Hyperglycaemia is a causal risk factor for upper limb pathologies

BACKGROUND

Diabetes (regardless of type) and obesity are associated with a range of musculoskeletal disorders. The causal mechanisms driving these associations are unknown for many upper limb pathologies. We used genetic techniques to test the causal link between glycemia, obesity and musculoskeletal conditions.

METHODS

In the UK Biobank's unrelated European cohort (N = 379 708) we performed mendelian randomisation (MR) analyses to test for a causal effect of long-term high glycaemia and adiposity on four musculoskeletal pathologies: frozen shoulder, Dupuytren's disease, carpal tunnel syndrome and trigger finger. We also performed single-gene MR using rare variants in the GCK gene.

RESULTS

Using MR, we found evidence that long-term high glycaemia has a causal role in the aetiology of upper limb conditions. A 10-mmol/mol increase in genetically predicted haemoglobin A1C (HbA1c) was associated with frozen shoulder: odds ratio (OR) = 1.50 [95% confidence interval (CI), 1.20-1.88], Dupuytren's disease: OR = 1.17 (95% CI, 1.01-1.35), trigger finger: OR = 1.30 (95% CI, 1.09-1.55) and carpal tunnel syndrome: OR = 1.20 (95% CI, 1.09-1.33). Carriers of GCK mutations have increased odds of frozen shoulder: OR = 7.16 (95% CI, 2.93-17.51) and carpal tunnel syndrome: OR = 2.86 (95% CI, 1.50-5.44) but not Dupuytren's disease or trigger finger. We found evidence that an increase in genetically predicted body mass index (BMI) of 5 kg/m2 was associated with carpal tunnel syndrome: OR = 1.13 (95% CI, 1.10-1.16) and associated negatively with Dupuytren's disease: OR = 0.94 (95% CI, 0.90-0.98), but no evidence of association with frozen shoulder or trigger finger. Trigger finger (OR 1.96 (95% CI, 1.42-2.69) P = 3.6e-05) and carpal tunnel syndrome [OR 1.63 (95% CI, 1.36-1.95) P = 8.5e-08] are associated with genetically predicted unfavourable adiposity increase of one standard deviation of body fat.

CONCLUSIONS

Our study consistently demonstrates a causal role of long-term high glycaemia in the aetiology of upper limb musculoskeletal conditions. Clinicians treating diabetes patients should be aware of these complications in clinic, specifically those managing the care of GCK mutation carriers. Upper limb musculoskeletal conditions should be considered diabetes complications.

Modifiable Risk Factors for Prevention in Dupuytren Disease: A UK Biobank Case-Control Study

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.

Diabetes mellitus-related musculoskeletal disorders: Unveiling the cluster of diseases

The current study ushers in a comprehensive review in clinical research to demonstrate the prevalence of musculoskeletal (MSK) complications in diabetes mellitus and the most relevant clinical aspects. In particular, revealing the early symptoms of the disorders, the pathology lurking behind the complications and their optimal management. In diabetes mellitus, MSK complications are common and are largely due to similar pathogenetic factors responsible for the internal organ complications associated with diabetes leading to chronic low-intensity inflammatory processes. MSK disorders develop by vasculopathy, neuropathy, arthropathy or combinations of the above, which are not specific to diabetes. However, their prevalence is significantly increased in diabetes and contributes to the disability impairing patients' quality of life. Locomotor disease affects approximately 34.4-83.5 % of patients suffering from type-2 diabetes mellitus. Several musculoskeletal abnormalities (cheiroarthropathy, Dupuytren's contracture, trigger finger, ect.) can be diagnosed upon physical examination, although certain symptoms (frozen shoulder, neurogenic arthropathy, septic arthritis, etc.) require differential diagnostic considerations. Early identification regarding characteristic symptoms in the treatment reducing inflammation and pain, followed with increasingly strenuous exercise therapy, aligned with optimal management of carbohydrate metabolism, proves essential in alleviating MSK complications.

Exposure to hand-arm vibrations in the workplace and the occurrence of hand-arm vibration syndrome, Dupuytren's contracture, and hypothenar hammer syndrome: a systematic review and meta-analysis

This study provides an overview of the relationships between exposure to work-related hand-arm vibration and the occurrence of pre-defined disorders of the hands. We searched Medline, Embase, Web of Science, Cochrane Central, and PsycINFO for cross-sectional and longitudinal studies on the association between work-related vibration exposure and the occurrence of hand-arm vibration syndrome (including vibration-induced white finger), Dupuytren's contracture, or hypothenar hammer syndrome. We used a 16-item checklist for assessing the risk of bias. We present results narratively, and we conducted random effects meta-analyses if possible. We included 10 studies with more than 24,381 participants. Our results showed statistically significant associations between the exposure to hand-arm vibrations and the occurrence of the selected disorders, with pooled odds ratios ranging between 1.35 (95% CI: 1.28 to 2.80) and 3.43 (95% CI: 2.10 to 5.59). Considerable between-study heterogeneity was observed. Our analyses show that exposure to vibrating tools at work is associated with an increased risk for the occurrence of selected disorders of the hands. Due to the majority of studies being cross-sectional, no firm conclusion is possible regarding causal relationships between vibration exposure and disorder occurrence. Future research should specifically address whether reducing exposure to hand-held vibrating tools at work reduces the incidence of the disorders of the hands investigated in this systematic review.

Dupuytren's disease is a work-related disorder: results of a population-based cohort study

OBJECTIVES

Dupuytren's disease (DD) is a fibroproliferative disorder of the hands, characterised by the development of fibrous nodules and cords that may cause disabling contractures of the fingers. The role of manual work exposure in the aetiology of DD is controversial. We investigated whether current occupational exposure to manual work is associated with DD, and if there is a dose-response relationship.

METHODS

In this population-based cohort analysis, we used data from the UK Biobank cohort. Our primary outcome was the presence of DD. The exposure of interest was manual work, measured for each participant in two different ways to allow two independent analyses to be undertaken: (1) the current manual work status of the occupation at the time of recruitment, and (2) a cumulative manual work exposure score, calculated based on the occupational history. We performed propensity score matching and applied a logistic regression model.

RESULTS

We included 196 265 participants for the current manual work analysis, and 96 563 participants for the dose-response analysis. Participants whose current occupation usually/always involved manual work were more often affected with DD than participants whose occupation sometimes/never involved manual work (OR 1.29, 95% CI 1.12 to 1.49, p<0.001). There was a positive dose-response relationship between cumulative manual work exposure score and DD. Each increment in cumulative work exposure score increased the odds by 17% (OR 1.17, 95% CI 1.08 to 1.27, p<0.001).

CONCLUSIONS

Manual work exposure is a risk factor for DD, with a clear dose-response relationship. Physicians treating patients should recognise DD as a work-related disorder and inform patients accordingly.

Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture

BACKGROUND

One of the most feared complications following treatment of Dupuytren contracture is complex regional pain syndrome (CRPS). This study aims to provide a national perspective on the incidence of CRPS following treatment of Dupuytren contracture and identify patient factors to target for risk reduction.

METHODS

Using the Truven MarketScan databases from 2007 to 2016, individuals aged ≥18 years who developed CRPS within 1 year of treatment of Dupuytren contracture were identified using the International Classification of Disease diagnosis code for CRPS. Predictor variables included: age, sex, employment status, region, type of procedure, and concurrent carpal tunnel surgery. Multivariable logistic regression was used to analyze outcomes.

RESULTS

In all, 48 327 patients received treatment for Dupuytren contracture, including collagenase injection (13.6%); percutaneous palmar fasciotomy (10.3%); open palmar fasciotomy (3.9%); palmar fasciectomy with 0 (10.8%), 1 (29.2%), or multiple (19.6%) digit releases; or a combination of these procedures (12.8%). One hundred forty-five patients (0.31%) were diagnosed with CRPS at a mean of 3.4 months (standard deviation, 2.3) following treatment. Significant predictors of CRPS included female sex (odds ratio [OR], 2.02; P < .001), Southern region (OR, 1.80; P = .022), long-term disability status (OR, 4.73; P = .035), palmar fasciectomy with release of 1 (OR, 5.91; P = .003) or >1 digit (OR, 13.32; P < .001), or multiple concurrent procedures for Dupuytren contracture (OR, 8.23; P = .001).

CONCLUSIONS

Based on national commercial claims data, there is a lower incidence of CRPS following treatment of Dupuytren contracture than previously reported. Risk factors identified should help with preoperative counseling and assist clinicians in targeting risk reduction measures.

Risk Factors for Dupuytren's Contracture: A Case-Control Study

Objective

To study the risk factors of Dupuytren's contracture (DC) and to provide a reference for the clinical prevention and treatment of DC.

Methods

The clinical data of 21 DC patients treated with surgery in Qilu Hospital of Shandong University (Qingdao) from March 2014 to January 2022 were collected. During the same period, 31 subjects who were admitted to the hospital for treatment of finger numbness, difficulty in movement, and other reasons were selected as the control group, and the clinical data of the control group were collected. A case-control study was used to analyze the risk factors for DC. The receiver operating curve (ROC) was used to analyze the efficacy of blood biochemical indexes and coagulation-related indexes in predicting the occurrence of DC.

Results

Multivariate logistic regression analysis showed that male and diabetes were independent risk factors for the occurrence of DC (HR = 19.69, 95%CI: 3.12-124.19, P = 0.002; HR = 7.61, 95%CI: 1.25-46.47, P = 0.03). The results of the ROC analysis showed that the area under the curve (AUC) for the DC predicted by cystatin C was 0.7565 (95%CI: 0.6203-0.8928, P = 0.0018), and the AUC for the DC predicted by blood chloride level was 0.8121 (95%CI: 0.6880-0.9362, P = 0.0002), the AUC for the DC predicted by fibrinogen was 0.7796 (95%CI: 0.6439-0.9152, P = 0.0007), the AUC for the DC predicted by D-dimer level was 0.8740 (95%CI: 0.7812-0.9669, P < 0.0001), and the AUC for the DC predicted by thrombin time was 0.7803 (95%CI: 0.6411-0.9196, P = 0.0007). The AUC for the DC predicted by the combined detection of cystatin C, blood chloride, fibrinogen, D-dimer, and thrombin time was 0.9441 (95%CI: 0.8926-0.9957, P < 0.001).

Conclusion

Male and diabetes are independent risk factors for the occurrence of DC. Combined detection of cystatin C, blood chloride, fibrinogen, D-dimer, and thrombin time has a certain value in predicting the occurrence of DC.

Temporal Trends and Geographical Variation in Dupuytren Disease Surgery in England: A Population-Based Cohort Study

BACKGROUND

Dupuytren disease (DD) is a common fibroproliferative disease of the palmar fascia. The mainstay of DD treatment in England is surgery with either percutaneous needle fasciotomy, limited fasciectomy, or dermofasciectomy. This study aimed to investigate the temporal trends and geographical variation of primary DD surgery in England.

METHODS

A longitudinal population-based cohort study was perfomed using the Hospital Episode Statistics database from April 1, 2007, to March 31, 2017. Directly standarized rates were estimated over time (between financial years 2007-2008 and 2016-2017) and by geographic region (by clinical commissioning groups [CCGs]; financial years 2010-2011, 2013-2014, and 2016-2017). The Office for National Statistics midyear population estimates were used as the reference population.

MAIN FINDINGS

Primary DD surgery was undertaken at a steadily increasing rate from financial year 2007 to 2008, to 2016 to 2017 in England. There was a striking 3.6-fold variation in the rates of primary DD surgery among National Health Service CCGs in England place of residence.

CONCLUSIONS

This significant variation in DD surgical treatment in England suggests a need for the development of standardized surgical practice across all CCGs and National Health Service hospitals, promoting equality of access to cost-effective health care.

Dupuytren's Contracture: Incidence of Injury-Induced Cases and Specific Clinical Expression

Background and objectives: Dupuytren’s contracture is a chronic fibroproliferative hand disorder with a varying pattern of genetic predisposition across different regions and populations. Traumatic events have been found to have influence on the development of this illness and are likely to trigger different clinical forms of this disease. The aim of this study was to evaluate the phenomenon of development of Dupuytren’s contracture (DC) following an acute injury to the hand, and to observe the incidence and clinical diversity of such cases in daily clinical practice. Materials and Methods: We collected data of patients presenting with primary Dupuytren’s contracture in the Lithuanian population and evaluated the occurrence and clinical manifestation of this specific type of DC, arising following acute hand trauma. The diagnosis of DC was based on clinical signs and physical examination. Digit contractures were measured by goniometry, and the staging was done according to Tubiana classification. Injury-induced (injury-related) cases were identified using the “Criteria for recognition of Dupuytren’s contracture after acute injury” (established by Elliot and Ragoowansi). Results: 29 (22%) of a total of 132 cases were injury-induced DCs. Twenty-six of 29 patients in this group presented with stage I–II contractures. Duration of symptoms was 6 (SD 2.2) and 3.8 (SD 2.2) years in the injury-related and injury-unrelated DC groups, respectively. Mean age on the onset of symptoms in the injury-induced and non-injury-induced groups was 52 (SD 10.7) and 56 (SD 10.9), respectively. Patients from both groups expressed strong predisposition towards development of DC. Conclusions: Around one-fifth of patients seeking treatment for primary Dupuytren’s contracture seemed to suffer from injury-induced Dupuytren’s contracture. We noted that injury to the wrist and hand seems to trigger the development of less progressive Dupuytren’s contracture in younger age. Prospective randomized studies are required to confirm our findings.

Ethnic differences in prevalence of Dupuytren disease can partly be explained by known genetic risk variants

Dupuytren disease (DD), a fibroproliferative disorder of the palmar fascia that causes flexion contractures in the fingers, is prevalent in people of North-Western European descent and less so in other ethnicities. DD is a complex disorder, influenced by genetic risk variants. We aimed to study if the marked differences in prevalences in DD between ethnic (sub)groups could be explained by differences in allele frequencies of the 26 known genetic risk variants of DD. Therefore, genetic risk scores (GRS) composed of the 26 DD risk variants were calculated for the 26 populations from the 1000 Genomes database and correlated to observed DD prevalences from literature. For comparison, GRSs were generated for 10,000 sets of 26 random SNPs and also correlated to the observed DD prevalences to determine the significance of the observed correlation. To determine whether differences in allele frequencies between ethnicities were caused by natural selection, fixation indices (Fst) were calculated from the 26 SNPs and from the sets of 26 random SNPs for comparison. Observed prevalences could be determined from literature for 10 populations. Their correlation with the GRS composed of DD SNPs proved to be 0.60 (p = 0.0003). The Fsts between British and other populations were low for European, ad mixed American, and South-Asian populations, and moderate for East-Asians. African populations were significantly different from expected values determined from the random sets. In conclusion, the 26 known genetic risk variants associated with DD explain for a substantial part (R2 = 0.36) the differing DD prevalences observed between ethnicities.

The Epidemiology of Dupuytren's Disease in Korea: a Nationwide Population-based Study

BACKGROUND

To date, there have been few reports on the nationwide population-based epidemiology of Dupuytren's disease (DD). We investigated the prevalence and incidence of DD in Korea using the large dataset provided by the Korean Health Insurance Review and Assessment Service. This study is the second nationwide epidemiological study of DD after the study in Taiwan.

METHODS

Records of patients diagnosed with DD between 2007 and 2014 were extracted from the large dataset by diagnostic code searching (International Classification of Disease 10th revision code M72.0) and were included in the study. We calculated the prevalence and incidence of DD based on the total population of Korea provided by the Korean Statistical Information Service. Diseases associated with DD and the trends in surgery for DD were also analyzed.

RESULTS

A total 16,630 patients were diagnosed with DD during the study period. The mean annual prevalence was 32.2 per 100,000 population (41.8 per 100,000 for men; 22.5 per 100,000 for women). The mean annual incidence was 1.09 per 100,000 population (1.80 per 100,000 for men; 0.38 per 100,000 for women). The common diseases associated with DD were hypertension (30.5%), diabetes mellitus (26.7%), hyperlipidemia (20.4%), ischemic heart disease (7.9%), and cerebrovascular disease (4.6%). The mean annual proportion of the patients who had surgery for DD was 5.24% of all DD patients.

CONCLUSION

The prevalence and incidence of DD in Korea were 100-1,000 times lower than those in western countries; however, it was slightly larger than that in Taiwan.

Prevalence of hand syndromes among patients with diabetes mellitus in Taiwan: A population-based study

BACKGROUND

Population-based data for diabetic hand syndrome (DHS) are limited. The aim of the present epidemiological study was to estimate the overall and cause-specific prevalence and rate ratio (RR) of DHS in patients with diabetes.

METHODS

The present study was a cross-sectional study based on a random sample of 57 093 diabetics and matched controls, both identified from Taiwan National Health Insurance claims in 2010. The DHS analyzed in the present study included carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren's disease (DD).

RESULTS

The prevalence of overall DHS was estimated at 2472 per 10⁵ for the diabetics, compared with 1641 per 10⁵ for the controls, representing a prevalence RR of 1.51 (95 % confidence interval [CI] 1.39-1.64). Stratified analyses further revealed that the significantly increased prevalence of overall DHS was more evident in females than males (1.59 vs 1.36) and was only noted in diabetics aged ≥35 years. Cause-specific analysis suggested that patients with diabetes had the highest prevalence of CTS (1244 per 10⁵ ), followed by SFT (1209 per 10⁵ ), LJM (39 per 10⁵ ), and DD (6 per 10⁵ ). In addition, diabetes was only significantly associated with CTS (RR 1.34; 95 % CI 1.20-1.51) and SFT (1.74; 95 % CI 1.54-1.97).

CONCLUSION

The prevalence of overall and certain cause-specific DHS was significantly elevated in patients with diabetes in Taiwan.

Dupuytren's Contracture

Dupuytren's disorder is considered a genetic disorder and therefore not covered under workers' compensation. Personal risk factors include workers of Northern European descent and workers that are older than 50 years. However, new evidence has shown that certain occupational activities may increase the risk of developing this disorder. This article is a review of the literature with a case study. Work-related and personal risk factors are explored, as well as interventions and return to work recommendations.

Comorbidity in Dupuytren disease

In this report, a possible association between Dupuytren's disease (DD) and other health problems was investigated. The health problems included in this study are : cardiac ischemia, hypertension, hyper-lipidemia, diabetes mellitus, epilepsy, gout, rheumatoid arthritis, malignancy, asthma and COPD. The data of 725 patients with DD were collected from -Intego, a database including all morbidity presented to the General Practitioners (GPs) in Flanders. The control group of 2900 age and sex matched non-DD patients was selected from the same database. A possible influence of severity of DD was evaluated by comparing the data of 333 patients operated for DD with the group of Integopatients with DD. This study showed a significant association of every single studied health condition with DD. Comparison of the -operated group with the group from Intego with DD, demonstrated only some significant associations, a difference which may be explained by the difference in data collection.

Dupuytren’s Disease Risk Factors

Dupuytren’s is a common problem, but little is known about its a etiology. We have undertaken a large case-control study to assess and quantify the relative contributions of diabetes and epilepsy as risk factors for Dupuytren’s in the community. Cases were patients with a diagnosis of Dupuytren’s disease and, for each, two controls were individually matched by age, sex, and general practice. Our dataset included 821 cases and 1,642 controls. Five hundred and eighty-eight (72%) of the cases were men. The mean age at diagnosis was 62 (range 24–97) years. Diabetes was a significant risk factor for Dupuytren’s disease (OR = 1.75) and there was an increased risk for medicinally treated diabetes (metformin – R = 3.56; sulphonylureas – OR = 1.75) and particularly insulin controlled (OR = 4.39) rather than diet-controlled diabetes. Epilepsy (OR = 1.12) and antiepileptic medications were not associated with Dupuytren’s disease. Ascertainment bias in previous studies may explain the reported association with epilepsy.

Similar Distributions of Dupuytren's Contracture and Y-Chromosome Haplogroup I Among Modern Europeans Suggest Simultaneous Spreading of These Traits Some 40 to 10 KYA

A proposition is made that when two independent traits show similar regional patterns of incidence among modern European regions, a plausible expectation is that these two, otherwise unrelated traits, have simultaneously been spread by migration of our ancestors. As a potential example for the proposed concept, distribution of patients with Dupuytren's contracture is here compared with the reported European distribution of Y-Chromosome Haplogroup I, a genetic marker linked to the last glaciation period.

Risk of Hand Syndromes in Patients With Diabetes Mellitus: A Population-Based Cohort Study in Taiwan

The aim of this study was to assess the overall and cause-specific incidences of diabetic hand syndromes (DHS) in patients with diabetes mellitus (DM) by using age and sex stratifications.The DM and control cohorts comprised 606,152 patients with DM and 609,970 age- and sex-matched subjects, respectively, who were followed up from 2000 to 2008. We estimated the incidence densities (IDs) of overall and cause-specific DHS, namely carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren disease (DD), and calculated the hazard ratios (HRs) of DHS in relation to DM by using a Cox proportional hazards model with adjustment for potential confounders.Over a 9-year period, 51,207 patients with DM (8.45%) and 39,153 matched controls (6.42%) sought ambulatory care visits for various DHS, with an ID of 117.7 and 80.7 per 10,000 person-years, respectively. The highest cause-specific ID was observed for CTS, followed by SFT, LJM, and DD, regardless of the diabetic status. After adjustment for potential confounders, patients with DM had a significantly high HR of overall DHS (1.51, 95% confidence interval [CI] = 1.48-1.53). Men and women aged <35 years had the highest HR (2.64, 95% CI = 2.15-3.24 and 2.99, 95% CI = 2.55-3.50, respectively). Cause-specific analyses revealed that DM was more strongly associated with SFT (HR = 1.90, 95% CI = 1.86-1.95) and DD (HR = 1.83, 95% CI = 1.39-2.39) than with CTS (HR = 1.31, 95% CI = 1.28-1.34) and LJM (HR = 1.24, 95% CI = 1.13-1.35).Men and younger patients with DM have the highest risk of DHS. Certain hand syndromes, such as SFT and DD, were more strongly associated with DM than with other syndromes and require the attention of clinicians.

Hand disorders associated with diabetes: a review

The diabetes may cause damage many structures and organs of a human body and predispose to secondary disorders, including involvement of the hand. Carpal tunnel syndrome, trigger finger or Dupuytren's disease occur more frequently in diabetic patients as well as other, poorer recognized conditions such as limited joint mobility, or hand weakness. The paper presents these disorders, emphasizes differences in clinical presentation, methods and outcomes of treatment, comparing to the non-diabetic patients. Although there are not call complications, some evidence suggests that they may be, as their prevalence is related to the duration of the diabetes, poor metabolic control and occurrence of other disorders such as retino- and nephropathy.

A systematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries

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.

Coexisting psoriasis,psoriatic arthritis, gout and Dupuytren's contracture

The authors describe the case of a 60-year-old Caucasian man with psoriasis who subsequently developed psoriatic arthritis, gout and Dupuytren's contracture. This is the first report documenting the simultaneous occurrence of psoriasis, psoriatic arthritis, gout and Dupuytren's contracture in a single patient. The etiopathology underlying the concurrent presence of these diseases is discussed.

Association among work exposure, alcohol intake, smoking and Dupuytren's disease in a large cohort study (GAZEL)

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.

Prevalence and risk factors of five most common upper extremity disorders in diabetics

BACKGROUND

In addition to macrovascular and along with other microvascular complications, diabetic patients suffer from some common musculoskeletal complications. The aim of this study was to assess the prevalence of five musculoskeletal disorders of upper extremity including shoulder capsulitis (SC), limited joint mobility (LJM), Dupuytren's contracture (DC), carpal tunnel syndrome (CTS), and trigger finger (TF) as well as identify their related risk factors in diabetic patients.

METHODS

We recruited 432 types 1 or 2 diabetic patients and evaluated them for the presence of musculoskeletal disorders and their-related risk factors in 2012-13. The patients were examined by an endocrinologist and then suspected subjects evaluated by a rheumatologist for defining final diagnosis.

RESULTS

The most prevalent musculoskeletal disorder of upper extremity was SC (8.79%), followed by CTS (8.56%), LJM (6.94%), DC (7.4%), and TF (6.71%). Advanced age, female sex, smoking, and duration of diabetes were associated with the appearance of SC; female sex and duration of diabetes with CTS; advanced age and smoking with LJM; advanced age, duration of diabetes and history of foot ulcer with DC; and history of laser photocoagulation was associated with TF.

CONCLUSIONS

The results show lower prevalence of upper musculoskeletal disorders and different associated risk factors in our diabetic population in comparison with previous studies on other populations.

Epidemiological study for personal risk factors and quality of life related to Dupuytren's disease in a mountain village of Japan

BACKGROUND

This study investigated the etiology, personal risk factors, and quality of life related to Dupuytren's disease among residents of a mountain village in Japan.

METHODS

Medical examinations were conducted of 401 adult residents (163 men, 238 women; average age of 66.7 years, range 40-92) of a mountain village in Japan. All had completed a self-administered questionnaire including items for gender, weight, height, dominant hand, occupation, history of diabetes mellitus, and frequency of smoking tobacco and drinking alcohol, in addition to EuroQol-5-Dimensions-3-level Japanese version. Blood samples were collected and assessed for biochemical markers related to Dupuytren's disease. The Dupuytren's disease diagnosis was based on clinical signs. Meyerding's classification was used to ascertain the disease severity. After examining background data and physical examination data related to Dupuytren's disease, we evaluated the association of Dupuytren's disease with those factors using univariate and logistic regression analysis.

RESULTS

Dupuytren's disease was diagnosed in 28 subjects (7.0%). Univariate analysis revealed associations of age, male gender, occupation, history of diabetes mellitus, and alcohol intake with Dupuytren's disease. Logistic regression analysis after adjustment for age revealed a significant association between Dupuytren's disease and male gender, occupation, and history of alcohol intake. No significant difference was found between Dupuytren's disease patients and participants without this disease in the scoring and visual analog scale of EuroQol. No relation was found in scoring, the visual analog scale of EuroQol, or grading of Meyerding's classification in participants with Dupuytren's disease.

CONCLUSION

This cross-sectional study revealed Dupuytren's disease in 7.0% of 401 subjects among the general population of a mountain village in Japan. The prevalence is higher with age and is apparently associated with male gender, occupation and alcohol intake. Risk factors associated with Dupuytren's disease were identified as age, male gender, occupation, and alcohol consumption habits.

[Utilization of health care resources and cost associated to fasciectomy in Dupuytren's disease in Spain]

OBJECTIVE

To estimate the healthcare resource utilization and their associated costs secondary to fasciectomy of Dupuytren s disease (DD) treated under usual medical practice in Spain.

METHODS

This multicenter, observational, retrospective cohort study, extracted data through the revision of medical records of three tertiary public hospitals. Each center should recruit 40 patients operated for DD, as principal diagnose of Minimum Data Set, in which the surgical procedure conducted was fasciectomy, during 2007-2009. To collect all the resources used during surgery, a specific chart form was designed. Demographic (age, gender, occupational status), clinical (stage of contracture and comorbilities) and healthcare utilization (hospitalizations, medical visits, tests, drugs) data were collected under medical routine. Comparisons between stage of contracture grouped (I: stage N, 1 & 2; II: stage 3 & 4) and centers were made.

RESULTS

A total of 123 subjects (52% group I; 86.2% men; 35.8% active workers) were identified. 81.3% of patients presented at least one comorbidity, being hypertension the most frequent. 28.4% of patients were operated in ambulatory surgery and 71.6% hospitalized. All the patients had follow-up visits after surgery, 27% needed physical therapy, 88% performed preoperative tests and 8% visit the emergency room after surgery. Healthcare mean (SD) costs were as follows: fasciectomy €1,074 (0); hospitalizations €978 (743); ambulatory €186 (10); follow-up visits €260 (173); emergency rooms €13 (53); tests €78(43); drugs €7 (9); physical therapy €46 (134). Mean total costs were €2,250 (839). There were no significant differences between study groups grouped by stage of contracture. However, the center and the severity of the CD seem explanatory variables of cost, p<0.05.

CONCLUSIONS

Healthcare resources utilization for surgical treatment of Dupuytren's disease may cost €2,250 (839) per fasciectomy treated under usual medical practice.

[A coexistence of the Dupuytren's disease and malignant neoplasms: a review]

Dupuytren's disease is classified as a benign superficial fibromatosis, in which excessive proliferation of myofibroblats and formation of nodules and chords occurs, followed by development of finger contractures. The similarities between Dupuytren's disease and neoplasms were shown at molecular and clinical grounds. The objective of the study was to review of the literature investigating possible relationship between occurrence of Dupuytren's disease and malignancies. Review of the few available papers shows (1) statistically significantly increased malignant neoplasm mortality among men with advanced Dupuytren's disease, comparing to reference population and men with early stage of the disease, (2) statistically significantly increased malignant neoplasm morbidity, mainly related to smoking and alcohol consumption among patients (men and women) operated on for Dupuytren's disease and (3) increased sarcoma of the bone and soft tissue morbidity in patients 5 years after operation for Dupuytren's disease. Some genetical studies show also altered expression of the dehydrogenases ALDH2 and DHDH genes in patients with Dupuytren's disease and with digestive tract malignancies related to alcohol abuse.

Evaluation of a mitochondrial DNA mutation in maternally inherited and sporadic cases of Dupuytren disease

OBJECTIVE

The purpose was to test the hypothesis that Dupuytren disease (DD) is associated with a previously reported mutation in mitochondrial DNA at position 2839.

METHODS

Two hundred sixty-nine cases of DD and an equal number of matched controls were identified in Marshfield Clinic's Personalized Medicine Research Project (PMRP). Clinical data used to describe the cohort were abstracted from the electronic medical records of the population. Genetic analysis of all the cases and controls was done using a custom synthesis TaqMan assay, while genetic analysis of sixteen of the above cases with a familial history of DD was performed by mitochondrial DNA sequencing at position C2839A.

RESULTS

Cases and controls were evenly distributed with 167 (62%) men and 102 (38%) women. The majority, 264 (98%) of the cases and controls were white non-Hispanic. Of the 269 cases, 16 were found to have a familial history of DD. Two cases had a maternal history, eight a paternal history, five an affected sibling, and one a paternal grandfather. All cases and controls were found to have only the C allele at the site of the reported mitochondrial C2839A polymorphism.

CONCLUSIONS

The previously reported mitochondrial mutation was not present in our small, maternally inherited cohort or in the total population of 538 cases and controls. This finding does not support the reported incidence of this polymorphism in 90% of the affected population with a maternal inheritance, and calls into question the role of the C2839A mitochondrial DNA polymorphism in familial or sporadic cases of DD.

Deteriorating tactile sensation in patients with hand syndromes associated with diabetes: a two-year observational study

AIMS

To observe the natural history of hand function during a two-year period in participants with hand syndromes associated with diabetes and to determine factors related to changing function.

METHODS

Hand function was measured over three annual visits using Disability of the Arm, Shoulder and Hand (DASH) and SF-36v2 questionnaires, grip strength, light touch and 9-hole peg tests. Light touch was tested with WEST monofilaments at 7 sites on the hand (score 35 to 0). Data were analyzed using repeated-measures ANOVA, Spearman's correlation, and Wilcoxon signed-rank tests.

RESULTS

Participants (n=60) were aged 61 ± 10.5 years, 57% female, diagnosed with diabetes and at least one of four associated hand disorders. Presentations of carpal tunnel syndrome, or past release (n=27, 45%) and trigger finger (n=24, 40%) were common. Tactile sensation was reduced during the two-year period (median, range; 30 months, 25-40 months). Initial median (inter-quartile range) scores for the dominant hand of 25.5 (22-28.5) were reduced to 23 (21.5-27). This sensory loss was weakly associated with HbA1c (r=0.30, p=0.05) and occurred predominantly in participants with trigger finger (p=0.05).

CONCLUSIONS

Light touch perception was reduced in longstanding diabetic hand syndromes. Tactile abnormalities that were detected by clinical examination progressed during a two year period and were related to metabolic control and musculoskeletal diagnosis.

[Concomitance of Ledderhose's disease with Dupuytren's contracture. Own experience]

INTRODUCTION

Ledderhose's disease is a rare fibromatosis affecting plantar aponeurosis. Clinical picture and risk factors resemble the ones found in much more common cases of Dupuytren's disease.

MATERIAL AND METHODS

The group of 101 patients with Dupuytren's disease qualified for surgical treatment constituted material for the study. Within that group incidence of Ledderhose's disease was assessed on the basis of clinical and ultrasound examination. Estimation of the presence of risk factors common for both forms of fibromatosis was also evaluated.

RESULTS

Ledderhose's disease was found in 15 patients (14.85%) suffering from Dupuytren's contracture. Bilateral Ledderhose's disease was found in 10 of them. Established risk factors were similar to the ones found in Dupuytren's disease--tobacco and alcohol dominated. Indications for the surgical treatment were limited to the symptomatic cases of the disease. Two feet in 4 patients were operated on. Surgical technique was presented in broad outline. Pain relief on walking and normalization of feet pressure distribution were achieved in all cases.

Diabetic hand syndromes as a clinical and diagnostic tool for diabetes mellitus patients

Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia with various complications including diabetic hand syndrome (DHS); a condition characterized by association of distinct entities; limited joint mobility (LJM), Dupuytren's disease (DD), flexor tenosynovitis (FTS) and carpal tunnel syndrome (CTS) resulting in significant morbidity and mortality. The aim of this study was to evaluate the prevalence of these changes and their association to diabetes duration. We studied 142 type 2 and 45 type 1 DM patients and investigated the presence of these hand changes and peripheral neuropathy (PNP). The prevalence of LJM was 29.4%, DD was 17.6%, FTS was 10.7% and CTS 41.7% in all diabetics. The prevalence of CTS was more in type 2 DM (83.3%) as compared to type 1 DM (24.4%). Age and duration of diabetes were clearly related to these changes. A clear association between these changes and PNP was observed. The prevalence of CTS and hand changes was higher in type 2 diabetics. The association of DD and PNP suggests that common factors could contribute to their pathogenesis. Consequently, clinical examination for diabetic hand should not ignore it.

Should we consider Dupuytren's contracture as work-related? A review and meta-analysis of an old debate

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.

Prevalence of rheumatic conditions in patients with diabetes mellitus in a tertiary care hospital

Musculoskeletal disorders are common in diabetic subjects. The pathophysiology of these disorders in diabetic patients is not obvious. It could be due to connective tissue disorders, glycosylated end products, vasculopathy, neuropathy or combinations. A wide range of musculoskeletal syndromes have been described in association with diabetes, namely diabetic cheiro-arthropathy, adhesive capsulitis of shoulder, carpal tunnel syndrome, Dupuytren's contracture, hyperostosis, osteo-arthritis, hyperuricaemia, etc. This study was undertaken to find out the prevalence of these conditions in diabetes mellitus and to look for any associations with diabetic complications or therapy. A tertiary care centre-based cross-sectional study was carried out among 100 consecutive diabetic patients (WHO criteria) attending medicine department who were enrolled. The study was done at Calcutta National Medical College and Hospital, Kolkata, from March 2008 to February 2009. The diagnoses of the rheumatic conditions were made by unbiased clinical observations on the basis of standardised case definitions or criteria. Limited joint mobility (29%), adhesive capsulitis (18%), and osteo-arthritis of knee (27%) or hand (17%) were the most common rheumatic conditions in diabetics. Trigger finger (flexor tenosynovitis) and carpal tunnel syndrome were also present in 7% and 5% cases of diabetics respectively. Although hyperuricaemia was present in 9%, clinical gout was present in only 4%. There was no clear association of these syndromes with diabetic renal disease or micro-albuminuria. Most of these conditions were noted in chronic long duration diabetic subjects.

A high prevalence of Dupuytren's disease in Flanders

Dupuytren's disease has been the subject of numerous epidemiological surveys attempting to expand our knowledge on its origin and spread. In Flanders, although numerous studies on surgical outcome have been reported, information on prevalence of Dupuytren's disease is lacking. Therefore, Flanders' population in a non-hospital environment was studied by a clinical evaluation performed by a single hand specialist. Five different market places spread geographically in the 5 Flemish provinces of Belgium were visited to examine the hands of randomly chosen individuals over 50 years old visiting the market. In all, 500 people were examined; Dupuytren's disease was found to be present in 32% of the population. Nodules without finger contractures (stage 1) were seen in 24% of the population, in comparable proportions in males (28%) and females (20%). However, finger contractures (stage 2) were seen in 8%, significantly more often in males (11%) than in females (4%). The prevalence of stage 1 is somewhat lower in individuals over 80 years old. In men, the incidence of stage 2 was found to increase with age. These findings were compared with literature data on the prevalence of Dupuytren's disease in other countries and populations. It appears that, similar to northern Europe, Dupuytren's disease is also a common disease in Flanders.

[Hand disorders in diabetic patients]

Some commonly encountered hand disorders such as trigger finger, carpal tunnel syndrome and Dupuytren's contracture occur up to 4 times more frequently in diabetic patients, affecting their activity and decreasing the quality of their life. The natural history of these disorders in diabetic patients and the outcome of treatment may not be the same as in the general population. Furthermore, some patients develop hand problems due to limited joint mobility. In this article, the authors review epidemiologic aspects as well as therapeutic considerations and outcomes of these hand disorders in diabetics.

Dupuytren's contracture limited to the distal interphalangeal joint: a case report

Dupuytren contracture is not a rare disorder. However, the contracture limited to the DIP joint is rare conditions. In this study, we describe a case of Dupuytren contracture limited to the DIP joint occurred in the ring finger.

Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes

INTRODUCTION

An increased prevalence of musculoskeletal disease is recognised in diabetes and is a common source of disability. It is known to predominantly affect the upper limbs especially the hand and shoulder. The relationship with other complications of diabetes and glycaemic control is uncertain. We designed this study to clarify these relationships, and to assess differences between types 1 and 2 diabetes.

METHODS

We identified a group of 96 people with established diabetes and examined them for the presence of locomotor disease focussing on the upper limbs. We recorded the mean HbA1c and the presence of diabetic complications, together with the health assessment questionnaire (HAQ) score. We explored correlations between locomotor disease and these variables using logistic regression. We compared data between type 1 and type 2 diabetics and contrasted the amalgamated data with that of a matched control population of medical out patients using Students t tests.

RESULTS

Locomotor disease was present in 75% of diabetics with the upper limb the commonest site for abnormalities. This prevalence was significantly higher than that seen in the controls (53%) [p=0.02]. Shoulder capsulitis (25%), carpal tunnel syndrome (20%), tenosynovitis (29%), limited joint mobility (28%) and Dupuytrens contracture (13%) were the most frequent findings and were much commoner than in controls. Capsulitis usually coexisted with other upper limb abnormalities and best predicted the presence of retinopathy and/or neuropathy. The mean HbA1c was significantly higher in patients with combined shoulder and hand problems (9.1%) than in those with no upper limb problems (8.0%) [p=0.018]. The pattern of results was similar in type 1 and type 2 diabetes, although the prevalence of abnormalities and mean HAQ were significantly greater in type 2 patients, which may be in part a function of their greater mean age.

CONCLUSION

Upper limb locomotor abnormalities are very common in diabetes and are associated with worse glycaemic control and more diabetic complications. Assessment of upper limb locomotor disease in diabetes should include an estimate of glycaemic control and a search for other complications.

Dupuytren's disease characteristics in Primorsko-goranska County, Croatia

Dupuytren's disease predominantly occurs among Europeans, with higher reported prevalence in Northern than in Mediterranean European countries. We evaluated the recurrence and extension rates among Caucasian patients from Primorsko-goranska County in Croatia who underwent partial fasciectomy as treatment for Dupuytren's disease. Furthermore, we investigated the influence of diathesis factors on disease progression. Recurrent disease was observed in 68 out of 93 patients (73%). There where 48 (52%) patients with extension of the disease. Differences were found between patients with recurrent disease and those without recurrence regarding age at onset, age at operation and duration of disease. We compared patients younger and older than 50 years at disease onset, and found that older patients had a significantly higher recurrence rate. Characteristics of our patients fit into the picture of typical Dupuytren's disease except for the influence of early age at onset. Among our patients late age at onset proved to be a diathesis factor.

[Etiology of Dupuytren's contracture]

Dupuytren's contracture is a connective tissue disorder characterized by contractile palmar aponeurosis leading to shortening and progressive digital flexion deformity. Various investigators have proposed many theories and documented several findings regarding the aetiology of Dupuytren's contracture. However, none of them explains the causes well enough. Most studies have found relationships between the disorder and manual labor, previous hand injures, genetic susceptibility, diabetes mellitus, epilepsy, high cholesterol level profile and intake of either alcohol or tobacco. However, according to others, the evidence on risk factors associated with certain lifestyles has been conflicting. This article reviews the most common theories regarding the aetiology of Dupuytren's contracture such as genetic, microinjury, immunological, toxic and ischaemic theories.

Dupuytren's palmar contracture in women

BACKGROUND

Dupuytren's disease is a fibroproliferative disorder of the palmar fascia that can cause disabling digital contractures. The pathogensis of the disease is still unclear, and it afflicts predominantly white males of northern European origin. Gender-related differences of Dupuytren's disease and the distinctive characteristics of the disease in females are not yet well defined.

OBJECTIVES

To evaluate and illustrate the distinctive characteristics of Dupuytren's disease in females.

METHODS

A retrospective study was performed of all female patients with Dupuytren's disease seen and followed at our Hand Surgery Unit over a 20 year period. The study group consisted of 48 women (56 hands). The collected data included clinical and epidemiological features on admission, and outcome of surgical intervention.

RESULTS

Of the 48 women (56 hands) with Dupuytren's disease, 23 (26 hands) underwent limited fasciectomy. The average age at presentation was 60.1 years. A few of the patients originated from Asia and Africa. Manifestations and pattern of the disease were nearly comparable to those observed in the male group, except for a slightly higher incidence of proximal interphalangeal joint contracture in female patients. Generally, females expressed less severe contractures on presentation and a slower progression thereafter. A favorable functional postoperative outcome was observed. Seven patients had minor complications including local hematoma and painful scars. Two patients developed moderate signs of complex regional pain syndrome.

CONCLUSIONS

Further investigations are needed to assess the potential role of androgens in the pathogenesis of Dupuytren's disease, and a possible protective role of estrogenic hormones, rendering Dupuytren's contracture a postmenopausal affliction.

Dupuytren's disease: personal factors and occupational exposure

BACKGROUND

The etiology of Dupuytren's disease is unknown, and the role of occupational exposure is still debated. Our objective was to study the association between occupational exposures, personal risk factors and Dupuytren's disease.

METHODS

In this cross-sectional survey, nine occupational physicians performed clinical examinations, focused on Dupuytren's disease, of 2,406 French male civil servants employed at the Equipment Ministry in 1998 and interviewed them about medical history, leisure manual exposure and occupational biomechanical exposure to vibrations and manual work. A cumulative occupational exposure score was defined, with three levels of exposure.

RESULTS

Dupuytren's disease was diagnosed in 212 men (8.8%). The occupational exposure score was significantly higher in this group of cases than in the rest of the sample (377 (SD280) vs. 223 (SD250), respectively; P < 0.0001). Occupational exposure was associated with Dupuytren's disease (adjusted Odds Ratio = 2.20 [1.39-3.45] for the intermediate and 3.10 [1.99-4.84] for the high exposure groups), with adjustment for age, leisure physical activities, alcohol consumption (> or =5 servings per day), history of diabetes, epilepsy, hand trauma, and familial history of Dupuytren's disease.

CONCLUSION

Manual work exposure was associated with Dupuytren's disease after adjustment for personal risk factors. Longitudinal studies are needed to confirm these results.

Dupuytren's disease: outcome of the proximal interphalangeal joint in isolated fifth ray involvement

In this study of 38 patients, we assessed the clinical result following surgical treatment of Dupuytren's disease with isolated fifth ray involvement, particularly with respect to the proximal interphalangeal joint. Three surgical techniques were used: limited fasciectomy, segmental fasciectomy and dermofasciectomy. At a mean follow-up time of 53.6 months, there were no residual deformities nor recurrences in the metacarpophalangeal joint. At the proximal interphalangeal joint, there was an overall improvement of 45 degrees in movement with a residual flexion deformity avering 30 degrees. The recurrence rate in this series was 39%. There was no significant difference in residual deformity or recurrence rate between the various surgical techniques used. Fifth ray involvement in Dupuytren's disease remains a surgical challenge, especially at the proximal interphalangeal joint. Residual deformity and recurrence rate remain high, irrespective of the surgical technique used.

Dupuytren's diathesis revisited: Evaluation of prognostic indicators for risk of disease recurrence

PURPOSE

The term diathesis relates to certain features of Dupuytren's disease (DD) and dictates an aggressive course of disease. The initial description of DD diathesis included 4 factors: (1) ethnicity, (2) family history, (3) bilateral DD, and (4) ectopic lesions (DD outside the palm). The degree of diathesis is considered important in predicting recurrence and extension of DD after surgical management. Prognostic indicators of risks associated with surgery are important. We aimed to evaluate these 4 factors and known associated risk factors to formulate a statistical predictive value for DD diathesis.

METHODS

Caucasian patients diagnosed with DD between the ages of 25 and 90 years (n = 322) from Northwest England were assessed for DD diathesis with a clinical history and examination. DD diathesis assessment was analyzed by calculating the odds ratios of developing recurrent DD using logistic regression.

RESULTS

The observed recurrence rates in the presence of notable risk factors and corresponding odds ratios of recurrent DD were calculated. Of note, recurrent disease was observed in 121 (46%) males, 105 (47%) with bilateral DD, 68 (48%) with a family history of DD, 75 (47%) with age at onset younger than 50 years, 35 (52%) in those with ectopic lesions, and in 26 (63%) with Garrod's pads.

CONCLUSIONS

The original DD diathesis factors have been evaluated and modified. The original factors of family history, bilateral DD, and ectopic lesions now include 2 additional factors: male gender and age at onset of younger than 50 years. Family history and ectopic disease have now been modified to specify family history with one or more affected siblings/parents and ectopic lesions in the knuckles (Garrod's pads) alone. The presence of all new DD diathesis factors in a patient increases the risk of recurrent DD by 71% compared with a baseline risk of 23% in those DD patients with none of the earlier-described factors.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Dupuytren's contracture: an audit of the outcomes of surgery

This multi-centre postal questionnaire study was conducted by the Audit Committee of the BSSH to assess the outcomes of surgery for Dupuytren's Contracture using subjective data provided by 1177 patients at a mean follow-up of 27 (SD 8) months after surgery. Surgery for Dupuytren's contracture achieved a high rate of full, or almost full, correction in 826 patients (75%) but had a high incidence of post-operative patient-reported complications of 46%. A higher complication rate was seen in those patients with worse initial deformities. The rate of contracture recurrence or persistence was 158 of 1037 (15%). The severity of contracture correlated with the final hand function measured using the PEM score. Recurrence was more common in patients with greater initial deformity. Recurrence was less common if good correction was achieved at surgery. The relevance and limitations of this data are discussed.

[Dupuytren's disease]

Dupuytren's disease is a contracture of the hand derived from the retractile fibrosis of the palmar aponeurosis, that leads to a progressive deformity in flexion of fingers. It has been named from the French surgeon Guillaume Dupuytren (1777-1835), that described it in 1831. In this note it is sketched a short biography of Dupuytren and the main clinical features of the disease are described, underlining some particular aspects of therapy.

Dupuytren's disease in France--1831 to 2001--from description to economic burden

We recorded all elective admissions for Dupuytren's disease from the French National Hospital Database. We used the data from first hospitalizations to calculate the 2001 hospitalization rates for this condition and determine geographical differences between different regions of France. We also calculated the hospital costs of treating admissions with this disease. Fourteen thousand eight hundred and sixty hospitalizations for Dupuytren's disease were reported in France in 2001, of which 93% were for a first treatment. The disease was mostly present in men and was mostly managed by surgical fasciectomy. Most operations were carried out in private hospitals, with a mean stay of 2 days. Geographical differences were found in men only. The total hospital cost for all elective admissions was 14, 179, 998 Euros, indicating the considerable financial burden to the State of treating this condition.