Fourth Edition. Daniel J. Wallace and Bevra Hannahs Hahn; eds. 955 pages. Philadelphia: Lea & Febiger; 1993. $125.00.

The importance of lupus erythematosus exceeds its prevalence because its pathogenesis is relevant to many aspects of immunology and its varied clinical manifestations bring it to mind in the evaluation of patients with many diseases. The fourth edition of Dubois' Lupus Erythematosus, the second book devoted to lupus published in the 1990s, leads us through this complex condition in an informative, educational, and clinically helpful manner.

Although the book is multiauthored, extensive contributions from the editors help it to flow smoothly. The book is also enhanced by superb organization. Equivalent emphasis is given to factors related to the cause and pathogenesis of the disease, including autoantibody formation, and to clinical manifestations. Chapters dealing with underlying immunologic mechanisms cover their topics with such clarity that readers will rarely be forced to consult an immunology textbook. Equally helpful are the authors' personal interpretations and suggestions for clinical evaluation and management, exemplified by the chapters on nephritis and pregnancy. Most chapters have a clear introduction outlining background and purpose. Further, the frequent summaries, both within and at the end of most chapters, effectively interpret contradictory or voluminous data and, with the introductions, could almost serve as an abridged version of the text.

The book is undoubtedly meant to be all-inclusive, but many areas still seem longer than necessary and might have been more tightly edited. For example, the patient handout and discussion of the eosinophilia-myalgia syndrome might have been excluded. The association of human leukocyte antigen alleles with specific antinuclear antibodies is overemphasized, whereas complement deficiency, the most frequent underlying genetic abnormality for systemic lupus erythematosus, should have been discussed more comprehensively in a unified section outlining its potential pathogenetic role. Some color photographs of skin lesions should also have been included.

However, these deficiencies are minor compared with the book's strengths. It will be a welcome addition to the libraries of clinicians who specialize in caring for patients with lupus and of scientists investigating this disease, and should be a widely used reference for physicians who have interactions with patients with lupus.