Fibrosis

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton and Vidya Acharya  

Introduction

Micrograph: heart showing fibrosis (yellow – L)

The term fibrosis relates the development of fibrous connective tissue as a way to repair tissue following injury or damage. Pathophysiologic fibrosis, essentially an excessive accumulation of extracellular matrix components (particularly collagen), is the final result of a cascade of events following tissue injury via inflammation, and resulting in permanent scar formation. It is characterized by scarring and hardening of tissues and organs.

Fibrosis can affect all tissues of the body, and left unrestrained, can result in organ failure and death. It is caused by a process that stems from wound healing that has gone awry. Fibrogenesis is becoming increasingly recognized as a major cause of morbidity and death in most chronic inflammatory diseases, with a dearth of treatment strategies available to target the pathogenesis of fibrosis.

Main Types of Fibrosis

Fibrosis after a burn

Fibrosis in “Frozen Shoulder”

Fibrosis, the excessive accumulation of fibrous connective tissue, can lead to permanent scarring, organ malfunction and, ultimately, death. This can be seen in as seen in end-stage liver disease, kidney disease, idiopathic pulmonary fibrosis, liver cirrhosis and heart failure (cardiac fibrosis). Fibrosis is also a. feature in the following conditions.

1. Many chronic autoimmune disorders (eg scleroderma, rheumatoid arthritis, Crohn’s disease, myelofibrosis and systemic lupus erythematosus).
2. Pulmonary fibrosis, as: Replacement fibrosis (as occurs in response to lung damage caused by infarction or an infection); focal fibrosis, as occurs in a response to irritation by inhaled substances that are inhaled eg silica or asbestos; diffuse parenchymal lung disease (DPLD).
3. Soft tissue injuries eg Skeletal muscle injuries: With minor injuries the muscles are able to regenerate completely and recover their usual capabilities. However, in severe injuries, the injured muscle cannot recover to a functional level because of the formation of fibrous scar tissue. Fibrosis of the joints can lead to stiffness and pain in the joints. Fibrosis of the tendons can lead to eg Dupuytren's contracture. Fibrosis of the shoulder capsule may lead to adhesive capsulitis and frozen shoulder.
4. Fibrosis is a feature of metastasis, chronic graft rejection and the pathogenesis of many progressive myopathies eg Dysregulated muscle repair with persistent fibrosis rather than correct regeneration plays a major role in the decline and reduced life expectancy associated with severe muscular dystrophies, like Duchenne muscular dystrophy

Physiotherapy

Physiotherapy plays a role in eg minimising fibrotic changes, influencing scar tissue strength, living a better quality of life with fibrosis. See links for Physiotherapy specifics.