Rheumatic conditions are common both in general and hospital practice. Musculoskeletal symptoms are a primary feature of many multisystem illnesses, not only in the autoimmune joint and connective tissue diseases, but also metabolic, endocrine, neoplastic, and infectious conditions. Symptoms are also common in the context of injury, age-related change, and psychological distress. Many conditions in rheumatology are a major source of morbidity and mortality.
We have kept to the format of the first edition of this book, focusing first on history and physical signs in the differential diagnosis of rheumatic disease. The reader is then encouraged to consider diseases in more detail. There have been major advances in rheumatology, not least the introduction of biologic therapy. The second edition reflects this in being up-to-date with assessment, guidelines, and treatment options in 2006. We have also introduced several new chapters in Part 2 including one on rheumatological emergencies.
Part 1 offers a practical guide to arriving at an appropriate differential diagnosis given the realistic presentation of rheumatic disease; for example, how to assess someone complaining of a pain in the elbow, knee pain, or of difficulty moving the shoulder, etc. The book suggests appropriate lines of inquiry for patients who present with characteristic patterns of abnormality such as widespread joint or muscle pain, or joint pains in association with a rash. The aim is to provide a guide for obtaining diagnostic information but also for discriminating good from bad information—where to lay emphasis in eliciting a history and examination signs. In most chapters in Part 1, text is laid out under the headings of Taking a history, Examination, and Investigations, with the subheadings indicating important considerations and areas of inquiry.
Part 2 lists a number of rheumatic conditions encountered in rheumatology and general practice. There is a focus on clinical features, specific findings of relevant investigations, and management. There is reference to childhood and adolescent rheumatic disease throughout. The aim is to provide a comprehensive, clinically orientated text. Some reference is made to disease epidemiology and pathophysiology. However, for more detail on the basic sciences the reader is referred to The Oxford Textbook of Rheumatology.
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