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Book and Media Reviews
August 11, 2010

A Clinician’s Pearls and Myths in Rheumatology

JAMA. 2010;304(6):690. doi:10.1001/jama.2010.1127

Medical residents and specialty fellows are taught medical “pearls,” ie, heuristics, “rules of thumb,” clinical aphorisms, bits of wisdom, and principles that have been largely passed on verbally from one clinical generation to the next. These words of wisdom have rarely been evidence-based by current standards, and many do not withstand rigorous examination; those that do not are respectfully referred to as “myths” in John Stone's superb compilation.

The book is divided into 48 chapters averaging 8 to 10 pages each, with discussion based on each rheumatic disease as well as on some non–disease-based topics and issues commonly encountered, such as pregnancy in rheumatic disease (a common and difficult area with little evidence base), vasculitic neuropathy (which requires consultations with neurologists for shared diagnosis and management), inflammatory eye disease (which requires frequent consultations with ophthalmologists for therapeutic assistance with glucocorticoid management and help with immunosuppressive and biologic therapies), regional musculoskeletal complaints, and neck and low back pain (the management of which overlaps with many surgical and nonsurgical specialties).

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