled trials of alternative forms of therapy. Low back pain receives special attention Here Cyriax believes that most cases are due to disc lesions. He mentions specific spinal diseases such as ankylosing spondylitis but denies vehemently that back pain can be due to facet joint lesions. The more defined rheumatic diseases are dealt with relatively briefly. Here one feels on firmer ground, yet there are points of disagreement. For example, polymyalgia rheumatica is described as bilateral monarticular rheumatoid arthritis of the shoulders. In inflammatory arthritis there is an emphasis on the use of intraarticular triamcinolone that seems excessive. Cyriax is to be congratulated for concentrating on an extremely difficult field. Although there is much that is controversial, this volume should stimulate us to think more deeply about these common problems. M. JAYSON New Directions for Research in Systemic Lupus Erythematosus. Proceedings of a conference sponsored by the Arthritis Foundation. Arthritis and Rheumatism, 21, No. 5 (Supplement), June 1978. (US $15; $10 for orders of 100 or more.) Arthritis Foundation, 3400 Peachtree Road NE, Suite 1101, Atlanta, Ga 30326, USA. 1978.