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.
Weakness of muscles is the most common symptom of
polymyositis. The muscles involved usually are those that are closest to the
trunk of the body. The onset can be gradual or rapid. This results in
varying degrees of loss of muscle power and atrophy. The loss of strength can be noticed as difficulty getting up from chairs, climbing stairs or lifting above the shoulders. Trouble with swallowing and weakness lifting the head from the pillow can occur. Occasionally, the muscles ache and are tender to the touch (25% of patients).
Patients can also feel fatigue, a general feeling of
discomfort and have weight loss and/or low-grade fever.
With skin involvement (dermatomyositis), the eyes can
be surrounded by a violet discoloration with swelling. There can be scaly
reddish discoloration over the knuckles, elbows, and knees (Gottron's sign).
There can also be reddish rash on the face, neck, and upper chest.
Hard lumps of calcium deposits can develop in the fatty layer of the skin,
most commonly in childhood dermatomyositis.
Heart and lung involvement can lead to irregular heart rhythm, heart failure, and shortness of breath.
Because polymyositis can present in combination with other
illnesses (see related articles on systemic lupus erythematosus, scleroderma and rheumatoid arthritis), it can also have overlap features with them. These illnesses are discussed elsewhere.
Both polymyositis and dermatomyositis can sometimes be
associated with cancers, including lymphoma, breast cancer, lung cancer, ovarian cancer, and colon cancer. The cancer risk is reported to be much greater with dermatomyositis than polymyositis.
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.
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