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. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
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's
syndrome (a term that has lost favor because of Dr. Hans Reiter's
dubious past, one of enthusiastically embracing Nazi politics and medical abominations). In addition, Reiter's syndrome would refer to a specific type of reactive arthritis limiting inflammation to eye, urethra, and joints.
Reactive arthritis most frequently occurs in patients in their 30s
or 40s, but it can occur at any age. The form of reactive arthritis that occurs after genital infection (venereal) occurs more frequently in
males. The form that develops after bowel infection (dysentery) occurs in
equal frequency in males and females.
Reactive arthritis is considered a systemic rheumatic disease. This means
it can affect other organs than the joints, causing inflammation in tissues such as the eyes, mouth, skin,
kidneys, heart, and lungs. Reactive arthritis shares many features with
several other arthritic conditions, such as psoriatic arthritis,
ankylosing spondylitis, and arthritis associated with Crohn's disease and
ulcerative colitis. Each of these arthritic conditions can cause similar
disease and inflammation in the spine and other joints, eyes, skin, mouth,
and various organs. In view of their similarities and tendency to inflame
the spine, these conditions are collectively referred to as "spondyloarthropathies."
What Is the Outlook For People With Reactive Arthritis?
The prognosis for reactive arthritis varies. Most people recover in three to four months, but about half have recurrences for several years. Some people develop complications that may include inflammation of the heart muscle, inflammation with stiffening of the spine, glaucoma, progressive blindness, feet abnormalities, or accumulation of fluid in the lungs.