Clinical care in the rheumatic diseases, 2nd edition


Clinical Care in the Rheumatic Diseases, 2nd Edition LauraRobbins, Carol S.Burckhardt, Marian T.Hannan, Ralph J.DeHoratius Atlanta, GA, Association of Rheumatology Health Professionals, 2001. 302 pp. Illustrated. $38.00/nonmember, $28.00/member

Maura Daly Iversen PT, MPH, ScD*, * Simmons College Boston, MA.

Clinical Care in the Rheumatic Diseases, the clinical companion to the Arthritis Foundation Primer, is a premier source for clinicians and health services providers specializing in the management of patients with rheumatic diseases. The goal of this second edition was to present the state of the art in rheumatologic management as influenced by current issues facing health care professionals. The authors provide a succinct and useful discussion of these issues, contrasting the efficacy and effectiveness of research in various clinical diagnoses and health services management, and extending these concepts to evidence-based care and applications for education and dissemination of information.

The text features new chapters on the epidemiology of rheumatic diseases, clinical applications, health services management, evidence-based practice, and uses of the World Wide Web. More than 60 health care professionals contributed to this book, including highly respected rheumatologists, physical therapists, occupational therapists, social workers, psychologists, and nurses.

Clinical Care in the Rheumatic Diseases is divided into 6 sections. The first section describes the clinical foundations of rheumatology including a wonderful review of the musculoskeletal system, the epidemiology of rheumatic conditions, and the impact of rheumatic conditions on society. This section also includes a comprehensive and clearly-presented chapter on immunology, inflammation, and genetics, and a new chapter on human development in rheumatic diseases. The chapter on human development provides a rich foundation for understanding the impact of rheumatic disease on the developmental tasks occurring at each stage of the patient's lifespan.

The second section focuses on diagnosis and assessment. The chapters included in this section provide a refreshingly comprehensive and pragmatic approach to clinical examination. The chapters discuss traditional methods such as history taking, physical assessment, diagnostic laboratory tests, and imaging, as well as psychological, social, and cultural issues. Recognizing the influence of clients, providers, and third- party payers on the quality and access to care, this section features a new chapter on evidence-based medicine and clinical trials. This chapter provides a template for the critical evaluation and synthesis of clinical data to determine the quality and applicability of clinical research. The chapter on functional ability, health status, and quality of life presents a practical introduction to outcomes measurement, outlining the characteristics of the various generic and disease-specific measures used for patients with rheumatic conditions.

Rheumatologic disorders encompass more than 100 conditions. The third section of the text is devoted to the common rheumatic diseases. Each chapter sequentially walks the reader through the clinical manifestations of each condition, differential diagnoses, and state-of-the-art interventions. This second edition includes 2 new chapters on osteoporosis and fibromyalgia.

The fourth section provides a comprehensive overview of clinical interventions recommended for patients with rheumatic conditions. Chapters focus on exercise, surgery, common pharmacologic agents, assistive devices, and the role of rest and physical modalities in managing the symptoms of arthritis. This section also describes interventions for specific areas of the body affected such as the foot and ankle, low back, and shoulder. These chapters articulately present the interrelationships of structure, function, and clinical manifestations. New chapters in this section discuss the role of complementary therapies and conservative realignment therapies.

Section 5 provides a discussion on problem-focused management. The topics of pain management, fatigue, sleep problems, mood disorders, deconditioning, adherence, and work disability have been completely updated from the original edition of the text. The sixth and final section is directed toward clinical care resources available on the World Wide Web. The reader is given information on web searches, evaluating various web sites, and creating web sites. Specific links and references for patient support and community programs are also provided.

The Clinical Care Text is extremely informative and quite readable. The information presented is a significant contribution to the management of patients with rheumatologic conditions. It is highly recommended for clinicians, rheumatology fellows/trainees, health care administrators, and health professional students who desire a practical and comprehensive approach to patient assessment, intervention planning, and outcome measurement.