Arthritis and Inflammation in the Lab

Author: Dr. Hinshaw, MD – Bio-Center Laboratory Director

Inflammation is a normal physiologic response that is essential to our bodies. Without it, injuries and infections could be life-threatening. When the body is inflamed, chemicals are released to the damaged area to start the process of healing. Once the body is healed, the inflammation process ends. Arthritis is defined as chronic swelling and tenderness of one or more joints and is an inflammatory process that does not end.

Testing for Inflammation

Tests that focus on inflammation can be useful in helping to diagnose arthritis. For example, C-Reactive Protein (CRP) is a protein made in the liver. It is routinely used as a non-specific indicator of systemic inflammation,¹ and is one of the most sensitive indicators of acute inflammation. CRP is released into the blood a few hours after an injury, at the start of an infection, or as a result of inflammation. Continuou1sly high levels of CRP in the blood indicate chronic inflammation² such as that which occurs in arthritis.

Nutrients and Inflammation

Dietary habits and nutritional status can be both indicators of risk and indicators of protective factors. For example, a diet high in saturated fats, trans fats, and refined carbohydrates (red meat, fast food, sugars, white bread) have increased arthritis risk because of increased inflammation.3 Conversely, diets rich in omega-3 fatty acids (oil, fatty fish) can be protective because omega-3 fatty acids may have anti-inflammatory properties.³

The Essential Fatty Acids (EFA) test and the Hemoglobin A1c test can be used to evaluate these risk factors. The EFA test measures levels of fatty acids and evaluates the balance between omega-3, omega-6, saturated, and monounsaturated fatty acids. Hemoglobin A1c⁴ is an indicator of average blood glucose and a marker for type 2 diabetes. Diabetes has been associated with an increased rheumatoid arthritis risk because of increased inflammation⁵ related to insulin resistance and obesity.

Antioxidants and Inflammation

An overproduction of oxidation can induce an inflammatory response.⁶ Antioxidants inhibit oxidation. They are substances that may prevent some kinds of cell damage and may help to reduce inflammation. Increased intake of antioxidants such as vitamin C, beta-carotene, selenium, and vitamin E may decrease free-radical damage to joint linings, diminishing arthritic swelling and pain.⁷ Measuring levels of antioxidant nutrients through laboratory testing can help optimize diet and supplementation. 

Other vitamins and minerals that are important in helping to prevent, delay the onset, or mitigate the symptoms of arthritis include vitamin D, vitamin B6, vitamin B12, folic acid, and the minerals calcium, magnesium, and zinc.⁷ These nutrients are commonly observed to be deficient in patients with rheumatoid arthritis.

REFERENCES:

1. Pope, J. E., & Choy, E. H. (2021, February 1). C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Seminars in Arthritis and Rheumatism. W.B. Saunders. https://doi.org/10.1016/j.semarthrit.2020.11.005
2. Luan, Y. Y., & Yao, Y. M. (2018). The Clinical Significance and Potential Role of C-Reactive Protein in Chronic Inflammatory and Neurodegenerative Diseases. Frontiers in immunology, 9, 1302. https://doi.org/10.3389/fimmu.2018.01302
3. Gioia, C., Lucchino, B., Tarsitano, M. G., Iannuccelli, C., & Di Franco, M. (2020). Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations?. Nutrients, 12(5), 1456. https://doi.org/10.3390/nu12051456
4. Lyons, T. J., & Basu, A. (2012). Biomarkers in diabetes: hemoglobin A1c, vascular and tissue markers. Translational research : the journal of laboratory and clinical medicine, 159(4), 303–312. https://doi.org/10.1016/j.trsl.2012.01.009
5. Tian, Z., Mclaughlin, J., Verma, A., Chinoy, H., & Heald, A. H. (2021). The relationship between rheumatoid arthritis and diabetes mellitus: a systematic review and meta-analysis. Cardiovascular endocrinology & metabolism, 10(2), 125–131. https://doi.org/10.1097/XCE.0000000000000244
6. Vida C, González EM, De la Fuente M. Increase of oxidation and inflammation in nervous and immune systems with aging and anxiety. Curr Pharm Des. 2014;20(29):4656-78. doi: 10.2174/1381612820666140130201734. PMID: 24588831.
7. “Role of Nutrition in Rheumatoid Arthrtis Management.” Johns Hopkins Arthritis Center, 11 May 2015, https://www.hopkinsarthritis.org/patient-corner/disease-management/rheumatoid-arthrtis-nutrition/.