<aside>
</aside>
<aside>
</aside>
<aside>
</aside>
Arthrofibrosis occurs when myofibroblasts (the cells that make fibrosis) continue to create scar tissue, adhesions and contractions after they should have disappeared.
Prolonged exposure to an inflammatory stimulus (environmental causes)
Arthrofibrosis may have been primarily caused by prolonged exposure to an inflammatory stimulus (environmental causes), such as:
This group doesn’t have systemic chronic inflammation, so for these people their biology likely plays a less significant role in their arthrofibrosis pathology.
With appropriate care, these people may recover from injury or surgery to a greater extent (compared to immune-activated people), even without the help of specialized medications.
Inappropriate immune reaction against self (your own cells)
In this group, biology (genetic makeup) is the most important driver that activates chronic inflammation. Let’s call these the “immune-activated” group, which covers a variety of immune system irregularities. Many arthrofibrosis patients were fit and healthy, and their inflammatory status was not apparent until they got arthrofibrosis. Their cytokine panel test results then indicated that they actually were immune-activated.
It’s important to understand what the main fibrosis drivers are for each individual, as this affects the medications they need. But how do we know who belongs to which group, since on the surface there is often no way to tell.
Luckily, we have access to more sensitive and specific inflammation tests, called cytokine tests. Cytokines are compounds the body makes for protection and healing, but they cause pathology when their production or signaling becomes dysregulated. A blood test to determine the levels of systemic cytokines is very useful for understanding an individual’s inflammatory status.
An abnormally elevated level of one or more systemic cytokines suggests that the individual is in the immune-activated group. The classic inflammatory cytokines are:
TNF-α
IL-1
IL-6
However there are quite a lot of them. Some cytokines are occasionally referred to as anti-inflammatory, but this label is misleading, because their actions are often context-dependant and in chronic inflammation they can become pro-inflammatory. Some of these strongly stimulate fibrosis, so elevations in these are not a welcome result. These include:
TGF-β
IL-4
IL-13
A cytokine panel test can be very useful for indicating which treatments will be the most effective. There are many pathways that can become dysregulated and these may arise from innate or adaptive immunity. If certain serum cytokines are elevated, they can sometimes be specifically targeted with modern medications that are more effective at reducing inflammation.
If you’re given the option, prioritize TNF-α, IL-1, IL-17 and IL-6 as well as TGF-β, CTGF, IL-4, IL-13, IFN- γ and GM-CSF. The more tests you’re able to add, the more complete the picture is.
In addition to cytokine tests, the following blood tests are recommended for people with arthrofibrosis:
A rheumatologist is best placed to order and interpret these tests