Illustrated Textbook of Paediatrics

that joint pain and stiffness can be divided into diffuse pain or localized pain near or at a joint. If you subdivide the diffuse pain group, this separates out into chronic pain syndrome, polymyalgia rheumatica or malignancy, whereas the localized pains can be divided up into either no joint swelling, in which case osteoarthritis, tendinitis, bursitis and systemic lupus come to mind, or objective joint swelling, which is divided into monoarticular (subdivided further into brief episodes or chronic prolonged episodes) and polyarticular disease. You can then embroider on top of that immunology, radiology, and so on although radiology is here perhaps underplayed as a means of investigation. The big drawback of such an approach is that it is all-embracing. It does not allow for variance. It raises the problem that patients do not always conform to guidelines and that diseases have to be tailored to patients, not patients to diseases. Nevertheless, the theoretical idea is not a bad one and the book is full of useful detail. With the authorship, it is not too surprising that systemic lupus is somewhat overplayed. I had difficulties with the section on polymyalgia rheumatica, where some of the treatment specifications are open to doubt; for example, few would agree that the disease can be predominantly treated in a year. My anxiety is that this should not be the only textbook that is read by a trainee or a general practitioner. If it is used to stimulate the mind along with other textbooks, then it has a useful contribution to make.