One kind of back pain has genetic roots

DEAR DR. DONOHUE: My brother was recently told he has ankylosing spondylitis. He's in his early 50s and has posture like Ed Sullivan, who had the same disease. He gives himself a shot of Humira. He has a lot of pain. Is ankylosing spondylitis inherited? How likely is it that some of the rest of us nine kids could inherit it? -- K.H.

ANSWER: Ankylosing (ANkuh LOW-sing) spondylitis (SPAWN-duh-LITE-is) is arthritis that affects primarily the backbones -- the vertebrae. It often begins as a dull pain in the low back or deep in the hips and gradually ascends the spinal column. "Ankylosing" means "fusion" or "welding together." In time, the backbones become welded to each other so that back mobility is close to zero. The back and neck become so rigid that turning them is impossible. Affected people have a stooped neck and are bent forward at the waist. Ed Sullivan is a good example. I'll bet many readers don't know who he was.

This kind of arthritis has strong genetic links. If an identical twin has it, there's a 65 percent chance that the other twin will also have it. Identical twins have identical genes. There is not such a strong relationship between brothers and sisters, however. The hereditary component can be demonstrated by finding the HLA-B27 antigen in the blood. People with this inherited antigen have a good chance of coming down with the condition.

Your brother developed this illness in an era when medicines have changed the outlook for ankylosing spondylitis patients. Remicade, Enbrel and your brother's Humira are new medicines unlike any of the past medicines, and they have transformed the picture for patients to a remarkable degree. They can make people more susceptible to infections, so they have to be used with some caution.

For people with less-severe involvement, nonsteroidal anti-inflammatory drugs like Indocin can control symptoms.

DEAR DR. DONOHUE: My 25-year-old daughter is expecting my first grandchild, a girl, and she recently learned she has a two vessel umbilical cord. Her doctor did not explain this in any detail, only mentioning lower birth weight. However, after researching it on the Internet, we are afraid the baby will have serious problems. My daughter is in her fifth month of pregnancy. -- J.B.

ANSWER: Normally the umbilical cord has three vessels: two arteries and one vein. A single artery -- therefore, a two vessel umbilical cord -- is found in five to 10 newborns out of 1,000. In 20 percent to 30 percent of those children, a congenital abnormality is found, and kidney problems are the most common of those abnormalities. Looking at this in another way, 70 percent to 80 percent of these babies are fine.

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. Readers may also order health newsletters from www.rbmamall.com. 2006 North America Syndicate Inc. All Rights Reserved