More than 20 years ago, in the preface to the first edition of the Textbook of Rheumatology, we suggested that "The field of rheumatology has come of age." What we meant was that rheumatology had shed its strictly empirical base and its host of unproven remedies and become a healing discipline thoroughly grounded in science. We thought it was time for a new textbook, one that reflected this passage through epistemological puberty.
The sixth edition reflects the maturation of rheumatology as a subspecialty. It is instructive to compare the contents of the first and sixth editions. Many chapters have disappeared entirely, and their material has been condensed and incorporated into existing chapters. Consider, for example, that in the basic science section of the first edition we devoted entire chapters to immunoglobulin structure, the contact activation system, and lysosomes (not to mention purine metabolism, a subject dear to the heart of the then senior editor). Cyclic nucleotides and eosinophilic chemotactic factor of anaphylaxis figured prominently in the titles of other basic science chapters. None of these has a place in the Table of Contents of the current edition. Instead, there are chapters dealing with dendritic cells, leukotrienes, mast cells, nitric oxide, fibroblasts, cytokines, and apoptosis. The importance of these topics to understanding the rheumatic diseases was unknown 20 years ago, and some of them hadn't even been discovered! Who can imagine what the scientific basis of rheumatology will be in the 10th edition, 20 years from now? Surely, knowledge obtained from the working through of the human genome will figure prominently.
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