The Lupus Book: A Guide for Patients and Their Families By Daniel J. Wallace (review)

and reenter the laboratory to fight the reality ofHIV disease, rather than HIV theory and its adherents. Peter D. Friedmann, MD, MPH Assistant Professor ofMedicine University of Chicago Pritzker School ofMedicine The Lupus Book: A Guide for Patients and Their Families. By Daniel J. Wallace. Oxford University Press, 1995. Dr. Wallace, Clinical Chief of Rheumatology at Cedars-Sinai Medical Center in Los Angeles, has written an extremely helpful, up-to-date, and fact-filled book for people who desire more information about systemic lupus erythematosus (lupus) . The book is very technical in certain areas and not intended to be read from cover to cover but best serves the reader as a reference book. Lupus and arthritis societies and organizations need this on the shelf or by the telephone to answer questions from patients and family members. There is a detailed glossary and an Appendix of Lupus Resource Materials that provides names and references about lupus organizations , textbooks on lupus, availability of videos, etc. Dr. Wallace along, with Dr. Bevra Hahn, both from the UCLA Medical School, co-author a standard and widely used lupus textbook for rheumatologists, and much of the data for The Lupus Book comes from that source. Some of the chapters arejust great for patients. Chapter 10 outlines the history, symptoms and physical findings seen in lupus patients. It describes what a patient should expect when consulting a rheumatologist and why the examination and history need to be so thorough. The treatment chapter (Chapter 27) that discusses disease-modifying medications is especially informative. Dr. Wallace has great respect for the value of anti-malarial medications, and I think most rheumatologists are also becoming increasingly enthusiastic about their early and frequent use in some ofthe non-life-threatening manifestations oflupus. Information on sun exposure and its consequences (Chapter 24) is very helpful, and Chapter 25 (coping) will be informative for all of the newly diagnosed and the depressed lupus patients. There are brief sections in this chapter on "But you don't look sick," "My doctor is not listening," "Guilt," and "Unproven remedies" that will strike a responsive chord. Dr. Wallace has many informative and illustrative case reports scattered throughout the book, describing specific problems that patients experience and that are easy to read and identify with. These will also be reassuring to patients and families. Chapter 30, "Can a Woman with Lupus Have a Baby?" is must reading for patients of child-bearing age. Much of the book is devoted to fairly detailed science about the immune system, genetics, organ involvement, laboratory testing, etc., that will very be hard reading for the lay public. Some of the information is detailed enough for medical students, and indeed they would benefit by reading this book (junior housestaffdoctors also) . The information is too detailed to be just read through, but the facts are there to be researched when needed. Some of the information provided in this book is quite sophisticated. Ifyou want to know about cryoglobulins, spinal fluid and oligoclonal Perspectives in Biology and Medicine, 40, 3 ¦ Spring 1997 | 469 bands, Libman Sacks endocarditis, thoracentesis, lupus panniculitis, etc., they, are all here and explained well. I have some disagreements with Dr. Wallace about the medical approach or treatment of the patient. He states that lupus can be distinguished from fibromyalgia by a bone scan. That test generally should not be needed to distinguish between those two illnesses. I am also surprised that he doesn't administer influenza vaccine to his patients. It is something that we provide almost all of our lupus patients. Some of my patients would be surprised to hear that azathioprine is not associated with loss of menstrual periods. Dr. Wallace administers cortisone to his immediate post-partum patients in an effort to reduce lupus flares; I am not aware of data to support this "preventive" approach. In one discussion about corticosteroids and pregnancy (pg. 228), he considers less than 40 mg of prednisone as moderate or low dose; I consider only 10 mg or less of prednisone as low dose. Doses of prednisone greater than 10 nig are not well tolerated by pregnant patients. Lupus patients of course need to review all of the treatment and...