Saturday, December 3, 2011

What's Going on With Chronic Inflammation?

Sometimes you ask a question rhetorically, to make a point. Other times you ask out of legitimate curiosity, like today.

When I had constant knee pain, I was pretty certain that chronic inflammation had set in, from the burning sensations that plagued me so much of the time. And I was quite curious about what that implied for my prospects for healing.

Nothing good, I concluded after doing some reading about inflammation. There are a couple of types, almost like cholesterol. There's the good inflammation, that occurs in the aftermath of an injury and signals the body to speed "troops" to the area to spur healing. Then there's the bad kind that spirals out of control and leads to further problems (arthritis pain research has shown that a pro-inflammatory molecule called Interleukin-1 stimulates the synovial cells to produce more of the enzymes that degrade cartilage, and also inhibits the creation of new tissue).

My research into inflammation never went very deep though. I did learn enough to know that there are plenty of mysteries about chronic inflammatory processes. Battling bad knees, I became preoccupied with two questions. They are below, and anyone with insights (or other questions), please feel free to chime in.

1. Can chronic inflammation in the knee joint spread to other parts of the body and even become systemic on some level?

I once mentioned this to a general physician, who quickly pooh-pooh'ed the idea. But I still wonder. The internal plumbing of our bodies is all connected, after all. The knee -- or any other part of the body -- isn't "firewalled" off from any other part.

Readers of Saving My Knees will understand why I'm asking this. The book describes my battle with problems in multiple joints -- elbow tendons, back, knees. Were they all really completely unrelated? Or did the chronic inflammation in my knees, after a long enough period of time (about a year) make me more susceptible to other joint issues?

At one point I thought I had rheumatoid arthritis! So did my father, frankly (a blood test ruled it out). While writing the book, I was a bit worried that the multiple joint problems would somehow undermine the authenticity of my story, or lead people to think, "Oh, he didn't have chondromalacia, he had something else." Then, months later, when discussing the book online, I found lots of other knee pain sufferers who thought they too might have had rheumatoid arthritis (but didn't). My story become more authentic, not less.

2. If chronic inflammation is bad, then shouldn't anti-inflammatory medication be good, if you want to heal?

I began by asking doctors a variation of this question. I wasn't interested in anti-inflammatories for their ability to mute pain signals (which is why most people like them). I knew they did that. I wanted to find out if they'd help my injured knees to heal. On this, the doctors seemed uncertain.

The more I thought about it, the more I saw evidence of a tradeoff. Perhaps anti-inflammatories would slow the degradation of cartilage, all else being equal. But all else wouldn't be equal. Anti-inflammatories would trick my knees into thinking they felt better than they really did, and thus might encourage me to do stupid things (walk too far, sit too long) that I otherwise wouldn't. These activities might cause further damage inside the joints.

I did take a prescription anti-inflammatory once, an experience I mention in the book. It allowed me to sit at work with less discomfort, but the next day my knees felt a little worse. Had I taken enough of the pills, I probably could have run a road race, but what price would I have paid afterwards?

Still, I think an intriguing question remains: If it were possible to take anti-inflammatories that didn't dull the important signaling to "not do this and not do that" that's coming from your knees (of course this would be medicine that didn't offer pain relief, so who'd take it?), would the medicine then help slow the rate of tissue breakdown, or help you heal?

Maybe yes, maybe no. I'm not sure.

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