August 25, 2005

Q Our son, age 53, who has never been sick before, has been diagnosed with ankylosing spondylitis. He is being treated with Enbrel, but so far, no success. What is his prognosis in life?

A Ankylosing (ANN-kuh-LOW-sing) spondylitis (SPAWN-duh-LITE-us) is a kind of arthritis that affects mostly the back. It’s more common in men than in women, often runs in families and usually begins at a relatively young age, with the average age of onset being 23.

It begins without arousing suspicion as nondescript lower back or hip pain, or both. Pain and stiffness inch their way upward in the back. In time, the entire spine can be involved and can immobilize a person. When the process is extensive, people walk locked in a forward stoop, with their knees and hips slightly bent. It can make turning the neck impossible. Not all patients have this extensive involvement.

Other joints can also be involved –– hips and shoulders are two examples.

Sometimes the inflammatory characteristic of this illness affects the eye, and it can cause the heart’s aortic valve to leak.

As with other varieties of arthritis, anti-inflammatory medicines are the first drugs turned to. Your son’s medicine, Enbrel, has been a recent godsend treatment for many. I don’t know how long he’s been on it, but it might be only a matter of time before things turn around for him Another new medicine is Remicade. It might benefit him if Enbrel fails.

A physical-therapy programme is a must for all A-S patients to preserve as much flexibility in their spines as possible.

Although things are not going your son’s way at present, most A-S patients stay functional, with only some limitations of activity, and live a normal life span.

Q I am 87. I have had several heart attacks, and two years ago I had a stroke. I was told my arteries had hardened because of them. My doctor says my blood pressure is too high in spite of all the pills I take. The medicines gave me a kidney infection. Should I continue to take all these pills?

A ‘Artery hardening’ is the common name for arteriosclerosis, the primary cause of heart attacks and strokes.

Hardened arteries fill with a buildup of cholesterol and fats that blocks the circulation of blood to the heart muscle and the brain. High blood pressure is one of the biggest contributors to artery hardening.

Don’t stop your medicines. If they aren’t bringing your pressure down or if they are giving you grief, let your doctor know. There are so many high blood pressure medicines that there will be one or two that are bound to work for you without causing you distress.

I can assure you that your medicines did not cause your kidney infection. A bacterium did that.

Q Will you write about undulant fever? I had it years ago. It seems the doctors in the state I have moved to, have never heard of it.

A Undulant fever also goes by the name “brucellosis.” It was once a somewhat common infection in the United States, but now there are less than 100 cases a year, so most doctors have had no experience with it. It is acquired through contact with infected animals or their secretions. The germ gets into people through cuts, through breathing it in or through eating or handling foods contaminated with it.

The illness causes waves of high fever. “Undulant” is derived from the Latin word for waves. Severe back pain is often a prominent feature, as are headaches and profuse sweating. Bones, joints, skin, eyes, kidneys and even the heart can be involved. The antibiotic doxycycline along with rifampin or streptomycin usually effects a cure.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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