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.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Featured vasculitis patient discussions on experience with condition
"I was 21 when I had my first ectopic pregnancy, which led to me having my right tube removed. The pain started in my tube and went up to my shoulder. The reason I am writing this is because I was told the chances of me having children were slim. Sadly, I did have six miscarriages. But in 2004, I had my wonderful little boy. Last week, the pain started again, and I was taken into the hospital. I was told I was having another ectopic pregnancy, which led to my left tube being removed. The point I am trying to make is it can have a happy ending, so don’t give up."
"My problem started as a tingling of the toes. As six months went by, the pain increased monthly until it felt like someone had poured gasoline on my feet. My doctor had no idea what the problem was. I went to a neuroscience institute where they gave me a biopsy of the calf muscle and foot nerve. It came back as positive for vasculitis. I took 12 months of cytoxin and prednisone. These lessened the pain, but the pain never went away totally in my feet. A second biopsy determined the vasculitis was in remission. I was finally weaned off the prednisone after two years, but I’m still taking oxycontin and gabapentin, which only take the edge off the pain. They now continue to look for ways to stop the pain, but I'm so tired of the constant pain in my feet."
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What is vasculitis?
Vasculitis is a general term for a group of uncommon diseases that
feature inflammation of the
blood vessels. The blood vessels of the
body are referred to as the vascular system. The
blood vessels are comprised of arteries that pass oxygen-rich blood to the
tissues of the body and veins that return oxygen-depleted blood from the
tissues to the lungs for oxygen. Vasculitis is characterized by
inflammation in and damage to the walls of various blood vessels.
Each of the vasculitis diseases is defined by certain patterns of distribution of
blood vessel involvement, particular organ involvement, and laboratory test abnormalities.
As a group, these diseases are referred to as vasculitides.
The word vasculitis is derived from the Latin
"vasculum", vessel + "- itis", inflammation. Another term for vasculitis is
angiitis. When arteries are the inflamed blood vessels, the condition is also referred to as arteritis. When the veins are inflamed, it is referred to as venulitis.
What causes vasculitis and what are examples of diseases with vasculitis?
The actual cause of these vasculitis diseases is usually not known.
However, immune system abnormality and inflammation of blood vessels are common features. Each form of vasculitis has its own characteristic pattern of symptoms,
much of which depends on what particular organs are affected.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Sjögren's syndrome is an autoimmune disease involving the abnormal production of extra antibodies that attack the glands and connective tissue. Sjögren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjögren's syndrome. Sjögren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjögren's syndrome. Though there is no cure for Sjögren's syndrome, the symptoms may be treated by using lubricating eye ointments, drinking plenty of water, humidifying the air, and using glycerin swabs. Medications are also available to treat dry eye and dry mouth.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Henoch-Schonlein Purpura (HSP or anaphylactoid purpura), a type of blood vessel inflammation, results in rash, arthritis, and occasional abdominal cramping. HSP often resolves on its own. Joint pain may be treated with anti-inflammatory and cortisone medications.
Polymyalgia rheumatica (PMR) is a disorder of the muscles and joints that causes pain and stiffness in the arms, neck, shoulders, and buttocks. Treatment for polymyalgia rheumatica aims to reduce inflammation with aspirin, ibuprofen and low doses of cortisone medications. Giant cell arteritis, inflammation of blood vessel walls, affects 10-15 percent of polymyalgia rheumatica patients. Symptoms of giant cell arteritis include fatigue, weight loss, low-grade fever, jaw pain when chewing, scalp tenderness, and headaches. High doses of cortisone medications are used to treat giant cell arteritis.
Kawasaki disease is a rare children's disease characterized by a fever that lasts more than five days and at least four of the following five symptoms are present: rash, swollen neck lymph gland, red tongue, swelling or redness of the hands or feet, and conjunctivitis. High doses of aspirin are used to treat Kawasaki disease. Cortisone and antiinflammatory drugs may also be used during treatment.
Wegener's granulomatosis, a condition that usually affects young or middle-aged adults, is an inflammation of the arteries supplying blood to the sinuses, lungs, and kidneys. Symptoms of Wegener's granulomatosis include bloody sputum, fatigue, weight loss, joint pain, sinusitis, shortness of breath, and fever. Wegener's granulomatosis may be fatal within months without treatment. Treatment aims to stop inflammation with high doses of prednisone and cyclophosphamide.
Renal artery stenosis is a narrowing of the diameter of the renal arteries. When the renal arteries narrow, the result is restricted blood flow to the kidneys, which may lead to impaired kidney function and high blood pressure (referred to as renovascular hypertension (RVHT). Renal artery stenosis can occur in one or both kidneys. The primary cause of renal artery stenosis is atherosclerosis. Risk factors for renal artery stenosis include high blood pressure, high cholesterol levels, age, cigarette smoking, and diabetes. Symptoms of renal artery stenosis include high blood pressure that does not respond to treatment, severe high blood pressure in individuals younger than 30 or greater than 50 years of age. Renal artery stenosis is diagnosed with imaging and functional tests. Treatment for renal artery stenosis include medication or surgery.
Behcet's syndrome is a disease characterized by three symptoms: genital ulcers, recurring mouth ulcers, and inflammation around the pupil of the eye. Symptoms of Behcet's syndrome may also include inflammation of other areas of the body, such as the brain, joints, skin, retina, and bowels. Oral steroids, antiinflammatory drugs, and steroid gels, pastes, and creams may be used to treat Behcet's syndrome.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
Churg-Strauss Syndrome is a form of vasculitis. Vasculitis is an inflammation of the blood vessels. Symptoms of Churg-Strauss syndrome include fatigue, weight loss, inflammation of the nasal passages, numbness, and weakness. Treatment is directed toward both quieting the vasculitis and suppressing the immune system.
Takayasu disease (also referred to as Takayasu arteritis) is a chronic inflammation of the aorta and it's branch arteries. Takayasu disease is most common of Women of Asian descent and usually begins between 10 and 30 years of age. Symptoms include: painful extremities, dizziness, headaches, chest and abdominal pain, and a low-grade fever. Treatment for Takayasu disease includes cortisone medication to suppress the inflammation.
Polyarteritis nodosa is a rare autoimmune disease characterized by spontaneous inflammation of the arteries of the body. The most common areas of involvement include the muscles, joints, intestines (bowels), nerves, kidneys, and skin. Poor function or pain in any of these organs can be a symptom. Polyarteritis nodosa is most common in middle age persons. Polyarteritis is a serious illness that can be fatal. Treatment is focused on decreasing the inflammation of the arteries by suppressing the immune system.
Severe acute respiratory syndrome (SARS) is a respiratory disease caused by the coronavirus SARS-CoV. Symptoms include fever and shortness of breath. Patients with SARS often require oxygen and severe cases require mechanical ventilation.
Essential mixed cryoglobulinemia is a condition caused by abnormal blood proteins called cryoglobulins. Symptoms include joint pain, swelling, skin vasculitis, enlarged spleen, and nerve and kidney disease. Treatment involves medications that reduce inflammation and suppress the immune system.
HCV is one of several viruses that cause hepatitis (inflammation of the
liver).
Up to 85% of individuals who are initially (acutely) infected with HCV will
fail to eliminate the virus and will become chronically infected.
HCV is spread most commonly through inadvertent
exposure to infected blood. Intravenous
drug abuse is the most common mode of transmission. The risk of
acquiring HCV through sexual contact is low.
Generally, patients do not develop symptoms of chronic infection with HCV
until they have extensive scarring of the liver (cirrhosis). Some individuals,
however, may have fatigue and other non-specific symptoms in the absence of
cirrhosis. A minority of patients with HCV have symptoms from organs outside of
the liver.
In the U.S., Infection with HCV is the most common cause of chronic
hepatitis and the most common reason for liver transplantation.
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