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.

A: Ankylosing (AN-kuh-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.

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