With all the current regulatory changes, many physicians might agree with Virchow’s lament. Certainly, the regulations
and documentation requirements continue to increase. Fortunately, there has been continued medical progress in
Rheumatology over the past five years since the last edition of Rheumatology Secrets. I continue to be amazed with the
advances that have occurred in both the science and treatment of the rheumatic diseases. Each chapter in the present
edition has been extensively reviewed and updated to include those advancements through July 2018.
As in the previous editions, Rheumatology Secrets, 4th Edition, is presented in the Socratic question and answer

format that is the hallmark of The Secrets Series. The chapters are organized into 16 sections, most with a com-
mon theme emphasized by an introductory quotation. Common and uncommon rheumatic disease problems that

we encounter in clinical practice, discuss during teaching rounds, and find on board examinations are covered. Each
chapter reviews basic immunology and pathophysiology, important disease manifestations, and practical management
issues. The book also contains a wealth of mnemonics, lists, tables, figures, and illustrations to emphasize important
points. Chapter 2 lists some of the top Rheumatology Secrets and I encourage readers to send in their top secrets.