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.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In most patients, the psoriasis precedes the arthritis by months to years. The arthritis frequently involve the knees, ankles, and joints in the feet. Usually, only a few joints are inflamed at a time. The inflamed joints become painful, swollen, hot, and red. Sometimes, joint inflammation in the fingers or toes can cause swelling of the entire digit, giving them the appearance of a "sausage." Joint stiffness is common and is typically worse early in the morning. Less commonly, psoriatic arthritis may involve many joints of the body in a symmetrical fashion, mimicking the pattern seen in rheumatoid arthritis. Psoriatic arthritis can also cause inflammation of the spine (spondylitis) and the sacrum, causing pain and stiffness in the low back, buttocks, neck and upper back. In approximately 50% of those with spondylitis, the genetic marker HLA-B27 can be found. In rare instances, psoriatic arthritis involves the small joints at the ends of the fingers. A very destructive form of arthritis, called "mutilans," can cause rapid damage to the joints. Fortunately, this form of arthritis is rare in patients with psoriatic arthritis.
About one in 10 people with psoriasis also develop
inflammation of joints (psoriatic arthritis).
The first appearance of the skin disease (psoriasis)
can be separated from the onset of joint disease (arthritis) by years.
Psoriatic arthritis belongs to a group of arthritis
conditions that cause inflammation of the spine (spondyloarthropathies).
Patients with psoriatic arthritis can develop
inflammation of tendons, cartilage, eyes, lung lining, and, rarely, the aorta.
The arthritis of psoriatic arthritis is treated independently of the
psoriasis, with exercise, ice applications, medications, and surgery.
What is psoriatic arthritis?
Psoriatic arthritis is a chronic disease characterized by
a form of inflammation
of the skin (psoriasis) and joints
(arthritis). Psoriasis is a common skin condition affecting 2% of the Caucasian population in
the United States. It features patchy, raised, red areas of
skin inflammation with scaling. Psoriasis often affects the tips of the elbows
and knees, the scalp and ears, the navel, and around the genital areas or anus.
Approximately 10% of patients who have psoriasis also develop an associated inflammation
of their joints. Patients who have inflammatory arthritis and psoriasis are diagnosed as
having psoriatic arthritis.
The onset of psoriatic arthritis generally occurs in the fourth and
fifth decades of life. Males and females are affected equally. The skin
disease (psoriasis) and the joint disease (arthritis) often appear
separately. In fact, the skin disease precedes the arthritis in nearly 80%
of patients. However, the arthritis may precede the psoriasis in up to 15% of
patients. In some patients, the diagnosis of psoriatic arthritis can be
difficult if the arthritis precedes psoriasis by many years. In fact, some
patients have had arthritis for over 20 years before psoriasis
eventually appears! Conversely, patients can have psoriasis for over 20
years prior to the development of arthritis, leading to the ultimate diagnosis
of psoriatic arthritis.
Psoriatic arthritis is a systemic rheumatic disease that also can cause
inflammation in body tissues away from the joints other than the skin, such as in the eyes, heart, lungs, and kidneys. Psoriatic arthritis
shares many features with several other arthritic conditions, such as
ankylosing spondylitis, reactive arthritis, and arthritis associated with
Crohn's disease and ulcerative colitis. All of these conditions can cause
inflammation in the spine and other joints, and the eyes, skin, mouth, and
various organs. In view of their similarities and tendency to cause
inflammation of the spine, these conditions are collectively referred to
as "spondyloarthropathies."
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Ankle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Costochondritis is inflammation of the cartilage where the ribs attach to the sternum. Tietze syndrome affects the same region of the chest and causes inflammation, tenderness, and swelling. Anti-inflammatory medications, rest, physical therapy, and cortisone injections are suitable methods of treatment for both costochondritis and Tietze syndrome.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
SAPHO syndrome is a chronic disorder that involves the skin, bone, and joints. SAPHO syndrome is an eponym for the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome is related to arthritic conditions such as ankylosing spondylitis and reactive arthritis. Treatment is directed toward the individual symptoms that are present, and includes medications such as nonsteroidal antiinflammatory drugs (NSAIDs), and cortisone medications.
Reactive arthritis is a chronic form of arthritis featuring
the following three conditions: (1) inflamed joints, (2)
inflammation of the eyes (conjunctivitis), and (3) inflammation of the
genital, urinary, or gastrointestinal systems.
This form of joint inflammation is called "reactive arthritis" because it is
felt to involve an immune system that is "reacting" to
the presence of bacterial infections in the genital, urinary, or
gastrointestinal systems. Accordingly, certain people's immune systems are
genetically primed to react aberrantly when these areas are exposed to
certain bacteria. The aberrant reaction of the immune system leads to
spontaneous inflammation in the joints and eyes. This can be confounding to the patient and the doctor when the infection has long passed at the time of presentation with arthritis or eye inflammation.
Reactive arthritis has, in the past, been referred to as Reiter
syndr...
In most patients, the psoriasis precedes the arthritis by months to years. The arthritis frequently involve the knees, ankles, and joints in the feet. Usually, only a few joints are inflamed at a time. The inflamed joints become painful, swollen, hot, and red. Sometimes, joint inflammation in the fingers or toes can cause swelling of the entire digit, giving them the appearance of a "sausage." Joint stiffness is common and is typically worse early in the morning. Less commonly, psoriatic arthritis may involve many joints of the body in a symmetrical fashion, mimicking the pattern seen in rheumatoid arthritis. Psoriatic arthritis can also cause inflammation of the spine (spondylitis) and the sacrum, causing pain and stiffness in the low back, buttocks, neck and upper back. In approximately 50% of those with spondylitis, the genetic marker HLA-B27 can be found. In rare instances, psoriatic arthritis involves the small joints at the ends of the fingers. A very destructive form of arthritis, called "mutilans," can cause rapid damage to the joints. Fortunately, this form of arthritis is rare in patients with psoriatic arthritis.
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