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.
There is no single lab test used to diagnose reactive arthritis.
Reactive arthritis is diagnosed based upon recognition of the combination
of arthritis with inflammation of the eyes, and the genital, urinary,
and/or gastrointestinal systems. The doctor obtains a medical history to
note the time course of possible infection in the genital or urinary
tracts, or the bowel. Stiffness and pain are monitored. Inflammatory
types of joint problems typically cause more stiffness in the morning.
Blood tests such as a "sedimentation rate" may be obtained to
document the presence of inflammation in the body. The rheumatoid factor,
which is typically present in rheumatoid arthritis, is usually negative in
reactive arthritis. The HLA-B27 gene marker blood test can be helpful,
especially in the diagnosis of patients with spine disease.
X-rays of the spine or other joints can reveal typical changes of
inflammation in these areas but generally not until later in the disease. Occasionally, there are areas of unusual
calcifications at the points where the tendons attach to the bones,
indicating past inflammation in these areas. Those patients with eye
inflammation may require ophthalmology evaluation to document the degree
of inflammation in the iris. Stool cultures might be obtained to detect
the presence of infections in the bowel. Similarly, urinalysis and culture
of the urine may be necessary to detect bacterial infection in the urinary
tract. The prostate gland, which can also be inflamed in a patient with
reactive arthritis, may be examined for tenderness.
How is reactive arthritis treated?
Treatment of reactive arthritis is based on where it has become manifest
in the body. For joint inflammation, patients are generally initially
treated with nonsteroidal antiinflammatory drugs (NSAIDs). These
medications include aspirin, indomethacin (Indocin), tolmetin (Tolectin),
sulindac (Clinoril), piroxicam (Feldene), and others. Among their
potential side effects are gastrointestinal irritation, including
ulceration and bleeding. They should be taken with food to minimize this
risk. Corticosteroids, such as prednisone, can be helpful to reduce inflammation and are used
in the short-term treatment of inflammation in reactive arthritis. They can
be given by mouth or by local injection into the joint. They are also used
to decrease tendon inflammation in some forms of tendinitis.
Sulfasalazine (Azulfadine) has been shown to be effective in some
patients with persistent reactive arthritis. Potential side effects of this
sulfa-based medication include sulfa rash
reaction and suppression of the bone marrow. Therefore, blood counts are
monitored when Azulfidine is used long-term.
For the aggressive inflammation of chronic joint inflammation in reactive arthritis, medications that suppress the immune system, including
methotrexate
(Rheumatrex, Trexall), are used. Methotrexate can be given orally by
injection. It is given on a weekly basis and requires regular monitoring
of blood counts and blood liver tests because of potential toxicity to the
bone marrow and liver.
Reactive arthritis has been reported in association with HIV infection
(AIDS virus). In this context, immune suppression medicine is generally
avoided because of the potential for worsening the HIV disease.
Eye inflammation can be alleviated with antiinflammatory drops. Some
patients with severe iritis require local injections of cortisone to
prevent damaging inflammation to the eye, which can lead to blindness.
The inflammation around the penis can be helped by cortisone creams
(such as Topicort). When bacteria are discovered in the bowel or urine,
antibiotics specific for those bacteria are given.
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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