Sunday, 19 April 2015

Related Conditions survey - Can we find a link?

The results of the associated conditions survey are in, although this is using a limited dataset it could be useful to help guide a more comprehensive study on the conditions we now think might be related.


It will come as no surprise that it looks like frozen shoulder, keloids and knuckle pads seem to show an increased incidence in Dupuytren’s and Ledderhose patients. 



Another condition that has already been shown to have a link is Psoriasis and again this link appears to be observed.  However there are some other examples which I shall going into in more detail.



Firstly please see the graph below summarising all of the results. The public rows that are blank are because I was unable to find a good and reliable figure for the general public.






Raynauds:



This condition is explained better than I could do it on the following link:




The linkage in this condition can be seen when looking at the totals with nearly 20% of all patients having this condition compared to the figure of 10% in the general public. When looking into this condition I noticed that the rates are different between men and women, when this is done on the survey data the results are quite striking. Only 4% of men have the condition (compared to the expected 8%) whilst 26% of women have this condition (compared to the expected 13%). This seems to indicate that there is a gender specific bias for the manifestation of this condition as an associated condition with Dupuytren’s and Ledderhose.



The next step here was to drill down into the results, the starting point for this was to determine whether the link was in Dupuytren’s or Ledderhose patients perhaps both. Given this is a condition of the extremities it could be linked to both conditions so it was surprising to see that when the results were limited to the Dupuytren’s population the percentage of women with both increased to 44% whilst in Ledderhose only patients the rate was down the 26% again (note the in the Dupuytren’s group Ledderhose patients were included). On the male side of things there were no patients with Ledderhose and Raynauds whilst 5% of Dupuytren’s patients had the condition.

Clearly the above data appears to indicate that there is a strong link between Raynauds and Dupuytren’s in female patients, a larger study into this could show whether this is just a limitation of this dataset or a true correlation exists. Based on the information I have found on this condition it is not clear to see why it should have a higher occurrence in Dupuytren’s patient or indeed how one could impact the other.  





Plantar Fasciitis:



This is another condition in the plantar fascia, I have covered this previously and as expected we again see an increased incidence in Ledderhose patients.

(See this linked for previous survey, sorry the graphs are broken I will look into this http://ledderhose.blogspot.co.uk/2014/10/association-of-plantar-fasciitis-and.html)

Scoliosis:


On first reading about this condition I was baffled as to how it could have any relationship to Dupuytren’s, however from the links I could find the figure for the general public was around 3% whilst in this mini survey the patients had a 14% chance of having this conditions.


Due to this I did a bit more research and it turns out that one of the genes / proteins (Matrilin) that has been implicated in Scoliosis has a function in the extra-cellular matrix which is one of the key areas from Dupuytren’s. In theory this could a link between the 2, perhaps there is some crossover in the extra cellular pathways that result in the manifestation of the 2 conditions. This is something I would love to have the time to do a bit more research on as looking at pathways at this sort of level is what I used to do. To give me some idea of any potential link I googled Matrilin and looked at the images and lots of structures/pathways appeared showing Collagen.

It has also been found that a lack of Matrilin 2 increases the risk of Liver tumour development, although not cancer both Dupuytren's and Ledderhose do of course have the development of tumours. 



Fuch's Corneal Dystrophy:



This also seems to show an increase, from 0.09% in the public to 2.17% in Dupuytren’s and Ledderhose patients. This is a condition that impacts the eye but I am unable to see how this could be related to Dupuytren’s from the research that I have done.



Sources: