Your Guide to Understanding Arthritis Inflammation

Check out our Psoriatic Arthritis Patient Audio Guides for more information on this topic. 

Waking up every morning with stiffness and pain coursing through your joints, feeling as if they’ve been replaced with rusted hinges — it’s a reality for many living with chronic inflammation. Simple tasks like getting out of bed or tying shoelaces become daunting challenges, while constant fatigue makes even the simplest activities feel like climbing a mountain. If chronic inflammation is left unmanaged, it can feel like navigating through a relentless storm that never seems to subside.

Chronic inflammation plays a significant role in worsening symptoms and accelerating the progression of inflammatory conditions like psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA), making it difficult to enjoy the activities you love. Understanding and communicating inflammation with your doctor is crucial for improved disease management and overall well-being. By sharing symptoms or changes related to inflammation, you can work with your doctor to make treatment decisions tailored to your specific challenges.

Together, you and your doctor can develop a comprehensive care plan aimed at better symptom control, reduced pain, and enhanced quality of life.

Defining Inflammation

Inflammation serves as the body’s natural defense mechanism, activated in response to injury, infection, or harmful stimuli. This intricate biological process entails the mobilization of various cells, chemicals, and proteins to eliminate the source of cell injury, clear damaged tissues, and initiate tissue repair.

“Inflammation, in short, really refers to an acceleration in the activity of our immune system. And that can play an important and positive role in some circumstances,” says Jeffrey Stark, MD, rheumatologist, and Head of Immunology Medical at UCB.

There are three primary types of inflammation: acute, subacute, and chronic.

• Acute inflammation: Quick response to injury or infection, showing redness, warmth, swelling, and pain.
• Subacute inflammation: Slower healing than acute, with milder signs like slight swelling and discomfort.
• Chronic inflammation: Long-lasting response to ongoing issues, potentially causing harm. Can lead to health problems and lasting damage, persisting for months to years.

Inflammation can be helpful — as in the case of acute inflammation — but it can also be harmful. Dr. Stark likens acute inflammation to getting a cold, infection, or injury. “Your immune system reacts and helps you defend yourself against the infection, he says, “those acute inflammation episodes resolve when the trigger that causes them to begin is gone.”

In chronic conditions like PsA and axSpA, however, “the inflammation turns on and it’s unable to turn off on its own,” he explains, “and, in those instances, the ongoing inflammation can cause symptoms…and damage parts of the body like the joints in an irreversible way.”

There are five cardinal signs of inflammation: redness, warmth, swelling, pain, and loss of function.

Understanding Inflammation in PsA and AxSpA

Psoriatic arthritis is a type of arthritis that not only hurts your joints but can also affect your skin, causing psoriasis. Usually, our body uses inflammation to fight off sickness or help with healing, but with psoriatic arthritis, it keeps going and targets healthy skin, nails, and joints, causing pain and harm.

Psoriatic arthritis is characterized by six different domains or manifestations that individuals may experience, including peripheral arthritis (large joints like elbows, wrists, knees, and ankles), axial disease (spine and sacroiliac joints), enthesitis (where tendons attach to the bone, like Achilles tendon), dactylitis (finger or toe digits), skin psoriasis, and nail lesions.

The primary symptom of axial spondyloarthritis (axSpA) is inflammatory back pain, which is back pain that occurs because of chronic inflammation in the joints of your spine. This type of back pain is different from mechanical back pain caused by factors like muscle strains or disc issues.

Inflammation in axSpA may cause other symptoms like uveitis (eye inflammation), inflammatory bowel disease, arthritis in peripheral joints (hands, feet, arms, and legs), and enthesitis, which is inflammation at ligament and tendon attachment sites, such as the Achilles heel in the foot.

Why Do Doctors Measure Inflammation?

Doctors measure inflammation to understand how your body is responding to health issues. It’s like checking for signs that may show if there’s a problem or if your treatment plan is working.

If inflammation is left untreated, it can lead to various issues and potential damage in the body. Persistent inflammation may harm tissues and organs, causing long-term damage and increasing the risk of chronic conditions including cancer.

In rheumatic conditions, untreated inflammation can damage joints, leading to pain and reduced mobility, as well as emotional/mental issues. Inflammation may also contribute to the progression of diseases such as heart disease, diabetes, and autoimmune disorders. Timely treatment is crucial to manage inflammation and prevent complications.

How Is Inflammation Measured?

Unfortunately, measuring inflammation isn’t always as simple as analyzing blood work, since labs never tell the whole story. Dr. Stark acknowledges that the tools we have to measure inflammation are not perfect, so it is critical for doctors to view a patient holistically.

Health care providers use a variety of methods to assess inflammation, including:

• Tracking symptoms
• Conducting physical examinations
• Utilizing laboratory studies or biological markers

Tracking Symptoms

Doctors often determine inflammation based on your symptoms to determine if the cause is inflammatory or non-inflammatory. “For example, a patient with psoriatic arthritis may have joint pain from their psoriatic arthritis, which is inflammatory, but they could have another type of arthritis, like osteoarthritis, for example, which is non-inflammatory,” explains Dr. Stark.

Questions your doctor may ask to determine inflammatory versus non-inflammatory symptoms, include:

• How long do you experience stiffness in the morning?
• Are your joints warm or swollen?

Physical Examination

Another way rheumatologists check for inflammation is through a physical examination. Rheumatologists will look for joints that are tender or swollen or warm, says Dr. Stark. He adds that for patients with PsA, the doctor may also examine the skin to see how inflamed areas of the skin may be with psoriasis.

Laboratory Studies/Biological Markers

Biological markers are used to check for inflammation. Erythocyte Sedimentation Rate (ESR or sed rate), and C-Reactive Protein (CRP) test can provide doctors and patients with a means of measuring inflammation levels.

Erythocyte Sedimentation Rate

A sed rate measures how fast red blood cells settle in a tube of whole blood. It provides an indirect measure of inflammation.

Other factors to keep in mind:

• An ESR result of 100 mm/hour or higher suggests active disease.
• Normal ESR results are 0-15 mm/hour for men under 50, 0-20 mm/hour for women under 50 or men over 50, and 0-30 mm/hour for women over 50.
• A high ESR or sed rate indicates high levels of inflammation.
• Most people with an autoimmune disease will have an elevated ESR.
• ESR results can help you and your doctor evaluate how well your treatments are working.

C-Reactive Protein

Measuring CRP levels is a common and sensitive way to check inflammation in your body. When there’s swelling, like in joints or muscles, your body makes CRP. It shows if there’s inflammation, even if you don’t have a specific condition. CRP levels are good at telling us about ongoing, long-term inflammation, especially in chronic conditions.

Other key factors to keep in mind:

• For adults, normal CRP levels are below 10 mg/L, and a higher reading may suggest the presence of inflammation.
• The higher the CRP level, the more inflammation detected in your body.
• It is not unique to one disease, so it is not very specific.
• CRP test results can be used to help monitor disease progress and flares.

Interpreting Inflammation Markers

Sometimes, even when you’re feeling inflammation, it might not show up in blood tests like CRP. Dr. Iris Navarro Millan, a rheumatologist with the Hospital for Special Surgery in New York, NY, explains that “CRP and ESR levels are not always elevated in patients with PsA or axSpA.” In these cases, an ultrasound may provide more insight.

Many in the CreakyJoints community wonder why their test results seem normal when they’re experiencing inflammation. “If you can feel and see inflammation, why doesn’t it show in bloodwork?” wrote @jody_f.

This disparity can occur because CRP might not accurately reflect disease activity or how a person feels. Factors like mood disorders or fibromyalgia can affect measurements. Additionally, some PsA patients may have normal CRP levels despite inflammation. Other blood markers may be used to assess inflammation, as different PsA subtypes may exhibit varied inflammation markers.

CRP changes quickly in response to infection or inflammation, while ESR may be affected by factors like elevated fibrinogen levels. People with chronic inflammatory conditions may have low CRP and ESR levels but still experience pain and swelling.

In this case, it’s important to discuss other potential causes of inflammation and pain with your doctor, including:

• External injuries: (scrapes or wounds)
• Acute infections or illnesses: cold and flu, COVID, skin infection, bacterial infections, viruses, insect bites or stings)
• Allergens (food allergies, gluten, alcohol, artificial trans fats)
• Toxic exposure: effects of chemicals or radiation)
• Lifestyle factors: obesity, diet, exercise, smoking, alcohol consumption, stress
• Diet: processed foods, red meat, baked goods, high sugar foods, deep fried foods
• Other diseases or medical conditions (including many inflammatory conditions ending in “itis” like psoriatic arthritis, rheumatoid arthritis, axial spondyloarthritis, dermatitis, bronchitis, and diverticulitis)

Monitoring Your Inflammation

Inflammation is your body’s way of signaling that something might be wrong. It is important to pay attention to what your body is telling you. Understanding what inflammation is, why it happens, and how to measure and monitor it helps you and your doctor keep track of your health.

By talking with your doctor about inflammation, you can work together to figure out the best ways to manage it and prevent any potential problems. This communication is like having a roadmap to guide you both in making decisions about your treatment and ensuring you feel your best.

Be a More Proactive Patient with PatientSpot

PatientSpot (formerly ArthritisPower) is an app and website made for people living with chronic conditions. You can track your symptoms and treatments, access support resources relevant to your needs, and choose to participate in research to help advance the understanding of chronic diseases. Learn more and sign up here.

This article was made possible with support from UCB.