As reported
here.
Phil Mickelson Reveals His Struggle with Psoriatic Arthritis
The pro-golfer says quick diagnosis, effective treatment helped him get back in the game.
By Bill Sanders
8/17/2010 Golfer Phil Mickelson, the No. 2-ranked player in the world, has revealed that he is battling psoriatic arthritis, an inflammatory form of arthritis that came on suddenly and left him temporarily in a near-crippled state this summer.
Mickelson said he first noticed symptoms, including searing pain, in the days leading up to the U.S. Open in June.
After a trip to the Mayo Clinic in Rochester, Minn., Mickelson began taking weekly injections of etanercept (Enbrel), an injected, biologic drug that helps to lower levels of a protein that spurs inflammation.
In the days leading up to last week’s PGA Championship, the year’s last major golf tournament, Mickelson first talked about his arthritis and said he was pleased with how he was responding to medication.
“I feel great,” he said to a group of golf reporters. “I’m able to work out and don’t have any pain. So I’ve had some good immediate response. And that’s why I feel comfortable talking about it, knowing that long term and short term, things are fine.”
Psoriatic arthritis is not the first serious medical issue that the Mickelson family has had to face. Mickelson took most of 2009 off after his wife Amy was diagnosed with breast cancer. Already a fan favorite, he became even more popular for the way he stepped away from the game to take care of his family. Mickelson came back this year and won The Masters in April.
It was soon after that he began to experience mysterious pain and stiffness.
Psoriatic arthritis (PA) is an autoimmune disease, meaning that the body’s immune system attacks its own organs and tissues. The condition is rare, affecting about 1 out of 100 people in the general population. People with psoriatic arthritis not only have joint pain, but also experience plaque psoriasis, a red scaly rash that commonly appears on the skin of the arms and legs, scalp, palms and the soles of the feet. Over time, psoriatic arthritis can lead to permanent joint damage and disability.
The fact that he was even able to play golf, much less compete in a couple of major tournaments with this condition, is amazing, says Robert Shaw, MD, a practicing rheumatologist and instructor of medicine at Johns Hopkins University in Baltimore.
“It clearly shows what an elite athlete he is,” Dr. Shaw says. “People with PA sometimes have trouble dressing themselves. He could have had a milder case of it, but eventually, untreated, it still overtakes you. You can’t just move on. The hallmark of this type of inflammatory arthritis is that it causes you to stiffen with even minutes of rest. So if he takes a short water break while playing, his joints would stiffen up.”
Enbrel is one of four “big-gun” medications used to treat PA, and Dr. Shaw says that for some people they are almost miracle drugs.
“These protein inhibitors have changed completely the face of treating inflammatory arthritis,” Dr. Shaw says. “If he’d have gotten this 15 years ago, his playing career would have been over.”
Mickelson said he plans on taking the injections for about a year, after which he believes he’ll be symptom free.
Dr. Shaw, who has not treated Mickelson, says Mickelson and his doctors will decide the best long-term treatment plan, but that in his experience, patients with PA need to stay with the treatments for the rest of their lives.
“The disease goes in and out of remission without treatment, but the disease is still there,” he says. “I think patients need chronic therapy that never stops. What he does will be between him and his doctor, but most of us keep it going chronically.”
The most common side effect of the injections is infection, Dr. Shaw says.
“The drug is playing with your immune system, lowering it ever-so-slightly, but still lowering it. So it leaves you susceptible to infections. If you get a fever, you go off [the drug for] a little while, get well and then go back on it.”
Philip Mease, MD, a practicing rheumatologist and clinical professor at the University of Washington School of Medicine in Seattle, agreed with Dr. Shaw that Mickelson probably wouldn’t be able to come off the injections anytime soon.
“I never like to use the word ‘forever,’ but for the foreseeable future, unless something new comes along and there’s a cure for it, I’d say he’ll need to be on it,” Dr. Mease says. “And even for the high-end athlete, I don’t know if he’ll be able to not have some impact from the PA, even on the Enbrel.”
Dr. Mease hopes Mickelson’s case will raise awareness of PA.
“It can elude diagnosis,” Dr. Mease says. “It typically takes a savvy dermatologist or rheumatologist to find it. It’s not always that the person even knew he or she had psoriasis. That can be misdiagnosed as eczema or not diagnosed at all.”
Even grappling with such significant health issues, Mickelson rallied in the final rounds of the PGA tournament to finish at 6-under, tying for 12th place.
