While doing some leisure reading on the upcoming Masters Golf Tournament, it was mentioned that three-time tournament champion Phil Mickelson suffers from a condition known as Psoriatic Arthritis. Reading that Mickelson's campaign for a fourth Green Jacket may be complicated by an extremely painful joint condition, my interest was piqued. What exactly is Psoriatic Arthritis?
Judging from the name of the condition alone, my first guess was that it is a condition affiliated with both the skin condition psoriasis and some form of pain in the joints. According to the National Institutes of Health, "Psoriatic arthritis is an arthritis that is often associated with psoriasis of the skin." Suspicions confirmed, apparently.
Osteoarthritis, the most common form of arthritis, affects joints through a degenerative process. It causes the cartilage to wear out, removing the necessary lubricating barrier between bones. Rheumatoid arthritis is an auto-immune disease that destroys the cartilage in joints. What does this have to do with a skin condition?
Psoriasis is "a chronic skin disease of scaling and inflammation that affects greater than ... five million adults" (NIH). The disease occurs when skin cells rise to the surface at an accelerated rate, denying the natural growth and death of the skin. Instead, the skin cells pile up on the surface of the skin, creating patches of inflamed skin covered with silvery scales. Of these five million American adults with psoriasis, about 30 percent exhibit symptoms similar to arthritis in their joints near the affected skin.
Much like osteoarthritis, symptoms of psoriatic arthritis include joint swelling or stiffness. This form of arthritis can be identified through x-rays of the joint in question. The onset of the arthritic symptoms is coupled with skin flare-ups; as the skin gets worse, the symptoms in the joints gets worse as well. In some cases, psoriatic arthritis can lead to permanent joint damage.
The NIH reports that "the course of the disease is often mild and affects only a few joints" and that many symptoms of psoriatic arthritis can be treated with NSAIDs to reduce inflammation and pain. More severe cases may require disease-modifying antirheumatic drugs (DMARDs). In some cases, the joint can be directly injected with steroid medications.
Psoriatic arthritis is commonly known to affect the hands and feet. In the case of Mickelson, this would, presumably, critically affect his ability to swing a golf club and maintain complete control over a ball. When he was diagnosed in June 2010 just before the US Open, Mickelson had to address the severe joint pain he was experiencing. Mickelson treated his symptoms with etanercept (Enbrel), an injection used to lower levels of an inflammatory protein called tumor necrosis factor (TNF).
Dr. Robert Shaw, MD, told ArthritisToday.org that, "People with psoriatic arthritis sometimes have trouble dressing themselves." But psoriatic arthritis symptoms are not always so severe. In Mickelson's case, he is able to play golf expertly despite his condition.