Chronic Inflammation With a Focus on CRMO and other Autoimmune Disorders
Maritssia Abdelshiheed¹, Arushi Gupta², Jalyn Huang³#
¹ Woodbridge High School
² Irvine High School
³ Irvine High School
#Advisor
ABSTRACT
Chronic inflammation is a central feature in many disorders, ranging from autoimmune diseases to autoinflammatory conditions such as Chronic Recurrent Multifocal Osteomyelitis (CRMO).
The main findings emphasize that chronic immune dysregulation plays a critical role in disease development, with CRMO serving as an important example of how innate immune dysfunction manifests clinically. Current diagnostic approaches, such as whole-body MRI, and available treatment options, including nonsteroidal anti-inflammatory drugs and biologic therapies, have improved outcomes but remain limited in scope.
By situating CRMO within the larger framework of inflammation and immune-mediated disease, this research underscores the importance of continued investigation into underlying mechanisms, improved diagnostic strategies, and novel therapeutic approaches.
This paper explores the fundamental components of the immune system, the processes of inflammation, and the progression from acute to chronic states that can drive disease.
References
1. Leuti, A., Fazio, D., Fava, M., Piccoli, A., Oddi, S., & Maccarrone, M. (2020). Bioactive lipids, inflammation and chronic diseases. Advanced Drug Delivery Reviews, 159, 133–169. https://doi.org/10.1016/j.addr.2020.06.028
2. Distler, O., Ludwig, R. J., Niemann, S., Riemekasten, G., & Schreiber, S. (2021). Editorial: Precision Medicine in Chronic Inflammation. Frontiers in Immunology, 12. https://doi.org/10.3389/fimmu.2021.770462
3. Nugent, R. (2019). Preventing and managing chronic diseases. BMJ, 364, l459. https://doi.org/10.1136/bmj.l459
4. Rafferty, B. A., & Thakrar, P. (2024). Chronic Recurrent Multifocal Osteomyelitis. Medical Clinics of North America, 108(1), 227–239.
https://doi.org/10.1016/j.mcna.2023.05.022
5. Zhao, D. Y., McCann, L., Hahn, G., & Hedrich, C. M. (2021). Chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO). Journal of Translational Autoimmunity, 4, 100095. https://doi.org/10.1016/j.jtauto.2021.100095
6. Vernino, S. (2020). Autoimmune Autonomic Disorders. Continuum, 26(1), 44–57. https://doi.org/10.1212/CON.0000000000000812
7. Duan, T., Du, Y., Xing, C., Wang, H. Y., & Wang, R.-F. (2022). Toll-Like Receptor Signaling and Its Role in Cell-Mediated Immunity. Frontiers in Immunology, 13, 812774. https://doi.org/10.3389/fimmu.2022.812774
8. Nobs, S. P., Zmora, N., & Elinav, E. (2020). Nutrition Regulates Innate Immunity in Health and Disease. Annual Review of Nutrition, 40, 189–219.
https://doi.org/10.1146/annurev-nutr-120919-094440
9. Zhang, Q., & Cao, X. (2021). Epigenetic Remodeling in Innate Immunity and Inflammation. Annual Review of Immunology, 39, 279–311.
https://doi.org/10.1146/annurev-immunol-093019-123619
10. Taguchi, T., & Mukai, K. (2019). Innate immunity signalling and membrane trafficking. Current Opinion in Cell Biology, 59, 1–7. https://doi.org/10.1016/j.ceb.2019.02.002 11. Bonilla, F. A., & Oettgen, H. C. (2010). Adaptive immunity. The Journal of Allergy and Clinical Immunology, 125(2 Suppl 2), S33-40. https://doi.org/10.1016/j.jaci.2009.09.017
12. Carroll, S. L., Pasare, C., & Barton, G. M. (2024). Control of adaptive immunity by pattern recognition receptors. Immunity, 57(4), 632–648.
https://doi.org/10.1016/j.immuni.2024.03.014
13. Zhou, Y., Xu, Z., & Liu, Z. (2023). Role of IL-33-ST2 pathway in regulating inflammation: current evidence and future perspectives. Journal of Translational Medicine, 21(1), 902. https://doi.org/10.1186/s12967-023-04782-4
14. Roe, K. (2021). An inflammation classification system using cytokine parameters. Scandinavian Journal of Immunology, 93(2), e12970. https://doi.org/10.1111/sji.12970 15. Leńska-Mieciek, M., Madetko-Alster, N., Alster, P., Królicki, L., Fiszer, U., & Koziorowski, D. (2023). Inflammation in multiple system atrophy. Frontiers in Immunology, 14, 1214677. https://doi.org/10.3389/fimmu.2023.1214677 16. Zhong, J., & Shi, G. (2019). Editorial: Regulation of Inflammation in Chronic Disease. Frontiers in Immunology, 10, 737. https://doi.org/10.3389/fimmu.2019.00737 17. Schutt, C., & Siegel, D. M. (2023). Autoinflammatory Diseases/Periodic Fevers. Pediatrics in Review, 44(9), 481–490. https://doi.org/10.1542/pir.2022-005635 18. Akiyama, M. (2024). Diseases categorized as autoinflammatory keratinization diseases (AiKDs), and their pathologies and treatments. Nagoya Journal of Medical Science, 86(1), 1–15. https://doi.org/10.18999/nagjms.86.1.1
19. Himuro, H., Kurata, S., Nagata, S., Sumi, A., Tsubaki, F., Matsuda, A., Fujimoto, K., & Abe, T. (2020). Imaging features in patients with SAPHO/CRMO: a pictorial review. Japanese Journal of Radiology, 38(7), 622–629.
https://doi.org/10.1007/s11604-020-00953-1
20. Hofmann, S. R., Kapplusch, F., Girschick, H. J., Morbach, H., Pablik, J., Ferguson, P. J., & Hedrich, C. M. (2017). Chronic Recurrent Multifocal Osteomyelitis (CRMO): Presentation, Pathogenesis, and Treatment. Current Osteoporosis Reports, 15(6), 542–554. https://doi.org/10.1007/s11914-017-0405-9
21. Shah, A., Rosenkranz, M., & Thapa, M. (2022). Review of spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO): What radiologists need to know about CRMO and its imitators. Clinical Imaging, 86, 1.
https://doi.org/10.1016/j.clinimag.2022.03.001
22. Moreno-Mateo, F., Perea, S. H., & Onel, K. B. (2021). Chronic recurrent multifocal osteomyelitis: diagnosis and treatment. Current Opinion in Pediatrics, 33(1), 90–96. https://doi.org/10.1097/MOP.0000000000000970
23. Przepiera-Będzak, H., & Brzosko, M. (2021). SAPHO syndrome: pathogenesis, clinical presentation, imaging, comorbidities and treatment: a review. Postepy Dermatologii I Alergologii, 38(6), 937–942. https://doi.org/10.5114/ada.2020.97394