I’m a GP – these are the signs your body has chronic inflammation

A case I encountered this summer represented one of the quickest medical turnarounds I’ve seen in my years of practice. A patient had presented with profound fatigue, pain across their hips and shoulders, and extreme stiffness, especially noticeable first thing in the morning. These symptoms had been present for at least six months, maybe more, and had worsened to the point of making everyday tasks extremely difficult, some even impossible – from reaching for a shelf in the kitchen and standing from a chair, to simply brushing their hair in the morning. By the afternoon, most of their symptoms had vanished. Their own diagnosis? “Getting on”. Age is a common and understandable conclusion, and it’s a mistake many people reasonably make, which often encourages them to put their worsening symptoms to one side, and just get on with it. In fact, the patient had polymyalgia rheumatica, or PMR, a condition which can present abruptly or insidiously, and progressively interfere with daily life. Shorts PMR is a common inflammatory disorder which can often be effectively treated with corticosteroids once recognised. It affects nearly 1 per cent of the UK population, and women are 2-3 times more likely to be affected than men. It’s also a condition associated with ageing: it’s exceptionally rare to see it in patients under 50. The condition rarely improves on its own, and if left untreated can worsen and become increasingly disabling – potentially restricting both mobility and independence. The associated symptoms could also reflect a range of other inflammatory or indeed autoimmune conditions, many of which are becoming increasingly common. Possibilities include rheumatoid arthritis, myositis (another inflammatory muscle condition), even an underactive thyroid gland. One of the telltale signs pointing towards PMR is that steroids often bring about striking improvement and significant relief soon afterwards – usually within a few days. This particular patient was suddenly able to resume activities they’d been incapable of doing for months. Whilst this represents a much swifter response than most, it just goes to show that (in some instances) there is such a thing as a quick fix. But in order to get there, you need to be able to recognise the true nature of certain symptoms. So, how can you recognise when vague symptoms might signal a diagnosis of something inflammatory or autoimmune? When inflammation goes awry Firstly, it’s helpful to define these two conditions. Inflammation, despite its association with disease, is often a good thing. It’s part of the normal response by which damaged body tissues heal, or fight infection. Immune cells, including white blood cells, are attracted to the site of an injury, which initiates the repair process. It’s when these processes go awry and become excessive or persistent that we call it inflammatory disease – like arthritis, hepatitis, pancreatitis or dermatitis (in fact, anything with “-itis” at the end of its name refers to inflammation). There are many different causes of inflammation, from infection to trauma, to allergies, cancer and metabolic disease. But another is autoimmunity, where the immune system mistakenly attacks its own tissues instead of protecting them. Examples here include lupus, coeliac disease, even type 1 diabetes. So, autoimmunity can trigger inflammation, but it isn’t the sole cause. It appears that long-term “chronic” inflammation becomes more common as you age – as your immune system and metabolism change, and begin to respond differently. Shifts in the bacterial composition of your gut – the microbiome – may also play a part. Symptoms are wide-reaching, and sometimes difficult to spot The fact that inflammation can affect almost every body tissue complicates things somewhat – since it can cause remarkably widespread symptoms, from diarrhoea and abdominal discomfort, to red or dry eyes, and unusual rashes. The other complicating factor is that many of these symptoms are non-specific, occurring in many other short and long-term conditions too. PMR is one prime example here, but there are many others. Take lupus: a condition where widespread autoimmune attacks on the joints, skin, kidneys, lungs and heart can cause fever, joint pain, rashes, tiredness and even mouth ulcers. In fact, lupus is often known “the great imitator”, since it can affect so many different organs, and resemble many other conditions. Any one of these symptoms alone – particularly if it’s mild – may not feel like enough to warrant a trip to the doctor. Seeking medical advice might only become necessary when symptoms become persistent, worsen or won’t go away. Maybe it’s the shoulder pain you’ve been explaining away from that (very) minor injury you sustained three months ago (which is probably more like six, now you come to think of it). Or the tiredness, which is now so severe that you’re falling asleep within seconds of sitting down on the sofa. No more explaining away – time to see your GP. Treatment can make a real difference, but it’s not as simple as using ibuprofen When I tell patients that a new diagnosis is being driven by inflammation, a common response is: “Does that mean going on ibuprofen for a bit then?” Non-steroidal anti-inflammatories (NSAIDs) like ibuprofen and naproxen can indeed prove useful in treating some inflammatory conditions, but they’re not suitable for everyone, and long-term use increases the risk of side effects such as stomach irritation, bleeding or kidney injury. This means that their use is best restricted to short periods, or with medical supervision when needed for longer. Other medications can suppress inflammation more powerfully. Corticosteroids are central to treatment of PMR, gout and inflammatory bowel disease – but can also cause significant side effects, and again must be managed carefully. Inflammatory disease can behave differently between patients: it can also come and go, necessitating on-off periods of treatment – or be persistent, requiring more consistent medication. And treatment is not just about alleviating symptoms, but also reducing the risk of complications. Take rheumatoid arthritis, which can erode and deform joints, as well as affect the heart, lungs and eyes if inflammation is left untreated. PMR is also closely associated with another inflammatory condition, giant cell arteritis, or GCA – which requires urgent treatment because it can threaten eyesight. New headaches, scalp tenderness, jaw pain when chewing, or changes in vision alongside PMR symptoms therefore need prompt medical attention. The overall effect of lifestyle on inflammation is often bandied about on social media, but clinical evidence is less convincing. There may be some beneficial effect to simple measures like exercise, good sleep and not smoking – and adopting healthy diet patterns, like the Mediterranean diet. However, evidence for individual “anti-inflammatory foods” is limited, or inconsistent. And when it comes to managing an inflammatory condition like PMR (and many others), lifestyle measures alone are not going to cut the mustard – treatment with medication is necessary, and can’t be replaced by diet. So, the message with inflammation and autoimmunity is not to push symptoms to one side, or automatically attribute them to something else – but notice when they’re not going away, have become more severe or starting to affect your life in ways they clearly weren’t before. Prompt diagnosis can make a real difference. The answer may not always be a simple fix, or one that has you feeling better by the same afternoon – but the route to recovery becomes much clearer when both you and your doctor can see the wood for the trees. Or, to put it in more inflammatory terms, the sometimes cryptic cause behind the “-itis”.