DEAR DR. DONOHUE: I am a 36-year-old man who has had back pain for more than four months. I saw a doctor this past week, and he said he thinks I have a “special kind” of arthritis. He is doing more tests, and X-rays are ordered. What is this “special kind” of arthritis? Aren’t I too young to have arthritis? – D.K.

ANSWER: You are not too young to have ankylosing (AN-kuh-LOW-sing) spondylitis (spawn-duh-LITE-us). It’s a special kind of arthritis that comes on during the 30s or 40s and affects more men than women.

Its symptoms are also special. The first sign of trouble is pain deep in the buttocks. The pain worsens upon standing, and back stiffness reaches its acme when wakening in the morning. The buttock pain is an indication of arthritis of the sacroiliac joint, the junction of the backbone with the pelvis – another hallmark of this arthritis.

With the passage of years, back pain makes an ascent from the lower back to the upper back and even to the neck. The spine can become so frozen that it is only with great difficulty that a person can bend or turn the neck.

A family history of this arthritis is common. That suggests a genetic basis. Bolstering the gene influence is finding in the blood a protein called HLA-B27. Many ankylosing spondylitis patients have it, and its presence helps confirm the diagnosis.

Joints distant from the spine can also become arthritic. The hips, shoulders and knees are prime examples.

Furthermore, tissues and organs unrelated to joints might come under attack. The heart’s aortic valve is a case in point. Eye inflammation is another possibility.

I am sure I have freaked you out with a truly pessimistic picture. Things are not so grim. Many patients are not severely affected. And, for others, there are plenty of medicines that can control matters. Most important is an exercise program supervised by a physical therapist. Such programs keep the spine limber and permit a patient to engage in an active life.

DEAR DR. DONOHUE: What can you tell me about Marfan’s syndrome? A close relative has it and tells me I should be checked for it. Why? – B.A.

ANSWER: Marfan’s syndrome is an inherited condition. Marfan patients are tall and willowy with very long arms, legs and fingers. The breastbone is often malformed. There’s a defect in a protein that serves as a support structure for many body organs and tissues. The organs and tissues most affected include bones, aorta, heart, eyes and lungs.

The lens of the eye can slip out of place, and, in addition, many Marfan patients are quite nearsighted. Heart valves may be deformed. But the most serious problem for Marfan patients has to do with their aorta, the artery into which the heart pumps its blood. Marfan aortas can have defective walls that make them dilate and even split – a medical catastrophe.

Be checked. The doctor can check your aorta and eyes to see if they show any signs of trouble. If they do, medicines, and sometimes surgery, can remedy the situation.

All Marfan patients should contact the National Marfan Foundation at 1-800-862-7326 or through its Web site, www.marfan.org, for detailed information on this not-uncommon genetic disorder.

DEAR DR. DONOHUE: I have been treating blepharitis for more than two months without making much progress. I would appreciate your thoughts on treatment. Thank you. – J.P.

ANSWER: With blepharitis, the eyelids are red, often itch or hurt, have a yellow-brown crust and are frequently stuck to each other after a night’s sleep.

I can give you a standard treatment. Apply warm compresses for 10 minutes to the closed eyes three times a day. This softens the crusts, which can then be gently scrubbed off with a cotton-tipped applicator soaked in a solution of half baby shampoo and half water.

Blepharitis is a stubborn disorder. It takes patience and perseverance to overcome it. If the above regimen is not bringing results, a person must see the doctor for prescription antibiotic ointments or drops.

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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