The introductory chapter on joint development is a brief overview of structure, growth, and developmental abnormalities of the synovial joints. It is a good overview but does not fit well with the rest of the book, which emphasizes the clinical, emotional, and school- and work-related problems faced by the adolescent with a chronic rheumatic syndrome.
The strength of the book lies in the nine chapters on special needs and challenges for teenagers with arthritis and their doctors, including those related to recreation, nutrition, sexuality, medical and surgical rehabilitation, educational and vocational planning, and leaving home. The problems are thoughtfully identified and discussed, and specific suggestions are provided, often including checklists for implementation.
The middle eight chapters cover the major rheumatic disorders but do so in considerably less detail than the above-mentioned textbooks. Some illnesses, such as mixed connective-tissue disease, diabetic cheiroarthropathy, and the CREST syndrome (calcinosis cutis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia), are not covered at all, whereas others, such as Sjogren's syndrome and Kawasaki's disease, are covered in a cursory fashion. Treatment is mentioned but without much detail with respect to drug doses, side effects, and alternative drugs. Thus, this book cannot be considered definitive.
The chapter on pain syndromes by David Sherry is an exception. He discusses the commonality of fibromyalgia, reflex sympathetic dystrophy, causalgia, and psychogenic muscle pain; provides many clues to the diagnosis; and gives much common-sense advice concerning management. He also covers the differential diagnosis, something missing from many of the other disease-oriented chapters.
In sum, this book is an excellent supplement to standard textbooks on pediatric rheumatology. It is a must for health care professionals who deal with teenagers who have a rheumatologic disorder.
Reviewed by E. Richard Stiehm, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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