DEAR DR. DONOHUE: I am a 49-year-old female with ankylosing spondylitis. It took many years for me to get a diagnosis. Many doctors think this disease affects men only. Spondylitis can affect women and children, and can be just as severe in them as it is in men. Had I been diagnosed earlier, I could have begun treatment earlier and not ended up with the kind of back I have now. For current information on this subject, go to www.spondylitis.org. – K.B.

ANSWER: At one time, ankylosing (ANK-uh-LOW-sing) spondylitis (SPAWN-duh-LITE-us) was thought to be for men only. It’s not. As you say, women and children get it, but male patients still outnumber female patients by a ratio of 3-to-1.

This illness begins as nondescript back pain that most everyone thinks will go away. Or it starts as buttock pain that travels to the back side of the upper leg. The pain doesn’t go away. In addition, the back is quite stiff after wakening from sleep, and it takes an hour or so to limber up.

What happens next is unpredictable. In the worst scenario and for a distinct minority, stiffness and pain march up the spine and affect the neck. The spine can become immobile. It’s impossible to turn the head. People are often bent over at the waist. Breathing is impaired because the chest cannot expand.

In the less severely affected – and that is the majority – backs hurt and become stiff, but these people are able to carry on with everyday chores.

The hips and shoulder might also become arthritic, and the eyes can be inflamed. The heart’s aortic valve can leak. Inflammation of the intestinal tract is also possible. This is an illness with many target organs.

For lesser involvement, anti-inflammatory drugs like Indocin can often ease pain and permit greater spine motion. Since the turn of the 21st century, a new era has dawned in treatment. Drugs like Remicade and Enbrel have freed many ankylosing spondylitis patients from the locked-in positions that the disease had forced on them. New studies have thrown a little cold water on these agents. Physical therapy is a must.

Thanks for the Web site of the Spondylitis Association of America. It has great information on it.

DEAR DR. DONOHUE: I was interested in your column in which you suggested that your readers donate their orthopedic devices to different facilities. I would like to point out that you neglected to recommend their treating orthopedic surgeons. I treat many patients who do not have insurance or the financial means to purchase canes, walkers, crutches or wheelchairs. In our practice, we recycle them to our patients. I hope you will use this information in the future. – Dr. D.F.

ANSWER: Thank you, doctor, for writing. I get the “duh” award. I never thought of asking an orthopedic surgeon for help on this question. I’m happy to hear that these doctors provide unwanted orthopedic devices for their patients. I’ll mention this from now on.

DEAR DR. DONOHUE: Would you help me explain what algodystrophie is in English? What causes it? – Anon.

ANSWER: The material you sent is in French. I am not a French scholar, but I struggled through it – haltingly.

In English it is called complex regional pain syndrome. It used to be known as reflex sympathetic dystrophy. An injury or illness causes it, and the injury can be slight, like a mildly sprained ankle. The ankle heals, but the pain doesn’t go away. Eventually tissues, including the skin of the involved site, become thin and cold.

It takes determination and stick-to-itiveness with physical therapy to conquer this complication of an injury. Most, however, do recover. It can take a long, long time – a year or more.

DEAR DR. DONOHUE: Is age the only cause of age spots? Will vitamins remove them? – D.K.

ANSWER: “Age” spots are brown spots often seen on the back of the hands. Age is one element in their appearance. Sun exposure is another.

Vitamins won’t remove them. Doctors can remove them with liquid nitrogen. Or they can be left alone.

DEAR DR. DONOHUE: I recently had a stroke. I had been massaging my head with a hand-held massager in the area where the stroke occurred before it happened. Did that cause the stroke? – M.

ANSWER: No, it did not. It was purely coincidental that you suffered a stroke and had been using a hand-held massager.

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