What is Triggering It?

In the introduction to this series of blogs on inflammation I mentioned that understanding and reducing its impact comes down to 2 points:

• What is triggering it?
• Is it self-limiting and resolving?

In response to what is triggering it, these factors can be helpful in response to infection and in resolving injury, or harmful in response to chronic lifestyle triggers such as diet. 

Inflammation in response to infection is the first reaction by the immune system to kill the infection.  Inflammation drives the migration of immune fighting cells to an area of infection as well as instructing certain immune cells to eat and digest the infectious organism and to others to make antibodies.  Once that job is done the inflammation resolves.

With injury, inflammation helps recruit cells to the damaged tissue to look for any infection, produce enzymes to dissolve the damage structures and to initiate healing.  Without inflammation healing cannot occur.  Some recent research has actually found that using NSAIDs such as ibuprofen early in response to injury actually increases the production of inflammatory initiating chemicals called cytokines by inflammatory cells.(1)  While it is helpful from a symptomatic standpoint to soften early inflammation in an injury, more heavily blocking it can actually lengthen the associated pain and hinder healing.(2)

So, when what is triggering inflammation is in response to infection or injury, it is appropriate and helpful.  That brings up the question, what may inappropriately trigger inflammation?  The answer is unfortunately, many things.  They may include:

• Chronic injury/degeneration
• Chronic infection
• Poor diet
• Age – “Inflammaging”

Tissue degeneration associated with joint degeneration is, in essence, chronic tissue injury. It is one of the more common causes of ongoing chronic inflammation.  In acute tissue injury, the tissue debris is what triggers receptors on immune cells activating inflammation.  This tissue debris is referred to as “damage associated molecular patterns” simply called DAMPs. 

As discussed above in acute injury, this triggers the release of enzymes to dissolve and clean up that debris.  With joint degeneration DAMPs are chronically being released perpetuating inflammation and not allowing healing to proceed.  A common history seen in those with joint degeneration is that some increased activity which used to be tolerated activates inflammatory pain.

An effective approach to helping chronic inflammation associated with joint degeneration is some form of regenerative therapy.  These are therapies that attempt to activate tissue repair that should occur after acute inflammation.  Their goal is to reduce the release of excessive DAMPs which perpetuate inflammation.

There are different methods of joint regeneration including platelet rich plasma injections (PRP), stem cell injections and non-invasive therapies such as pulsed electromagnetic frequency (PEMF). These therapies often bring significant reduction in inflammatory symptoms and increase tissue repair to reduce ongoing DAMP release.

Certain supplements have been found to be helpful augmenting joint regenerative therapies.  One such supplement is Cyplexinol®, an extract from bovine bone matrix.(3)  As tissue degenerates it also releases members of the TGF beta group of cytokines which are used to flip acute inflammation into the repair stage.  It is also helpful to supplement with specific collagen peptides which are needed for tissue repair.(4)

It is also very important to identify additional triggers of inflammation that can co-exist and worsen that which is seen in joint degeneration.  These may include poor diet and a common chronic “infection”, dysbiosis of the gut which involves a shift in the bacteria living in the gut from one that reduces inflammation to one that causes it.

In the next blog we will discuss chronic infections as an ongoing driver of inflammation.

1. Na et al.  CONSISTENT INHIBITION OF CYCLOOXYGENASE DRIVES MACROPHAGES TOWARDS THE INFLAMMATORY PHENOTYPE. PLoS ONE, 2015;10(2):e0118203. Sci Transl Med
2. Parisien et al.  ACUTE INFLAMMATORY RESPONSE VIA NEUTROPHIL ACTIVATION PROTECTS AGAINST THE DEVELOPMENT OF CHRONIC PAIN.  Sci Transl Med. 2022;14:644.
3. Pence et al.  THE DIETARY SUPPLEMENT CYPLEXINOL^® ALLEVIATES JOINT PAIN IN MEN AND WOMEN. J Clin Transl Res. 2023 Apr 26;9(3):212-221.
4. Bello AE, Oesser S. COLLAGEN HYDROLYSATE FOR THE TREATMENT OF OSTEOARTHRITIS AND OTHER JOINT DISORDERS; A REVIEW OF THE LITERATURE. Curr Med Res Opin. 2006 Nov;22(11):2221-32.