Playing With Arthritis

Phil Mickelson brings attention to a painful subject for golfers

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By Dave Kindred

Illustration By Lou Beach

December 2010

For some people of a certain age, part of every morning is devoted to hearing reports from our extremities. Down below, there's a clicking in the old football knee. There's a grinding at the back of the skull, as if tiny mechanics inserted into the bloodstream have arrived with wrenches to twist the third and fourth cervical vertebrae into place. Some days, from toes to fingers to earlobes, it's all one big squeaking hinge.

Five days before the 2010 U.S. Open at Pebble Beach, Phil Mickelson had one of those days, only worse.

When he thought to get out of bed, he couldn't do it. He was immobilized by pain that radiated throughout his body. He felt it in an Achilles tendon, his left index finger and right wrist. Checking in with his hips and buttocks, ankles, elbows and shoulders, he heard screams.

Mickelson, a world-class athlete, accepts the truth of no pain, no gain. The work to create and sustain the athletic machine at the highest level puts extraordinary stress on the skeletal structure, particularly where tendons, ligaments and muscles come together to create a moving part. But on that day in June, he felt more than the usual run of aches and pains.

"Every time I would wake up in the morning," Mickelson told the media before the PGA Championship in August, "I couldn't walk."

Far as he knew, he hadn't actually been run over by a train, he just felt like it. He was 39 years old, not 69. He was an elite professional golfer, not a slacker chained to a desk. Making it all the stranger, the pain began soon after he told his wife, Amy, that he had never felt so strong and flexible. "Four days later, you know, it just -- it's crazy," he said.

For most of us, dealing with pain means we take two aspirin twice a day and soldier on. But when your life's work is at stake, when you're a one-man corporation earning millions, you call timeout. Maybe, late at night, you even find yourself thinking the pain is an intimation of mortality. So, at that scary moment, you do what Mickelson did. You take your aching shell of a body to the Mayo Clinic. There he was diagnosed with psoriatic arthritis.

Mickelson's announcement of his condition was cause for confusion. Psoriasis is familiar enough; it's an inflammation of the skin made visible by rashes. But psoriatic arthritis? Turns out it's the same disease except it attacks the body from the inside, setting fire to joints, sometimes inflaming the eyes, lungs and aorta. The cause unknown, it mostly flares up in the fourth or fifth decade of a person's life. Of an estimated 50 million Americans with arthritis, maybe one million have psoriatic arthritis.

Arthritis? Isn't that just grumpy old folks tolerating another visit from their obnoxious neighbor, Arthur Itis? Dr. John H. Klippel, a rheumatologist who is president and CEO of the Arthritis Foundation, asks us to know more. "The public perception too often is that it affects only old people, and it's only a nuisance," he says. "That's why Phil Mickelson is so important to education about arthritis. Here's a young guy with a disease that has been interfering with his life and profession in a major way."

The first question for Mickelson, the man: What to do now?

The first question for the golfer: What does it mean for your future?

The answers seem to have come quickly and positively. Psoriatic arthritis occurs when the immune system attacks good cells instead of bad. To deliver protein that inhibits such an assault, Mickelson injects himself weekly with Enbrel, a genetically engineered drug created by introducing human DNA into the cells of Chinese hamster ovaries. At the PGA Championship, Mickelson said he'd used the drug about two weeks, "and I seem to have some pretty immediate progress, so it's been great...And that's why I feel comfortable talking about it, knowing that long-term and short-term, things are fine."

To hear Mickelson pronounce everything fine is to remember that he is famous for his sunny spin on all topics. That makes the next question inevitable: Are things really fine?