Chronic inflammation is defined as: Inflammation of prolonged duration in which active inflammation, tissue destruction and attempts at repair are occurring simultaneously.

What we now know is that chronic inflammation is the central process in a host of diseases. These include heart disease, cancer, eczema, arthritis, Alzheimer’s disease, conditions with chronic pain, neurological disorders, depression, kidney, bowel disease, chronic muscle pain, chronic back ache. All these and many more are the result of chronic inflammation; a process which develops slowly and has many different characteristics from the acute inflammatory response.

It is now understood that inflammation can slumber in the body. It behaves like a slow burn in a forest that given more fuel bursts out into fire. It can occur anywhere and continue, unabated until it is finally put out.

Although chronic inflammation can be the result of unresolved acute inflammation it can originate from a set of conditions that bypass the acute stage.

Chronic inflammation arises from:

• Long term infections. These can be bacterial, viral, fungal or parasites. The result is delayed hypersensitivity. The immune system may try to wall off the pathogen in what is called a granuloma.
• Autoimmunity as in ulcerative colitis, psoriasis and rheumatoid arthritis.
• Exposure to toxins, free radicals, environmental toxins, inflammatory reactions to food and many other substances.

The key elements of chronic inflammation are:

• The presence of macrophages and other immune cells common in continued reactions to injury.
• Tissue destruction mostly created by the inflammatory cells at the site, especially macrophages, large white blood cells within tissues.
• Connective tissue healing by fibrosis (scarring)

Macrophages. The major cells in chronic inflammation.

Macrophages migrate early on in an acute inflammatory event and within 48 hours are the dominant immune cell in the area. They perform phagocytosis, engulfing invaders, but can also produce a range of chemical reactions when activated. In this active state macrophages produce enzymes and a greater ability to engulf and kill ingested pathogens. The signals which activate macrophages include cytokines, local signaling molecules from reacting T-lymphocytes, bacterial toxins, other chemical mediators and local tissue proteins.

If the inflammatory focus is eliminated the macrophages disperse. However their life in the tissues can be many months. They respond to different stimuli in different conditions and can persist over a long period. If the focus is not resolved there is continuing chemical attraction and new macrophages accumulate at the site.

Where an infection persists, if free radical damage continues, if there is an influx of toxins, continued free radical production or an autoimmune condition macrophage activity is continuous and expands. The panus of chronic arthritis is the product of this process. The very variety of the macrophages production of chemical substances leads to destruction of the body tissues, pain, swelling and further toxicity if the cause is not eliminated.

The products released by macrophages:
• Complement components (C1 to C5, properdin)
• Coagulant factors (factor V, VIII, tissue factor etc.)
• Cytokines, chemokines (IL-1, TNF, IL-8)
• Growth factors (PDGF, EGF, FGF, TGF-ß)
• Enzymes
• Proteases
• Elastase
• Collagenase
• Plasminogen activator
• Acid hydrolases
• Phosphatases
• Lipases
• Plasma proteins
• Free radicals
• Eicosanoids (prostaglandins, prostacyclins, leukotrienes)
• Nitric oxide

The first signs of chronic inflammation are a call to action. The first action is to lower the inflammatory level of the whole body by diet and an increase in the intake of anti-oxidants and anti-inflammatory compounds. Further action requires specific therapy to address the individual manifestation of chronic inflammation.

Anti-inflammatories from your pharmacy or doctor
• NSAIDs
• Corticosteroids

Nutrition
• Consulting with a registered nutritionist to devise an anti inflammatory diet

Naturopathic practice. A regime of anti-inflammatory botanicals, pain relief, antioxidants and tissue repair compounds which include:
• Green tea extracts
• Devils claw
• White willow
• Allantoin
• Alpha lipoic acid
• Boswellia
• Bioflavonoids
• Folic acid
• Glucosamine
• MSM
• Evening primrose oil
• Essential fatty acids
• Vitamins, A,E,K and C

The germ theory of disease focused medicine on external causes of disease. Our knowledge of inflammation shows that the major problem is within us.