What to Know About Chronic Inflammatory Diseases

Jan 4, 2024


Alto Pharmacy

Chronic inflammatory diseases and treatment
Chronic inflammatory diseases and treatment
Chronic inflammatory diseases and treatment

In the short term, inflammation is part of your immune system’s natural response to illness or infection. Symptoms of acute inflammation like pain, swelling, bruising, or redness typically indicate that your body is actively healing itself.

But sometimes inflammatory cells overstay their welcome. Chronic inflammation is when the body continues this response in the absence of an outside threat such as a bacteria, virus, or injury. It stems from a variety of causes, including inflammation-linked health conditions referred to as chronic inflammatory diseases. Below are some of the most common.

Common chronic inflammatory diseases

A variety of conditions fall under the category of chronic inflammatory diseases. They affect different systems and areas of the body including the joints, skin, digestive tract, heart, and lungs.

Crohn’s Disease

Crohn’s disease is an inflammatory bowel disease that causes inflammation in the digestive tract — a group of connected organs that includes your mouth, esophagus, stomach, small intestine, large intestine, and anus. While Crohn’s may develop in any portion of the digestive tract, it primarily affects the small or large intestine. Common symptoms include abdominal pain and cramping, diarrhea, and weight loss.

Various medications that suppress immune activity can reduce inflammation in the digestive tract and help people with Crohn’s achieve and maintain symptom-free periods referred to as remission.

  • Aminosalicylates (5-ASAs) such as sulfasalazine, mesalamine, olsalazine, and balsalazide are prescribed off-label to control Crohn’s-related inflammation and help heal damaged tissue. One benefit of these medications is that they work locally, meaning that they target inflammation in the bowel without affecting the entire immune system. These medications may be used as a long-term maintenance medication.

  • Corticosteroids such as prednisone and methylprednisolone are prescribed to treat moderate to severe inflammation during flare-ups, or periods of intensified symptoms. Like 5-ASAs, these medications also suppress immune activity, but they act on the entire immune system rather than targeting specific parts of the body. These medications should not be used long-term due to the potential for side effects.

  • Immunomodulators such as azathioprine, 6-mercaptopurine, cyclosporine, and tacrolimus also suppress the body’s immune response in order to prevent ongoing inflammation. It may take several months of using these medications before you start to experience the therapeutic benefits. They are typically prescribed after other treatments have been unsuccessful.

Antibiotics such as metronidazole, ampicillin, and ciprofloxacin are sometimes used to treat gastrointestinal bacterial infections caused by Crohn’s disease.

Ulcerative Colitis

Ulcerative colitis is another type of inflammatory bowel disease characterized by chronic inflammation of the digestive tract. Unlike Crohn’s disease, ulcerative colitis only affects the colon, an organ that comprises most of the large intestine. Common symptoms include diarrhea with blood, abdominal pain and cramping, and an urgent need to empty bowels.

Given the similarities between ulcerative colitis and Crohn’s disease, 5-ASAs, corticosteroids, and immunomodulators are also used to treat ulcerative colitis. Below are additional ulcerative colitis treatments.

  • Janus kinase (JAK) inhibitors such as tofacitinib (Xeljanz®) and upadacitinib (Rinvoq®) belong to a class of medications called targeted synthetic small molecules, which act on specific parts of the immune system to reduce inflammation in the intestine. Typically used during flare-ups, JAK inhibitors block inflammatory pathways to alleviate moderate to severe symptoms of ulcerative colitis.

  • Ozanimod (Zeposia®) is a different type of synthetic small molecule that reduces intestinal inflammation caused by ulcerative colitis. It works differently than JAK inhibitors, preventing immune cells in the lymph nodes from traveling to the intestines.

  • Biologics such as adalimumab (Humira®), golimumab (Simponi®), infliximab (Remicade®), ustekinumab (Stelara®), and vedolizumab (Entyvio®) may also be used to prevent inflammation in moderate to severe cases of ulcerative colitis. These medications are derived from natural sources including the sugars, proteins, cells, and tissues of plants and animals.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disorder in which the body attacks its own tissue, causing pain and inflammation in the joints. It is a progressive condition that can lead to joint damage and chronic pain if untreated.

Smaller joints, like those in the fingers, hands, toes, and feet, are often the first to be affected. In later stages, the condition may spread to the wrists, knees, ankles, elbows, hips, and shoulders. In more advanced stages, it can also affect other parts of the body, including the skin, blood vessels, lungs, and heart.

Specific presentation of symptoms varies by individual and may also evolve with time. Many people with rheumatoid arthritis experience flare-ups in which symptoms intensify, followed by periods of mild symptoms or none at all.

There are two main goals of treatment for rheumatoid arthritis: alleviating pain and inflammation during flare-ups, and slowing or preventing longer-term tissue damage.

Medications used for short-term pain management and inflammation reduction include:

  • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®, Motrin®), aspirin (Bayer®), and naproxen (Aleve®)

  • Corticosteroids such as cortisone, prednisone and methylprednisolone

  • JAK inhibitors such as baricitinib (Olumiant®), tofacitinib (Xeljanz), and upadacitinib (Rinvoq)

Medications used for long-term tissue protection include disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate (Rheumatrex®, Trexall®, Otrexup®) and sulfasalazine (Azulfidine®), which prevent the immune system’s response to triggers.

There are also injectable biologic DMARDs such as etanercept (Enbrel®), infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia®), which target a more specific pathway in the immune system. These medications are typically reserved for cases when other treatments, including traditional DMARDs, have been ineffective.


Psoriasis is an autoimmune disorder that affects the skin. It occurs when new skin cells grow too quickly as the result of immune-related inflammation, resulting in thick, scaly patches of skin. People with psoriasis may experience the following symptoms in addition to the characteristic inflamed patches of skin:

  • Dry skin that cracks or bleeds

  • Soreness, itching, or burning sensations on or near irritated skin

  • Thick, pitted nails

  • Joint pain or swelling

Topical corticosteroids, the first-line treatment for mild to moderate cases of psoriasis, can reduce swelling and redness. These treatments are available in many forms, including oils, ointments, creams, lotions, and gels. Mild corticosteroid ointments like hydrocortisone are often used for sensitive areas. Stronger creams and ointments like triamcinolone (Trianex®) and clobetasol (Cormax®, Temovate®) may be used for less sensitive areas or patches that don’t respond to hydrocortisone.

Non-steroid topicals, including synthetic forms of vitamin D such as calcipotriene (Dovonex®, Sorilux®) and calcitriol (Vectical®), may be prescribed as an alternative to steroids. Like steroids, these treatments can help control plaques. They may cause less irritation than other treatments.

There are other treatment options available for more severe symptoms, or symptoms that haven’t responded to first-line treatments, including the immunomodulator cyclosporine, DMARDs, and biologics. These medications are typically used for short periods of time or alternated with other treatments due to the potential for side effects.

Psoriatic Arthritis

Psoriatic arthritis is a type of arthritis that affects about 30% of everyone living with psoriasis. Like rheumatoid arthritis, the primary symptom of psoriatic arthritis is joint pain. However, it typically affects different joints than rheumatoid arthritis, with pain at the back of the heel or above the knee a common symptom. Other symptoms include swelling in the eyes and changes to the fingernails and toenails like discoloration. While the condition is often accompanied by psoriasis, typical psoriatic patches on the skin aren’t necessary for a diagnosis of psoriatic arthritis.

As with rheumatoid arthritis, psoriatic arthritis treatment focuses on both controlling symptoms and preventing longer-term joint damage. Over-the-counter NSAIDs can reduce acute inflammation. Medications used to slow the progression of the condition and protect the joints include:

  • Traditional DMARDs such as methotrexate (Rheumatrex, Trexall, Otrexup), the most commonly prescribed medication from this class, as well as leflunomide (Arava®) and sulfasalazine (Azulfidine)

  • JAK inhibitors such as tofacitinib (Xeljanz)

  • Injectable biologic DMARDs such as adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), ustekinumab (Stelara), secukinumab (Cosentyx®), ixekizumab (Taltz®), guselkumab (Tremfya®), and abatacept (Orencia®)

Injectable biologic DMARDs are typically reserved for cases when other treatments have been ineffective

Apremilast (Otezla®), a newer oral medication, is sometimes prescribed as an alternative to DMARDs in cases of mild to moderate psoriatic arthritis. This medication targets a specific enzyme related to inflammatory cells.


Lupus is a complex autoimmune disorder that can cause inflammation in many parts of the body, including the joints, skin, kidneys, blood cells, brain, hearts, and lungs. Fatigue, fever, joint pain, and a butterfly-shaped face rash are common symptoms, but given that lupus affects a wide variety of organs and systems, there is much variation in symptom presentation, severity, and duration. Acute flare-ups followed by remission are common in mild cases.

Treatment options are varied and serve different purposes. Some medications reduce inflammation during flare-ups while others control symptoms and reduce the risk of long-term complications. Some options are reserved for severe cases, or when symptoms haven’t responded to more common first-line treatments.

Corticosteroids are often used short-term to treat flare-ups. Medications used as a longer-term maintenance include:

  • Antimalarials, which reduce production of a protein related to immune system activity and inflammation. Hydroxychloroquine sulfate (Plaquenil®) is typically the first-line antimalarial used for lupus treatment, with chloroquine (Aralen®) as an alternative.

  • The DMARD methotrexate, commonly prescribed for arthritis, is used in lupus treatment to reduce inflammation. Azathioprine (Imuran®, Azasan®) may also be prescribed for lupus, though it is typically reserved as an alternative to first-line therapies.

  • Intravenous biologics such as belimumab (Benlysta®) and anifrolumab (Saphnelo®) may be used in severe cases, typically after other treatments have been ineffective. These medications are administered in a hospital setting.

Some chemotherapy medications typically used in cancer treatment are prescribed for severe cases of lupus due to their immunosuppressive effects.

Specialty medications and side effects

Many of the medications used to treat chronic inflammatory diseases are categorized as specialty medications. These medications are more complex than traditional or non-specialty medications and not available at all pharmacies. They often require routine testing and clinical monitoring due to their greater potential for side effects and interactions as well as the progressive and serious nature of many of the conditions they’re used to treat.

Staying on track with testing and monitoring is a part of taking these medications as prescribed. Your doctor can explain more about the risks and benefits of these medications before you decide to begin treatment.

Any medication that reduces immune system activity makes it more difficult for your body to fight an illness or infection. When taking this type of medication, seek prompt treatment if you experience any symptoms of sickness such as a fever, chills, or a sore throat.

An easier pharmacy experience for complex treatment

Living with any chronic condition is easier with a reliable pharmacy partner by your side. Our pharmacists have specialized training in the treatment of chronic inflammatory diseases and can answer any questions you may have. In addition, we offer reliable home delivery and medication management tools to help you stay on track with treatment.

To learn more, reach out any time through secure in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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