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Biomarkers in Chronic Nonbacterial Osteomyelitis: Bridging Autoinflammation and Classical Inflammatory Diseases
Angeliki Margoni1, Lampros Fotis2, Kostas A Papavassiliou3
1Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Journal of Inflammation Research
|July 28, 2026
Summary
Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease potentially unified by innate immunity disturbances. New biomarkers offer insights into CNO pathogenesis and patient stratification for precision medicine.
Area of Science:
- Immunology
- Rheumatology
- Bone Biology
Background:
- Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder with sterile bone lesions and no validated biomarkers.
- Traditionally viewed as distinct, CNO may represent a convergent phenotype of sterile bone inflammation due to innate immunity disturbances.
Purpose of the Study:
- To explore the potential of biomarkers in understanding CNO pathogenesis and guiding patient stratification.
- To reframe CNO as a convergent phenotype for mechanism-based classification and precision medicine.
Main Methods:
- Review of emerging genetic, mechanistic, and translational evidence.
- Analysis of conventional (CRP, ESR) and pathway-relevant biomarkers (cytokines, P2X7R, RANKL/OPG ratio).
- Integration of imaging (whole-body MRI) with molecular biomarkers.
Main Results:
- The inflammasome-interleukin-1 beta (IL-1β) axis is central to CNO pathogenesis.
- Pathway-relevant biomarkers offer deeper insights than conventional markers.
- Biomarkers may enable biologically driven patient stratification, though validation is needed.
Conclusions:
- CNO may be a convergent phenotype of sterile bone inflammation driven by innate immunity disruptions.
- Biomarkers are crucial translational tools for understanding CNO and developing targeted therapies.
- Reframing CNO supports a mechanism-based classification and precision medicine approach for inflammatory bone diseases.
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