Aug. 11, 2010 -- Pro golfer Phil Mickelson recently announced that he is being treated for psoriatic arthritis. According to media reports, he first developed symptoms right before the U.S. Open, and the pain quickly became so intense that he couldn’t walk.
To find out more about psoriatic arthritis and how it could have affected Mickelson's game, WebMD spoke with rheumatologist Stephen A. Paget, MD, of the Inflammatory Arthritis Center at Hospital for Special Surgery in New York City and his colleague Brian Halpern, MD, a sports medicine doctor. Neither of the doctors has treated Mickelson.
What is psoriatic arthritis and who is at risk of developing it?
Paget: Psoriatic arthritis is an autoimmune disease in which the body’s immune system misfires against its own joints and tendons, causing inflammation and pain. People with psoriatic arthritis may also have psoriasis, an inflammatory skin disease. Unlike some other autoimmune diseases that disproportionately affect women, psoriatic arthritis affects both sexes equally. It often strikes between the ages of 30 and 55. This disease can also flare when a person is under stress. Mickelson's wife and mother were recently diagnosed with breast cancer and that certainly didn’t help things.
What are some of the signs or symptoms of psoriatic arthritis?
Paget: Redness, warmth, or swelling in the joints is common. It often starts in the end joints of your fingers toward your nails, but it can involve any joint. Psoriatic arthritis may also involve four or fewer large joints in the lower extremities, and often occurs in an asymmetrical fashion. Sometimes psoriatic arthritis can look exactly like rheumatoid arthritis (RA). People with psoriatic arthritis may also have psoriasis, which is marked by scaly, silver patches of skin on the scalp, ears, elbows, or buttocks.
Could untreated psoriatic arthritis affect Mickelson's golf game?
Paget. Absolutely. There would be no way that he could play golf in a competitive way with untreated psoriatic arthritis.
How would it affect his swing or grip?
Halpern: The "sausage digit" is pretty classic in psoriatic arthritis. One of the joints in your hands and toes swells like a sausage and becomes very painful. If this happens in your foot, it is hard to walk and can also affect your golf swing because you need to stabilize your swing with your foot. If your hands are affected with psoriatic arthritis, it can affect your grip. The vibration of the ball up the golf club would also hurt your hand. Psoriatic arthritis can also affect the lower back. Whichever joint is affected becomes swollen and painful.
Mickelson said he was taking Enbrel to treat his arthritis. What is Enbrel?
Paget: Enbrel (etanercept) is a biologic drug that blocks tumor necrosis factor (TNF), a substance that can cause or worsen inflammation. Fully 50% to 60% of people who use Enbrel will respond, and it is like getting a whole new life. Mickelson can go back to playing golf as well as before.
Are there any side effects with Enbrel or other drugs in this class that Mickelson needs to watch out for?
Paget: These drugs do increase risk of infections, and that needs to be watched very carefully.
Does psoriatic arthritis increase Mickelson's risk for any other diseases?
Paget: Psoriasis and psoriatic arthritis do increase a person's risk of developing diabetes and heart disease. If the disease and the underlying inflammation are treated, these risks are minimized.
Mickelson said he saw a doctor when the pain became so bad he couldn't walk. When should a person see a doctor?
Paget: Talk to your internist and ask for a referral to a rheumatologist if you have been experiencing persistent pain, stiffness, and fatigue for more than a few weeks that can't be explained by weekend warrior activity or overuse and is limiting your function and affecting your life.