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.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
How does Still's disease relate to juvenile idiopathic arthritis?
Still's disease is one type of juvenile idiopathic arthritis (JIA) and is also known as systemic-onset JIA. Systemic-onset JIA was formerly known as systemic-onset juvenile rheumatoid arthritis (JRA) and is the same disease. Several years ago, the naming system for all types of JRA changed, and JRA is now called juvenile idiopathic arthritis or JIA. By "systemic" it is meant that along with joint inflammation it typically begins with symptoms and signs of systemic (body-wide) illness, such as high fevers, gland swelling, and internal organ involvement. Still's disease is named after the English physician Sir George F. Still (1861-1941).
What are symptoms and signs of Still's disease?
Still's disease usually begins with systemic (body-wide)
symptoms. Extreme fatigue can accompany waves of high fevers that rise daily to
102 F (39 C) or even higher and rapidly return to normal levels
or below. Fever spikes often occur at approximately the same time every day. A faint
salmon-colored skin rash characteristically comes and goes and does not itch.
Poor appetite, nausea, and weight loss are common. There is also commonly swelling of
the lymph glands, enlargement of the spleen and liver, and sore throat. Some patients develop
inflammation around the heart (pericarditis)
and lungs (pleuritis), with occasional fluid
accumulation around heart (pericardial
effusion) and lungs (pleural effusion). Arthritis, with joint swelling, often occurs after rash and fevers
have been present for some time. Although the arthritis may initially be
overlooked because of the impressive nature of the systemic symptoms, everyone
with Still's disease eventually develops joint pain and swelling. This usually
involves many joints (polyarticular arthritis). Any joint can be affected,
although there are preferential patterns of joint involvement in Still's disease.
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.
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.
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