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.
Pauciarticular juvenile rheumatoid arthritis (JRA) is defined by the involvement of less than four joints after six months of illness. This form often begins in young girls as a swollen knee or ankle that appears without injury or explanation. Usually it is
"painless," but someone may notice that the knee looks swollen or the child is walking awkwardly. Since arthritis causes morning stiffness, parents are slow to get concerned about this because
"she always looks okay once she gets going." This arthritis is often very mild and treated just with mild nonsteroidal antiinflammatory drugs, but it can cause two important problems. A serious problem that many children with pauciarticular juvenile rheumatoid arthritis (JRA) develop is inflammation of the eye (iridocyclitis). The inflammation is not painful, but if not detected and treated, it may lead to scarring of the lens and permanent visual damage (even blindness). At the beginning,
this inflammation cannot be seen except by an ophthalmologist using a special
instrument called a "slit lamp." Because the eye disease is more common in children with a positive test for antinuclear antibodies (ANA), these children require eye examinations every three months by an eye specialist. All other children with juvenile rheumatoid arthritis (JRA) need eye examinations every six months. No one has been able to completely explain the association of eye disease and arthritis or why it is more frequent in children with ANA. But we do know it happens, and it's important to make sure every child's eyes get checked.
The second important problem with pauciarticular juvenile rheumatoid
arthritis (JRA) is that it may
cause the bones in the legs to grow at different rates with the
result that one leg is longer than the other. When this happens,
children are forced to walk with a limp. This damages the knee and
the hip leading to premature arthritis, from "wearing out" the joints
by the time the child is an adult, and should be prevented.
Fortunately, this can be recognized early. When the knee or another joint is inflamed by the arthritis, its blood supply increases. Then, just like a plant that receives more water than the plants around it, it grows faster and larger. Doctors are always trying to stop the inflammation to prevent this problem. Most often the therapy is successful and the child does
not develop a significant leg-length discrepancy. If he or she does,
we can do two things. First we can put a lift in the shoe on the
short side to correct the effect of the different leg lengths. This
doesn't do anything for the knee, but it prevents excessive wear on
the hip and allows the child to walk more normally. The next step is
to monitor growth. When the child is getting closer to fully grown, an
orthopedist can look at x-rays of the legs and try to guess when the
bones are going to stop growing. If the leg with arthritis is 3 cm
longer than the other leg, they will look at the x-rays and try to
guess when there is 3 cm of leg growth left. Then you stop the growth
on the leg that is too long and allow the short leg to catch up. This
can be done with a very simple operation.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Kawasaki disease is a rare children's disease characterized by a fever that lasts more than five days and at least four of the following five symptoms are present: rash, swollen neck lymph gland, red tongue, swelling or redness of the hands or feet, and conjunctivitis. High doses of aspirin are used to treat Kawasaki disease. Cortisone and antiinflammatory drugs may also be used during treatment.
Still's disease (Systemic-Onset Juvenile Rheumatoid Arthritis) is a disorder characterized by inflammation with high fever spikes, fatigue, salmon-colored rash and/or arthritis. Though there have been several theories regarding the cause(s) of Still's disease, the cause is not yet known. Many symptoms of Still's disease are often treatable with anti-inflammatory drugs.
Iritis is inflammation of the iris, the colored portion of the eye. Symptoms include a red, painful eye, blurry vision, and light sensitivity. Treatment usually involves cortisone eyedrops.
Growth plate fractures and injuries occur in the area growing tissue near the end of the long bones of children and teens. Both boys and girls are susceptible to growth plate fracture and injury. Common causes include: a fall while playing sports or playing on furniture or playground equipment, overuse injury from sports, injuries from competitive sports, child abuse, frostbite, and juvenile arthritis. Growth plate fracture and injury are classified into five categories according to the Salter-Harris Classification.
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