Reiter Syndrome: treatment options

Dear Ask The Doctor: My nephew has been diagnosed with Reiters Syndrome. He spent almost 3 weeks in and out of doctors office and emergency room before he was diagnosed. He has no insurance and no one will now treat him. I have taken him to the emergency room twice since a specialist drained his elbow and gave him medication. The hospital said they did not have a specialist on staff and he should just keep taking his medication. He is now out of medication , when he tried to get the specialist that treated him in the hospital, the nurse refused him treatment saying that dont take charity care and he would have to pay his bill of 410 he had in the emergency room for him to even talk to the doctor. He was broght to his primary physician who looked up the disease on the internet and really didn't know how to treat him. He is in terrible pain, his knee is still swollen and we can not get advise, treatment or medication anywhere. Can you please point us in the right direction. His name is Ricky Olander he is 27. We live in Bayonne, nj 07002

Dear Rick: The Reiter syndrome is an autoimmune reactive arthritis that occurs in response to an infection, most of the time associated with gastrointestinal or urinary l infections. The treatment options depend on the severity of symptoms and currently they are as follows: first, NSAIDs (“Aleve”, “Advil” they are OTC medications that you can get) to control pain and inflammation along with a physical therapy(you could pay a few sessions and learn a routine of exercises) aimed to reduce pain and avoid the muscle wasting. If there is a poor response to NSAIDs, the next would be using Corticoesteroids as either intra articular injection or systemic therapy, meaning: pills (prednisone) (for this you will need consultation with a Rheumatologist).  If still there are symptoms or persistent inflammation in despite the use of the NSAIDs and/or corticosteroids, the second-line drugs can be used, these are called Disease Modifying Antirheumatic Drugs(DMARD) (sulfasalazine, methotrexate). The idea is to reduce symptoms and help to prevent the joint damage. In the view that this is a chronic condition, the long term follow up by a Rheumatologist is very important to avoid complications also Physical and Occupational therapy are very useful to keep function and gait.