Rheumatology Expert Group.
*Version 2. xxiii+315pp, ISBN 978-0-9804764-8-4. Melbourne, Therapeutic Guidelines Limited, AUD39.00, 2010 (2011 eBook also available).
Apart from major textbooks, there have been few handbooks published specifically on rheumatology guidelines. This second eBook Version of Therapeutic Guidelines: Rheumatology, part of a collection of 14 in the series of the popular and respected Therapeutic Guidelines series in Australia, is a significant step forward in filling this gap. Therapeutic Guidelines: Rheumatology has a table of Contents, list of Tables, Boxes and Figures, a list of the members of the Rheumatology Expert Group, Acknowledgments, Endorsements and support, About Therapeutic Guidelines Limited and their Board of Directors, a Preface, 19 Chapters, two Appendices, a useful Glossary, a comprehensive Index, and a Request for comment on guidelines proforma. It also includes 19 Tables, 11 Boxes and eight Figures.
As is usual in this series, the handbook is compact and, if consistent with others in the series, the reader will expect that updated guidelines would be released every few years; in this case approximately 4 years since the First Edition. The front cover has a basic but functional design with an image of an oil can dripping oil (suggestive of improving lubrication of joints). The back cover is virtually blank, except for the ISBN and barcode, and an opportunity has been missed to include a fast find contents list or an overview of the publication; however all of the Therapeutic Guidelines’ handbooks seem to take this minimalist approach. Similarly, it may be interesting to explore making better use of the inside front and back covers, as has been done in other series, such as the Oxford Handbooks, by listing for example major emergencies and the page references to find information to manage them. Each chapter has a useful highlighting strip on the edges of the pages, which importantly helps to identify the various chapters, although they are not staggered, which defeats their purpose somewhat. It is also important to note that the handbook is also available electronically and this would make it very easy to print out patient information sheets, for example.
As an Australian based publication, it is inevitable that the writing group would be predominantly Australian. It is interesting however that all 16 members of the Rheumatology Expert Group are Australian based. None-the-less, many of these experts would be well known in the rheumatology field. Apart from the field of rheumatology, there are experts from the fields of general practice, sports medicine and clinical pharmacology.
Therapeutic Guidelines: Rheumatology is well researched, concise and consistent in its presentation. Chapters include “Getting to know your drugs”; “Assessment of the patient with peripheral musculoskeletal symptoms”; “Joint aspiration and injection”; “Management of chronic rheumatological diseases”; “Osteoarthritis”; “Crystal deposition disease”; “Rheumatoid arthritis”; “Spondyloarthritides, including psoriatic arthritis”; “Inflammatory connective tissue disease”; “Generalised noninflammatory chronic pain syndrome (including fibromyalgia)”; “Polymyalgia rheumatica and giant cell arteritis”; “Vasculitis and other inflammatory syndromes”; “:Assessment of spinal pain”; “Neck pain”; “Low back pain”; “Upper limb conditions”; “Lower limb conditions”; “Rheumatological disorders in children and adolescents”; and “Musculoskeletal conditions in pregnancy”. There are also two Appendices, namely “Resources” and “Pregnancy and breastfeeding”. By far, the largest chapter is Chapter 1 “Getting to know your drugs” (pages 1-33). There is no consistent approach to the discussion of individual drugs or drug groups; however dosage, side-effects and toxicity are amongst the sub-headings inconsistently used. The drugs covered include Analgesics, Corticosteroids, Disease-modifying antirheumatic drugs and immunosuppressants, Cytokine modulators, Drugs used for the treatment of gout, Fish oil (omega-3 long chain polyunsaturated fatty acids), Vasoactive drugs used in rheumatology and Complementary medicine. There is no particular set pattern to the structure of the chapters and sections in the guidelines.
Version 2 is a major update of Therapeutic Guidelines: Rheumatology. There is a new chapter on assessment of peripheral musculoskeletal disorders, including clinical features (red flags) that indicate potentially serious pathology and a summary table to help determine rheumatological causes of inflammatory musculoskeletal symptoms (Ch. 1). There are updated recommendations concerning drug treatment of rheumatological pain, particularly for low back pain, osteoarthritis, acute neck pain and shoulder pain. There is an increased emphasis on the role of non-pharmacological therapy, including patient self-management, where appropriate. There is a new chapter on polymyalgia rheumatica and giant cell arteritis (Ch. 11). There are new sections, which provide information on non-inflammatory musculoskeletal pain in children and practical points for paediatric prescribing. There is also an increased emphasis on the importance of monitoring for adverse effects of drugs, such as for disease-modifying anti-rheumatic drugs and corticosteroids.
From the Australasian perspective, it is hard to fault the guidelines, although a more obvious multidisciplinary approach could have been adopted. One possible area for those interested in tropical medicine would be a chapter on issues connected with viral arthropathies associated with diseases such as Ross River virus infection or Barmah Forest virus infection, which are only briefly mentioned in a table (page 36) and in the corresponding main text (page 40). Another possible omission is that there is no special compilation of the rheumatological side-effects surrounding acute or chronic poisoning, such as with lead (mentioned on page 36), which might be found in a larger textbook. None-the-less, it is a very useful rapid therapeutic guidelines reference.
Therapeutic Guidelines: Rheumatology is not a substitute for training and experience in rheumatology or indeed related areas, such as sports medicine. It is also not meant to be a comprehensive textbook, especially as there have been several good textbooks published recently.1,2 The handbook does however provide an exceptionally useful and fairly comprehensive clinical reference on most aspects of rheumatology for the informed health professional, particularly those who are working or will be working professionally in rheumatology, sports medicine, occupational medicine, hospital practice and general practice. The book will also appeal to general physicians and other health professionals, who have an interest in rheumatology, as well as students and academics involved in psychotropic training courses. Therapeutic Guidelines: Rheumatology has little competition in the guidelines field and is an important guidelines reference handbook in Australasia.
