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.
When a patient first sees the doctor, the recent symptoms
especially concerning weakness will be discussed. The condition of many
other body areas might be reviewed, for example, the skin, heart, lungs,
and joints. An examination will further focus on these and other systems.
Various measures of strength might be noted.
Blood testing usually (but not always) reveals
abnormally high levels of muscle enzymes, CPK or creatinine phosphokinase,
aldolase, SGOT, SGPT, and LDH. These enzymes are released into the blood by
muscle that is being damaged by inflammation. They can also be used as measures of the activity of the inflammation. Other routine blood and urine tests can also look for internal organ abnormalities. Chest X-rays,mammograms,PAP smears, and other
screening tests might be considered.
An electromyograph (EMG) and nerve conduction velocity are
electrical tests of muscle and nerves that can show abnormal findings
typical of polymyositis as well as exclude other nerve-muscle diseases.
Imaging of the muscles using radiology tests, such as magnetic resonance imaging (MRI
scanning), can show areas of inflammation of muscle. This can sometimes can be used to determine muscle biopsy sites.
A muscle biopsy is used to confirm the presence of muscle
inflammation typical only of polymyositis. This is a surgical procedure
whereby muscle tissue is removed for analysis by a pathologist, a specialist
in examining tissue under a microscope. Muscles often used for biopsy
include the quadriceps muscle of the front of the thigh, the biceps muscle
of the arm, and the deltoid muscle of the shoulder.
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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