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.
As mentioned, reactive arthritis is felt in part to be genetic. There are
certain genetic markers that are far more frequent in patients
with reactive arthritis than in the normal population. For example, the HLA-B27
gene is commonly seen in patients with reactive arthritis. Even in patients
who have the genetic background that predisposes them to developing
reactive arthritis, however, exposure to certain infections seem to be required to
trigger the onset of the disease.
Reactive arthritis can occur after venereal infections. The most common
bacterium that has been associated with this post-venereal form
of reactive arthritis is an organism called Chlamydia trachomatis. Reactive arthritis
also occurs after infectious dysentery, with bacterial organisms in the bowel, such as
salmonella, shigella,
yersinia, and
campylobacter. Typically, the
arthritis develops one to three weeks after the onset of the bacterial
infection.
What are symptoms of reactive arthritis?
The symptoms of reactive arthritis can be divided into those that affect
the joints and those that affect the non-joint areas.
The classic joints that can become inflamed in reactive arthritis are the
knees, ankles, feet, and wrists. The particular joints involved are
usually asymmetric, that is, one side of the body or the other is
affected, rather than both sides simultaneously. The inflammation leads to
stiffness, pain, swelling, warmth, and redness of the joints involved.
Patients may develop inflammation of entire fingers or toes which can give
the appearance of a "sausage digit." This feature is also seen in
patients with another type of arthritis called
psoriatic arthritis that is associated with skin inflammation of psoriasis. The arthritis of reactive arthritis can be associated
with inflammation of the spine, leading to stiffness and pain in the back
or neck (characteristic of all of the spondyloarthropathies).
Cartilage can also become inflamed, especially around the breastbone
where the ribs meet in the front of the chest, this condition is called
costochondritis. Muscles attach to the bones by tendons. In reactive arthritis, the tendon insertion points can become inflamed (tendinitis),
tender, and painful when exercised.
Non-joint areas that become inflamed and cause symptoms of pain and irritation in patients with reactive arthritis include the eyes, genitals, urinary tract
(urethra, bladder and prostate gland), skin, mouth lining, large bowel, and the aorta.
Inflammation of the white portion of the eye (conjunctivitis) and the iris of
the eye (iritis) is frequently seen early in reactive arthritis and may be
intermittent. When the whites of the eye are inflamed causing
conjunctivitis, there may be no pain. When the colored part of the eye
(iris) is inflamed, causing iritis, it can be very painful and especially
worse when looking into bright lights.
Urinary tract inflammation commonly involves the urethra, the tube that
drains urine from the bladder. This inflammation (urethritis) can be
associated with burning on urination and/or pus drainage from the end of
the penis. The skin around the penis can become inflamed and peel. The
bladder and prostate gland can also become inflamed, leading to an urge to
urinate from cystitis and prostatitis respectively.
The skin of the palms of the hands and/or the soles of the feet can develop tiny fluid-filled blisters that sometimes are filled with old blood. The affected skin can peel and may mimic psoriasis. The classic appearance is medically referred to as keratoderma blennorrhagica.
The mouth can develop open sores (ulcerations) on the hard and soft
palate, and even on the tongue. These may go unnoticed by the patient, as
they are often painless. Inflammation of the large bowel (colitis) can
cause diarrhea, or pus or blood in the stool. Inflammation of the aorta
(aortitis) can be seen in a small percentage of patients who have reactive arthritis.
It can lead to failure of the aortic valve of the heart, which
can cause heart failure. The electrical conducting pathway of the heart
can also become scarred in reactive arthritis, leading to irregular
heartbeats (arrhythmias) that may require placement of a pacemaker to
regulate the heartbeat.
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.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
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.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Bone spurs are pointy outgrowths of bone that develop in areas of inflammation or injury. They commonly occur on the heel and spine and may be the result of reactive arthritis, ankylosing spondylitis, or diffuse idiopathic skeletal hyperostosis. Symptoms include pain, numbness, and tenderness. Treatment focuses on decreasing inflammation and avoiding re-injury.
Heel spurs, pointed, bony outgrowths of the heel, are caused by localized soft tissue inflammation and can be located at the back of the heel or under the heel, beneath the sole of the foot. Plantar fascitis is associated with inflammation caused by heel spurs on the soles of the feet. Both conditions are treated with ice application and anti-inflammatory medications. Orthotics may also provide some relief.
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.
Graves' disease is an autoimmune disease that affects the thyroid. Some of the symptoms of Graves' disease include hand tremors, rapid heartbeat, trouble sleeping, enlarged thyroid, thinning of the skin or fine brittle hair. Causes of Graves' disease are thought to be multifactorial such as genes, gender, stress, and infection. Treatment for Graves' disease is generally medication.
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.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
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