Oxford American Handbook of Rheumatology PDF
3.8 MB PDF
Rheumatology is one of the last great frontiers in medicine. In this modern era, in which we hear less about neck veins and more about BNP levels, rheumatology remains the exception to the rule. Despite the growing number of diagnostic tests we have at our disposal, they remain a mere adjunct to the patient evaluation. This is one of the last subspecialties in which it is not only common, but appropriate, to ignore a positive ANA or joint space narrowing, and instead listen to what the patient has to say.
That said, rheumatology is a field in transition. Long behind us are the days in which clinical trials compared the efficacy of one NSAID to another. The advent of biologic agents in particular has led to a new era in therapeutics in which largely nonspecifi c immunosuppressive drugs are being replaced by progressively more nuanced agents. The day that molecular phenotyping of patients joins clinical phenotyping as a way of selecting treatment strategies cannot be far behind.
During the last few years, the rate of transitions has occurred at breakneck speed. Since the publication of the first edition, new classification criteria have been published for systemic lupus erythematosus, Sj ö gren’s syndrome, polymyalgia rheumatica, and rheumatoid arthritis. For the first time, we have FDA-approved agents for the treatment of both systemic lupus erythematosus and ANCA-associated vasculitis. Finally, we are starting to see oral biologic agents hit the market, allowing patients to take advantage of our most advanced therapeutics without subjecting them to the needle.
For the present, rheumatology encompasses a dizzying amount of information; no book can be expected to replace years of clinical experience. I believe and hope, however, that this book will find a home in many white-coat pockets, from the attending who just needs to refresh his or her memory on a few details, to the trainee who is looking for some way of getting a toehold in this daunting field.
More than anything else, this book is meant to provide you with an approach to the patient, and a framework on which you can build. This book represents just the beginning of a continually evolving, continuously changing story that never fails to fascinate.
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