Second edition. Robert G. Lahita; ed. 1022 pages. New York: Churchill Livingstone; 1992. $175.00.

One might ask if another edition of Lahita's Systemic Lupus Erythematosus were needed after just 5 years. The overall organization of the second edition is exactly the same as the first. However, as is often the case with second editions, the book is physically larger, chapters have been added, and the format now features two columns of text on each page.

This edition includes some important new areas; most noteworthy is the antiphospholipid antibody syndrome, addressed by Nigel Harris in the Autoantibody section, Ron Asherson in the Clinical section, and David Essex and Sandor Shaprio in the Organ System section. Several other authors also discuss the syndrome.

Other new areas covered in this second edition include lupus hepatitis and vasculitis, neonatal lupus, and genetic susceptibility as it relates to class III complement genes.

The chapter on the imaging of system lupus erythematosus has been greatly expanded. The quality of this chapter's photographs seems significantly improved; reproductions appear sharper. The chapter nicely describes and illustrates the role of various imaging techniques for diagnosing the disease and its complications in each organ system.

The book also contains a more thorough overview of the neuropsychiatric manifestations of the disease; the subject is split into three subsets: the central nervous system, psychiatric aspects, and a new chapter on cognitive dysfunction. This latter chapter concludes that cognitive impairment most likely reflects central nervous system dysfunction that has heretofore been greatly underestimated.

Many new tables and figures are of high quality. The book consequently appears far more readable and better organized than the first edition.

However, this book seems best suited as an up-to-date resource for the library of physicians and other scientists who are involved in the management and study of patients with lupus or lupus-like syndromes. This is a reference book, meant not to be read from cover to cover but selectively to obtain codified information or guidelines by specific authors on specific topics. Much information is repeated throughout the book, even in the tables; there is also the dilemma of divergent emphases and viewpoints by authors on various topics (for example, epidemiologic data and the approach to the laboratory investigation of patients with the disease).

Chapter 3 on etiologic hypotheses for the disease is especially well-written and easy to follow, although an admitted bias toward microbial hypotheses is clearly evident. Other chapters, such as that on the genetic susceptibility to the disease, although authoritative, will be difficult for many clinicians to absorb. This unevenness, however, is not necessarily a fault; the book will be useful for a wide spectrum of readers.

This second edition has been extensively revised and will be a standard reference for anyone interested in systemic lupus erythematosus. I look forward to a third edition in no more than 5 years.