Many of us wake up tired and achy. Our joints feel stiff. We take days to recover from a workout. It’s easy to discount these symptoms or attribute them to stress and aging. But for some people, the real culprit is chronic inflammation. According to Dr. Nneoma Oparaji, a physician triple board-certified in obesity, lifestyle and internal medicine, a common misconception is that chronic inflammation is a diagnosis or disease by itself. Another myth is that chronic inflammation only affects people with an autoimmune disease, when, in fact, diseases such as Type 2 diabetes and hypertension can be a consequence of chronic inflammation.So how can you tell if your symptoms are due to age, stress, inflammation or a combination of these? For advice, we spoke to Oparaji and two rheumatologists about the signs of chronic inflammation, how it’s different from normal aging, and what you can do if you’re struggling to get through the day or bounce back from an injury. How is chronic inflammation different from normal aging?Inflammation is your body’s natural defense against an injury or infection. You might get a sore throat or develop a rash after scratching a mosquito bite. “Acute inflammation is usually short-lived while chronic inflammation lasts for months or years, even when there is no infection or injury to heal,” Oparaji said. Let’s say you strain your knee. This can cause an acute inflammatory response, which can lead to swelling, pain, redness and immobility, Dr. Beth Rubinstein, chief of the Division of Rheumatology, Allergy and Immunology at Virginia Commonwealth University, told HuffPost. “When we talk about chronic inflammation, this is typically defined as being present longer than six to 12 weeks. It may ebb and flow a bit, but it never goes away completely like an acute injury might.”It gets more complicated when you throw in getting older. “Normal aging involves gradual changes in muscle mass, metabolism and bone density while chronic inflammation often leads to diseases such as Type 2 diabetes and heart disease,” Oparaji said. “I often tell my patients that getting older is inevitable, but chronic inflammation is not.” Although they overlap, normal aging isn’t the same as chronic inflammation. “It can be hard for a patient to tell the difference, and I wouldn’t put that burden on them,” Dr. James Miceli, assistant professor of medicine at New York Medical College. “I would encourage them to work with a doctor they trust to get to the bottom of it.” How do doctors diagnose chronic inflammation?Getting a diagnosis can be challenging for several reasons. “These diseases tend to be rare, and oftentimes, we lack a gold standard diagnostic test,” Miceli said. Some inflammatory diseases have a wide spectrum of symptoms and manifestations. “The best way to do it is to see your doctor and see a rheumatologist for a complete evaluation,” he said. This includes a detailed history, physical exam and bloodwork. Examples of blood tests are an antinuclear antibody test, C-reactive protein, erythrocyte sedimentation rate and a metabolic panel. An antinuclear antibody test is used to screen for autoimmune diseases. It works by detecting the presence of autoantibodies, which mistakenly attack healthy cells and tissues. Based on these results, your doctor may order additional bloodwork or imaging.“Those lab tests by themselves can’t make a diagnosis,” he said. That’s because many of these tests are highly sensitive and have a high false positive rate. For example, 15% of the general population tests positive for an autoimmune disease without ever developing such a disease. Oparaji added that these tests can detect inflammation, but they don’t tell you the cause. Her advice is to start with your primary care physician, who may recommend seeing a rheumatologist if you have symptoms such as joint pain, swelling, rashes or fatigue. She also said to be wary of social media and avoid diagnosing yourself.skynesher via Getty ImagesFatigue in the middle of the day for no specific reason isn’t normal.What are signs of chronic inflammation that people dismiss?Experts say there are some pretty big red flags to watch for when it comes to chronic inflammation. They are:FatiguePresent in many conditions, fatigue is associated with vitamin deficiencies, endocrine problems, sleep apnea and depression. But it’s also one of the most common symptoms among people with chronic inflammatory disease, Miceli said. Fatigue isn’t just feeling tired or sleepy. Often it’s severe and makes daily functioning difficult. Joint Pain And StiffnessAnother commonly reported symptom is joint pain and stiffness. “A lot of times when patients are having pain, especially as they get a bit older, it’s due to osteoarthritis, which is a wear-and-tear arthritis,” Miceli said. “It’s uncommon to see true joint swelling with those disorders, whereas with inflammatory arthritis, the joints will be swollen.” The affected joints might also be red and warm. It’s also important to distinguish between true joint inflammation and medication side effects. For example, statin medications for cholesterol can cause muscle aches, but you wouldn’t expect your joints to be red or swollen, Rubinstein said. Similarly, medications for breast cancer can cause aches and pains. In such cases, your doctor might recommend switching medications or stopping the medication if it’s not essential. Other clues that point to inflammatory disease are a family history of disease, symmetrical symptoms (e.g., pain on both sides of the body) and having multiple joints affected, Rubinstein explained. For example, months after a knee injury, you might notice pain or swelling in your ankle and hip. If your spine or sacroiliac joint is involved, you might have trouble getting out of bed or bending over to put on your socks and shoes. This might sound counterintuitive, but with inflammatory joint disease, the pain often gets worse with rest. So, you might be stiff when you first wake up. The more you move and use the joint, the more it loosens up. With mechanical or osteoarthritis pain, it hurts when you use the joint and feels better when you rest, he added. Weight Changes Another sign of systemic inflammation is unintentional weight loss, Rubinstein said. The key word is unintentional. “A lot of people are intentionally trying to lose weight because it takes the pressure off of a painful joint,” she said. But if you’re losing weight without trying and you’re not on any medications, that can be a red flag. Likewise, unintentional weight gain can be a sign of an inflammatory disease, Miceli added. Skin IssuesSkin problems vary depending on the disease. It might be a rash or something specific like psoriasis. “There’s a long list of lupus-related rashes,” Miceli said. He recommended seeing a doctor for any rash that doesn’t improve within a couple of weeks. In the case of psoriasis, a person may also have arthritis or inflammatory bowel disease, Rubinstein noted. Plus, they may have a history of rashes or family members with similar skin conditions. Poor SleepNot getting enough sleep contributes to fatigue and chronic pain. With inflammatory diseases, a person may not be able to sleep on one side or switch to the other because their joints are so stiff and painful. “That is something we take pretty seriously because typically the non-inflammatory kind of pain, with osteoarthritis, may hurt briefly as you’re moving positions, but it shouldn’t prevent you from doing so,” Rubinstein said. Malaise This is the kind of blah feeling when you’re unmotivated, depressed, or just not yourself, Miceli said.Gastrointestinal ProblemsYou might also have nausea or a loss of appetite. “With inflammatory bowel disease, for example, people may have diarrhea or blood in the stool,” Miceli said. Fevers And Chills Extreme temperatures can affect you more intensely with age. So, fevers and chills might not seem like a big deal on their own. However, unexplained fevers or those lasting longer than two weeks could be a sign of chronic inflammation, Miceli said. Difficulty Concentrating If you’re having trouble focusing, it’s easy to blame it on stress or being busy. Likewise, you might attribute brain fog to getting older. But these cognitive symptoms can also be a sign of an inflammatory disease, so it’s worth getting them checked out by a doctor. What increases your risk of chronic inflammation and how do you address it? The theory behind inflammatory conditions, especially autoimmune diseases, is that people have a genetic predisposition and, at some point, another factor can trigger the onset of disease, Rubinstein explained. “For example, UV rays can activate lupus, and that might present with arthritis. Or you might be exposed to a certain medication that leads to the onset of rheumatoid arthritis.”Some diseases have well-described risk factors, Miceli said, adding that smoking is a risk factor for rheumatoid arthritis. Although the evidence is mixed, there’s some research to suggest that high stress, alcohol use, excess abdominal fat, poor sleep, physical inactivity, and diets higher in processed food contribute to these diseases. Rubinstein added that some people feel better when they eliminate certain foods from their diet, but there’s no sound medical data to prove that diet triggers particular diseases. In his practice, Miceli sees patients ranging in age from 18 to 90. “An older person may expect to have some normal age-related joint pain and perhaps a decline in energy, whereas in a young person, that’s never normal.” Sometimes it’s easier to diagnose these conditions in a younger patient because symptoms are less common in these age groups. Oparaji added that low-grade inflammation tends to increase with age, known as “inflammaging,” but it can occur among people in their 30s and 40s. Despite these risk factors, there are steps you can take to lower inflammation. “The same habits that support our overall health also help reduce chronic inflammation,” Oparaji said. “These include quality sleep, stress management, consistent exercise, maintaining a healthy weight, and eating fruits, vegetables and whole grains.”All three experts agreed that quitting smoking and moderating your alcohol use are beneficial. “Smoking is a trigger for rheumatoid arthritis, and so if someone has the power to eliminate that trigger, that will help their condition and may even prevent them from developing it,” Rubinstein said. She also emphasized the importance of exercise and doing it safely. For joint pain, you’d want to prioritize strength training and avoid deep squats. She also recommended talking to your doctor about losing weight safely. Both she and Miceli said the Mediterranean diet has modest anti-inflammatory effects along with other health advantages. Miceli also suggested fish oil because of its anti-inflammatory and cardiovascular benefits.