Rheumatology
Arthrofibrosis is a complex disease involving interactions between many aspects of the immune system, wound healing responses, nervous system, physiology and hormones
Once infection and apparent mechanical causes have been eliminated, rheumatologists and immunologists are best placed to effectively treat an individual with arthrofibrosis. These branches of medicine specialise in disorders of the immune system and should be consulted as soon as possible after diagnosis since early treatment is necessary for resolution. Arthrofibrosis is a complex disease involving interactions between many aspects of the immune system, wound healing responses, nervous system, physiology and hormones [1]. Different people also frequently have different responses to the same stimuli and medication, depending on their genetic makeup, life history, epigenetic changes and environment, making finding the right treatment for each individual even more difficult.
Tests typically begin with markers for autoimmune diseases and inflammatory conditions such as lupus, connective tissue disorders, thyroid function, innate immunity mutations etc. Tests for essential nutrients and blood sugar control are also helpful in guiding treatment, and more detailed blood tests for inflammatory cytokines and hormones are increasingly used for understanding an individual’s physiology. Abnormal results can suggest specific treatment targets and medications. Despite its enormous complexity our understanding of the immune system continues to improve, leading to new medications and the re-purposing of old medications over time.
Interview with
Dr. Will
Dr. Kayley Usher interviews Dr. Rob Will about arthrofibrosis. Dr. Will is trained in rheumatology, osteoporosis and epidemiology. He runs a private research group with interests in osteoarthritis, as well as clinical studies in RA, psoriatic arthritis, spondyloarthritis, osteoarthritis and osteoporosis.
‘Rheumatologists are the professionals in the musculoskeletal area who are really best equipped to advise on what the most appropriate treatment might be for these patients’
‘The important messages are to get the correct diagnosis, and get it as early as possible… get that treatment early’
‘Usual approaches are to look at arranging investigations to narrow down the diagnosis to make sure we're not dealing with lupus or rheumatoid arthritis or spondyloarthritis, and the classic example of that is ankylosing spondylitis that's associated with the HLA B-27 gene.’
‘There might well be a difference in in those inflammatory markers (between active and residual arthrofibrosis), it would certainly be an interesting study to look at that.’
‘There's a lower rate of arthrofibrosis in people, for example, who are on metformin at the time of the surgery or on ACE inhibitors and angiotensin receptor inhibitors.’
‘We do occasionally see patients who are labelled as rheumatoid arthritis who in fact probably now we could regard as having generalised arthrofibrosis so they can present with multiple stiff joints. And the actual evidence of inflammation may be relatively scant.’
References
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Usher, K. M. et al. Pathological mechanisms and therapeutic outlooks for arthrofibrosis. Bone Research 7, doi:10.1038/s41413-019-0047-x (2019).
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