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.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
I am a rheumatologist—an internal medicine
specialist who is trained to evaluate, diagnose, and treat diseases that involve
the muscles and joints. Because rheumatologists have a keen interest in
undiagnosed conditions, I see a number of patients every week who are seeking a
first diagnosis.
It is commonplace for doctors to refer patients to a
rheumatologist for the evaluation of painful muscles. There are many diseases
that are associated with inflammation of muscles. Furthermore, many conditions
may appear to involve muscles but may actually be a result of disease of the
tendons, joints, or bones.
By way of illustration, I want to call viewers'
attention to a patient that I just saw in the office this week. I feel that this
patient is very representative of a muscle condition that is under appreciated nowadays. I also know that patients and doctors should have a heightened
awareness of this condition since it is easily managed when discovered early.
When discovered late, it can lead to serious injury—not only to the muscles
but also potentially to the kidneys and heart.
Mr. Jones is a 75-year-old man who was referred by a
cardiologist because of pains and stiffness in the muscles of his arms,
shoulders, thighs, and buttocks. He has been taking Lipitor (atorvastatin) for
six months to control elevated cholesterol levels in his blood. Mr. Jones
reported muscle aching for the past eight weeks. He was also weak in the
locations of pain. Blood testing for the muscle enzyme, CPK, was mildly
elevated.
Polymyositis is a disease of muscle featuring inflammation of the muscle fibers. The cause of the disease is not known. It begins when white blood cells, the immune cells of inflammation, spontaneously invade muscles. The muscles affected are typically those closest to the trunk or torso. This results in weakness that can be severe. Polymyositis is a chronic illness with periods of increased symptoms, called flares or relapses, and minimal or no symptoms, known as
remissions.
Polymyositis is slightly more common in females. It affects
all age groups, although its onset is most common in middle childhood
and in the 20s. Polymyositis occurs throughout the world. Polymyositis can be associated with skin rash and is then referred to as "dermatomyositis." It
also can affect other areas of the body and is, therefore, referred to as a systemic illness. Occasionally, it is associated with cancer or with other
diseases of connective tissue (see systemic lupus erythematosus,
scleroderma and rheumatoid arthritis).
What causes polymyositis?
To date, no cause of polymyositis has been isolated by
scientific researchers. There are indicators of heredity (genetic)
susceptibility that can be found in some patients. There is indirect evidence
of infection by a virus that has yet to be identified in a form of polymyositis that is particularly resistant to treatment,
called inclusion body myositis. This form of polymyositis is diagnosed by the
pathologist, a physician specialist who interprets the microscope findings
of muscle tissue. The muscle tissue in this form of polymyositis displays
clear areas within the muscle cells (called vacuoles) when viewed
under the magnification of a microscope.
Researchers from Sweden at the national meeting of the American College of Rheumatology in 2007 reported their findings that T-cells of the immune system in some polymyositis or dermatomyositis patients reacted against cytomegalovirus (CMV) and that detectable antibodies against CMV were present. Their conclusion was that there may be subsets of patients who develop their disease, in part, because of infection with this particular virus.
Aside from diseases with which polymyositis can be associated (as
mentioned above), many other diseases and conditions can mimic polymyositis. These include nerve-muscle diseases (such as
muscular dystrophies), drug toxins (such as alcohol, cocaine, steroids, colchicine, hydroxychloroquine,
and cholesterol-lowering drugs, called statins), metabolic disorders (where muscle cells are unable to process chemicals normally), hormone disorders (such as abnormal thyroid), calcium and magnesium conditions, and infectious diseases (such as influenza virus, AIDS, streptococcus and Lyme
bacteria, pork tapeworm and schistosomiasis).
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.
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).
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Connective tissue disease is when the body's connective tissues come under attack, possibly becoming injured by inflammation. Inherited connective tissue diseases include Marfan syndrome and Ehlers-Danlos syndrome. Systemic lupus erythematosus, rheumatoid arthritis, scleroderma, polymositis, and dermatomyositis are examples of connective tissue diseases that have no known cause.
Connective tissue diseases are disorders featuring abnormalities involving the collagen and elastin.
Connective tissue diseases that are strictly inheritable include Marfan syndrome and Ehlers-Danlos syndrome. The classic immune-related connective tissue diseases include systemic lupus erythematosus, rheumatoid arthritis, scleroderma, polymyositis, and dermatomyositis. Treatment is often directed at suppressing the inflammation present in the tissues by using anti-inflammatory and immunosuppressive medications.
Apheresis is a medical procedure that involves removing whole blood from a donor or patient and separating the blood into individual components so that one particular component can be removed. The remaining blood components then are re-introduced back into the bloodstream of the patient or donor.
Apheresis is used for the collection of donor blood components (such a platelets or plasma) as well as for the treatment for certain medical conditions in which a part of the blood that contains disease-provoking elements is removed.
Apheresis is also called pheresis or hemapheresis. The terminology used may also reflect the component of blood that is being removed, such as:
I am a rheumatologist—an internal medicine
specialist who is trained to evaluate, diagnose, and treat diseases that involve
the muscles and joints. Because rheumatologists have a keen interest in
undiagnosed conditions, I see a number of patients every week who are seeking a
first diagnosis.
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