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.
Often the most difficult form of juvenile rheumatoid arthritis is systemic-onset JRA, also known as Still's disease. This form of juvenile rheumatoid arthritis begins with high fevers and a rash. It is very important in this setting to make sure the patient really has systemic-onset juvenile rheumatoid arthritis and not another condition, such as infection. One of the most important findings is that the fever goes away for at least part of every day in someone with systemic-onset juvenile rheumatoid arthritis. Usually the fever is high once or twice each day. At those times, the child looks very sick and doesn't want to be touched, but when the fever goes down to normal again, they look and feel better. Sometimes it goes completely away and never comes back again. Other times, the fevers and rash go away, but the arthritis progresses over time and can be very severe. This form of juvenile rheumatoid arthritis can involve the internal organs and rarely is a
"life-threatening" disease.
Treatments for systemic-onset JRA include nonsteroidal antiinflammatory drugs (NSAIDs such as ibuprofen and naproxen), hydroxychloroquine (Plaquenil), cortisone medications (such as prednisone and prednisolone), methotrexate, and for resistant disease, anakinra (Kineret). Some research has suggested that thalidomide may be an effective treatment for children with systemic-onset JRA.
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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