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Journal of Pathology and Translational... Jul 2021Palmar fibromatosis (Dupuytren disease/contracture) is the most common type of fibromatosis, defined as a benign proliferation of fibroblasts and myofibroblasts. The... (Review)
Review
Palmar fibromatosis (Dupuytren disease/contracture) is the most common type of fibromatosis, defined as a benign proliferation of fibroblasts and myofibroblasts. The disease process is most common in white, middle-aged and older men occurring at the distal palmar crease leading to nodules and contracture, which in many cases recur after surgical treatment. In a similar process, plantar fibromatosis (Ledderhose disease) is a proliferation of fibroblasts and myofibroblasts on the plantar aponeurosis of mostly middle-aged patients that may lead to painful nodules but usually does not lead to contracture. Both processes are histologically similar, composed of a bland cellular proliferation of spindle cells with a bluish appearance and with a variable amount of background collagen, depending on the age of the lesion. The etiology of both lesions is still uncertain, while treatment ranges from observation to surgery, with some pharmacologic agents being investigated with mixed success. In this paper we provide an overview of both processes with regards to clinical and radiologic findings, pathophysiology, diagnosis, treatment, and prognosis.
PubMed: 34225446
DOI: 10.4132/jptm.2021.06.14 -
The Oncologist Mar 2022Palmar and plantar fibromatosis are benign proliferative processes which present as a diffuse thickening or nodules of the hands and/or feet and may lead to flexion...
Palmar and plantar fibromatosis are benign proliferative processes which present as a diffuse thickening or nodules of the hands and/or feet and may lead to flexion contractures, pain, and functional impairment known as Dupuytren and Ledderhose diseases, respectively. Current treatments are noncurative and associated with significant morbidity. Here, we report on the outcomes of 5 patients with advanced disease, no longer surgical candidates, treated with sorafenib. Sorafenib exhibited an expected safety profile. All 5 patients demonstrated objective responses as evaluated by a decrease in tumor size and/or tumor cellularity from baseline and all 5 patients reported subjective pain relief and/or functional improvement. Mechanistically, immunohistochemistry revealed patchy positivity for PDGFRβ, a known target of sorafenib. The outcomes of these 5 patients suggest the safety and efficacy of a relatively well-tolerated oral agent in the treatment of Dupuytren and Ledderhose diseases and suggest the need for future controlled studies.
Topics: Dupuytren Contracture; Fibromatosis, Plantar; Humans; Pain; Pain Management; Sorafenib
PubMed: 35274715
DOI: 10.1093/oncolo/oyab050 -
BMJ (Clinical Research Ed.) Jun 2021
Topics: Activities of Daily Living; Conservative Treatment; Dupuytren Contracture; Enzyme Therapy; Fasciotomy; Humans; Microbial Collagenase; Occupational Health; Primary Health Care; Prognosis; Recurrence; Risk Factors; Secondary Care; United Kingdom
PubMed: 34088710
DOI: 10.1136/bmj.n1308 -
Acta Orthopaedica Belgica Sep 2020To investigate pain in patients with Dupuytren disease, we analyzed the literature on pre- and post-interventional pain and complex regional pain syndrome. The... (Review)
Review
To investigate pain in patients with Dupuytren disease, we analyzed the literature on pre- and post-interventional pain and complex regional pain syndrome. The pre-interventional pain intensity score of primary Dupuytren ranged from 0.3/10 to 2.0/10. One year after surgery or needle fasciotomy, no significant change of pain could be found. Collagenase therapy significantly reduced the mean pain intensity score from 1.3/10 [SD 2.2] to 0.5/10 [1.5] (p<0.01) after one year. The prevalence of complex regional pain syndrome after fasciectomy ranged from 0% to 12.8%, after needle fasciotomy from 0% to 6.3%, and after collagenase therapy from 0% to 3.0%. We conclude that for most Dupuytren patients, pain is not an issue. A minority seems to suffer pain and collagenase treatment appears to reduce this complaint significantly. However, complex regional pain syndrome is a known complication of Dupuytren treatment, with a low incidence after minimal invasive treatment.
Topics: Amputation, Surgical; Arthrodesis; Chronic Pain; Complex Regional Pain Syndromes; Dupuytren Contracture; Fasciotomy; Humans; Pain Measurement; Postoperative Complications
PubMed: 33581042
DOI: No ID Found -
The Orthopedic Clinics of North America Jul 2020Percutaneous fasciotomy is a safe, simple, and inexpensive treatment for mild to moderate Dupuytren contracture. The decrease in extension deficit in the... (Review)
Review
Percutaneous fasciotomy is a safe, simple, and inexpensive treatment for mild to moderate Dupuytren contracture. The decrease in extension deficit in the metacarpophalangeal and proximal interphalangeal joints after release correlates with improvement in patient-reported outcomes. Complications are rare and primarily include skin tears, which occur in approximately 4% of patients. Most patients are satisfied with the outcomes of the procedure at 1 year.
Topics: Dupuytren Contracture; Fasciotomy; Humans; Minimally Invasive Surgical Procedures; Treatment Outcome
PubMed: 32498955
DOI: 10.1016/j.ocl.2020.02.008 -
Current Sports Medicine Reports Sep 2022
Topics: Dupuytren Contracture; Hand; Humans
PubMed: 36083703
DOI: 10.1249/JSR.0000000000000986 -
Communications Biology Nov 2023Dupuytren's contracture, a superficial dermal fibrosis, causes flexion contracture of the affected finger, impairing hand function. Specific single-nucleotide...
Dupuytren's contracture, a superficial dermal fibrosis, causes flexion contracture of the affected finger, impairing hand function. Specific single-nucleotide polymorphisms within genes in the Wnt signalling pathway are associated with the disease. However, the precise role of Wnt signalling dysregulation in the onset and progression of Dupuytren's contracture remains unclear. Here, using a fibrosis mouse model and clinical samples of human Dupuytren's contractures, we demonstrate that the activation of Wnt/β-catenin signalling in Tppp3-positive cells in the dermis of the paw is associated with the development of fibrosis. Fibrosis development and progression via Wnt/β-catenin signalling are closely related to stromal cell-macrophage interactions, and Wnt/β-catenin signalling activation in Tppp3-positive stromal cells causes M2 macrophage infiltration via chemokine Cxcl14, resulting in the formation of a TGF-β-expressing fibrotic niche. Inhibition of Cxcl14 mitigates fibrosis by decreasing macrophage infiltration. These findings suggest that Cxcl14-mediated stromal cell-macrophage interaction is a promising therapeutic target for Wnt/β-catenin-induced fibrosis.
Topics: Animals; Mice; Humans; Dupuytren Contracture; beta Catenin; Ligands; Wnt Signaling Pathway; Fibrosis
PubMed: 37980373
DOI: 10.1038/s42003-023-05558-8 -
BMC Medical Genomics Sep 2023The correlation between smoking and alcohol consumption and the development of Dupuytren's disease (DD) has been acknowledged. However, the definitive causal...
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.
Topics: Humans; Smoking; Dupuytren Contracture; Genome-Wide Association Study; Mendelian Randomization Analysis; Ethanol; Alcohol Drinking
PubMed: 37679690
DOI: 10.1186/s12920-023-01650-4 -
The Journal of Hand Surgery... Feb 2022Collagenase clostridium histolyticum has become a widely used treatment in the management of Dupuytren disease. The aims of this study are to assess the immediate...
Collagenase clostridium histolyticum has become a widely used treatment in the management of Dupuytren disease. The aims of this study are to assess the immediate success of treatment of Dupuytren contracture with collagenase injection, to measure long-term patient-rated outcomes, to determine whether the risk factors for the disease impacted outcomes and to report complications of collagenase treatment. A prospective study was performed in a tertiary referral centre. Measurements were recorded pre-treatment, day 1 and day 90. Patient-rated outcome scores were measured using Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Michigan Hand Questionnaire (MHQ) at minimum 36 months post-injection. The study included 45 patients with 53 hands with a mean age of 65.7 years. The treatment was successful in 62% of patients with the greatest improvement in the metacarpal-phalangeal joint of the little finger. Diabetes, epilepsy, gender, alcohol intake and positive family history had no statistically significant predictive value on successful outcomes. Patient satisfaction at 41 months was high with mean MHQ score of 97.3. Collagenase is effective in the treatment of Dupuytren contracture, with disease involving the little finger showing the greatest benefit. Risk factors for development of Dupuytren disease had no effect on successful outcome and long-term satisfaction rates are high. Level III (Therapeutic).
Topics: Aged; Collagenases; Dupuytren Contracture; Humans; Patient Satisfaction; Prospective Studies; Treatment Outcome
PubMed: 35135420
DOI: 10.1142/S2424835522500138 -
The Journal of Hand Surgery Oct 2021Dupuytren disease is a fibroproliferative disorder that affects the palmar fascia of the hand and results in varying degrees of nodule and cord formation. Over time,... (Review)
Review
Dupuytren disease is a fibroproliferative disorder that affects the palmar fascia of the hand and results in varying degrees of nodule and cord formation. Over time, patients may develop progressive contractures, impairing their ability to type, to perform with fine instruments, or to participate in social activities such as shaking hands. Treatment options for Dupuytren contractures include needle aponeurotomy (NA), injection of collagenase Clostridium histolyticum (CCH) with manipulation of the digits, and surgical fasciectomy. Over the past decade, the use of CCH has increased. Recent studies have provided additional data regarding the pathophysiology, indications, outcomes, and costs associated with the treatment for Dupuytren contractures, and this review highlights these advances.
Topics: Dupuytren Contracture; Fasciotomy; Hand; Humans; Microbial Collagenase; Treatment Outcome
PubMed: 34452797
DOI: 10.1016/j.jhsa.2021.07.005