Relationship between Diabetes and Ledderhose Disease
(Plantar Fibromatosis) and Dupuytren’s Disease.
I am looking today at some of the information behind this
link to see if we can find out if it is real and if it is real why is it real?
So firstly as I said
yesterday I was led to a paper where this is briefly discussed and so thought
I would make it the topic for today. Firstly I do not have diabetes and none of
the people whom I have spoken to have mentioned having it but then I haven’t
asked that many people whether or not they have diabetes so maybe it is
something I should go back and ask them.
Still part of my curiosity behind whether this is fact or
fiction is based on the fact that most of the people I am coming across do not
display many of the predisposing factors such as diabetes, smoking, drinking and
epilepsy. This lack of a correlation behind the literature and my experience is
probably purely down to the small numbers of people that I have spoken to and I
am sure that if you speak to the people in the know over at the International
Dupuytren’s Society of the British Dupuytren’s Society they will tell you that
they have seen the higher incidence in diabetes suffers (I will ask).
So I will try and
take us on a journey of the literature to see if this link exists which after a
quick glance I think it does but I lets how I feel by the time I finish this
post and the research. From what I have seen though I can say that there
appears to be no or little understanding of the molecular mechanism which may
underlie this predisposition.
(1) Elhadd et al, 2007, Plantar Fibromatosis and
Dupuytren’s disease: an association to remember in patients with diabetes,
Diabetic Medicine, 24, p1305:
So this is the paper
that was referenced in yesterday’s paper and I will probably be using a lot of
the references this paper to work my way back through the data. Here they, through
a past paper, comment that the link between DD and diabetes maybe oxidative
stress. Oxidative stress is a type of cellular stress and it will result in the
production of reactive oxygen species (ROS) which can then in turn cause damage
including DNA damage etc which then causes problems with the cell. ROS being a
factor towards the occurrence of Dupuytren’s would also make sense of the link
to smoking.
They then go on to mention the link between Dupuytren’s and
other hyperproliferative disorders such as Ledderhose. They mention a case
where a lady had long term Dupuytren’s in both hands and had recently started
to show Ledderhose in both feet and she is a diabetic. I think the main purpose
of this article though is to raise awareness that in diabetic individuals with
Dupuytren’s or indeed anyone with Dupuytren’s or diabetes that you should keep
an eye out for the lesser known Ledderhose disease.
(2) This Abstract:
Ok so I cannot say a lot from this abstract and I get the
impression that the full article is in French. Still here they discuss 42
diabetic patients with Dupuytren’s and say that there it is usually not that
bad in diabetic patients and often due to age the requirement for surgery is minimal.
Although they say that if you have one
disease you should check for the other they do not give any stats as to
frequency other than to say it is 5 to 10 times greater than in the rest of the
population.
Right so at this point I decided that things were not going
to plan as I hadn’t found any facts or figures that were actually showing me
that this link existed. Then however with a bit more perseverance and some time
on PubMed I stumbled across a couple of useful papers. Here I am only able to
discuss the abstracts as they are both in foreign languages and are too old for
me to be able to easily plonk them somewhere on the internet to get them
translated. So...
So here they are looking at 100 randomised diabetic patients
for the occurrence of Dupuytren’s contracture and found that there were 42
(therefore 42%) cases of Dupuytren’s disease which is clearly higher than what
you would expect in the normal population. Further to this they also say that
the rate of Dupuytren’s increased with age and length of time with diabetes
though of course these things are interlinked so the only thing they would say
is that it is also linked with age.
(4) Ravid et al, 1977, Dupuytren’s
Disease in diabetes mellitus, Acta Diabetol Lat, Vol 14, P170-174.
In this paper they are looking at nearly 1000 patients with
diabetes and 1400 without diabetes though apart from this I am unable to determine
other background such as male / female, smoker / non-smoker etc etc. Still here
they find that nearly 18% of diabetic patients have Dupuytren’s disease whilst less
than 1% of the non-diabetic patients have Dupuytren’s disease. Further to this
again there was an increase in DD cases with age and that it was rarely found
in patients under 40 years old.
I think that the above 2 papers in particular indicate that
there is in all likelihood a link between diabetes and Dupuytren’s although I
am unable to see information linking this to Ledderhose but I guess due to the
similar nature of Dupuytren’s and Ledderhose it would make since.
This all got me thinking about how can the 2 be connected
and my mind instantly jumped to IGF2. For those that have not seen it before
see the picture below.
The reason that my mind went here is because IGF2 is short
for insulin like growth factor and I know that the maybe some interplay between
the two pathways and perhaps IGF2 gets up-regulated and this leads to a predisposition
to Dupuytren’s and related disorders. So I did a Pubmed search for IGF2 and
diabetes and not a lot has popped up, I think I saw one that suggested that
IGF2 is actually down in diabetic patients so this route is probably not
correct but I imagine that it has to be something along this way.
So at the end of the day I have to agree with the data that
supports this link and was unable to further expand my knowledge about the
cause of this link as I could not find any supporting information.
No comments:
Post a Comment