Inflammation, signs of and reasons for - chronic

Definition and causes

Chronic inflammation - a prolonged inflammatory process (weeks to years) where inflammation, tissue destruction, and attempted repair occur simultaneously, rather than the stereotyped, self-limited sequence of acute inflammation
Arises either as a continuation of unresolved acute inflammation, or as a distinct process from the outset (e.g. autoimmune disease, chronic infection)

Dominant cell types shift from neutrophils to macrophages, lymphocytes, and plasma cells
Granuloma formation - a specific pattern of chronic inflammation where macrophages differentiate into epithelioid cells and fuse into multinucleate giant cells, walling off a persistent, poorly degradable antigen (classic causes: TB, sarcoidosis, foreign body reaction, fungal infection)
Persistent macrophage activation drives fibroblast proliferation and angiogenesis, producing progressive fibrosis as inflammation continues without resolution

Often more indolent/less clinically obvious than acute inflammation - systemic symptoms (fatigue, weight loss, low-grade fever) and raised inflammatory markers over a prolonged period are typical rather than the dramatic local signs of acute inflammation
Tissue biopsy showing lymphoplasmacytic infiltrate +/- granulomas supports the diagnosis and can identify the underlying cause

Treatment targets the underlying driver (antimicrobial therapy for chronic infection, immunosuppression for autoimmune disease, removal of a foreign body) rather than the inflammation in isolation, since the process will persist while the trigger remains

Rheumatoid arthritis, inflammatory bowel disease, tuberculosis, sarcoidosis, chronic infection (e.g. osteomyelitis), foreign body reaction

Untreated chronic inflammation drives progressive, often irreversible tissue fibrosis and organ dysfunction - the rationale for early, aggressive treatment of chronic inflammatory disease rather than symptomatic management alone

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