Sunday, 29 June 2014

Association of Ledderhose and Dupuytren's

Today I have a review of a paper that came out last year.

Association of Morbus Ledderhose With Dupuytren’s Contracture
Kristj√°n G. Gudmundsson et al

There was not a huge amount of new information in this paper but it is always interesting to see what they have to say or just if there is any information to back up what we already know. 

In this paper they have looked at a previous analysis of Dupuytren's patients and asked them to come back many years after they were originally diagnosed / analysed, there was also a control group which they also asked to come back. Their aim was to see whether there was a correlation between Dupuytren's and Ledderhose by comparing the number of Dupuytren's patients with the condition and the number of patients in the control group with the condition. 

They mention in the introduction one of the annoying facts about Ledderhose, that the prevalence is not known, why have studies not been done to specifically look at this? Anyway... 

Interestingly they do quote figures for treatment options, well surgery and radiotherapy. They say that surgery has a failure rate of up to 60% (I have heard it being much higher than this, though also lower, they only quote one reference so I guess that they have taken it from this) whilst when looking at the radiotherapy results they quote a figure of complete or partial remission in 88% of patients. If anyone can remind me why lots of people are against radiotherapy compared to surgery or indeed why is it that on the NHS we are only able to get surgery but not radiotherapy? Again anyway... 

Effectively they say that there is an increased incidence of Ledderhose in patients that have Dupuytren's, I have tried to summarise their results in the graphs below. 


The above graph shows that in their control group of non-Dupuytren's patients there were no cases of Ledderhose, the study did have a limited number of people so this is not surprising, a similar study with 10,000+ people would ensure that some Ledderhose patients were found in the control group without Dupuytren's (like myself). It then shows that as the Dupuytren's progresses from nodule to cords, to contracted figure to having to have surgery the levels of Ledderhose increase. The patients have all had Dupuytren's for a prolonged period of time which rules out the time since onset as the factor in developing Ledderhose. What the above results suggests is that with an increasing severity of Dupuytren's you have an increased risk of Ledderhose, confirming that in all likelihood they are linked.
The second graph that I have produced from their data is one that shows that those who have a family history of Dupuytren's have a significantly increased risk of developing Ledderhose. This suggests that the genetic elements that predispose a person to get Dupuytren's are the same or overlap those that increase predisposition to developing Ledderhose.

I think that summarises the key points, basically Ledderhose and Dupuytren's are linked and if you have Dupuytren's the more severe it is the more likely you are to get Ledderhose and a family history of Dupuytren's will predispose you to both conditions.