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.
Patients who experience progressive joint destruction in spite of NSAIDs
are candidates for more aggressive disease-modifying medications. Disease-modifying medications are important to
prevent progressive joint destruction and deformity. These
medications include methotrexate, which is used orally or can be given by injection on
a weekly basis for psoriatic arthritis as well as for psoriasis alone. It
can cause bone-marrow suppression, as well as liver damage with long-term use. Regular monitoring of blood counts and liver blood tests should
be performed during therapy with methotrexate.
Antimalarial medication such as hydroxychloroquine (Plaquenil) is also
used for persistent psoriatic arthritis. Its potential side effects
include injury to the retina of the eye. Regular ophthalmologist
examinations are suggested while using this medication.
Sulfasalazine (Azulfidine) is an oral sulfa-related medicine that has
also been helpful in some patients with persistent psoriatic arthritis.
Traditionally, Azulfidine has been an important agent in the treatment of
ulcerative and Crohn's colitis. It should be taken with food, as it too
can cause gastrointestinal upset.
Research has demonstrated effective
treatment of both psoriasis and psoriatic arthritis with leflunomide
(Arava), a medication that is also used for the treatment of
rheumatoid arthritis.
Medications that block the chemical known as tumor necrosis factor (TNF) are another treatment option for severe cases. The TNF-blockers etanercept (Enbrel), infliximab (Remicade),
and adalimumab (Humira), and golimumab (Simponi) can be very
effective for severe psoriatic arthritis, and they can significantly improve or eradicate both the psoriasis and the arthritis as well as stop progressive joint damage.
Corticosteroids are potent anti-inflammatory agents. Corticosteroids can
be given by mouth (such as prednisone) or injected (cortisone) directly
into the joints to reduce inflammation. They can have side effects,
especially with long-term use. These include thinning of the skin, easy
bruising, infections, diabetes, osteoporosis and, rarely, bone death
(necrosis) of the hips and knees.
While the relationship between the skin disease and joint disease is not
clear, there are reports of improvement of the arthritis simultaneously
with clearing of the psoriasis. Patients with psoriasis can benefit by
direct sunlight exposure and are often treated with direct ultraviolet
light therapy.
Finally, patients who have severe destruction of the joints may be
candidates for orthopedic surgical repair. Total hip joint replacement and
total knee joint replacement surgery are now commonplace in community
hospitals throughout the United States.
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.
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