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.
Still's disease is diagnosed purely on the basis of the typical clinical features of the
illness. These features include high intermittent fever, joint inflammation and
pain, muscle pain, faint salmon-colored skin rash, swelling of the lymph glands
or enlargement of the spleen and liver, and inflammation around the heart (pericarditis)
or lungs
(pleuritis). Persistent arthritis (arthritis
lasting at least six weeks) is required to make a firm diagnosis of Still's disease. Other
diseases (especially infections, cancers, and other types of
arthritis) are excluded.
Many patients with Still's disease develop
markedly elevated white blood cell counts, as if they have a serious infection,
but no infection is found. Low red blood counts (anemia) and elevated blood tests
that indicate inflammation (such as sedimentation rate,
C-reactive protein, and ferritin) are common. However, the classic blood tests
for rheumatoid arthritis (rheumatoid
factor) and systemic lupus erythematosus (antinuclear antibodies) are usually negative.
What is the frequency of Still's disease and its features?
Still's disease accounts for 10%-20% of all cases of JIA. It affects about 25,000-50,000 children in the United States. It is rare in
adults, a majority of whom are between 20 and 35 years of age at onset of symptoms.
Of all patients with Still's disease, 100% have high intermittent fever, and 100% have joint inflammation and pain, muscle pain with fevers, and develop persistent
chronic arthritis. Approximately 95% of Still's disease patients have the faint salmon-colored skin rash, 85% have swelling of the lymph glands or enlargement of the spleen and liver, 85% have a marked increase in the white blood cell count, 60% have inflammation of the lungs (pleuritis) or around the heart (pericarditis), 40% have severe anemia,
and 20% have abdominal pain.
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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