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Chronic Inflammation Hit List.

Chronic Inflammation Hit List

Our immune system uses inflammation as a form of defense, used to remove harmful substances like damaged cells or bacteria and begin the healing process. There are two categories of inflammation: acute and chronic. When your body experiences acute inflammation, the body responds rapidly and the inflammation lasts for a few days to a couple weeks.  This is the type of inflammatory response you are used to seeing when you have a cold, flu, or muscle strain due to injury. With chronic inflammation, the normal regulatory function of your immune system does not shut off correctly and the inflammatory response can last for several months or years.

Inflammation overload

Chronic inflammation may occur due to the body’s failure to eliminate the source of acute inflammation, a chronic irritant that persists, or an autoimmune disease. Research has demonstrated that psoriatic arthritis (PsA) is an autoimmune disease in which the body’s immune system is triggered, begins a cascade of inflammatory responses, and attacks healthy tissues in the joints.1

While the primary symptoms of psoriatic arthritis are characterized as joint issues, the inflammation that creates the swelling, pain, and redness of the joints can also affect other areas of the body. Chronic inflammation of PsA can affect the heart, eyes, ears, kidneys, and liver. In addition, chronic inflammation in the body is linked to depression, fatigue, diabetes, and inflammatory bowel disease. Each of these conditions has complex causes and mechanisms of action. Yet, some of the same inflammatory pathways are involved in each of these conditions, leading researchers to believe inflammation may be a common causal element.

Fatigue

Although the exact cause of fatigue experienced by people with PsA is largely unknown, researchers believe that it is in part due to the inflammatory process. The chemical messengers known as cytokines that cause inflammation also cause fatigue. The incidence of fatigue is also more common among people with more severe disease, including people with many joints affected by PsA, those who experience the sausage-like swelling of the fingers and toes called dactylitis, and those who experience inflammation at the points where ligaments and tendons attach, called enthesitis.2

Depression

Living with a painful, chronic condition like psoriatic arthritis can take a toll on a person’s emotional health, and people with PsA are twice as likely to be depressed as those with the skin condition psoriasis, and they are also more likely to have clinical depression and anxiety. In addition to the emotional toll, some research suggests depression may also be linked to the same inflammatory processes that cause psoriasis and psoriatic arthritis. Data suggests that while chronic inflammation can cause depression, depression may also make inflammation worse, creating a terrible cycle. The inflammatory cytokines are thought to act on the brain in a negative way just as they cause the destructive chronic inflammation to joint tissue.3,4

Diabetes

People with psoriatic arthritis are at a higher risk of developing type 2 diabetes, and diabetes has been observed in up to 18% of people with PsA. Diabetes can cause serious problems, including damaging eyes, kidneys and nerves and increasing the risk of heart disease. Some of the same inflammatory processes that are involved in psoriasis and PsA are also seen in diabetes, leading researchers to believe that chronic inflammation is one thing linking these diseases. Other similarities are seen in shared genetic risk factors and common environmental factors.5,6

Vascular inflammation

Research has shown that people with psoriatic arthritis have heightened levels of vascular inflammation or the inflammation in the blood vessels. This type of inflammation is a hidden, but potentially deadly.  Vascular inflammation can significantly increase the risk of heart disease. A marker of inflammation throughout the body is C-reactive protein (CRP). CRP has been documented by researchers as a risk factor for cardiovascular disease and CRP and other inflammation markers are higher in patients with PsA than in healthy subjects or patients with only psoriasis.7

1. Nordqvist, C. (2015, September 16). "Inflammation: Causes, Symptoms and Treatment." Medical News Today. Accessed online on 10/18/16 at http://www.medicalnewstoday.com/articles/248423.php. 2. Walsh JA, McFadden ML, Morgan MD, Sawitzke AD, Duffin KC, Krueger GG, Clegg DO. Work productivity loss and fatigue in psoriatic arthritis. J Rheumatol. 2014 Aug;41(8):1670-4. 3. McDonough E, Ayearst R, Eder L, et al., Depression and Anxiety in Psoriatic Disease: Prevalence and Associated Factors. J Rheumatol. 2014 Apr 1. doi: 10.3899/jheum.130797. 4. Dantzer R, O’Connor JC, Freund GG, Johnson, RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nature Reviews Neuroscience. 2008 Jan;9:46-56. doi:10.1038/nrn2297 5. Ogdie A, Schwartzman S, Eder L, Maharaj AB, Zisman D, Raychaudhuri SP, Reddy SM, Husni E. Comprehensive treatment of psoriatic arthritis: managing comorbidities and extraarticular manifestations. J Rheumatol. 2014 Nov;41(11):2315-22. 6. Davidovici BB, Sattar N, Jörg PC, Puig L, Emery P, et al. Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions. J of Investigative Derm. 2010 Jul;130(7):1785-1796. http://dx.doi.org/10.1038/jid.2010.103 7. de Vlam K, Gottlieb AB, Mease PJ. Current concepts in psoriatic arthritis: pathogenesis and management. Acta Derm Venereol. 2014 Nov;94(6):627-34.

Comments

  • susana
    2 weeks ago

    It is possible, with PsA, to have inflammation in the body, but the common signs of inflammation in the body don’t appear in blood analises, like de C-reactive protein and the erythrocyte velocity?

  • VickiN moderator
    2 weeks ago

    Hi @susana! Unfortunately, yes. Community members are frequently sharing their stories of having obvious signs of PsA, but totally perfect bloodwork. We are also told a lot that this can delay diagnosis because Docs question whether symptoms are “all in your head.” There’s nothing more frustrating!
    I thought you might find this article helpful, as it explains a bit about PsA bloodwork:
    https://psoriatic-arthritis.com/clinical/bloodwork-for-psa-results/
    Best wishes to you today,
    -Victoria, Community Moderator

  • susana
    2 weeks ago

    Thank you so much… Vicki! I know that so well, but it seems my doctor does’t think same way. I really need some texts, studies about that. Thank you!!!

  • CathyD moderator
    2 weeks ago

    Hi @susana, thank you for your comment! It is possible to have inflammation but blood markers be within the normal range. A few of us have discussed our experiences with this here: https://psoriatic-arthritis.com/q-and-a/negative-lab-tests/ Is this something you’re going through at the moment? -Catherine, Community Moderator

  • susana
    2 weeks ago

    My autoimmune diseases Doctor, working in conjunction with the Medical Pain Unit, told her that I am in remission. Result: I was discharged from the Chronic Pain Unit, although I am currently in need of counseling in this regard. I know that one of the reasons is this, laboratory tests, which have always been good, in my case… Thanks for the article, I have to show all of these to my Doctor!…

  • Rojo
    4 months ago

    If I ruled the world, this article and “PsA versus RA” would be mandatory handouts for everyone when first diagnosed with PsA and RA. When formally diagnosed with PsA five years ago (hindsight tells me I could have been diagnosed thirty-five years ago) I knew next to nothing about arthritis (“It’s an aging thing, right? You’re telling me there’s more than one kind?”).

    Despite a career working collaboratively with RN’s I knew so little about the how’s and why’s of our autoimmune system.

    Five years post-diagnosis, currently on my fourth Biologic, DMARD’s an unpleasant memory, it seems like for four of those five years I would awaken every other day in a different body than the one I had known all my life; different from the one I knew the previous day. I had no idea why some days my eyes felt like there was sand in them, my knuckles were large and red, tinnitus, no appetite except for candy bars and soda, stabbing joint pains. Why do I want to stay in bed when I just woke up? Me! My family’s designated “health nut”.

    LSS: These two articles in particular, plus this community’s input, feedback, etc., concisely answers questions I spent months (years) worrying about along with countless internet research hours. Thanks to all!

  • Rebecca moderator
    4 months ago

    I’m so happy to hear that you’ve found value and support here!!!!!

  • Eileen B moderator
    4 months ago

    Thanks for sharing your PsA journey, @rojo. It sure sounds like you’ve been through some incredibly tough days, but your strength shines through it all. We’d love to have your contribution at https://psoriatic-arthritis.com/stories/welcome/. Only if you’re comfortable doing so, of course! It’s a great way to raise awareness — and perhaps prevent others from having the 35 years of hindsight you have. -Eileen, Psoriatic-Arthritis.com Team

  • Koffegurl
    2 years ago

    Hi jennyb and everyone else. I’ve had psoriasis for 43 years, and PsA for 35 years. I’d had full mouth peridontal surgery twice, but still lost all my upper teeth 20+years ago due to bone loss. I also have had compression fractures and stress fractures, and my bone loss is horrible My rheumatologist feels it’s probably not only because of PsA but because I’d been on steroids off and on since I was 14 years old.

  • CathyD moderator
    2 years ago

    Koffegurl, I’m sorry you have had to deal with all of this with your jaw and teeth, it sounds very difficult and painful. We really appreciate you taking the time to share your experiences and this information with us all – thank you!

    – CathyD (Psoriatic-Arthritis.com team)

  • jennyb
    2 years ago

    Further…………..I went to the dentist today and was told that I have a lot of inflammation in my gums.Is this another place it can show up? I have trouble telling one from another.

  • CathyD moderator
    2 years ago

    Hey jennyb! I found this article from our sister site, https://plaquepsoriasis.com/, which I thought may interest you: https://plaquepsoriasis.com/clinical/psoriasis-risk-periodontal-disease/ I hope this is helpful! Did you get a chance to discuss it with your doctor?

    – CathyD (Psoriatic-Arthritis.com team)

  • Casey moderator
    2 years ago

    Hi again, jennyb!

    With PsA, inflammation can arise in many unexpected and unusual places! While gums could be one of these areas, it’s important to check in with your doctor to make sure that any additional swelling or new symptoms you have are related to your PsA, and not due to another underlying issue. If you do get a chance to talk with your doctor about this, let us know what they say! We’re here for you!

    Best, Casey (Psoriatic-Arthritis.com Team)

  • jennyb
    2 years ago

    I have PsA and MS too. The symptoms overlap a lot. I am on the same medicine for both. PsA came first, MS several years later.

  • Casey moderator
    2 years ago

    Hi jennyb,

    I’m so sorry to hear you’re battling both of these conditions. Please keep us posted, and know we’re here for you! Also, feel free to check out our MS sister site as well, which you can find here, https://multiplesclerosis.net/

    Wishing you relief soon,

    Casey, Psoriatic-Arthritis.com Team

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