Understanding Arthritis and Inflammation

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The body’s white blood cells and substances that they produce to protect our bodies from infection by foreign organisms, such as bacteria and viruses.

In some inflammatory diseases, however, the body’s defense system — the immune system — triggers a response when there are no foreign substances to fight off. In these diseases, called autoimmune disorders, the body’s normally protective immune system causes damage to its own tissues. The body responds as if normal tissues are infected or somehow abnormal.

Some, but not all, types of arthritis are the result of misdirected inflammation. Arthritis is a general term that describes inflammation in the joints. Some types of arthritis associated with inflammation include the following:

  • Rheumatoid arthritis
  • Psoriatic arthritis
  • Gouty arthritis

Other painful conditions of the joints and musculoskeletal system that may not be associated with inflammation include osteoarthritis, fibromyalgia, muscular low back pain, and muscular neck pain.

Inflammation is characterized by:

  • Redness
  • Swollen joint that’s warm to the touch
  • Joint pain
  • Joint stiffness
  • Loss of joint function
    Often, only a few of these symptoms are present.

    Inflammation may also be associated with general “flu-like” symptoms including:

    • Fever
    • Chills
    • Fatigue/loss of energy
    • Headaches
    • Loss of appetite
    • Muscle stiffness

    Inflammation occurs when substances from the body’s white blood cells are released into the blood or affected tissues to protect your body from foreign invaders. This release of chemicals increases the blood flow to the area of injury or infection, and may result in redness and warmth. Some of the chemicals cause a leak of fluid into the tissues, resulting in swelling. This protective process may stimulate nerves and cause pain.

     

    The increased number of cells and inflammatory substances within the joint cause irritation, swelling of the joint lining, and eventual wearing down of cartilage (cushions at the end of bones).

    Inflammatory diseases are diagnosed after careful evaluation of the following:

    • Complete medical history and physical exam with attention to the location of painful joints
    • Presence of joint stiffness in the morning
    • Evaluation of accompanying symptoms and signs
    • Results of X-rays and laboratory tests

    Yes. Inflammation can affect organs as part of an autoimmune disorder. The type of symptoms experienced depends on which organs are affected. For example:

    • Inflammation of the heart (myocarditis) may cause shortness of breath or fluid retention.
    • Inflammation of the small tubes that transport air to the lungs may cause shortness of breath.
    • Inflammation of the kidneys (nephritis) may cause high blood pressure or kidney failure.

    Pain may not be a primary symptom of an inflammatory disease, because many organs do not have pain-sensitive nerves. Treatment of organ inflammation is directed at the cause of inflammation whenever possible.

    There are a number of treatment options for inflammatory diseases including medications, rest, exercise, and surgery to correct joint damage. The type of treatment prescribed will depend on several factors, including the type of disease, the person’s age, type of medications they are taking, overall health, medical history, and severity of symptoms.

    The goals of treatment are the following:

    • Correct, control, or slow down the underlying disease process
    • Avoid or modify activities that aggravate pain
    • Relieve pain through pain medications and anti-inflammatory drugs
    • Maintain joint movement and muscle strength through physical therapy
    • Decrease stress on the joints by using braces, splints, or canes as needed

      There are many drugs available to decrease joint pain, swelling, and inflammation, and possibly prevent or minimize the progression of the inflammatory disease. The medications include the following:

      • Nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin, ibuprofen or naproxen)
      • Corticosteroids (such as prednisone)
      • Antimalarial medications (such as hydroxychloroquine)
      • Other oral drugs, including apremilast (Otezla), azathioprine (Imuran), cyclophosphamide (Cytoxan), leflunomide (Arava), methotrexate, and sulfasalazine
      • Biologic drugs such as abatacept, adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), enercept-szzs (Ereizi), golimumab (Simponi, Simponi Aria), infliximab (Remicade), rituximab (Rituxin), and tocilizumab (Actemra).

      Some of these medications are traditionally used to treat other conditions such as cancer or inflammatory bowel disease, or to reduce the risk of rejection of a transplanted organ. However, when “chemotherapy” drugs (such as methotrexate or cyclophosphamide) are used to treat inflammatory diseases, the doses are significantly lower and the risks of side effects tend to be less than when prescribed in higher doses for cancer treatment.

      When you are prescribed any medication, it is important to meet with your doctor regularly so they can detect the development of any side effects.

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