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USC athlete endures pain of arthritis, keeps moving by Dawn Brazell Special to The Catalyst When Kristy McPherson wakes in the morning, she instantly knows the weather without even a peak outside. She just senses it in her joints. If it’s cold and rainy, the pain’s intense.   For someone with juvenile rheumatoid arthritis, this is just life. Patients learn to work around the pain, to go about their daily lives. What’s a bit unusual about McPherson is that her daily life includes competing at the collegiate level as a golfer at the University of South Carolina.   McPherson knows better than most golfers about how to lower a handicap. She’s been doing it since she was 11, when her life went from that of a normal, athletic sixth-grader to that of a homebound child desperately ill.  “It all happened within an hour. I was walking home from school and walking across the yard when my brother tackled me. All of a sudden my back started hurting, and I sat down. Then I couldn’t get up when I wanted to get up.”   Over the weekend she developed a rash in her throat. It got so bad that her throat felt like it was closing up, and her mother took her to the doctor. She was kept in the hospital for a couple of weeks as they tested her for various things, including tick-born illnesses. Her throat improved and she was sent home. But then her rash moved to different parts of her body, and her knee and ankle joints began to ache. Five months later, she was diagnosed with juvenile rheumatoid arthritis.    For 11 months, she sat in bed in pain doing nothing, she said.  “I was totally confused. I didn’t know what had happened to me. I was perfectly fine that Friday and then I couldn’t walk for 11 months. It was really discouraging because all my friends were out playing, and I was stuck in the bed.”   McPherson said she was lucky that her friends continued to visit. Her brother, Kevin, also kept encouraging her to get moving. Formerly she had played softball and basketball and a little golf. Once she started walking again, her brother got her out on the greens. Once McPherson tried it, she was hooked.  “When I got out there, I knew I could do it if I wanted it badly enough.”   Family, friends and her doctor, Richard Silver, M.D., director of MUSC’s Division of Rheumatology and Immunology, encouraged her. “A lot of doctors were discouraging. But he told me I could do whatever I wanted to do if I tried hard enough.”   She took him at his word. That became her philosophy and got her through intense bouts of frustration as she put in the time and practice needed to be on the golf team, which was all boys, at Conway High School. McPherson says she felt there was some reason she was supposed to be playing golf. There were times the frustration seemed overwhelming, but she stayed the course.   She became a two-time winner of the Beth Daniel Award for the best female high school golfer in the state. Attending USC on a full women’s golf scholarship, she has continued to do well and has loved touring with the team, she said.   That doesn’t mean it’s easy for her. There are times she has to manually unbend her fingers that are clenched in pain. When the weather’s poor, her bad left knee will make her change her swing. But there are those good days, too. McPherson, 18, knows without a doubt that she has fared so well because she has stayed active. She hopes to play in some future LPGA Tour events. If the pain should stop her, she wants to be an agent.   “Every day I get up, and I know there’s going to be pain. It’s pretty much a habit now. I used to get frustrated. Now I’ve learned how to accept it and to be grateful that I’m able to be out there playing at all. It just feels so good to be out there. I don’t focus on the pain.”   It’s that coping attitude Silver admires. “That’s something that the doctor can’t provide. That comes from inside.” He also gives credit to her family for teaching her good coping skills to deal with the chronic pain.   “That’s something that anyone with any chronic condition has to learn. It’s well known that arthritis patients who develop good coping skills do far better in the long run than those patients who do not, for one reason or another, develop those strategies. It’s an ability to find a way around or over an obstacle. It involves self-help rather than a learned helplessness, which we strive against.”   What’s so nice about McPherson is that she had a wonderful response to treatment and went into remission. This occurred before joint damage had happened, so she has been able to achieve her expectations, he said.    It’s a goal doctors strive for at MUSC’s Pediatric Rheumatology Clinic, the only clinic in the state devoted to the diagnosis and care of children with juvenile arthritis, lupus, dermatomyositis and other less common childhood rheumatic diseases.   Silver is excited about advances in the treatment of rheumatoid arthritis. “We’ve seen more advances in the past five years than there has been in the history of treating rheumatoid arthritis.”   There are more effective and safer anti-inflammatory drugs out now, he said. What’s particularly exciting, though, are the DMARDS or disease modifying anti-rheumatic drugs that do more than just treat the symptoms. These drugs can actually change the course of the disease by targeting the inflammatory process that happens in the joints.    “We’re seeing the tip of the iceberg in new biologic agents that will modify the course of the disease. We’ve come a long way. We don’t see children crippled and in wheelchairs because we make the diagnoses earlier. We have more effective medical treatments. We have surgical treatments when medical treatments fail. It’s really rare to have a child with this disease in a wheelchair,” said Silver.    McPherson will be a wonderful role model. “Most of the children the center treats do quite well, but few go on to become athletes at Division I colleges. She’s a terrific kid. I think the future hope is to have all children like Kristy fulfill all their expectations.” DID YOU KNOW? Rheumatoid arthritis is an autoimmune disorder in which the body’s immune system acts against and damages joints and surrounding soft tissues. Many joints—most commonly those in the hands, feet and arms, become extremely painful, stiff and deformed. Juvenile rheumatoid arthritis (JRA) is more prevalent than most people think, ranging from 60 to 115 cases per 100,000 children. To put it in perspective, JRA affects about the same number of children as juvenile diabetes, at least four times more than sickle cell anemia or cystic fibrosis and at least 10 times more than leukemia or muscular dystrophy. The signs and symptoms of JRA vary from child to child. It usually begins with swelling of one or more joints, often with redness and warmth. If the arthritis persists and if other causes such as infections are ruled out, a diagnosis of JRA is likely.  HOW CAN YOU HELP?   Physicians and parents need to be educated to recognize the signs so earlier diagnosis can be made before there is joint damage, said Richard M. Silver, M.D., director of the Division of Rheumatology and Immunology at MUSC.    In spite of new insights into the cause and considerable advances in treatment, JRA remains an important cause of chronic pain and disability in childhood.      To request a free brochure that explains JRA in more detail, check out the web site <http://www.arthritis.org/ajao> and look for the booklet “Arthritis in Children.” Another helpful site is <http://www.musc.edu/rheumatology>.   Numerous fundraisers are planned throughout the year including a wine tasting and silent auction in the summer and a 5K walk in the fall. For more information about participating in these events call the Arthritis Foundation Carolinas Chapter at 1-800-883-8806.