Inflammation is part of your immune system’s response when the body encounters something harmful—like, say, the bacteria that get into your body from a wound. When you cut yourself, what’s known as acute inflammation helps you heal.
As bacteria make their way into the tissue beneath the skin, cells release chemical messengers, kicking off the inflammatory response. Nearby blood vessels respond in a way that makes it easier for blood, fluid and immune cells to flow to the area. The subsequent swelling—a hallmark sign of inflammation—prevents the bacteria from reaching other parts of the body. White blood cells, which help consume germs, are also called into action. Within days, the cut has healed. Mission accomplished.
But inflammation isn’t always the hero.
Sometimes inflammatory cells overreact and kick into action even when there’s no injury or infection, says Shashi Adsul, M.D., Head of Global Immunology Medical Affairs for Gastroenterology at Johnson & Johnson.
With this kind of chronic inflammatory response, your body’s natural immune response stays activated even though there’s no reason to—whether it’s because your body has healed or there was no injury or infection to begin with. This overreaction can persist for months or even years, damaging healthy cells, tissues and organs. So the inflammatory response, typically meant to protect the body, ends up harming it, explains Dr. Adsul. This can lead to various diseases, including heart disease, cancer and autoimmune disorders.
Here’s what to know about chronic inflammation, including the triggers, who’s at risk and how Johnson & Johnson is innovating to treat the many conditions it’s linked to.
What causes chronic inflammation—and who’s at risk?
The exact cause of chronic inflammation is not well understood, says Dr. Adsul. But it’s linked to lifestyle habits, genetic factors, ongoing infections and environmental triggers like pollution, he explains. “All of these things come together to keep these pro-inflammatory mechanisms active.”
Since experts can’t say with certainty what causes chronic inflammation, it’s difficult to know who’s most at risk. However, stress, both physical and emotional, is a known risk factor; and older adults, as well as those who are obese, smoke or have a family history of autoimmune conditions tend to be at greater risk than those who don’t check one or more of these boxes.
The symptoms of chronic inflammation
Signs of acute inflammation tend to be pretty obvious: pain, swelling, redness, a fever. Not so with chronic inflammation. Symptoms of long-lasting inflammation tend to be more subtle and less specific and can include fatigue, insomnia, anxiety, weight changes and frequent infections.
While inflammation itself isn’t a disease, it is linked to a number of serious medical conditions, including autoimmune disorders like lupus, Sjogren’s disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis and inflammatory bowel disease (IBD); cardiovascular diseases; certain cancers; and neurodegenerative conditions such as Alzheimer’s disease. What’s more, chronic inflammation can lead to long-term damage and as it affects the entire body, it may damage other organs and systems as well, including the heart and lungs.
As a result, many symptoms associated with chronic inflammation vary depending on the health condition it plays a role in causing. For example, people with IBD—which is mainly ulcerative colitis and Crohn’s disease—usually have abdominal pain, diarrhea, an urgency to have a bowel movement and unintended weight loss. The symptoms of rheumatoid arthritis include joint pain, swelling and sometimes joint damage. Psoriatic arthritis affects the joints as well but also causes scaly patches on the skin, nail changes and eye inflammation. Lupus may cause fatigue, memory problems, a facial rash and gastrointestinal symptoms. “All of these symptoms of chronic inflammation burden patients, impacting physical health, mental well-being and daily life,” Dr. Adsul says.
People with diseases related to chronic inflammation may experience periods of severe symptoms and times of stabilization, during which symptoms become less severe or almost nonexistent, says Meredith Hans Moore, Ph.D., Vice President of Global Medical Affairs Immunology at Johnson & Johnson.
Is chronic inflammation treatable?
Some people can manage chronic inflammation through lifestyle changes, such as increasing their physical activity, losing weight and swapping inflammatory foods (think ultra-processed fare and foods rich in saturated fat and refined sugar) for fruits, vegetables, nuts, whole grains and fatty fish.
In many instances, diseases linked to chronic inflammation are treated with high-dose corticosteroids or immunosuppressant drugs, says Hans Moore. These medications work by switching off your immune system to tamp down inflammation. “That obviously has other implications and side effects that are not good for you because we need our immune system,” she explains. These therapies could put you at risk for other infections.
And while these treatments may help patients temporarily manage symptoms of IBD, rheumatoid arthritis, psoriasis, lupus and other chronic inflammatory diseases, often they are not entirely effective, creating safety concerns and not fully addressing symptoms.
That leaves a huge unmet need for patients, which can impact overall health as well as quality of life, Dr. Adsul says. For example, people with IBD experience frequent bowel movements, up to 20 times a day, and as a result sometimes don’t leave their homes for periods of time. “This high unmet need drives us to find innovative solutions to help patients get back to their normal life,” adds Dr. Adsul.
There’s a strong need among patients dealing with immune-mediated inflammatory diseases, many of which still lack approved therapies.
The future of treating chronic inflammatory diseases
For decades, Johnson & Johnson has worked to develop therapies for many autoimmune diseases linked to chronic inflammation. And that work continues, Hans Moore says.
The company has developed a type of medication that targets and blocks a certain protein in the body, known as tumor necrosis factor-alpha (TNF-alpha), which is produced by the immune system and plays a role in inflammation. Another therapy targets the protein interleukin-23 (IL-23), which is “an important driver of inflammation,” notes Dr. Adsul.
These medications are delivered via injections in the vein or under the skin. However, Johnson & Johnson is in the process of developing an oral medication that can inhibit the IL-23 pathway, which will be a more convenient option for patients, he says.
The company is also investigating a combination therapy (using two different medications at once) to treat people with autoimmune diseases.
“Johnson & Johnson remains deeply committed to developing treatments for immune-mediated inflammatory diseases,” Hans Moore says. “There’s a strong need among patients dealing with these illnesses, many of which still lack approved therapies.”
The ultimate goal, she says, is “to see a world free of immune-mediated diseases.”
