Inflammation – The good, bad and ugly

Our immune systems work hard to keep us healthy and happy, but when our immune system turns on us and mistakenly starts to attack the healthy cells in our joints, your joints are not going to be happy. This is what happens in inflammatory types of arthritis. Inflammation is so pervasive so that the non-inflammatory types can eventually become inflammatory.

  • Inflammatory types of arthritis encompass conditions such as:
    • Rheumatoid Arthritis (most common)
    • Psoriatic Arthritis
    • Ankylosing spondylitis
    • Reactive Arthritis

So we understand what chronic inflammation actually is, in this article, we will go through –

  • The difference between good and bad inflammation
  • How it affects people living with arthritis
  • How it links to other diseases
  • What you can do to reduce inflammation

Good Inflammation VS Bad Inflammation

Acute inflammation is a natural immune response triggered by the immune system usually in response to an injury, a burn, infection, or pathogen. During acute inflammation, the immune system releases chemicals, which can help immune cells heal the affected area. This is why you might see redness, swelling, heat, pain, when you get a burn or a deep cut. This is a healthy response of the body actively responding to the injury or infection.

We all need this type of inflammation to heal but when the inflammatory response becomes persistent and starts to attack healthy cells, it can become chronic and lead to tissue degeneration and disease. Chronic inflammation can occur due to auto-immune disorders, persistent infections, exposure to environmental toxins, and/or lifestyle factors like obesity and smoking.

Arthritis & Inflammation

In the case of inflammatory forms of arthritis, inflammation is caused by a maladaptive immune system attacking healthy tissue in the joint capsule. This inflammatory attack usually affects smaller joints, such as the joints in your hands and feet, but can also affect larger joints like your knees and hips. This can lead to the destruction of joint tissues over time which can cause the joints and bone to weaken, swell, stiffen up, maybe even change shape if not treated effectively.

Rheumatoid arthritis affects people in different ways. Some people can experience occasional flare ups—followed by months, or even years, with few symptoms. Other people may have symptoms that slowly worsen over time.

What else is inflammation linked to?

Rheumatoid arthritis can affect other parts of your body, such as your lungs, heart or eyes, especially if the disease is not properly treated.

CVD & Inflammation

Chronic inflammation is recognized as a major precursor to the development of various cardiovascular conditions, including atherosclerosis, coronary artery disease, and myocardial infarction (heart attack). When the inner lining of the arteries in the heart become damaged, inflammatory molecules are released at the location to promote healing. In chronic inflammation, this response becomes persistent and ends up being problematic due to the sticking of immune cells at the damaged site, which can cause fat to build up in the area.

Over time, this can lead to the formation of fatty streaks and the accumulation of cholesterol in the arterial wall, resulting in the development of plaque. These plaques cause narrowing of the arteries, and eventually lead to a blockage or rupture, which can cause a heart attack or stroke.

How are inflammatory forms of Arthritis, like Rheumatoid Arthritis treated?

There is no cure for rheumatoid arthritis but your doctor and/or rheumatologist may talk to you about a combination of medicines, including:

Pain relief medicines, such as paracetamol.

Omega-3 supplements. This is an essential fatty acid that is naturally found in foods like fish that you can take as a dietary supplement to help with pain and stiffness.

Non-steroidal anti-inflammatory drugs (NSAIDs) or cyclo-oxygenase-2 selective (COX-2) inhibitors. These are pain relief medicines that your doctor might prescribe when paracetamol and supplements do not relieve your pain and stiffness.

Disease modifying antirheumatic drugs (DMARDs), such as methotrexate. These are a group of medicines that are designed to suppress your immune system to control inflammation and prevent further damage to your joints.

Corticosteroids, such as prednisone. These are designed to suppress immune system anti-bodies which are responsible for causing inflammation in a joint. Corticosteroids are available as tablets, or it might be injected by your doctor into a joint to reduce pain.

The link between diet and inflammation

Diet can also play a role in inflammation several ways…

  • People with RA, with diets higher in fat and processed meat have been found to have higher levels of circulating inflammatory markers like C-Reactive Protein, Homocysteine and Interleukin-6 (IL-6) which are the main inflammatory markers that are reportedly higher in RA (Alwarith et al., 2019).
  • Foods loaded with sugar, salt, high fructose corn syrup, saturated fats and trans fats can alter the gut microbiome and disrupt the balance between good and bad bacteria in the gut which can lead to the production of pro-inflammatory molecules and trigger a systemic inflammatory response. This may have a negative effect on those already experiencing high levels of inflammation in the body (Badsha, 2018).

As for the key foods you should be consuming to keep your inflammation under control – check out our previous article “8 foods to keep your joints healthy”


Weight management: Excess body fat, especially visceral fat (fat around the abdominal organs), is associated with higher levels of inflammation. Maintaining a healthy weight through a balanced diet and regular physical activity can help reduce inflammation.

Physical activity: Regular exercise has anti-inflammatory effects on the body. It can help reduce levels of inflammatory markers and promote the release of anti-inflammatory substances. Engaging in moderate-intensity aerobic exercise, strength training, and flexibility exercises can be beneficial.

Smoking: Smoking is a significant source of oxidative stress and inflammation in the body. It can increase the production of free radicals and inflammatory substances. Quitting smoking or avoiding exposure to second-hand smoke can help lower inflammation levels.

Alcohol consumption: Excessive alcohol intake can contribute to chronic inflammation. Limiting alcohol consumption or avoiding it altogether can help reduce inflammation.

Stress management: Chronic stress can lead to increased inflammation in the body. Finding healthy ways to manage stress, such as practicing relaxation techniques, engaging in hobbies, getting enough sleep, and seeking support from others, can help reduce inflammation.

Sleep quality: Inadequate sleep or poor sleep quality has been associated with increased inflammation. Prioritizing good sleep habits, aiming for 7-9 hours of quality sleep per night, and addressing sleep disorders can help reduce inflammation.

Alwarith, J., Kahleova, H., Rembert, E., Yonas, W., Dort, S., Calcagno, M., Burgess, N., Crosby, L., & Barnard, N. D. (2019). Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review. Frontiers in nutrition, 6, 141.

Badsha H. (2018). Role of Diet in Influencing Rheumatoid Arthritis Disease Activity. The open rheumatology journal, 12, 19–28.

Mary Zagotsis
Health Educator
Arthritis NSW

July 2023