Early Diagnosis Could Keep Mickelson's Psoriatic Arthritis at Bay
Pro golfer's announcement brings attention to misunderstood disease
Top professional golfer Phil Mickelson's announcement this past summer that he has psoriatic arthritis, a potentially disabling disease, brought nationwide attention to a condition that is not well-known or understood.
At an August news conference, just before he was to play in the PGA Championship in Wisconsin, Mickelson revealed that two months before, he had been struck seemingly overnight by intense pain in some of his joints and tendons, so much so that he was unable to walk. His condition progressively got worse, prompting him to see a doctor.
He told reporters he sought a second opinion at the Mayo Clinic in Minnesota, where physicians confirmed that he had psoriatic arthritis, a disease usually accompanied by psoriasis. Mickelson has not said whether he also has psoriasis.
Mickelson immediately began treatment—taking weekly, self-administered injections of the drug Enbrel—and quickly began seeing positive results. He said he is optimistic about being able to continue to play well for both the short term and the long term.
Experts such as Christopher T. Ritchlin, M.D., professor of medicine at the University of Rochester School of Medicine and Dentistry, confirm that psoriatic arthritis is treatable, using a variety of drugs, although doctors emphasize that it also is chronic and possibly debilitating.
"There's a big focus on trying to diagnosis patients early," he says. "That's critical, because you can see damage very early, in the first year or two." Beginning treatment soon after diagnosis can "greatly prevent inflammation and further damage," he says.
Ritchlin, a rheumatologist with expertise in treating psoriatic arthritis and other diseases of the joints, bones and muscles, said that whether Mickelson will be able to play golf as well as he could before developing the disease is uncertain. "The fact he was diagnosed and treated so early—it's possible he could do very well. We don't usually get patients diagnosed as early as he was."
Having begun treatment so soon, Mickelson, considered by some sports analysts to be the country's No.1 golfer, could continue to perform "at the level to which he is accustomed, but I don't know for sure," Ritchlin said.
Bob Murphy's experience
Similarly, psoriatic arthritis struck Bob Murphy, a former pro golfer and golf sportscaster, in 1986 at the age of 43. Murphy had been a touring pro since 1968, having won five tournaments.
"I went a good four or five years hurting, and we did not know why," says Murphy, who lives in Florida. Now retired from golf, he still works as a broadcaster. "I had a couple of different (psoriatic arthritis) surges after I played really well in 1985 or '86. By the middle of 1987, I couldn't play. I was incapable of holding onto the golf club." Six of his fingers were swollen and disfigured.
Not long after that, Murphy recounts, he was out fishing with his rheumatologist, who noticed the golfer's red, scale-covered legs and asked him, "Bob, do you have psoriasis?" Murphy replied, "Yeah, I've had psoriasis for seven or eight years." The doctor called him that night and told him, "We know (now) why you've been hurting." He said Murphy had psoriatic arthritis.
In 1993, when he turned 50, Murphy became eligible for the Champions Tour for senior pro golfers. In hopes that he could play on that tour, in the early '90s he began taking massive doses of intravenous antibiotics such as tetracycline. The regimen helped. He also took methotrexate. "Lo and behold, it became under control," he says of the arthritis. "I was able to play with no pain or swelling." He won 11 times on the Champions Tour. Today, he takes Enbrel shots once a week and also uses magnet therapy on the parts of his body that hurt.
Murphy calls psoriatic arthritis "migratory—you don't hurt in the same place all the time. This stuff bounces around." His own experience with the disease makes him empathetic with Mickelson and everyone else who copes with the problem. "I understand what people go through."
But he concurs with doctors who say Mickelson's prospects are enhanced by his timely diagnosis. "I think he's probably lucky. They discovered this pretty early."
Staying active is key
Ritchlin, the rheumatologist, says he treats musicians with the local orchestra who have psoriatic arthritis, and, even though the disease frequently affects the hands, these patients have been able to continue performing after starting treatment. He also treats weekend athletes who can continue their activities, and has treated a baseball pitcher who was able to play in college and do well.
Physical trauma can cause flares in the disease and should be avoided, if possible. That means that athletes such as football players would not be able to continue playing if they had the disease, Ritchlin says.
Murphy's advice to others who have psoriatic arthritis is to try to move as much as possible. "It's very important to stay active," he says. "Stay active as often as you can." He says you can't expect to wake up in the morning and feel "raring to go" when the arthritis hurts. Wait a little while, he says, and maybe take a hot bath first.
Ritchlin says people with psoriatic arthritis need to rest more than others and not push themselves too hard. He advises wearing comfortable shoes and trying to maintain an optimal body weight because being overweight is harder on the joints. Controlling stress, which can make the disease worse, also is important, whether through exercise, meditation or any other means that helps.