On a long plane trip from Orlando back home to Seattle, an article in the November 2009 issue of Scientific American grabbed my attention. In the article, called “New Culprits in Chronic Pain”, the author discusses chronic pain that is not alleviated by traditional medications like morphine. [i] The offender appears to be overactive nerve cells called glia that help regulate nerve messenger chemicals. As I flipped to a diagram showing the processes involved, I was surprised to see that familiar enemy of RA patients called tumor necrosis factor (TNFα) listed as an inflammatory cytokine being released by the glia. The first thing that came to mind was that TNF blockers like Enbrel may help. A turn of the page revealed a table listing potential medicines being tested to help fight chronic pain…Etanercept (Enbrel) was listed as being in human trials. Excess inflammation seems to be connected to numerous diseases and medical problems.
Inflammation is normally a good thing. It’s part of an immune response when an infection or invader gets inside the body. [ii] My son recently had the flu (probably swine flu since it’s running rampant around here right now). His body was fighting the virus through inflammation which included fever, chills, fatigue, headaches, loss of appetite, and muscle pain. [iii] My son’s reaction to the flu is an example of acute or short term inflammation. He’s better now and fortunately no one else in the family shows signs of the flu but we’re still in the incubation period for a few more days. (By the way…anyone out there get an H1N1 vaccine yet?)
Chronic or long term inflammation is bad and is linked to all sorts of ugly diseases including RA, inflammatory bowel disease, psoriasis, lupus, scleroderma, polymyositis, vasculitis, rosacea, celiac disease, multiple sclerosis, asthma, and even arthrosclerosis leading to heart attacks and strokes. [iv][v][vi] And now chronic pain is associated with inflammation.
As mentioned in an earlier post , inflammation results in messenger proteins called cytokines being released by cells. [vii] In autoimmune diseases like RA, the system is out of whack and too many of these cytokines are released resulting in ongoing inflammation. Most widely used medical treatments for RA are targeted at reducing the inflammatory impact of cytokines.
One of the least publically understood aspects of inflammation is chronic fatigue. This is way beyond just being tired – I refer to this feeling as being run over by a truck. Other than permanent joint damage, for me this is the hardest aspect of dealing with RA. Malaise, lack of interest in social interaction, brain fog, and depression are regularly linked to inflammatory diseases. The causes for this escaped scientists. But now researchers are beginning to unravel possible connections between inflammation and the brain. [viii] Interestingly, this recently discovered connection brings us back to the research about chronic pain – the glia nerve cells are implicated. Perhaps these connections will lead to new treatments that will keep RA sufferers from being “run over by the truck” as a result of chronic inflammation!
In the meantime, the multifaceted fight against inflammation continues (my next blog topic).