DEAR DR. DONOHUE: I am trying to find out something about ankylosing spondylitis. I never heard of it until two years ago, when my grandson was told he had it. There’s no history on either side of his family. In less than a year he has lost 100 pounds. He is unable to work and has no money coming in. He has been on Enbrel and Remicade. Neither has helped. He takes morphine for pain, but it only knocks the edge off. — J.B.

ANSWER: As a rule, ankylosing  spondylitis is a problem that begins early in life, between the ages of 20 and 30, and mostly is a problem of men. Genes are involved, but the illness might not be found in other family members. One gene that has been identified is the HLA-B27. Finding that gene with a blood test aids in making the diagnosis.

The backbone inflammation starts in the lowermost part of the spine, and ascends up to and often includes the neck. Not every patient has such an extensive involvement, but some do. Affected people walk stiffly, bent slightly forward at the waist. Frequently, they cannot take a deep breath because the chest portion of the spine is so restricted in its movement. When the neck is involved, it, too, is bent forward in a fixed position.

The pain and stiffness worsen with inactivity and loosen somewhat with motion. The knees, hips and shoulders also might be involved with this arthritis. Organs other than the joints can suffer. The eyes, for example, might become inflamed.

Your grandson has had the latest treatments for this arthritis — Remicade and Enbrel. Another newer drug is Humira. Most often, patients start with the nonsteroidal anti-inflammatory drugs like Indocin. Physical therapy is essential for keeping the spine limber.

Does your grandson know about the Spondylitis Association of America? It can help him in a number of ways. Not only does it keep members abreast of new developments, it might be able to assist your grandson in applying for disability benefits. The website is www.spondylitis.org, and the toll-free number is 800-777-8189.

DEAR DR. DONOHUE: It’s that time of year again — the no-see-um season. I can feel a sharp sting when bitten. It goes away and then returns as a large swelling with incessant itching. What can I do to prevent this reaction? Others don’t react this bad. I also use DEET to deter these diabolical pests. Should I wash it off as soon as I get indoors? — C.R.

ANSWERS: No-see-ums got that name because they’re barely visible, only 1/16th of an inch. Dawn and dusk are their busiest hours. Avoidance is the best protection. The red welt you describe arises about 12 or more hours after the bite and can be as large as an inch in diameter. It does itch. DEET is the best repellent, but it’s not a 100 percent barrier for all users. Have you tried a higher concentration? Are you following label directions regarding when to reapply it? When you get back home, wash treated skin with soap and water. Also, you can spray your clothes with permethrin. It will give you additional protection. Wear long slacks tucked into your socks and long-sleeved tops. As for the itch, antihistamines are suggested. I admit they don’t work for everyone.

DEAR DR. DONOHUE: I have developed trochanteric bursitis, which causes pain in my left hip. I experience the pain when walking and sleeping. An orthopedist recommended Aleve. Does the bursitis have to run its course, or do I have to live with it for the rest of my life? — A.H.

ANSWER: The body has hundreds of bursas, little disks interposed between tendons and bones to prevent friction as the tendons pass over bones. At the top of the thigh are three bursas, trochanteric bursas, whose inflammation is felt as pain on the upper, outer leg. Did you try Aleve? It should give you relief. If it doesn’t, an injection of cortisone into the bursa almost always stops the pain. Resting the leg is important. Resting doesn’t mean total immobilization. Heat or cold can ease inflammation. See which works better for you. This isn’t a lifelong proposition.

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.