When you hear the word ‘inflammation’, images of elderly people wringing their hands due to arthritis, or the redness and swelling on a child’s arm after a bee sting may come to mind. While there are indeed signs and symptoms of inflammation, the pain and damage may go well beyond the surface.

Inflammation is defined as redness, swelling, pain, tenderness, heat, and disturbed function of an area of the body that occurs as a reaction of injury and/or tissue damage. When we experience a temperature due to underlying illness, this is a form of inflammation in response to the body’s immune system reacting to fight disease. ¹

The same is true if we sprain our ankle. It becomes red, swollen, and painful due to the injury. These are examples of acute inflammation. And while painful and uncomfortable, our bodies usually recover and we move on.The weight of inflammationChronic inflammation is a bird of a different feather. When our bodies are under 24/7 attack from chronic inflammation, there’s a lot more damage done. Take arthritis for example. There are several hundred forms including osteoarthritis, gout, and rheumatoid arthritis. No matter what type of inflammation a person has they all cause pain, swelling, and sometimes joint disfigurement.The most common type of arthritis is osteoarthritis, the wear and tear type people can develop at an early age (like in a high school football player) but can last a lifetime. In this type of arthritis, the cartilage that normally protects and cushions bones and joints break down. Being overweight or obese increases the risk (and pain) of osteoarthritis.²Excess weight not only puts more pressure on joints, but fat tissue also plays a role in inflammation. Dubbed “meta-inflammation”, low-grade inflammation occurs throughout the body due to adipose tissue. It’s initiated by macrophages that live in the colon, liver, muscle, and fat tissue.³Macrophages are part of the immune system and needed to fight infection. They can congregate and be altered by extracellular and intracellular cues that may lead to metabolic disorders including insulin resistance, heart disease, cancer, and autoimmunity.² Fat tissue secretes “adipokines”, chemicals including cytokines, hormones, and various proteins that can trigger pathophysiologic processes. ⁴ Autoimmunity and arthritisRheumatoid arthritis (RA) is a chronic inflammatory condition that impacts people of all ages. In RA, the body’s immune system attacks itself and causes joint damage and dysfunction over time. The cause of RA is unknown, though researchers believe it may be genetic, environmental, or related to the previous infection.Various factors in the immune system play a role in the development of RA. T cells and macrophages in joint synovial fluid are targets of interleukin 18 (IL-18) in RA. IL-18 activates these cells to make proinflammatory cytokines, chemokines, and other compounds that prolong inflammation and cause cartilage and bone destruction. ⁵Like other autoimmune conditions such as Lupus or MS, RA is a systemic disease and can impact other parts of the body including the heart and endocrine system. Compared to controls, one study found that heart disease occurs in 50% of patients with RA. Scientists believe it’s related to inflammatory cytokine activity, which advances ischemic heart disease and risk for stroke. ⁵In addition, endothelial cells in the body may become activated through inflammation. When these cells are turned on, they may lead to atherosclerosis through a rise in the expression of leukocyte adhesion molecules. When endothelial tissue is damaged, it is seen as an early preclinical sign of hardening of the arteries, commonly seen in patients with RA. Medications to target these cells and evaluation of endothelial function may be helpful to further monitor RA patients’ risk for heart disease.  RA patients are at higher risk for cardiovascular disease. ⁶What role does diet play?While there is no cure for any type of arthritis, diet is certainly a lifestyle factor that makes a difference. Avoiding “nightshade” fruits and vegetables has been advised for those with RA for several years. This class of produce includes potatoes, eggplant, peppers, tomatoes, and citrus fruit. To date, there is no research to support the avoidance of these fruits and vegetables. In fact, they’re all a source of antioxidants, which may be beneficial in reducing inflammation. ^{7, 8} Polyphenols from green tea, berries, cabbage family, and green leafy vegetables and red wine may aid in the reduction of inflammation. ⁸What to advise your clients:

• Lose weight if overweight. Even a 5 lb weight loss reduces 20 lbs. of pressure on your knees if you have OA. When patients with OA lose weight, they also reduce pain. ⁹
• Eat less saturated and trans-fat. Solid fats have been found to be pro-inflammatory and are also associated with heart disease and cancer. ¹⁰
• Stock up on a variety of fruits and vegetables daily.
• Have your vitamin D level checked and replaced if deficient. Low vitamin D is common in patients with autoimmune disease and the deficiency is linked with joint paint in both OA and RA patients. ¹¹

Lisa Andrews, MEd, RD, LDReferences:

1. https://www.merriam-webster.com/dictionary/inflammation
2. Li C, Xu MM, Wang K, Adler AJ, Vella AT, Zhou B. Macrophage polarization and meta-inflammation. Transl Res. 2018 Jan;191:29-44
3. Unamuno X, Gómez-Ambrosi J, Rodríguez A, Becerril S, Frühbeck G, Catalán V. Adipokine dysregulation and adipose tissue inflammation in human obesity. Eur J Clin Invest. 2018 Sep;48(9):e12997.
4. Dai SM, Shan ZZ, Xu H, Nishioka K. Cellular targets of interleukin-18 in rheumatoid arthritis. Annals of the Rheumatic Diseases. 2007 Nov;66(11):1411-1418. DOI: 10.1136/ard.2006.067793.
5. El Bakry SA, Fayez D, Morad CS, Abdel-Salam AM, Abdel-Salam Z, ElKabarity RH, El Dakrony AHM. Ischemic heart disease and rheumatoid arthritis: Do inflammatory cytokines have a role? Cytokine. 2017 Aug;96:228-233.
6. Yang X, Chang Y, Wei W. Endothelial Dysfunction and Inflammation: Immunity in Rheumatoid Arthritis. Mediators Inflamm. 2016;2016:6813016.
7. http://blog.arthritis.org/living-with-arthritis/nightshades-arthritis/
8. Oliviero F, Scanu A, Zamudio-Cuevas Y, Punzi L, Spinella P. Anti-inflammatory effects of polyphenols in arthritis. J Sci Food Agric. 2018 Mar;98(5):1653-1659
9. Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, deVita P, Hunter DJ, Lyles MF, Eckstein F, Guermazi A, Loeser RF. Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better? Arthritis Care Res (Hoboken). 2018 Nov;70(11):1569-1575.
10. Fritsche KL. The science of fatty acids and inflammation. Adv Nutr. 2015 May 15;6(3):293S-301S.
11. Manoy P, Yuktanandana P, Tanavalee A, Anomasiri W, Ngarmukos S, Tanpowpong T, Honsawek S. Vitamin D Supplementation Improves Quality of Life and Physical Performance in Osteoarthritis Patients. Nutrients. 2017 Jul 26;9(8):799.

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