International Journal of Epidemiology 2002;31:1079-1080
© International Epidemiological Association 2002
Book Review |
Epidemiology of the Rheumatic Diseases Second Edition. AJ Silman, MC Hochberg (eds). Oxford: Oxford University Press, 2001, pp. 377, £95.00. ISBN: 0192631497.
This book is both excellent and annoying. Let us deal with these characteristics in turn.
Excellence: the first edition of the book was published in 1993, and soon became established as the world’s leading text in the epidemiology of rheumatic diseases. The editors and authors have revised it extensively, omitted some of the original chapters (e.g. pharmacoepidemiology) and added new ones (e.g. on the burden of rheumatic diseases, and on osteoporosis) for the second edition. The result is, without doubt, an improvement. The extended chapters on so-called soft tissue rheumatism are particularly welcome. This is an authoritative, comprehensive account of rheumatic disease epidemiology, and a hugely valuable source book. Each chapter is laid out to a similar template —covering case definition and criteria, prevalence and incidence, trends, and then risk factors, which are split into genetic, host and environmental. This means that it is very easy to use the book, and to find specific information that you may want to look up about a specific disorder. Being rather a sad person, I went to the trouble of counting the number of references cited. I came to a total of 3209—enough to keep the most ardent reader happy I should think. Such anal behaviour also provides insights to the world of rheumatology: there are many more citations on the epidemiology of the very rare disease scleroderma than there are for very common ones such as gout and polymyalgia rheumatica, for example.
Annoyance: For all its excellence and value, I also find this book annoying. It is too careful. In their introduction the authors say that there are many problems associated with rheumatic disease epidemiology (true) and that, as they see it, their ‘art’ is in understanding the imperfections of the studies (false?). They are good at that. They go on and on about it. I see it differently: I would like to know what all the data might mean. They are not good at telling me that. There is very little interpretation and practically no speculation in this book. Thus some of the really interesting issues, such as the decreasing incidence and severity of rheumatoid arthritis over the last few decades, are carefully reviewed and documented, with plenty of discussion on the likely flaws in the various studies, but with practically no mention of the many hypotheses as to why these fascinating time trends might be occurring. For the third edition (which this book will surely enjoy and certainly deserves) I would like to advise the editors to ‘lighten-up’ a little and risk some interpretation and speculation. Epidemiology can be a very dry subject without this.
It may have escaped your notice, but we are currently living in the WHO’s ‘Bone and Joint Decade’. As part of the developed world’s move away from limiting their health concerns to fatal diseases, and thinking about chronic, disabling ones, the WHO has recognized that musculoskeletal disorders are amongst the most important chronic health problems throughout the world. Hence the ‘Decade’ which is concentrating on five issues: inflammatory rheumatic diseases, osteoarthritis and related disorders, back pain, osteoporosis and musculoskeletal trauma. In the developing world trauma is often the biggest of these problems, whilst in the ageing developed world osteoarthritis and osteoporosis assume the greatest importance. And that brings me to my only significant criticism of this book (as a reviewer I felt duty bound to find one): it deliberately limits itself to rheumatic disease problems of the developed world, and makes no mention of the types of problem that afflict the much bigger developing world. I realise that data on these problems are limited, and that much of the existing data would find fault with our rigorous, careful editors, nevertheless, they provide fascinating insights into other disorders, and are important to those populations that get them. The ‘Decade’ is a one-world initiative. Perhaps the publishers and editors could get the third edition out before the decade ends, and make it speak to the huge, increasing worldwide burden of the rheumatic diseases in a more representative way.
The excellence and value of this book far outweigh my minor criticism and those features of it that annoyed me. This is an excellent book. Anyone with a professional interest in rheumatic disease epidemiology should acquire it as soon as possible.
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