Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Aseptic necrosis is a bone condition that results from poor blood supply to an area of bone, causing localized bone death.
Aseptic necrosis can be caused by trauma, damage to the blood vessels that supply bone its oxygen, poor blood circulation to the bone, abnormally thick blood (hypercoagulable state), and atherosclerosis or inflammation of the blood vessel walls (vasculitis).
Steroid medications (cortisone, such as
prednisone [Deltasone, Liquid
Pred] and methylprednisolone
[Medrol, Depo-Medrol]) are the most common medications to cause aseptic necrosis.
The treatment of aseptic necrosis is critically dependent on the stage of the condition.
What is aseptic necrosis?
Aseptic necrosis is a bone condition that results from poor blood
supply to an area of bone, causing localized bone death. This is a serious
condition because the dead areas of bone do not function normally,
are weakened, and can collapse. Aseptic necrosis is also referred to as avascular necrosis
or osteonecrosis.
What causes aseptic necrosis?
Aseptic necrosis can be caused by trauma and damage to the blood vessels that supply bone its oxygen. Other causes of poor blood circulation to the bone include a blockage by air or fat (embolism) that obstructs the blood flow through the blood vessels, abnormally thick blood (hypercoagulable state), atherosclerosis (hardening of the arteries), or inflammation of the blood vessel walls (vasculitis). Steroid medications (cortisone, such as prednisone
[Deltasone, Liquid Pred] and methylprednisolone [Medrol, Depo-Medrol]) are the most common medications to cause aseptic necrosis. Typical bones affected by steroids include the femur bone of the hip, the humerus bone of the shoulder, and the tibia bone of the knee, sometimes in combinations and frequently affecting both sides of the body (bilateral). Aseptic necrosis of the jawbone has been associated with the use of medications (bisphosphonates) used to treat high blood calcium levels from cancer.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Leprosy (Hansen's disease) is a disfiguring disease caused by infection with Mycobacterium leprae bacteria. The disease is spread from person to person through nasal secretions or droplets. Symptoms and signs of leprosy include numbness, loss of temperature sensation, painless ulcers, eye damage, loss of digits, and facial disfigurement. Leprosy is treated with antibiotics and the dosage and length of time of administration depends upon which form of leprosy the patient has.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Sickle cell anemia (sickle cell disease), a blood disease which shortens life expectancy, is cause by an inherited abnormal hemoglobin. Symptoms may include bacterial infections, painful swelling of the hands and feet, fever, leg ulcers, fatigue, anemia, eye damage, and lung and heart injury. Treatment for sickle cell anemia aims to manage and prevent the worst manifestations of the disease and focuses on therapies that block red blood cells from stacking together, which can lead to tissue and organ damage and pain.
Leprosy is a disease caused by the bacteria Mycobacterium leprae, which causes
damage to the skin and the peripheral nervous system. The disease develops
slowly (from six months to 40 years!) and results in skin lesions and deformities,
most often affecting the cooler places on the body (for example, eyes, nose,
earlobes, hands, feet, and testicles). The skin lesions and deformities can be
very disfiguring and are the reason that infected individuals historically were considered
outcasts in many cultures. Although human-to-human transmission is the primary
source of infection, three other species can carry and (rarely) transfer M.
leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos. The
disease is termed a chronic granulomatous disease, similar to tuberculosis, because it produces
inflammatory nodules (granulomas) in the skin and nerves over time.
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