Forward by Dr. Morris Ziff
When I entered the field of rheumatology in 1950, clinical practice in this budding area of specialization was relatively straightforward, but at the same time it had its difficulties. Take rheumatoid arthritis as an example. The diagnosis was made essentially on the basis of the history, physical examination, and sedimentation rate. Sensitized sheep cell agglutination tests for rheumatoid factor were being done, but practitioners sneered at them, proclaiming that in those patients in whom the test was positive, they could make the diagnosis from the history and physical alone. The difficult part of treating the patient with rheumatoid arthritis came at the end of the examination. One had two drugs to offer— aspirin and gold salts. Gold salts were thought to be toxic and to be reserved for people with severe disease. So, one faced the inevitable embarrassment of telling the patient to take aspirin. Thus, a patient visit that started with a bang ended with a whimper. This period of limited treatment options has dramatically changed in the last half century.
When I started in rheumatology in 1950, laboratory investigation was centered on the composition of the connective tissue and how it became abnormal in disease. This was a natural consequence of the state of knowledge at the time. Investigation of connective tissue biochemistry had made good progress: the amino acid composition of collagen had been worked out, and the proteoglycan constituents, hyaluronic acid and chondroitin sulfate, had been isolated and characterized by Karl Meyer. A phenomenon called “fibrinoid degeneration” occupied people’s minds. It was supposed to be so characteristic of the rheumatic diseases that Robert Good used to call them the “fibrinoid diseases.” Observing the diffuse deposition of fibrinoid in the collagen of the connective tissue in systemic lupus erythematosus, Klemperer and coworkers in 1942 coined the name “collagen diseases.” However, the re-discovery of the rheumatoid factor by Rose and Ragan and the discovery of the L.E. cell factor by Hargraves in 1948 sparked an explosion of research on the role of the immune response in the etiology and pathogenesis of this group of diseases. This, in turn, has lead to a massive growth in our knowledge of these diseases and, consequently, the number of outlets for dissemination of this knowledge.
There are journals of rheumatology in every major country, three large text-books of rheumatology, and, inevitably, a half-dozen “condensed” texts. The present book, (RheumaKnowledgy) is unique among these condensed texts. Its uniqueness lies in the fact that it is essentially a compendium of the rheumatic diseases helpfully organized into three sections: (1) tests and procedures utilized in the diagnosis of the rheumatic diseases; (2) clinical information about the individual diseases, including their diagnosis and treatment; and (3) drugs used in treatment, with pertinent information about each drug. This format makes it possible for the reader to focus rapidly on the information he or she needs. In each of the three sections, the amount of information provided for each item listed is substantial.
As mentioned above, a vast amount of knowledge has accumulated in the field of rheumatology in the last fifty years. The amount of information has grown sufficiently large for the health professional to profit from having this “compendium” readily at hand.
Morris Ziff, PhD, MD
Ashbel Smith Professor Emeritus of Internal Medicine
Morris Ziff Professor of Rheumatology
The University of Texas Southwestern Medical Center
Dallas, Texas
(1987)
