By the time she was 12, Caitlin Bryan, of Needham, Mass., sustained and recovered from three stress fractures in her spine. For a young, strong and lifelong gymnast, this injury occurring so often in such a short time was a concern. At a visit with her primary care doctor, Caitlin was diagnosed with sacroiliitis, an inflammatory condition of the lower back that threatened to put a halt to Caitlin’s love for competitive sport.

Caitlin, then 13, stepped away from gymnastics in search of treatment options to manage her pain and, if possible, a sport that was gentler on her back. Caitlin was ultimately diagnosed with juvenile spondyloarthritis, a type of juvenile idiopathic arthritis (JIA), and was subsequently referred to Pediatric Rheumatology at Mass General for Children (MGfC) with the hope that the right treatment would get her back in the game.

“I was in agonizing pain every day. There were some days when I couldn’t even get out of bed,” said Caitlin, now 18. “I couldn’t stand for more than 10 minutes at a time, and I couldn’t sit in class for the 90-minute periods. The pain made it hard to focus on my schoolwork.”

The next two years were filled with doctor’s appointments, imaging tests and new biologic disease-modifying anti-rheumatic drugs (DMARDS), or medications that can slow or stop damaging joint inflammation. Not being involved in a sport took a toll on Caitlin’s mental health and she found herself feeling lost and dismayed.

“I loved being involved in a sport,” said Caitlin. “I lost my gymnastics family, and I had a lot of time that I didn’t know what to do with. It was a bleak time for me, honestly.”

After a brief stint on a swim team, Caitlin, who was 14 at the time, discovered her passion for diving, a sport with the fierce competition and rigor of gymnastics but a gentler impact on her joints. Training required three-hour practice sessions 5-6 days a week, with additional conditioning on her own.

Caitlin Bryan doesn't let juvenile spondyloarthritis stop her from pursuing her dream of being a college athlete and competitive diver.

A balance of treatments for juvenile spondyloarthritis and stretching exercises got Caitlin on the diving board and controlled her pain. With less pain, Caitlin could concentrate on her schoolwork and diving career. “Caitlin and I discussed how her pain affects her focus and ability to concentrate. A lot goes into her ability to perform as a diver, and it’s not just pain management,” said Thomas Fry, MD, Caitlin’s primary care doctor at Massachusetts General Hospital. “We talk about her nutrition, workout routines, relationships with her family and friends, sleep and stress. By talking about all those aspects, it helps her see the whole forest for the trees.”

For patients with juvenile spondyloarthritis and other forms of JIA, one goal of care is to help patients reach their full potential. “Our goal is always to help patients with juvenile spondyloarthritis and other types of JIA achieve everything they are capable of, regardless of having JIA. But the ‘ups and downs’ of JIA, even with the best treatments, can be really frustrating for kids dealing with this,” said Marc Natter, MD, an attending physician in Pediatric Rheumatology at MGfC and member of Caitlin’s care team. “That’s why we try so hard to work in a team approach with our patients, their families and their other physicians, which, in Caitlin’s situation as an elite athlete, meant that involving her Sports Medicine physicians was an especially important part of her care.”

With her intense schedule and physical demands on her body, Caitlin is grateful that, in partnership with her care team, she could achieve her goals. “My doctors were all willing to work with me and figure out how to make that happen even with my disease,” she said. “They modified my medications whenever I needed. They also made suggestions on stretches and different things I could do to manage my symptoms.”

Caitlin competes on not one, but two diving teams – Charles River Diving in Waltham, Mass., and Long Island Diving in the Greater New York area. “Her passion for sports is obvious to her doctors,” said Caitlin’s mother, Stephanie. “Dr. Natter is very accessible. In 2020 when she had an exacerbation of her symptoms, he helped coordinate an MRI and steroid injections into the sacroiliac joints.” Caitlin then went on to participate in a diving competition the following spring.

Caitlin is now a senior at Needham High School and her experiences on her diving teams has given her the opportunity compete on all levels, from local in her hometown area to international in China. While she loves springboard diving, the 10-meter platform, which is more common in New York than Massachusetts, is where she shines. Caitlin is also looking to pursue a collegiate diving career once she graduates high school and recovers from an injury she sustained earlier this year.

“Caitlin is a force to be reckoned with. She is very resilient, although not participating in sports for some time was hard on her mental health,” said Stephanie. “Caitlin wishes every athlete had access to Mass General, top medical care and mental health care because it’s helped her so much.”

Photos and videos courtesy of Stephanie Bryan.