INFLAMMATION
Inflammation is a process by which the body's white blood cells and chemicals protect us from infection and foreign substances such as bacteria and viruses. In some diseases, however, the body's defense system (immune system) inappropriately triggers an inflammatory response when there are no foreign substances to fight off. In these diseases, called autoimmune diseases, 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.
What diseases are associated with inflammation?
Some, but not all, types of arthritis are the result of misdirected inflammation. Arthritis is a general term that describes inflammation in joints. Some types of arthritis associated with inflammation include:
- Rheumatoid arthritis
- Shoulder tendinitis or bursitis
- Gouty arthritis
- Polymyalgia rheumatic
Other painful conditions of the joints and musculoskeletal system that are not associated with inflammation include osteoarthritis, fibromyalgia, muscular low back pain and muscular neck pain.
Figure 1. When inflammation occurs normally, chemicals from the body's white blood cells are released to protect us from foreign substances. Sometimes, however, the white blood cells and their inflammatory chemicals cause damage to the body's tissues.
What are the symptoms of inflammation?
Inflammation is characterized by:
- Redness
- Swollen joint that is warm to 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
What causes the symptoms of inflammation?
When inflammation occurs, chemicals from the body's white blood cells are released into the blood or affected tissues in an attempt to rid the body of foreign substances. This release of chemicals increases the blood flow to the area and may result in redness and warmth. Some of the chemicals cause leakage of fluid into the tissues, resulting in swelling. The inflammatory process may stimulate nerves and cause pain.
What are the results of joint inflammation?
The increased number of cells and inflammatory substances within the joint cause irritation, wearing down of cartilage (cushions at the end of bones) and swelling of the joint lining.
How are inflammatory diseases diagnosed?
Inflammatory diseases are diagnosed after careful evaluation of:
- Complete medical history and physical exam
- The location of painful joints
- Presence of joint stiffness in the morning
- Evaluation of other symptoms
- Results of X-rays and other tests
Can inflammation affect internal organs?
Yes. Inflammation can affect organs as part of an autoimmune disorder. The type of symptoms depends on which organs are affected. For example inflammation of the:
- heart (myocarditis), may cause shortness of breath or leg swelling
- small tubes that transport air to the lungs, may cause an asthma attack
- kidneys (nephritis), may cause high blood pressure or kidney failure
- large intestine (colitis), may cause cramps and diarrhea
Pain may not be a primary symptom of the inflammatory disease, since many organs do not have many pain-sensitive nerves. Treatment of organ inflammation is directed at the cause of inflammation whenever possible.
How are inflammatory joint diseases treated?
There are a number of treatment options for inflammatory diseases including medications, rest and 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 he or she is taking, overall health, medical history and severity of symptoms.
The goals of treatment are to:
- Avoid or modify activities that aggravate pain
- Relieve pain through analgesics (pain-relieving medications) and anti-inflammatory medications
- Maintain joint movement and muscle strength through physical therapy
- Decrease stress on the joints by using braces, splints or canes as needed
What medications are used to treat inflammatory diseases?
There are many medications available to decrease joint pain, swelling and inflammation and hopefully prevent or minimize the progression of the inflammatory disease. The medications include:
- Non-steroidal anti-inflammatory drugs (NSAIDs - such as aspirin, ibuprofen or naproxen)
- Corticosteroids (such as prednisone)
- Anti-malarial medications (such as hydroxychloroquine)
- Other medications* including methotrexate, sulfasalazine, leflunomide, anti-TNF medications, cyclophosphamide and mycophenolate
* Some of these medications are traditionally used to treat other conditions such as cancer, inflammatory bowel disease or organ transplants. However, when "chemotherapy" types of medications (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 considerably less than when prescribed in higher doses for cancer.