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.
Polyarticular juvenile rheumatoid arthritis is the form in which four or more joints are
involved after six months of illness. This form is more severe both because of
the greater number of joints involved and the fact that it tends to
get worse over time. These children may have a great deal of
difficulty with normal activities and need to be treated
aggressively.
From a doctor's point of view, the most important thing
is to bring inflammatory arthritis under control as quickly as possible. Typically, this involves at least medications that reduce inflammation, nonsteroidal antiinflammatory drugs (NSAIDs).
This may also require use of some fairly strong medications, but it's important
to recognize that they are necessary to reduce symptoms and prevent permanent
damage. One thing to watch out for is using steroids (for example,
prednisone). In severe cases, this may be necessary, but it is not a
"real" solution. Steroids make patients with arthritis feel
wonderful, but it's like sweeping dirt under the rug. Everything looks
good, but it really isn't. Taking too much steroid for a long period
causes lots of problems, like short stature and weak bones. Whenever
we are required to put a child on steroid medications, we want to wean them as quickly
as possible. Nonsteroidal antiinflammatory drugs are enough for many
children with polyarticular juvenile rheumatoid arthritis, but more severe cases may require more aggressive "second-line" medications, such as
gold shots, sulfasalazine, or
methotrexate. Severe cases requiring steroids or second-line
medications should be under the care of experienced physicians.
A newer form of medication, biologics called TNF-blockers, is now available.
Tumor necrosis factor alpha (TNF-alpha) is a substance made by cells of the body that has an important role in promoting inflammation. By blocking the action of TNF-alpha, TNF-blockers reduce the signs and symptoms of inflammation. Etanercept (Enbrel) is a self-injectable TNF-blocker that is injected into the skin twice weekly and is indicated for reduction in signs and symptoms of moderately to severely active polyarticular-course juvenile rheumatoid arthritis in patients who have had an inadequate response to one or more disease-modifying medicine(s). Infliximab (Remicade) is an intravenously infused antibody that blocks the effects of TNF-alpha. Remicade is given by intravenous infusion every
two months. Remicade is effective for treating juvenile rheumatoid arthritis and can result in a significant and prompt reduction in disease activity and improved quality of life. Adalimumab (Humira) is also a self-injectable TNF-blocker that reduces the signs and symptoms of moderate to severely active polyarticular juvenile inflammatory arthritis in children 4 years of age or older.
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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