Saturday, 3 March 2012

My review of: Dupuytren's Disease: Review of the Current Literature

As I have been rattling on about for a few days I have been meaning to get round to doing a post of a review I found for Dupuytren's contracture (DD) and so I am going to do that at least. If you are interested in this disease in particular then please do read the paper for yourselves there are bits that I am not going to cover because I personally am just not that interested in which finger is worst hit etc so there might be some details you are interested in that I miss. The paper is this one here:

Dupuytren's Disease: Review of the Current Literature
Khashan et al, 2011, The open Orthopaedics journal, 5, 283-288.

So some of the points that are of interest and come from the introduction are:

  • DD is fairly common and depending on age, gender and ethnicity can occur is as much as 40% of the population but lower estimates are more like 2%. Still this is much more common that LD and it is unknown as to why this might be. 
  • Interestingly they actually say that the most common locations globally are the UK, USA and Australia and which 3 places do you think that I get most of my hits from? UK, USA and somewhere else and to be honest this is likely due to the language spoken. 
  • Men are more likely to get the disease than women by ask much as 9:1 and consistent with what I have posted about before you are also much more likely to get this disease once you are above 40 years old. 

  They then move on to looking at some of the causes of the disease:

  • Local Trauma - Say that there are studies that have both supported this and that have discredited this. I think that this probably means that in some causes there is local trauma that triggers the formation of the lumps and in other cases there is not this trauma and maybe it is genetic in these cases. Anyway I think other than giving me some papers to research for a future post on does trauma cause these disease I didn't learn anything new. 
  • Genetics - They say that in cases where this disease is genetic is is autosomal dominant disease with variable penetrance. What this means is--- Autosomal - this means that it is not carried on one of the sex chromosomes but on one of the others. ----- Dominant - So we get one copy of each gene from each parent and if a disease is dominant then only one gene needs to be defective for you to present with the disease ----- variable penterance - This just means (as best I can tell) that despite being dominant it will not always appear for reasons unknown, 
  • Occupation - There have been reports in the past the certain occupations can increase the likelihood of getting DD, they say that this is highly debatable and in my eyes is probably linked to the trauma aspect of the disease. Of you have a job that gives you an increased chance of having trauma to your hand then you have an increased chance of getting DD. 
Pathophysiology of DD: 

Here they say that there are 3 main phases to the disease. 
  1. Proliferative stage: This is the stage where the cells go into overdrive and grow uncontrollably and this results in the formation of a nodule. 
  2. Involution: They say that it is during this point that the cells rearrange along the stress lines of the diseased tissue and this is how cords being to form in DD patients. The cells are also producing collagen and smooth muscle actin which is a key player in regulating contraction of muscles. So you have the beginnings of contraction and also more collagen so more nodule formation. 
  3. Residual Phase: Here, apparently, the nodules regress and leave behind a cord and it as at this point that contraction starts to become very severe and much more visible. 
They do say a bit about the presentation of the disease and indeed the operative treatments but as this is less of an option for Ledderhose disease I am going to stick more to looking at the non-operative treatments. 

  • Many different things including: Vitamin E, splinting and other have proved to be ineffective.
  • Steroid injections (as I have discussed for Ledderhose before) have been shown to only have limited success which is much the same as what I would say. 
  • They say that radiation has been used with some success when used early on and that the same is true of Verapmil.
  • They also talk about some other collegenase injections which they are hopeful about for use as a future treatment.
I think I have covered this quite well and think that only other bit of information from the paper that I would like to include is that that this disease is mainly bilateral which is different from Ledderhose where the odds of it being bilateral are (I think) below 50%).