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.
What are some other forms of arthritis which can affect children?
There are several other forms of arthritis that can affect children and adolescents that can be considered separately from juvenile rheumatoid arthritis. Interestingly,
these most often affect older children (greater than 8 years of
age) and teenagers, while typical juvenile rheumatoid arthritis most often affects young
children. One of these is the teenager who has rheumatoid factor-positive arthritis with involvement of the small joints in the hands
and feet. Rheumatoid factor is a blood-test finding which is present
in most adults with rheumatoid arthritis but is absent in most
children with JRA. It is present in this group because they usually
are teenagers who have adult-type rheumatoid arthritis starting
early. Because it is starting early, this is a very worrisome group,
and these children need to be treated aggressively. Often they will
have lifelong arthritis.
Another form of arthritis that is common in this "older" group is spondyloarthropathy. This is a family of diseases in which the arthritis is the same, but the associated problems are very different. The typical findings of a spondyloarthropathy are early involvement of the hips and other large joints. In addition, these forms of arthritis tend to be asymmetric (one side of the body is more severely affected than the other). The key finding is that these children not only have inflamed joints, but they also have inflammation at the points where tissues attach to bone, such as tendons and ligaments. Often they have ankle or heel pain due to inflammation of the tendons inserting in the foot. In some mild cases, the tendon inflammation occurs without obvious swollen joints.
It is important to recognize the spondyloarthropathies as different from juvenile rheumatoid arthritis because the optimal treatment, monitoring, and outcome is likely to be different. In addition, one must look carefully for evidence of the other diseases that can be associated with spondyloarthropathies. These include inflammatory bowel disease, psoriasis, reactive arthritis, and Behcet's syndrome. The most worrisome children with spondyloarthropathies are the HLA B27-positive boys. They are at risk for developing ankylosing spondylitis. However, most children with spondyloarthropathies seem
to do reasonably well. In general, for children who are HLA B27
negative and do not have an associated condition, the arthritis is
more likely than JRA to come and go repeatedly over a period of
years but is less likely to be very severe or destructive.
Unfortunately, we have only recognized children with spondyloarthropathies as being
"different" since the middle 1970s, so
no good long-term follow-up data is available yet.
Sometimes, children with a form of chronic skin inflammation, called psoriasis, can develop arthritis. This form of arthritis is referred to as psoriatic arthritis. Occasionally, there is a family history of psoriasis that can help to clue the doctor into this diagnosis.
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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