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However, in conditions such as chronic inflammation, pro-inflammatory cytokines stimulate various cell types, such as periodontal ligament cells in periodontitis and synovial fibroblasts in arthritis, leading to increased RANKL production ( TNF-α, primarily produced by macrophages, promotes the inflammatory response by activating various signaling pathways within osteoclasts, including NF-κB, proteases, JNK, and MAPK, thereby inducing the release of multiple cytokines and chemokines and activating immune cells