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Yunes MJ. Radiation Therapy for Dupuytren Contracture. Pract Radiat Oncol 2025; 15:248-252. [PMID: 39818682 DOI: 10.1016/j.prro.2024.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 11/28/2024] [Indexed: 01/18/2025]
Affiliation(s)
- Michael J Yunes
- Department of Radiation Oncology, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts.
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Ohmes LB, Ghilzai UM, Netscher DTJ. Update on Dupuytren Disease: Pathogenesis, Natural History, Treatment, and Outcomes. Plast Reconstr Surg 2025; 155:618e-631e. [PMID: 39999238 DOI: 10.1097/prs.0000000000011854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2025]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the current molecular biology of Dupuytren disease. 2. Critically evaluate the functional outcomes of treatment. 3. Confidently use any of the commonly used treatments. 4. Provide patients with appropriately selected treatment choices. SUMMARY Dupuytren disease is a fibroproliferative disease of the palmar fascia that results in debilitating digital contractures. Despite medical advances, the measurement of disease severity, functional deficits, and treatment outcomes remains challenging. Treatment options vary widely, yet practitioners often use only a small number of modalities. These options range from minimally invasive office procedures to extensive surgery, with adjuncts such as radiation and soft-tissue flaps. A thorough understanding of disease pathophysiology and treatment options can help surgeons offer more individualized care for this elusive disease.
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Affiliation(s)
| | | | - David T J Netscher
- From the Department of Orthopedic Surgery
- Division of Plastic Surgery, Baylor College of Medicine
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Pepperday CA, Murthy N, Kakar S, McKenzie GA. Palmar Fibromatosis, Updated Review With Relationship to the A1 Pulley, Trigger Finger, and Presence of the Sonographic Comb Sign. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:2281-2293. [PMID: 39177333 DOI: 10.1002/jum.16560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/30/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES Updated retrospective review of the sonographic appearance of palmar fibromatosis (PF) with evaluation of the utility of the Comb Sign previously described in plantar fibromas. Additional evaluation was conducted on the location relative to the flexor tendon, anatomic proximity of palmar fibromas to the A1 pulley and evaluate any potential association with trigger finger. METHODS Medical record and imaging review was performed from 2017 to 2023, for patients with a new onset ultrasound or clinical diagnosis of PF. Clinical associations and imaging morphology were reviewed including presence of the Comb Sign, fibroma association with the A1 pulley, and fibroma association with trigger finger. RESULTS Exactly 87 total fibromas in 53 patients were evaluated. The Comb Sign was present in 39% of fibromas, usually seen in transverse plane, more prevalent in multifocal disease and larger fibromas. Most (72%) palmar fibromas were within 1 cm of, contacted, or covered the A1 pulley (P < .001). Lateral extension beyond the flexor tendon axis can be seen (44%). Trigger finger and tenosynovitis were rare. However, volume and SI dimension of fibromas were associated with tenosynovitis (P < .0001) and all nine patients with concomitant trigger finger had fibromas within 1 cm from the A1 pulley. CONCLUSIONS The Comb Sign can aid in sonographic diagnosis of PF. Lateral extension of fibromas can occur. Most palmar fibromas have a significant intimate association with the A1 pulley, and presence of trigger finger with adjacent palmar fibroma can exist and is important for hand surgeons to know preoperatively.
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Affiliation(s)
- Cody A Pepperday
- Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naveen Murthy
- Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjeev Kakar
- Department of Orthopedics, Hand Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gavin A McKenzie
- Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Jahn A, Andersen JH, Descatha A, Dalbøge A. Dupuytren's disease and occupational mechanical exposures: a systematic review and meta-analysis. Occup Environ Med 2024; 81:535-542. [PMID: 39317441 DOI: 10.1136/oemed-2024-109649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/06/2024] [Indexed: 09/26/2024]
Abstract
The risk of developing Dupuytren's disease among workers exposed to occupational mechanical exposures has been reported in few systematic reviews, mainly related to vibration. Expanding the investigation to all occupational mechanical exposures is essential for advancing scientific knowledge, health policies and improving workplace safety. The aim of this systematic review and meta-analysis was to study the association between occupational mechanical exposures and Dupuytren's disease.We conducted a systematic review and meta-analysis using guidelines stated by PRISMA. The systematic literature search was performed in Medline, EMBASE, CINAHL, Cochrane Library and Web of Science databases in April 2023. Inclusion criteria were conducted using the PECOS. Two independent authors conducted the literature screening, data extraction and risk of bias assessment. In the meta-analyses, data was pooled using random-effects models and stratified by the risk of bias and study design. The level of evidence was evaluated using GRADE.The literature search identified 563 unique articles and 15 were deemed eligible for inclusion, categorised into hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. Exposure to hand-transmitted vibration showed an OR of 2.0 (95% CI 1.5 to 2.7, I2=64%), lifting/carrying loads had an OR of 1.5 (95% CI 1.1 to 2.0, I2=77%) and combined mechanical exposures had an OR of 2.1 (95% CI 1.4 to 3.1, I2=94%). When grading the level of evidence, we found moderate evidence for hand-transmitted vibration, while low evidence was found for lifting/carrying loads and combined mechanical exposures.We found an association between hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. The level of evidence was considered moderate for hand-transmitted vibration and low for lifting/carrying loads and combined mechanical exposures.
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Affiliation(s)
- Alexander Jahn
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Johan Hviid Andersen
- Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Regional Hospital Goedstrup, Herning, Denmark
- Aarhus University Department of Clinical Medicine, Aarhus, Denmark
| | - Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, CAPTV CDC, Angers, France
- Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Aarhus University Department of Clinical Medicine, Aarhus, Denmark
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Kang Y, Stewart M, Patel M, Furniss D, Wiberg A. Modifiable Risk Factors for Prevention in Dupuytren Disease: A UK Biobank Case-Control Study. Plast Reconstr Surg 2024; 153:363e-372e. [PMID: 37257135 DOI: 10.1097/prs.0000000000010774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Dupuytren disease is associated with significant comorbidity and mortality, and it has no existing prevention strategies. It is unclear which modifiable risk factors are most amenable for prevention. This study aimed to determine the strength of modifiable risk factors for Dupuytren disease, and to investigate associations with other diseases. METHODS Using UK Biobank data, this case-control study analyzed the association between phenotypic variables and Dupuytren disease through multivariable logistic regression. Exposures assessed were age, sex, body mass index, waist-to-hip ratio, Townsend deprivation index, smoking status, alcohol intake, diabetes mellitus, hypertension, cancer, liver disease, respiratory disease, rheumatoid arthritis, epilepsy, psoriasis, and gout. RESULTS There were 4148 cases and 397,425 controls. Male sex (OR, 3.23; 95% CI, 2.90 to 3.60; P = 1.07 × 10 -100 ), increasing age (OR, 1.08; 95% CI, 1.07 to 1.08; P = 6.78 × 10 -167 ), material deprivation (OR, 1.01; 95% CI, 1.00 to 1.02; P = 0.0305), high-density lipoprotein cholesterol (OR, 1.76; 95% CI, 1.58 to 1.96; P = 3.35 × 10 -24 ), smoking exposure, and alcohol intake were all associated with increased odds of Dupuytren disease. With increasing obesity class, there was approximately 25% decreased odds (OR, 0.774; 95% CI, 0.734 to 0.816; P = 4.71 × 10 -21 ). Diabetes with microvascular or end-organ complications was associated with more than 2.5 times increased odds of Dupuytren disease (OR, 2.59; 95% CI, 1.92 to 3.44; P = 1.92 × 10 -10 ). Within this group, increasing hemoglobin A1c values by 10 mmol/mol, or 0.9%, increased the odds by 31% (OR, 1.31; 95% CI, 1.13 to 1.51; P = 2.19 × 10 -4 ). CONCLUSION Diabetes and poor glycemic control are major risk factors for Dupuytren disease, which present an opportunity for prevention. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Youngjoo Kang
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
| | - Max Stewart
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
| | - Manal Patel
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
| | - Dominic Furniss
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital
| | - Akira Wiberg
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital
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Wang Z, Wang Z, Yan Z, Xu Z, Gao A. Smoking, alcohol consumption and risk of Dupuytren's disease: a Mendelian randomization study. BMC Med Genomics 2023; 16:212. [PMID: 37679690 PMCID: PMC10483747 DOI: 10.1186/s12920-023-01650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The correlation between smoking and alcohol consumption and the development of Dupuytren's disease (DD) has been acknowledged. However, the definitive causal relationship between these two factors and DD remains elusive. In order to establish a causal connection, we employed the two-sample Mendelian randomization method to evaluate the relationship between smoking and alcohol consumption and DD. METHODS Based on publicly available genome-wide association studies (GWAS), two-sample univariate MR analyses were performed to assess the causal effects of drinks per week, cigarettes per day, smoking initiation, age of initiation, and smoking cessation on DD. We used inverse variance weighted (IVW) to generate the primary results for the MR analysis. Furthermore, we performed sensitivity MR analyses based on various methods to assess the robustness of estimations. Bidirectional MR analyses were used to study the interaction between smoking and alcohol consumption. Multivariate MR analyses were used to obtain independent causal effects of smoking or drinking on DD. RESULTS Our two-sample MR, which was predominately based on IVW, revealed a causal relationship between drinks per week and DD (OR = 2.948, 95%CI: 1.746-4.975, P = 5.16E-05). In addition, there is no causal association between cigarettes per day, smoking initiation, age of initiation, smoking cessation and DD. Similar conclusions were reached by other MR methods. The results of the bidirectional MR analyses showed that the causal relationships between age of initiation and drinks per week were robust and significant. Multivariate MR results indicated that the causal effect of alcohol consumption on DD was independent of smoking. CONCLUSION Our Mendelian Randomization study indicated that there is a causality between drinking alcohol and DD, but no such causality was found between smoking and DD. This is the first study to prove that drinking alcohol could cause DD. This could help people who are trying to prevent DD from happening in the first place.
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Affiliation(s)
- Zifeng Wang
- Department of Orthopedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214000, China
- Department of Orthopedics, Taicang Shaxi People's Hospital, Taicang, 215400, China
| | - Zhenyu Wang
- Department of Orthopedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214000, China
| | - Zijian Yan
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zhujie Xu
- Department of Orthopedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214000, China.
| | - Aiguo Gao
- Department of Orthopedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214000, China.
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Lambi AG, Morrell NT, Popoff SN, Benhaim P, Barbe MF. Let's Focus on the Fibrosis in Dupuytren Disease: Cell Communication Network Factor 2 as a Novel Target. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:682-688. [PMID: 37790821 PMCID: PMC10543811 DOI: 10.1016/j.jhsg.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 10/05/2023] Open
Abstract
Dupuytren disease is a progressive, benign fibroproliferative disorder of the hands that can lead to debilitating hand contractures. Once symptomatic, treatment involves either surgical intervention, specifically fasciectomy or percutaneous needle aponeurotomy, or enzymatic degradation with clostridial collagenase. Currently, collagenase is the only pharmacotherapy that has been approved for the treatment of Dupuytren contracture. There is a need for a pharmacotherapeutic that can be administered to limit disease progression and prevent recurrence after treatment. Targeting the underlying fibrotic pathophysiology is critical. We propose a novel target to be considered in Dupuytren disease-cell communication network factor 2/connective tissue growth factor-an established mediator of musculoskeletal tissue fibrosis.
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Affiliation(s)
- Alex G. Lambi
- Department of Orthopedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM
- Department of Surgery Division of Plastic Surgery, University of New Mexico School of Medicine, Albuquerque, NM
- Department of Surgery Plastic Surgery Section, New Mexico Veterans Affairs Health Science Center, Albuquerque, NM
| | - Nathan T. Morrell
- Department of Orthopedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM
| | - Steven N. Popoff
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
- Department of Orthopaedic Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Prosper Benhaim
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
| | - Mary F. Barbe
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
- Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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Putnam J. Advanced Dupuytren Contracture: Approach to Management. Hand Clin 2023; 39:455-463. [PMID: 37453772 DOI: 10.1016/j.hcl.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Dupuytren disease is a common pathologic condition that can be especially challenging to hand surgeons in recurrent or severe contractures. Recurrence risk may be reduced with a variety of techniques, including skin grafting, external fixator application, radiation, and many others described in this article. Management of recurrence requires special attention to anatomy at risk. Adjuvant therapy may help to prevent the progression or recurrence of severe disease.
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Affiliation(s)
- Jill Putnam
- The Hand and Upper Extremity Center, The Ohio State University, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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Lambi AG, Popoff SN, Benhaim P, Barbe MF. Pharmacotherapies in Dupuytren Disease: Current and Novel Strategies. J Hand Surg Am 2023; 48:810-821. [PMID: 36935324 PMCID: PMC10440226 DOI: 10.1016/j.jhsa.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/27/2022] [Accepted: 02/06/2023] [Indexed: 03/21/2023]
Abstract
Dupuytren disease is a benign, progressive fibroproliferative disorder of the hands. To date, only one pharmacotherapy (clostridial collagenase) has been approved for use in Dupuytren disease. There is a great need for additional nonsurgical methods that can be used to either avoid the risks of invasive treatments or help minimize recurrence rates following treatment. A number of nonsurgical modalities have been discussed in the past and continue to appear in discussions among hand surgeons, despite highly variable and often poor or no long-term clinical data. This article reviews many of the pharmacotherapies discussed in the treatment of Dupuytren disease and novel therapies used in inflammation and fibrosis that offer potential treatment options.
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Affiliation(s)
- Alex G Lambi
- Department of Orthopedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Steven N Popoff
- Department of Orthopaedic Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Prosper Benhaim
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
| | - Mary F Barbe
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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Samulenas G, Insodaite R, Kunceviciene E, Poceviciute R, Masionyte L, Zitkeviciute U, Pilipaityte L, Smalinskiene A. The Role of Functional Polymorphisms in the Extracellular Matrix Modulation-Related Genes on Dupuytren's Contracture. Genes (Basel) 2022; 13:743. [PMID: 35627129 PMCID: PMC9141853 DOI: 10.3390/genes13050743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: genetic variations, localized in the functional regions of the extracellular matrix (ECM) modulation-related genes, may alter the transcription process and impact the Dupuytren's contracture (DC). The present study investigated the association of single nucleotide polymorphisms (SNPs), localized in the functional regions of the MMP8, MMP14, and CHST6 genes, with DC risk. (2) Methods: we enrolled 219 genomic DNA samples, which were extracted from 116 patients with DC and 103 healthy controls. Genotyping of selected SNPs was performed using TaqMan single nucleotide polymorphisms genotyping assay. Three polymorphisms (MMP8 rs11225395, MMP14 rs1042704, and CHST6 rs977987) were analyzed. All studied SNPs were in Hardy-Weinberg equilibrium. (3) Results: significant associations of the studied SNPs with the previous onset of the disease were observed between the CHST6 rs977987 minor T allele (p = 0.036) and the MMP14 rs1042704 mutant AA genotype (p = 0.024). Significant associations with the previous onset of the disease were also observed with a positive family history of the DC (p = 0.035). Moreover, risk factor analysis revealed that a combination of major disease risk factors (smoking and manual labor) and the MMP14 minor A allele increases the risk of DC development by fourteen times (p = 0.010). (4) Conclusions: our findings suggest that CHST6 rs977987, MMP14 rs1042704, and positive family history are associated with the previous onset of Dupuytren's contracture. In addition, the combination of the MMP14 minor A allele and additional risk factors increase the likelihood of the manifestation of the DC.
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Affiliation(s)
- Gediminas Samulenas
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, LT 50009 Kaunas, Lithuania; (G.S.); (L.P.)
| | - Ruta Insodaite
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
| | - Edita Kunceviciene
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
| | - Roberta Poceviciute
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
| | - Lorena Masionyte
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
| | - Urte Zitkeviciute
- Faculty of Medicine, Lithuanian University of Health Sciences, LT 44307 Kaunas, Lithuania;
| | - Loreta Pilipaityte
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, LT 50009 Kaunas, Lithuania; (G.S.); (L.P.)
| | - Alina Smalinskiene
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
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Affiliation(s)
- Marta Karbowiak
- Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
| | | | | | - Arvind Mohan
- Croydon Health Services NHS Trust, Croydon CR7 7YE, UK
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Gelbard MK, Rosenbloom J. Fibroproliferative disorders and diabetes: Understanding the pathophysiologic relationship between Peyronie's disease, Dupuytren disease and diabetes. Endocrinol Diabetes Metab 2021; 4:e00195. [PMID: 33855203 PMCID: PMC8029506 DOI: 10.1002/edm2.195] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Fibrosis is characterized by dysregulation and accumulation of extracellular matrix. Peyronie's disease and Dupuytren disease are fibroproliferative disorders of the tunica albuginea of the penis and fascia of the hand, respectively. Chronic hyperglycaemia due to diabetes mellitus can also lead to tissue injury and fibrosis. A meta-analysis has shown a relationship between Dupuytren disease and diabetes (overall odds ratio, 3.1; 95% confidence interval, 2.7-3.5). This review explores commonalities in the pathogenesis of Peyronie's disease, Dupuytren disease and diabetes. Methods A search of the PubMed database was conducted using the search terms "diabetes" AND "Peyronie's disease"; and "diabetes" AND "Dupuytren." Results Genome-wide association and gene expression studies conducted with tissue from people with Peyronie's disease or Dupuytren disease identified signalling pathways associated with wingless-type mammary-tumour virus integration site signalling, extracellular matrix modulation and inflammation. Biochemical studies confirmed the importance of these pathways in the pathogenesis of fibrosis with Peyronie's disease and Dupuytren disease. Dysregulation of matrix metalloproteinase activity associated with extracellular matrix breakdown was implicated in fibroproliferative complications of diabetes and in the aetiology of Peyronie's disease and Dupuytren disease. A notable percentage of people with diabetes have comorbid Peyronie's disease and/or Dupuytren disease. Conclusions Studies have not been performed to identify fibroproliferative pathways that all 3 conditions might have in common, but data suggest that common pathways are involved in the fibroproliferative processes of Peyronie's disease, Dupuytren disease, and diabetes.
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Affiliation(s)
- Martin K. Gelbard
- Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Joel Rosenbloom
- Department of Dermatology and Cutaneous BiologyThe Joan and Joel Rosenbloom Research Center for Fibrotic DiseasesSidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPAUSA
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Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren's disease an occupational illness? Occup Med (Lond) 2021; 71:28-33. [PMID: 33420499 DOI: 10.1093/occmed/kqaa211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is growing evidence for the risk of Dupuytren's disease (DD) from occupational exposure. For workers exposed to hand-transmitted vibrations (HTVs) and heavy manual work (HMW) who develop the disease, the inclusion of DD in hand-arm vibration syndrome and diseases of skeletal muscle overload could be beneficial for compensation purposes. AIMS To assess the risk of DD in workers exposed to HTVs and HMW, and to evaluate the length of exposure times that may significantly affect the development of DD. METHODS This study included male workers in Košice, Slovak Republic. Participants were divided into three groups: those exposed to HTVs, those exposed to HMW and controls. We evaluated the association between DD and HTVs, HMW, cardiovascular diseases, metabolic diseases, epilepsy, smoking and alcohol consumption for all groups. We also compared the length of exposure time to HTV and HMW between workers with and without DD. RESULTS The sample was comprised of 515 men, with 13% suffering from DD. Significant associations were found between DD and HTVs (OR 4.59 [95% CI 2.05-10.32]) and HMV (OR 3.10 [95% CI 1.21-7.91]). Highly significant associations were found between DD and older ages and alcohol consumption as well. No associations were found for the other variables. Exposure times greater than 15 years significantly increased the risk for DD (P < 0.01). CONCLUSIONS This study confirms a significant association between DD and both HTVs and HMW after long exposures. We suggest that DD should be considered as an occupational disease.
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Affiliation(s)
- L Murínová
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Safarik University and the L. Pasteur University Hospital, Kosice, Slovak Republic
| | - S Perečinský
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Safarik University and the L. Pasteur University Hospital, Kosice, Slovak Republic
| | - A Jančová
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Safarik University and the L. Pasteur University Hospital, Kosice, Slovak Republic
| | - P Murín
- Department of Cardiology, East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Kosice, Slovak Republic
| | - Ľ Legáth
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Safarik University and the L. Pasteur University Hospital, Kosice, Slovak Republic
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Salari N, Heydari M, Hassanabadi M, Kazeminia M, Farshchian N, Niaparast M, Solaymaninasab Y, Mohammadi M, Shohaimi S, Daneshkhah A. The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis. J Orthop Surg Res 2020; 15:495. [PMID: 33115483 PMCID: PMC7594412 DOI: 10.1186/s13018-020-01999-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background The Dupuytren disease is a benign fibroproliferative disorder that leads to the formation of the collagen knots and fibres in the palmar fascia. The previous studies reveal different levels of Dupuytren’s prevalence worldwide; hence, this study uses meta-analysis to approximate the prevalence of Dupuytren globally. Methods In this study, systematic review and meta-analysis have been conducted on the previous studies focused on the prevalence of the Dupuytren disease. The search keywords were Prevalence, Prevalent, Epidemiology, Dupuytren Contracture, Dupuytren and Incidence. Subsequently, SID, MagIran, ScienceDirect, Embase, Scopus, PubMed and Web of Science databases and Google Scholar search engine were searched without a lower time limit and until June 2020. In order to analyse reliable studies, the stochastic effects model was used and the I2 index was applied to test the heterogeneity of the selected studies. Data analysis was performed within the Comprehensive Meta-Analysis Software version 2.0. Results By evaluating 85 studies (10 in Asia, 56 in Europe, 2 in Africa and 17 studies in America) with a total sample size of 6628506 individuals, the prevalence of Dupuytren disease in the world is found as 8.2% (95% CI 5.7–11.7%). The highest prevalence rate is reported in Africa with 17.2% (95% CI 13–22.3%). According to the subgroup analysis, in terms of underlying diseases, the highest prevalence was obtained in patients with type 1 diabetes with 34.1% (95% CI 25–44.6%). The results of meta-regression revealed a decreasing trend in the prevalence of Dupuytren disease by increasing the sample size and the research year (P < 0.05). Conclusion The results of this study show that the prevalence of Dupuytren disease is particularly higher in alcoholic patients with diabetes. Therefore, the officials of the World Health Organization should design measures for the prevention and treatment of this disease.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Hassanabadi
- Lecturer in International Business & Strategy, Faculty of Business & Law, University of Northampton, Northampton, UK
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nikzad Farshchian
- Department of Otolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Yousef Solaymaninasab
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Alireza Daneshkhah
- School of Computing, Electronics and Maths, Coventry University, London, UK
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15
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Abstract
BACKGROUND Dupuytren's disease is a common complex disease caused by genetic and nongenetic factors. The role of many nongenetic risk factors is still unclear and debatable. This study aimed to systematically review the association between Dupuytren's disease and nongenetic risk factors. METHODS A search strategy was developed based on the Population, Exposure, Comparison, Outcomes and Study framework. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature search was conducted in MEDLINE, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to November of 2018. Title and abstract and then full-text screening against eligibility criteria was performed independently by two reviewers, and consensus was achieved by a third reviewer. The Effective Public Health Practice Project and the Oxford Centre for Evidence Based Medicine tools were used to assess study quality and to evaluate the level of evidence of included studies, respectively. RESULTS Reviewers identified 4434 studies, of which 54 were included in the analysis. There was strong evidence for the association between Dupuytren's disease and advanced age, male sex, family history of Dupuytren's disease, and diabetes mellitus. Furthermore, heavy alcohol drinking, cigarette smoking, and manual work exposure showed a significant dose-response relationship. The quality of the included studies was mainly low or moderate, and most studies were level 3 or 4 on the Oxford Centre for Evidence Based Medicine scale. CONCLUSIONS The study results show a strong association between Dupuytren's disease and advanced age, male sex, family history of Dupuytren's disease, diabetes mellitus, heavy alcohol drinking, cigarette smoking, and manual work exposure. Further studies are required to explain the causal relationship of these associations.
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Stirling PHC, Jenkins PJ, McEachan JE. Previous vibration exposure in patients undergoing surgical treatment of Dupuytren's contracture. J Hand Surg Eur Vol 2020; 45:525-527. [PMID: 32000568 DOI: 10.1177/1753193420903675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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17
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A Review on Ergonomics in Agriculture. Part II: Mechanized Operations. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10103484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Musculoskeletal disorders (MSDs) have long been recognized as the most common risks that operation of agricultural machineries poses, thus, undermining the ability to labor and quality of life. The purpose of this investigation was to thoroughly review the recent scholarly literature on ergonomics in agricultural mechanized operations; Methods: Electronic database research over the last ten years was conducted based on specific inclusion criteria. Furthermore, an assessment of the methodological quality and strength of evidence of potential risk factors causing MSDs was performed; Results: The results demonstrated that ergonomics in agriculture is an interdisciplinary topic and concerns both developed and developing countries. The machines with driving seats seem to be associated with painful disorders of the low back, while handheld machines with disorders of the upper extremities. The main roots of these disorders are the whole-body vibration (WBV) and hand-arm transmitted vibration (HATV). However, personal characteristics, awkward postures, mechanical shocks and seat discomfort were also recognized to cause MSDs; Conclusions: The present ergonomic interventions aim mainly at damping of vibrations and improving the comfort of operator. Nevertheless, more collaborative efforts among physicians, ergonomists, engineers and manufacturers are required in terms of both creating new ergonomic technologies and increasing the awareness of workers for the involved risk factors.
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18
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Jung J, Kim GW, Lee B, Joo JWJ, Jang W. Integrative genomic and transcriptomic analysis of genetic markers in Dupuytren's disease. BMC Med Genomics 2019; 12:98. [PMID: 31296227 PMCID: PMC6624179 DOI: 10.1186/s12920-019-0518-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Dupuytren’s disease (DD) is a fibroproliferative disorder characterized by thickening and contracting palmar fascia. The exact pathogenesis of DD remains unknown. Results In this study, we identified co-expressed gene set (DD signature) consisting of 753 genes via weighted gene co-expression network analysis. To confirm the robustness of DD signature, module enrichment analysis and meta-analysis were performed. Moreover, this signature effectively classified DD disease samples. The DD signature were significantly enriched in unfolded protein response (UPR) related to endoplasmic reticulum (ER) stress. Next, we conducted multiple-phenotype regression analysis to identify trans-regulatory hotspots regulating expression levels of DD signature using Genotype-Tissue Expression data. Finally, 10 trans-regulatory hotspots and 16 eGenes genes that are significantly associated with at least one cis-eQTL were identified. Conclusions Among these eGenes, major histocompatibility complex class II genes and ZFP57 zinc finger protein were closely related to ER stress and UPR, suggesting that these genetic markers might be potential therapeutic targets for DD. Electronic supplementary material The online version of this article (10.1186/s12920-019-0518-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Junghyun Jung
- Department of Life science, Dongguk University-Seoul, Seoul, 04620, Republic of Korea
| | - Go Woon Kim
- Department of Pharmacology, College of Pharmacy, Kyung Hee University, 26 Kyungheedae-ro, Seoul, 02447, South Korea
| | - Byungjo Lee
- Department of Life science, Dongguk University-Seoul, Seoul, 04620, Republic of Korea
| | - Jong Wha J Joo
- Department of Computer Science and Engineering, Dongguk University-Seoul, Seoul, 04620, South Korea.
| | - Wonhee Jang
- Department of Life science, Dongguk University-Seoul, Seoul, 04620, Republic of Korea.
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19
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Sakai A, Zenke Y, Menuki K, Yamanaka Y, Tajima T, Uchida S. Current Smoking Is Associated with Delayed Wound Healing But Not with Improvement of Contracture after the Open Palm Technique for Dupuytren's Disease. J Hand Surg Asian Pac Vol 2019; 24:65-71. [PMID: 30760148 DOI: 10.1142/s2424835519500127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Some cases treated with open palm technique need relatively long wound healing time. This study aims to clarify whether the preoperative lifestyle-related diseases or factors are associated with surgical results after the open palm technique for Dupuytren's contracture. METHODS The study included 122 fingers of 84 hands of 84 consecutive male patients with Dupuytren's contracture who were treated with McCash's open palm technique at our hospital from 1980 to 2016. The average age of the patients was 68.0 years (range, 39-86). The follow-up period was at least 6 months (average, 36.3 months). Using multiple regression analysis, we investigated preoperative factors associated with surgical results. The factors examined were age, affected side, contracture of the little finger, number of contracted fingers, contracture of the proximal interphalangeal (PIP) joint, Meyerding classification, diabetes mellitus, hypertension, alcohol intake, and smoking. Surgical results were judged at 6 months after surgery and wound healing time was evaluated. RESULTS According to Tubiana's criteria, there were 59 excellent hands (70.2%), 18 good hands (21.4%), 5 fair hands (6.0%), and 2 poor hands (2.4%) at the final physical examination after surgery. The average of the percentage of improvement in contracture was 86.1%. The average number of days needed until complete open wound closure was 22.9 days. Multiple regression analysis revealed that the significant preoperative factors associated with the percentage of improvement in contracture were multiple contracted fingers and involvement of PIP joint contracture, and that the factor associated with delayed wound healing was current smoking. CONCLUSIONS Multiple contracted fingers and involvement of PIP joint contracture are associated with insufficient improvement of joint contracture. Current smoking is associated with delayed wound healing, but not with improvement of joint contracture, after the open palm technique for Dupuytren's disease in men.
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Affiliation(s)
- Akinori Sakai
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yukichi Zenke
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kunitaka Menuki
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiaki Yamanaka
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takafumi Tajima
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- † Department of Orthopaedic Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
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20
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A Systematic Review and Meta-Analysis on the Strength and Consistency of the Associations between Dupuytren Disease and Diabetes Mellitus, Liver Disease, and Epilepsy. Plast Reconstr Surg 2018; 141:367e-379e. [PMID: 29481401 PMCID: PMC5841852 DOI: 10.1097/prs.0000000000004120] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The role of diabetes mellitus, liver disease, and epilepsy as risk factors for Dupuytren disease remains unclear. In this systematic review and meta-analysis, the strength and consistency of these associations were examined. Methods: The MEDLINE, EMBASE, and Web of Science databases were searched for articles reporting an association between Dupuytren disease and diabetes mellitus, liver disease, and epilepsy published before September 26, 2016. The frequencies of Dupuytren disease and diabetes mellitus, liver disease, and epilepsy were extracted, as was information on potential confounders. Generalized linear mixed models were applied to estimate pooled odds ratios, adjusted for confounders. Heterogeneity between studies was quantified using an intraclass correlation coefficient and was accounted for by a random effect for study. Results: One thousand two hundred sixty unique studies were identified, of which 32 were used in the meta-analyses. An association between Dupuytren disease and diabetes mellitus was observed (OR, 3.06; 95 percent CI, 2.69 to 3.48, adjusted for age), which was stronger for type 1 diabetes mellitus than for type 2 diabetes mellitus but was not statistically significant (p = 0.24). An association between Dupuytren disease and liver disease was observed (OR, 2.92; 95 percent CI, 2.08 to 4.12, adjusted for sex). Dupuytren disease and epilepsy were associated, yielding an OR of 2.80 (95 percent CI, 2.49 to 3.15). Heterogeneity between studies was moderate to low. Conclusions: These findings demonstrate an association between Dupuytren disease and diabetes mellitus, liver disease, and epilepsy. Prospective, longitudinal studies are needed to elucidate the pathways causing these associations.
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21
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Matsui Y, Kon S, Funakoshi T, Miyashita T, Matsuda T, Iwasaki N. Increased expression of αv integrin as a regulator of fibrosis in Dupuytren's nodules. J Hand Surg Eur Vol 2017; 42:18-25. [PMID: 26969686 DOI: 10.1177/1753193416635489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Although Dupuytren's contracture is characterized by increased transforming growth factor-β1 (TGF-β1) and fibrosis in the palmar fascia, the relationship between TGF-β1 and integrins, which are considered to be related to fibrosis, remains unclear. We investigated the involvement of TGF-β1 and integrins in the pathological palmar fascia of Dupuytren's contracture. Seven patients underwent partial fasciectomy for treatment of this disease. The nodule and cord were isolated from the fascial tissues of the patients. Control fasciae were obtained from seven patients with carpal tunnel syndrome. Immunohistochemical analysis was performed to detect the fibrosis marker α-smooth muscle actin and integrins in the fascial tissues. The expression of TGF-β1 and integrins was assessed by real-time polymerase chain reaction. The results suggest that nodules may be areas involved in activation of fibrosis in the fascia, associated with increased expression of TGF-β1 and αv integrin. Thus, αv integrin may contribute to fibrosis in Dupuytren's contracture by activating TGF-β1. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Y Matsui
- 1 Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Kon
- 2 Department of Immunology, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - T Funakoshi
- 1 Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Miyashita
- 2 Department of Immunology, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - T Matsuda
- 2 Department of Immunology, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - N Iwasaki
- 1 Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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22
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Broekstra DC, van den Heuvel ER, Lanting R, Harder T, Smits I, Werker PMN. Dupuytren disease is highly prevalent in male field hockey players aged over 60 years. Br J Sports Med 2016; 52:1327-1331. [PMID: 27660370 DOI: 10.1136/bjsports-2016-096236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Dupuytren disease is a fibroproliferative hand condition. The role of exposure to vibration as a risk factor has been studied with contradictory results. Since field hockey is expected to be a strong source of hand-arm vibration, we hypothesised that long-term exposure to field hockey is associated with Dupuytren disease. METHODS In this cross-sectional cohort study, the hands of 169 male field hockey players (IQR: 65-71 years) and 156 male controls (IQR: 59-71 years) were examined for signs of Dupuytren disease. Details about their age, lifestyle factors, medical history, employment history and leisure activities were gathered. Prior to the analyses, the groups were balanced in risk factors using propensity score matching. The association between field hockey and Dupuytren disease was determined using a subject-specific generalised linear mixed model with a binomial distribution and logit link function (matched pairs analysis). RESULTS Dupuytren disease was observed in 51.7% of the field hockey players, and in 13.8% of the controls. After propensity score matching, field hockey playing as dichotomous variable, was associated with Dupuytren disease (OR=9.42, 95% CI 3.01 to 29.53). A linear dose-response effect of field hockey (hours/week x years) within the field hockey players could not be demonstrated (OR=1.03, 95% CI 0.68 to 1.56). DISCUSSION We found that field hockey playing has a strong association with the presence of Dupuytren disease. Clinicians in sports medicine should be alert to this less common diagnosis in this sport.
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Affiliation(s)
- Dieuwke C Broekstra
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edwin R van den Heuvel
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rosanne Lanting
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Surgery, Martini Hospital, Groningen, The Netherlands
| | - Tom Harder
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Emergency Medicine, Ommelander Hospital, Winschoten, The Netherlands
| | - Inge Smits
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Plastic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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23
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Smeraglia F, Del Buono A, Maffulli N. Collagenase clostridium histolyticum in Dupuytren's contracture: a systematic review. Br Med Bull 2016; 118:149-58. [PMID: 27151958 PMCID: PMC5127428 DOI: 10.1093/bmb/ldw020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In the last few years, the use of collagenase clostridium histolyticum for management of Dupuytren's contracture has increased. The procedure of enzymatic fasciectomy has become popular because it is non-invasive, safe and fast to perform. SOURCES OF DATA A systematic search was performed on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'Dupuytren collagenase' and 'Dupuytren clostridium histolyticum'. Forty-three studies were identified. The quality of the studies was assessed using the Coleman Methodological Score. AREAS OF AGREEMENT The use of collagenase clostridium histolyticum provides better outcomes in patients with mild-moderate joint contracture, with lower complications and side effects than open fasciectomy. Manipulation can be performed 2-7 days after the injection. The use of collagenase is cost-effective. AREAS OF CONTROVERSY Most of the studies did not report patient-related outcomes. The role of dynamic splint has to be investigated with randomized clinical trials. GROWING POINTS The shorter recovery time and the low incidence of serious or major adverse effects are the main advantages of this new technology. AREAS TIMELY FOR DEVELOPING RESEARCH There is a need to perform studies with longer follow-up because the recurrence rate seems to increase with time. Further investigations are necessary to assess whether it is safe and effective to inject two or more cords at the same time.
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Affiliation(s)
- Francesco Smeraglia
- Department of Orthopaedic Surgery, 'Federico II' University of Naples, Naples, Italy
| | - Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Ospedale Vaio Fidenza(PR), Fidenza, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84081 Baronissi, Salerno, Italy Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentirstry, Mile End Hospital, 275 Bancroft Road, London E1 4 DG, UK
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24
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Mayerl C, Del Frari B, Parson W, Boeck G, Piza-Katzer H, Wick G, Wolfram D. Characterisation of the inflammatory response in Dupuytren's disease. J Plast Surg Hand Surg 2016; 50:171-9. [PMID: 26852784 DOI: 10.3109/2000656x.2016.1140054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Dupuytren's disease is characterised by fibrotic nodule and cord formation in the palmar aponeurosis. The pathophysiology of the disease is still unknown, although cell stress and subsequent activation of immune mechanisms seems to be crucial. MATERIALS AND METHODS Surgically obtained tissue and blood samples of 100 Dupuytren patients were processed by immunohistochemistry, flow cytometry, as well as immunoscope analysis. Macroscopically normal aponeurotic tissue served as control. RESULTS Locally, microvascular alterations and massive infiltration by mononuclear cells (CD3+, CD4 > CD8, CD45RO > CD45RA, S100 protein, CD56, CD68, scarce CD19 and mast cells) forming perivascular clusters were found in DD tissue. Cytokine profiling of fibromatosis tissue-derived T-cells showed a Th1/TH17-weighted immune response. Immunoscope analysis revealed a restricted T-cell receptor α/β repertoire pointing to an (auto)antigen-driven process. CONCLUSION The striking accumulation of immune cells, expression of leukocyte adhesion molecules, as well as pro-inflammatory and pro-fibrotic cytokines near markedly narrowed vessels supports the theory that the abnormal proliferation of fibroblasts and production of extracellular matrix proteins in DD seems to be related to immune-mediated microvascular damage. The restricted T-cell receptor repertoire of intra-lesional T-cells points to an antigen-driven process. T-cells seem to play an important role in the development of Dupuytren's disease.
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Affiliation(s)
- Christina Mayerl
- a Laboratory of Autoimmunity, Division of Experimental Pathophysiology and Immunology, Biocenter , Medical University of Innsbruck , Innsbruck , Austria .,b Department of Internal Medicine III - Cardiology and Angiology , Medical University of Innsbruck , Innsbruck , Austria
| | - Barbara Del Frari
- c Department of Plastic, Reconstructive and Aesthetic Surgery , Medical University of Innsbruck , Innsbruck , Austria , and
| | - Walther Parson
- d Institute of Legal Medicine , Medical University of Innsbruck , Innsbruck , Austria
| | - Guenther Boeck
- a Laboratory of Autoimmunity, Division of Experimental Pathophysiology and Immunology, Biocenter , Medical University of Innsbruck , Innsbruck , Austria
| | - Hildegunde Piza-Katzer
- c Department of Plastic, Reconstructive and Aesthetic Surgery , Medical University of Innsbruck , Innsbruck , Austria , and
| | - Georg Wick
- a Laboratory of Autoimmunity, Division of Experimental Pathophysiology and Immunology, Biocenter , Medical University of Innsbruck , Innsbruck , Austria
| | - Dolores Wolfram
- c Department of Plastic, Reconstructive and Aesthetic Surgery , Medical University of Innsbruck , Innsbruck , Austria , and
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25
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Nunn AC, Schreuder FB. Dupuytren's contracture: emerging insight into a Viking disease. ACTA ACUST UNITED AC 2015; 19:481-90. [PMID: 25288296 DOI: 10.1142/s0218810414300058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dupuytren's disease is a fibroproliferative condition of the palm, with a predilection for men, which has affected Northern Europeans since the Viking conquests. Although strongly heritable, clear evidence exists for environmental factors that modify the underlying genetic risk, such as diabetes, heavy drinking, and smoking. Evidence also exists for epilepsy (probably due to treatment with certain anti-epileptic drugs), and Human Immunodeficiency Virus infection. Recent large studies have shown no relationship with manual labour or vibrating tools. Two theories have emerged regarding the pathogenic mechanism: the first attributes the aberrant healing process that characterises Dupuytren's to free radicals, generated as a result of microangiopathy, whereas the second cites a genetic tendency toward apoptosis-resistant myofibroblasts. Despite only one study demonstrating linkage, emerging data from genome-wide association studies highlight a series of single nucleotide polymorphisms near members of the Wnt signalling pathway, and transcriptional profiling studies have consistently identified certain components of the extracellular matrix.
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Affiliation(s)
- Adam C Nunn
- Department of Older People's Medicine, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
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26
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Abstract
Occupational exposures to vibration come in many guises, and they are very common at a population level. It follows that an important minority of working-aged patients seen by medical services will have been exposed to this hazard of employment. Vibration can cause human health effects, which may manifest in the patients that rheumatologists see. In this chapter, we identify the health effects of relevance to them, and review their epidemiology, pathophysiology, clinical presentation, differential diagnosis and vocational and clinical management. On either side of this, we describe the nature and assessment of the hazard, the scale and common patterns of exposure to vibration in the community and the legal basis for controlling health risks, and we comment on the role of health surveillance in detecting early adverse effects and what can be done to prevent the rheumatic effects of vibration at work.
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Affiliation(s)
- Keith T Palmer
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, ARUK-MRC Centre for Work and Musculoskeletal Heath, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Massimo Bovenzi
- Clinical Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste 34100, Italy.
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Wukich DK. Diabetes and its negative impact on outcomes in orthopaedic surgery. World J Orthop 2015; 6:331-339. [PMID: 25893176 PMCID: PMC4390895 DOI: 10.5312/wjo.v6.i3.331] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/21/2014] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
An estimated 285 million adults (aged 20-79 years) worldwide were diagnosed to have diabetes mellitus (DM) in 2010, and this number is projected to grow to 439 million adults by the year 2030. Orthopaedic surgeons, regardless of their subspecialty interest, will encounter patients with DM during their career since this epidemic involves both developed and emerging countries. Diabetes results in complications affecting multiple organ systems, potentially resulting in adverse outcomes after orthopaedic surgery. The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients. Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle, upper extremity, adult reconstructive, pediatrics, spine surgery and sports medicine. Poorly controlled diabetes negatively impacts bone, soft tissue, ligament and tendon healing. It is the complications of diabetes such as neuropathy, peripheral artery disease, and end stage renal disease which contributes to adverse outcomes. Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes. Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control.
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Larsen S, Krogsgaard DG, Larsen LA, Iachina M, Skytthe A, Frederiksen H. Genetic and environmental influences in Dupuytren's disease: a study of 30,330 Danish twin pairs. J Hand Surg Eur Vol 2015; 40:171-6. [PMID: 24835475 PMCID: PMC4810018 DOI: 10.1177/1753193414535720] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We aimed to assess the relative contribution of genes and environment in the aetiology of Dupuytren's disease by studying Danish twins born between 1870 and 2000. Twins with a diagnosis (n = 365) and the subgroup who also had an operation (n = 259) after 1977 were identified through linkage with a nationwide hospital registry among 30,330 monozygotic and same-sexed dizygotic twin pairs. Since monozygotic twins share all their genes and dizygotic twins share on average half of their genetic material, greater phenotypic similarity is expected in monozygotic than in dizygotic twins if a genetic component is involved. The number of concordant male twin pairs with Dupuytren's disease was 17 and 7 (monozygotic and dizygotic pairs, respectively), compared with 60 and 174 discordant monozygotic and dizygotic pairs, yielding probandwise concordance rates of 0.37 (95% confidence interval (CI): 0.26 to 0.50) and 0.07 (95% CI: 0.04 to 0.14), respectively. The heritability of Dupuytren's disease was approximately 80%. We conclude that genetic factors play a major role in the development of Dupuytren's disease.
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Affiliation(s)
- S. Larsen
- Department of Orthopaedics, Odense University Hospital, Odense, Denmark
| | - D. G. Krogsgaard
- Department of Orthopaedics, Odense University Hospital, Odense, Denmark
| | - L. Aagaard Larsen
- The Danish Twin Registry, Epidemiology Unit, University of Southern Denmark, Denmark
| | - M. Iachina
- The Danish Twin Registry, Epidemiology Unit, University of Southern Denmark, Denmark
| | - A. Skytthe
- The Danish Twin Registry, Epidemiology Unit, University of Southern Denmark, Denmark
| | - H. Frederiksen
- Department of Haematology, Odense University Hospital, Odense, Denmark
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Zirbs M, Anzeneder T, Bruckbauer H, Hofmann H, Brockow K, Ring J, Eberlein B. Radiotherapy with soft X-rays in Dupuytren's disease - successful, well-tolerated and satisfying. J Eur Acad Dermatol Venereol 2014; 29:904-11. [DOI: 10.1111/jdv.12711] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 07/21/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. Zirbs
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar; Technische Universität München; Munich Germany
- Christine Kühne Center for Allergy Research and Education (CK-CARE); München, Munich Germany
| | - T. Anzeneder
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | | | - H. Hofmann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - K. Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - J. Ring
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar; Technische Universität München; Munich Germany
- Christine Kühne Center for Allergy Research and Education (CK-CARE); München, Munich Germany
| | - B. Eberlein
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar; Technische Universität München; Munich Germany
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Analysis of Efficacy and Safety of Treatment With Collagenase Clostridium histolyticum Among Subgroups of Patients With Dupuytren Contracture. Ann Plast Surg 2014; 73:286-90. [DOI: 10.1097/sap.0b013e31827ae9d0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Becker K, Tinschert S, Lienert A, Bleuler PE, Staub F, Meinel A, Rößler J, Wach W, Hoffmann R, Kühnel F, Damert HG, Nick HE, Spicher R, Lenze W, Langer M, Nürnberg P, Hennies HC. The importance of genetic susceptibility in Dupuytren's disease. Clin Genet 2014; 87:483-7. [PMID: 24749973 DOI: 10.1111/cge.12410] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
Dupuytren's disease (DD) is a progressive fibromatosis that causes the formation of nodules and cords in the palmar aponeurosis leading to flexion contracture of affected fingers. The etiopathogenesis is multifactorial with a strong genetic predisposition. It is the most frequent genetic disorder of connective tissues. We have collected clinical data from 736 unrelated individuals with DD who underwent surgical treatment from Germany and Switzerland. We evaluated a standardised questionnaire, assessed the importance of different risk factors and compared subgroups with and without positive family history. We found that family history clearly had the strongest influence on the age at first surgery compared to environmental factors, followed by male sex. Participants with a positive family history were on average 55.9 years of age at the first surgical intervention, 5.2 years younger than probands without known family history (p = 6.7 × 10(-8) ). The percentage of familial cases decreased with age of onset from 55% in the 40-49 years old to 17% at age 80 years or older. Further risk factors analysed were cigarettes, alcohol, diabetes, hypertension, and epilepsy. Our data pinpoint the importance of genetic susceptibility for DD, which has long been underestimated.
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Affiliation(s)
- K Becker
- Cologne Center for Genomics; Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases, University of Cologne, Cologne, Germany
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A systematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries. Plast Reconstr Surg 2014; 133:593-603. [PMID: 24263394 DOI: 10.1097/01.prs.0000438455.37604.0f] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dupuytren disease is a fibroproliferative disease of palmar fascia of the hand. Its prevalence has been the subject of several reviews; however, an accurate description of the prevalence range in the general population--and of the relation between age and disease--is lacking. METHODS Embase and PubMed were searched using database-specific Medical Subject Headings; titles and abstracts were searched for the words "Dupuytren," "incidence," and "prevalence." Two reviewers independently assessed the articles using inclusion and exclusion criteria, and rated the included studies with a quality assessment instrument. In a meta-analysis, the median prevalence, as a function of age by sex, was estimated, accompanied by 95 percent prediction intervals. The observed heterogeneity in prevalence was investigated with respect to study quality and geographic location. RESULTS Twenty-three of 199 unique identified articles were included. The number of participants ranged from 37 to 97,537, and age ranged from 18 to 100 years. Prevalence varied from 0.6 to 31.6 percent. The quality of studies differed but could not explain the heterogeneity among studies. Mean prevalence was estimated as 12, 21, and 29 percent at ages 55, 65, and 75 years, respectively, based on the relation between age and prevalence determined from 10 studies. CONCLUSIONS The authors describe a prevalence range of Dupuytren disease in the general population of Western countries. The relation between age and prevalence of Dupuytren disease is given according to sex, including 95 percent prediction intervals. It is possible to determine disease prevalence at a certain age for the total population, and for men and women separately.
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Eckerdal D, Nivestam A, Dahlin LB. Surgical treatment of Dupuytren's disease - outcome and health economy in relation to smoking and diabetes. BMC Musculoskelet Disord 2014; 15:117. [PMID: 24694095 PMCID: PMC3976502 DOI: 10.1186/1471-2474-15-117] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/31/2014] [Indexed: 11/17/2022] Open
Abstract
Background The conventional treatment for Dupuytren’s disease is surgery. The introduction of alternative treatment strategies creates a need to track outcomes and costs relating to surgical treatment and risk factors, such as smoking and diabetes. This was the aim of the present study. Methods In a prospective study, the outcome of open surgical treatment for finger flexion contracture in Dupuytren’s disease (175 patients; 182 surgical procedures) was studied by evaluating valid QuickDASH forms answered by subjects before surgery and one year postoperatively. Data were also obtained from medical records, and preoperative declarations concerning health. Results In all subjects (median [25% - 75% percentiles] age 68 [62-73]), the QuickDASH score improved from 22 [9-36] to 5 [0-18]. Smokers (27/179 procedures) were younger and had a more severe degree of disease and dysfunction preoperatively than non-smokers, but the outcome of surgery did not differ between the groups. Subjects with diabetes (20/181 procedures) were younger than those without diabetes, but their disease severity or outcome did not differ. Hand specialists operated faster than residents, but the surgical outcome did not differ. Healthcare costs for surgery for Dupuytren’s contracture were $ 2392 (€ 1859), which were not higher among smokers or subjects with diabetes. Only 22 patients remained in hospital (2 [1-2.3] days) and 28 patients needed sick leave (28 [21-31] days). The occurrence of necrosis of skin flaps (12%) or infections (6%) was no more frequent among smokers or those with diabetes. Conclusions There is no difference in surgical outcome for finger flexion contracture in Dupuytren’s disease between smokers and non-smokers or between subjects with or without diabetes, although smokers had more severe preoperative contracture. The costs for surgical treatment for finger flexion contracture in Dupuytren’s disease should be viewed in relation to that for other treatment strategies.
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Affiliation(s)
| | | | - Lars B Dahlin
- Department of Clinical Sciences Malmö - Hand Surgery, Lund University and Skåne University Hospital, Malmö, Sweden.
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Descatha A, Carton M, Mediouni Z, Dumontier C, Roquelaure Y, Goldberg M, Zins M, Leclerc A. Association among work exposure, alcohol intake, smoking and Dupuytren's disease in a large cohort study (GAZEL). BMJ Open 2014; 4:e004214. [PMID: 24477316 PMCID: PMC3913034 DOI: 10.1136/bmjopen-2013-004214] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In view of the debate of factors in Dupuytren's disease, we aimed to describe its relationship with certain occupational factors, alcohol intake and smoking. SETTING The French GAZEL cohort (employees of Electricité de France and Gaz de France). PARTICIPANTS Participants of the cohort who answered a questionnaire in 2012, that is, 13 587 participants (73.7% of the questionnaire sent). In 2007, self-assessed lifetime occupational biomechanical exposure was recorded (carrying loads, manipulating a vibrating tool and climbing stairs), as well as alcohol intake, smoking and diabetes mellitus. Analyses were performed on high alcohol intake, smoking and duration of relevant work exposure, stratified by gender. PRIMARY AND SECONDARY OUTCOME MEASURES From a specific question on Dupuytren's disease assessed in 2012, the outcome measures were self-reported Dupuytren's disease (yes/no) and disabling Dupuytren's disease (including surgery). RESULTS A total of 10 017 men and 3570 women, aged 64-73 years, were included; the mean age for men was 68 years and for women was 65 years. Among men, the following were significantly associated with Dupuytren's disease: age (OR 1.03 (1.00; 1.06)), diabetes (OR 1.31 (1.07; 1.60)), heavy drinking (OR 1.36 (1.10; 1.69)) and over 15 years of manipulating a vibrating tool at work (OR 1.52 (1.15; 2.02)); except for diabetes, the association with these factors was stronger for disabling Dupuytren's disease (or surgery), with OR 1.07 (1.03; 1.11), 1.71 (1.25; 2.33) and 1.98(1.34; 2.91), respectively, for age, heavy drinking and over 15 years of manipulating a vibrating tool at work. Among the 3570 women included, 160 reported Dupuytren's disease (4.5%). The number of cases in the group of women was too low to reach conclusions, although the findings seemed similar for age, diabetes and vibration exposure. CONCLUSIONS In this large French cohort study, Dupuytren's disease in men was associated with high levels of alcohol consumption and exposure to hand-transmitted vibration. It is likely that the same applied to women.
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Affiliation(s)
- Alexis Descatha
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
- AP-HP, Occupational Health Unit/EMS (Samu92), University Hospital of Paris West Suburb, Garches, France
| | - Matthieu Carton
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
| | - Zakia Mediouni
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
- AP-HP, Occupational Health Unit/EMS (Samu92), University Hospital of Paris West Suburb, Garches, France
| | - Christian Dumontier
- Plastic and Hand Department, Nice University, St Roch Hospital, Nice, France
| | - Yves Roquelaure
- Laboratory of Ergonomics and Epidemiology in Occupational Health, LUNAM University, University of Angers, Angers, France
| | - Marcel Goldberg
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
| | - Marie Zins
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
| | - Annette Leclerc
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
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Palmer KT, D'Angelo S, Syddall H, Griffin MJ, Cooper C, Coggon D. Dupuytren's contracture and occupational exposure to hand-transmitted vibration. Occup Environ Med 2014; 71:241-5. [PMID: 24449599 PMCID: PMC3963601 DOI: 10.1136/oemed-2013-101981] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS The relation between Dupuytren's contracture and occupational exposure to hand-transmitted vibration (HTV) has frequently been debated. We explored associations in a representative national sample of workers with well-characterised exposure to HTV. METHODS We mailed a questionnaire to 21 201 subjects aged 16-64 years, selected at random from the age-sex registers of 34 general practices in Great Britain and to 993 subjects chosen randomly from military pay records, asking about occupational exposure to 39 sources of HTV and about fixed flexion contracture of the little or ring finger. Analysis was restricted to men at work in the previous week. Estimates were made of average daily vibration dose (A(8) root mean squared velocity (rms)) over that week. Associations with Dupuytren's contracture were estimated by Poisson regression, for lifetime exposure to HTV and for exposures in the past week >A(8) of 2.8 ms(-2) rms. Estimates of relative risk (prevalence ratio (PR)) were adjusted for age, smoking status, social class and certain manual activities at work. RESULTS In all 4969 eligible male respondents supplied full information on the study variables. These included 72 men with Dupuytren's contracture, 2287 with occupational exposure to HTV and 409 with A(8)>2.8 ms(-2) in the past week. PRs for occupational exposure to HTV were elevated 1.5-fold. For men with an A(8)>2.8 ms(-2) in the past week, the adjusted PR was 2.85 (95% CI 1.37 to 5.97). CONCLUSIONS Our findings suggest that risk of Dupuytren's contracture is more than doubled in men with high levels of weekly exposure to HTV.
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Affiliation(s)
- Keith T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Kam CC, Kaplan FTD. Injectable Collagenase for the Treatment of Dupuytren Contracture. JBJS Rev 2013; 1:01874474-201312000-00005. [DOI: 10.2106/jbjs.rvw.m.00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
BACKGROUND Dupuytren disease is a fibroproliferative disease of palmar fascias of the hand. The prevalence of Dupuytren disease and the association with potential risk factors have been the subject of several studies, although there is a paucity of such data from The Netherlands. METHODS To study the prevalence of Dupuytren disease, the authors drew a random sample of 1360 individuals, stratified by age, from the northern part of The Netherlands. Of this sample, 763 individuals aged 50 to 89 years participated in this cross-sectional study. The authors examined both hands for signs of Dupuytren disease, and a questionnaire was conducted to identify potential risk factors. The effects of these risk factors were investigated using logistic regression analysis. Additional analyses were performed to develop a logistic prediction model for the prevalence of Dupuytren disease. RESULTS The prevalence of Dupuytren disease was 22.1 percent. Nodules and cords were seen in 17.9 percent, and flexion contractures were present in 4.2 percent of the study population. Prevalence increased with age, from 4.9 percent in participants aged 50 to 55 years to 52.6 percent among those aged 76 to 80 years. Men were more often affected than women; 26.4 percent versus 18.6 percent, respectively (p=0.007). Other significant risk factors were previous hand injury, excessive alcohol consumption, familial occurrence of Dupuytren disease, and presence of Ledderhose disease. CONCLUSIONS The results show a high prevalence of Dupuytren disease in The Netherlands, particularly the nodular form. Using the developed logistic prediction model, the prevalence of Dupuytren disease can be estimated, based on the presence of significant risk factors. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Bañón S, Isenberg DA. Rheumatological manifestations occurring in patients with diabetes mellitus. Scand J Rheumatol 2012; 42:1-10. [DOI: 10.3109/03009742.2012.713983] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Michou L, Lermusiaux JL, Teyssedou JP, Bardin T, Beaudreuil J, Petit-Teixeira E. Genetics of Dupuytren's disease. Joint Bone Spine 2012; 79:7-12. [PMID: 21803632 DOI: 10.1016/j.jbspin.2011.05.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Laëtitia Michou
- Service de rhumatologie du CHUQ-CHUL, centre de recherche du CHUQ-CHUL, département de médecine, université Laval, 2705 boulevard Laurier, G1V4G2 Québec, Canada.
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Abstract
Dupuytren disease, a clinical entity originally described more than 400 years ago, is a progressive disease of genetic origin. Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia; the resultant digital flexion contractures may severely limit function. The pathophysiology is multifactorial and remains a topic of research and debate. Genetic predisposition, trauma, inflammatory response, ischemia, and environment, as well as variable expression of proteins and growth factors within the local tissue, all play a role in the disease process. Common treatments of severe disease include open fasciectomy or fasciotomy. These procedures may be complicated by the complex anatomic relationships between cords (pathologic contracted fascia) and adjacent neurovascular structures. Recent advances in the management of Dupuytren disease involve less invasive treatments, such as percutaneous needle fasciotomy and injectable collagenase Clostridium histolyticum. Postoperative management focuses on minimizing the cellular response of cord disruption and maximizing range of motion through static or dynamic extension splinting.
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Descatha A, Jauffret P, Chastang JF, Roquelaure Y, Leclerc A. Should we consider Dupuytren's contracture as work-related? A review and meta-analysis of an old debate. BMC Musculoskelet Disord 2011; 12:96. [PMID: 21575231 PMCID: PMC3123614 DOI: 10.1186/1471-2474-12-96] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 05/16/2011] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In view of the conflicting opinions published, a meta-analysis was undertaken on epidemiological studies in order to assess any association between Dupuytren's contracture and work exposure. METHODS Using the key words: "occupational disease", "work" and "Dupuytren contracture" without limitation on language or year of publication, epidemiological studies were selected from four databases (Pub-Med, Embase, Web of science, BDSP) after two rounds (valid control group, valid work exposure). A quality assessment list was constructed and used to isolate papers with high quality methodological criteria (scores of 13 or above, HQMC). Relevant associations between manual work, vibration exposure (at work) and Dupuytren's contracture were extracted from the articles and a metarisk calculated using the generic variance approach (meta-odds ratios, meta-OR). RESULTS From 1951 to 2007, 14 epidemiological studies (including 2 cohort studies, 3 case-control studies, and 9 cross-sectional studies/population surveys) were included. Two different results could be extracted from five studies (based on different types of exposure), leading to 19 results, 12 for manual work (9 studies), and 7 for vibration exposure (5 studies). Six studies met the HQMC, yielding 9 results, 5 for manual work and 4 for vibration exposure. Five studies found a dose-response relationship. The meta-OR for manual work was 2.02[1.57;2.60] (HQMC studies only: 2.01[1.51;2.66]), and the meta-OR for vibration exposure was 2.88 [1.36;6.07] (HQMC studies only: 2.14[1.59;2.88]). CONCLUSION These results support the hypothesis of an association between high levels of work exposure (manual work and vibration exposure) and Dupuytren's contracture in certain cases.
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Affiliation(s)
- Alexis Descatha
- Inserm U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, Villejuif, France
- Université de Versailles St-Quentin, UMRS 1018, France
- AP-HP, Poincaré University Hospital, Occupational Health Unit, Garches, France
| | - Pénélope Jauffret
- AP-HP, Poincaré University Hospital, Occupational Health Unit, Garches, France
| | - Jean-François Chastang
- Inserm U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, Villejuif, France
- Université de Versailles St-Quentin, UMRS 1018, France
| | - Yves Roquelaure
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, Angers, France
| | - Annette Leclerc
- Inserm U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, Villejuif, France
- Université de Versailles St-Quentin, UMRS 1018, France
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The Wide-Awake Approach to Dupuytren's Disease: Fasciectomy under Local Anesthetic with Epinephrine. Hand (N Y) 2010; 5:117-24. [PMID: 19902309 PMCID: PMC2880666 DOI: 10.1007/s11552-009-9239-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 10/13/2009] [Indexed: 10/20/2022]
Abstract
The Wide-Awake Approach to Dupuytren's contracture involves fasciectomy under local anesthetic with epinephrine and no tourniquet. The goal of this study is to show that the Wide-Awake Approach produces equivalent outcomes to fasciectomy under general anesthetic with a tourniquet, with fewer risks to the patient. A multicenter retrospective review was conducted on 111 patients with fasciectomies under local or general anesthetic between 2001 and 2007. Data on patient demographics, comorbidities, cost, as well as range of motion was collected and evaluated using Microsoft Excel and SAS. Of 148 fingers, 102 were treated under local and 46 under general anesthetic. The average postoperative Total Active Motion (TAM) for general anesthetic patients was 199.0 ± 29.6 (D5), 223.9 ± 29.3 (D4), 234.6 ± 14.6 (D3), and 246.7 ± 14.4 (D2). The average postoperative TAM for local anesthetic patients was 168.3 ± 62.2 (D5), 195.9 ± 67.5 (D4), 173.0 ± 72.6 (D3), and 177.5 ± 31.8 (D2). There were no significant differences between any of these individual groups (p = 0.09, 0.26, 0.12, and 0.20, respectively); however, when pooled, the overall TAM was significantly greater in the general anesthesia group (222.0 ± 29.7 vs. 186.0 ± 63.0, p = 0.002.). Complication rates and types were similar with both techniques. The Wide-Awake Approach to Dupuytren's contracture avoids general anesthetic risks and has cost benefits to healthcare providers. Although it yields similar range of motion outcomes to fasciectomy performed under general anesthesia, total active motion may be better with fasciectomy done under general anesthesia.
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Shih B, Brown JJ, Armstrong DJ, Lindau T, Bayat A. Differential gene expression analysis of subcutaneous fat, fascia, and skin overlying a Dupuytren's disease nodule in comparison to control tissue. Hand (N Y) 2009; 4:294-301. [PMID: 19184239 PMCID: PMC2724615 DOI: 10.1007/s11552-009-9164-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Accepted: 01/05/2009] [Indexed: 01/06/2023]
Abstract
Dupuytren's disease (DD) is a benign fibroproliferative tumor with an unknown etiology and high recurrence postsurgery. Several observations suggest the possible involvement of skin overlying nodule (SON) and the subcutaneous fat in the pathogenesis of DD. This study aims to (1) compare the gene expression levels of SON and subcutaneous fat in DD and normal subjects and (2) to compare transverse palmar fascia (Skoog's fibers) from DD patients as internal control tissue, with palmar fascia (transverse carpal ligament) from patients undergoing carpal tunnel release as external control. Skin, fat, and fascia were obtained from five DD patients of Caucasian origin (age = 66 +/- 14) and from five control subjects (age = 57 +/- 19) undergoing carpal tunnel release. Total ribonucleic acids was extracted from each sample and used for complementary deoxyribonucleic acid synthesis. Real-time quantitative polymerase chain reaction was used to assess the gene expression levels of six candidate genes: A disintegrin and metalloproteinase domain (ADAM12), aldehyde dehydrogenase 1 family member A1 (ALDH1A1), iroquois homeoboxprotein 6 (IRX6), periostin, osteoblast specific factor, proteoglycan 4, and tenascin C. Using independent t test, ADAM12, ALDH1A1, and IRX6 expression levels in DD fats were significantly (p < 0.05) higher than those in the controls. There is no significant difference in the gene expression levels of all six genes when comparing disease and control fascia and skin. Interestingly, ADAM12 up-regulation has also been observed in several other fibrotic and proliferative disorders. In conclusion, this study demonstrates potential roles for subcutaneous fat in DD pathogenesis as well as supports the use of transverse palmar fascia as appropriate control tissues in DD research.
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Affiliation(s)
- Barbara Shih
- Plastic & Reconstructive Surgery Research, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, UK
| | - Jason J. Brown
- Plastic & Reconstructive Surgery Research, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, UK
| | - Daniel J. Armstrong
- The Pulvertaft Hand Centre, Derbyshire Royal Infirmary, London Road, Derby, DE1 2QY UK
| | - Tommy Lindau
- The Pulvertaft Hand Centre, Derbyshire Royal Infirmary, London Road, Derby, DE1 2QY UK
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, UK ,Department of Plastic, Reconstructive and Hand Surgery, South Manchester University Hospital Foundation Trust, Manchester, UK
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Hindocha S, McGrouther DA, Bayat A. Epidemiological evaluation of Dupuytren's disease incidence and prevalence rates in relation to etiology. Hand (N Y) 2009; 4:256-69. [PMID: 19145463 PMCID: PMC2724613 DOI: 10.1007/s11552-008-9160-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 12/15/2008] [Indexed: 11/29/2022]
Abstract
Dupuytren's Disease (DD) is a common, fibroproliferative disorder affecting the palmar surface of the hands which is often irreversible and progressive. Understanding the epidemiology of DD is important in order to provide clues to its etiopathogenesis. This review aims to evaluate the epidemiological studies carried out in DD since 1951. Studies evaluating the epidemiology of DD were searched using Medline, Pubmed, and Scopus which dated back from 1951 to current date. Inclusion criteria were any studies investigating the prevalence or incidence of DD in any population group. A total of 620 articles were cited. Forty-nine studies were subsequently identified as relevant to evaluating the epidemiology of DD. The prevalence of DD in all studies increased with age with a male to female ratio of approximately 5.9:1. Prevalence rates ranged from 0.2% to 56% in varying age, population groups, and methods of data collection. The highest prevalence rate was reported in a study group of epileptic patients. Although, only one study calculated the incidence (as opposed to prevalence) of DD to be equal to 34.3 per 100,000 men (0.03%). In conclusion, the prevalence of DD in different geographical locations is extremely variable, and it is not clear whether this is genetic, environmental, or a combination of both. The majority of the prevalence studies have been conducted in Scandinavia or the UK, and the vast changes in population structure, the changes in prevalence of associated diseases, and the change in diagnostic criteria of DD makes understanding the epidemiology of this condition difficult.
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Affiliation(s)
- Sandip Hindocha
- Plastic and Reconstructive Surgery Research, Manchester Interdisciplinary Biocenter, University of Manchester, 131 Princess St, Manchester, M1 7DN. England UK
| | - Duncan Angus McGrouther
- Plastic and Reconstructive and Hand Surgery, South Manchester University Hospital Foundation Trust, Wythenshawe Hospital. Southmoor Road, Wythenshawe, Manchester, M23 9LT England UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, Manchester Interdisciplinary Biocenter, University of Manchester, 131 Princess St, Manchester, M1 7DN. England UK
- Plastic and Reconstructive and Hand Surgery, South Manchester University Hospital Foundation Trust, Wythenshawe Hospital. Southmoor Road, Wythenshawe, Manchester, M23 9LT England UK
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El-Sakka AI, Tayeb KA. Vascular Impairment of Erection in Patients with Diabetes and Peyronie's Disease: Is that Accumulative? J Sex Med 2009; 6:1736-1742. [DOI: 10.1111/j.1743-6109.2009.01243.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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