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Journal of Clinical Rheumatology :... Jan 2021
Topics: Dupuytren Contracture; Hand; Humans
PubMed: 31895108
DOI: 10.1097/RHU.0000000000001235 -
International Journal of Epidemiology Feb 2024Diabetes (regardless of type) and obesity are associated with a range of musculoskeletal disorders. The causal mechanisms driving these associations are unknown for many...
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.
Topics: Humans; Dupuytren Contracture; Carpal Tunnel Syndrome; Trigger Finger Disorder; Hyperglycemia; Upper Extremity; Musculoskeletal Diseases; Risk Factors; Diabetes Mellitus; Bursitis; Obesity
PubMed: 38205890
DOI: 10.1093/ije/dyad187 -
Cureus Jan 2022Unité Rhumatologique des Affections de la Main (URAM) is a novel and disease-specific questionnaire for Dupuytren contracture, a fibroproliferative disease that affects... (Review)
Review
BACKGROUND
Unité Rhumatologique des Affections de la Main (URAM) is a novel and disease-specific questionnaire for Dupuytren contracture, a fibroproliferative disease that affects hands causing progressive contracture in flexion of the fingers.
OBJECTIVES
To evaluate the sensitivity and specificity of the URAM scale in Dupuytren contracture.
MATERIALS AND METHODS
We performed meta-analyses of 10 articles published in PubMed, Embase, Cochrane, Google Scholar, Latin American and Caribbean Health Sciences Literature (LILACS), and in various grey literature databases that describe the use of the URAM and Tubiana scales to assess treatment outcomes in Dupuytren contracture. We built three models: a hierarchical summary receiver operating characteristic (HSROC) model to determine the optimal threshold for defining Dupuytren contracture, a difference in means model to assess the magnitude of the effect of different treatment modalities, and a meta-regression model to determine the effect on patient quality of life questionnaires such as the URAM, according to variations in Tubiana scores after treatment.
RESULTS
The HSROC and bivariate models showed a sensitivity of 80.23% (95% CI: 75.66 to 84.14) and an overall specificity of 2.61% (95% CI: 1.11 to 6.05). The second model showed an overall difference in means of 1.95 (95% CI: -2.86 to -1.04) for partial fasciectomy and collagenase (CCH) injections, and -1.30 (95% CI: -1.77 to -0.83) for partial fasciectomy, and -2.75 (95% CI: -4.73 to -0.78) for CCH. The coefficient obtained in the meta-regression model was -1.666 (95% CI: -4.183 to 0.851).
CONCLUSION
The URAM scale is highly sensitive to changes in Dupuytren contracture but has low specificity. It also showed a strong correlation with worsening of finger contracture as measured by the Tubiana scale.
PubMed: 35233314
DOI: 10.7759/cureus.21636 -
Journal of Plastic, Reconstructive &... May 2022Multiple studies have reported the effectiveness of treatment on contracture reduction in Dupuytren's disease. However, very few studies have attempted to quantify to...
Multiple studies have reported the effectiveness of treatment on contracture reduction in Dupuytren's disease. However, very few studies have attempted to quantify to which extent patient and disease characteristics influence the chance of achieving a straight finger after surgery. Therefore, the aim of this study is to explore to which extent pre-operative patient and disease characteristics can reliably predict a straight finger after surgery for Dupuytren's disease. In total, 812 and 281 patients, who underwent a limited fasciectomy or needle fasciotomy, respectively, were included in the final analyses. Analysis was performed using a logistic modeling framework. For both treatments, the combination of the extension deficit at baseline; which finger is most affected, which joint is most affected, and the number of affected fingers provided reliable predictions. Classical patient characteristics, such as age and sex, had no additional predictive value. The models presented in this study provide reliable predictions and could be helpful in informing patients and managing their expectations.
Topics: Dupuytren Contracture; Fasciotomy; Finger Joint; Fingers; Humans; Needles; Treatment Outcome
PubMed: 35370118
DOI: 10.1016/j.bjps.2021.11.087 -
The Bone & Joint Journal Apr 2021With novel promising therapies potentially limiting progression of Dupuytren's disease (DD), better patient stratification is needed. We aimed to quantify DD development...
AIMS
With novel promising therapies potentially limiting progression of Dupuytren's disease (DD), better patient stratification is needed. We aimed to quantify DD development and progression after seven years in a population-based cohort, and to identify factors predictive of disease development or progression.
METHODS
All surviving participants from our previous prevalence study were invited to participate in the current prospective cohort study. Participants were examined for presence of DD and Iselin's classification was applied. They were asked to complete comprehensive questionnaires. Disease progression was defined as advancement to a further Iselin stage or surgery. Potential predictive factors were assessed using multivariable regression analyses. Of 763 participants in our original study, 398 were available for further investigation seven years later.
RESULTS
We identified 143/398 (35.9%) participants with DD, of whom 56 (39.2%) were newly diagnosed. Overall, 20/93 (21.5%) previously affected participants had disease progression, while 6/93 (6.5%) patients showed disease regression. Disease progression occurred more often in patients who initially had advanced disease. Multivariable regression analyses revealed that both ectopic lesions and a positive family history of DD are independent predictors of disease progression. Previous hand injury predicts development of DD.
CONCLUSION
Disease progression occurred in 21.5% of DD patients in our study. The higher the initial disease stage, the greater the proportion of participants who had disease progression at follow-up. Both ectopic lesions and a positive family history of DD predict disease progression. These patient-specific factors may be used to identify patients who might benefit from treatment that prevents progression. Cite this article: 2021;103-B(4):704-710.
Topics: Aged; Disease Progression; Dupuytren Contracture; Female; Humans; Male; Middle Aged; Netherlands; Prospective Studies; Risk Factors; Surveys and Questionnaires
PubMed: 33789472
DOI: 10.1302/0301-620X.103B4.BJJ-2020-1364.R1 -
The Knee Mar 2021Total knee arthroplasty (TKA) is a successful treatment for patients with late stage osteoarthritis, yet arthrofibrosis remains a consistent cause of TKA failure....
BACKGROUND
Total knee arthroplasty (TKA) is a successful treatment for patients with late stage osteoarthritis, yet arthrofibrosis remains a consistent cause of TKA failure. Dupuytren's, Ledderhose and Peyronie's Diseases are related conditions of increased fibroblast proliferation. The aim of this study was to identify whether an association exists between these conditions and arthrofibrosis following TKA.
METHODS
Patient records were queried from 2010 to 2016 using an administrative claims database to compare the rates of arthrofibrosis, manipulation under anesthesia (MUA), lysis of adhesions (LOA), and revision TKA in patients with independent chart diagnoses of Dupuytren's Contracture, Ledderhose, or Peyronie's Diseases versus those without. Complications were queried and compared using multivariate logistic regression.
RESULTS
Patients with Dupuytren's (n = 5,232) and Ledderhose (n = 50,716) had a significantly higher rate of ankylosis following TKA: 30-days (OR, 1.54; OR, 1.23), 90-days (OR, 1.20; OR, 1.24), 6-months (OR, 1.23; OR, 1.23), and 1-year (OR, 1.28; OR, 1.23), while patients with Peyronie's (n = 1,186) had a higher rate of diagnosis at 6-months (OR, 1.37) and 1-year (OR, 1.35). Patients with diagnoses of any of the fibroproliferative diseases had a statistically higher risk of MUA at 90-days, 6-month, and 1-year following primary TKA. These cohorts did not have a significantly higher rate of revision TKA.
CONCLUSION
There is an increased odds risk of arthrofibrosis and MUA in patients who have undergone TKA and have a diagnosis of Dupuytren's Contracture, Ledderhose, or Peyronie's Diseases. Improvements to frequency and application of post-operative treatment should be considered in these cohorts to improve outcomes.
Topics: Aged; Aged, 80 and over; Ankylosis; Arthroplasty, Replacement, Knee; Dupuytren Contracture; Female; Fibromatosis, Plantar; Fibrosis; Humans; Joint Diseases; Male; Middle Aged; Penile Induration; Postoperative Complications; Risk Factors
PubMed: 33640618
DOI: 10.1016/j.knee.2021.02.009 -
Frontiers in Immunology 2023Frozen shoulder (FS) and Dupuytren's disease (DD) are two closely related diseases, but the mechanism of their interaction is unknown. Our study sought to elucidate the...
BACKGROUND
Frozen shoulder (FS) and Dupuytren's disease (DD) are two closely related diseases, but the mechanism of their interaction is unknown. Our study sought to elucidate the molecular mechanism of these two diseases through shared gene and protein interactions.
METHODS
GSE75152 and GSE140731 data were downloaded from the Gene Expression Omnibus (GEO) database, and shared genes between FS and DD were selected by using R packages. Then, we used Cytoscape software and the STRING database to produce a protein-protein interaction (PPI) network. Important interaction networks and hub genes were selected through MCODE and cytoHubba algorithms. To explore the potential mechanisms of the development of the two diseases, the hub genes were further enriched by GO and KEGG analyses. We predicted the transcription factors (TFs) of hub genes with Transcriptional Regulatory Relationships Unraveled by Sentence-based Text mining (TRRUST). Moreover, we identified candidate genes for FS with DD with cytoHubba and machine learning algorithms. Finally, we analyzed the role of immunocyte infiltration in FS and constructed the relationship between candidate genes and immunocytes in FS.
RESULTS
We identified a total of 321 shared genes. The results of GO and KEGG enrichment of shared genes showed that extracellular matrix and collagen fibril tissue play a certain role in the occurrence and development of disease. According to the importance of genes, we constructed the key PPI network of shared genes and the top 15 hub genes for FS with DD. Then, we predicted that five TFs are related to the hub genes and are highly expressed in the FS group. Machine learning results show that the candidate genes POSTN and COL11A1 may be key for FS with DD. Finally, immune cell infiltration revealed the disorder of immunocytes in FS patients, and expression of candidate genes can affect immunocyte infiltration.
CONCLUSION
We identified a PPI network, 15 hub genes, and two immune-related candidate genes (POSTN and COL11A1) using bioinformatics analysis and machine learning algorithms. These genes have the potential to serve as diagnostic genes for FS in DD patients. Furthermore, our study reveals disorder of immunocytes in FS.
Topics: Humans; Dupuytren Contracture; Algorithms; Bursitis; Computational Biology; Machine Learning
PubMed: 37720213
DOI: 10.3389/fimmu.2023.1230027 -
Journal of Hand and Microsurgery Oct 2022This study aimed to compare the outcomes of hand therapy alone versus additional splinting post fasciectomy for Dupuytren's contracture patients. A systematic review and...
This study aimed to compare the outcomes of hand therapy alone versus additional splinting post fasciectomy for Dupuytren's contracture patients. A systematic review and meta-analysis were conducted, and a search was performed identifying all relevant studies comparing the two groups. Primary outcome measures included Total active flexion and extension (TAF and TAE) and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Secondary outcome measures included pain intensity, grip strength, and global perceived effect and patients' satisfaction. A random effects model was used for the analysis. Four RCTs were identified enrolling 295 patients. There were no significant differences between hand therapy and splintage groups in terms of all outcomes (both primary and secondary). Splintage offers no added functional benefit to hand therapy alone for post fasciectomy patients with Dupuytren's contracture, however, orthotic regimes may still be applied on an intention to treat basis in those patients who develop an extension deficit postoperatively.
PubMed: 36994455
DOI: 10.1055/s-0041-1725221 -
Handchirurgie, Mikrochirurgie,... Apr 2022The biological mechanism of Dupuytren's contracture needs to be further studied in order to minimize postoperative recurrence and provide a pathological basis for the...
BACKGROUND
The biological mechanism of Dupuytren's contracture needs to be further studied in order to minimize postoperative recurrence and provide a pathological basis for the development of new therapeutic targets.
METHODS
HE staining, immunohistochemistry, PCR and western blotting were performed in pathological palmar aponeurosis specimens and normal palmar aponeurosis tissues for comparative study.
RESULTS
(1) TNF-α expression was up-regulated: TNF-α mRNA was more highly expressed in the pathological tissues of DD patients than in the CT group, P < 0.05, and the difference between the two groups was statistically significant; (2) Dkk-1 expression was down-regulated: Dkk-1 mRNA was lower expressed in the pathological tissues of DD patients than in the CT group, P < 0.05, and the difference between the two groups was statistically significant; (3) TGF-β1 expression was up-regulated: TGF-β1 mRNA was higher expressed in the pathological tissues of DD patients than in the CT group, P < 0.05, and the difference between the two groups was statistically significant; (4) Pearson correlation analysis suggested that TNF-α expression was positively correlated with TGF-β1 expression, TNF-α expression was negatively correlated with DKK-1 expression, and TGF-β1 expression was negatively correlated with DKK-1 expression.
CONCLUSION
TNF-α, DKK-1 and TGF-β1 may play a role in the pathogenesis of palmar aponeurosis contracture, and there is a relationship between them. The study of the relationship between the three and their related signaling pathways provides a therapeutic target and a basis for the prevention and early treatment of palmar aponeurotic contracture.
Topics: Dupuytren Contracture; Humans; Intercellular Signaling Peptides and Proteins; RNA, Messenger; Transforming Growth Factor beta1; Tumor Necrosis Factor-alpha
PubMed: 35419784
DOI: 10.1055/a-1794-5668 -
The Journal of Hand Surgery, European... Jul 2022This study describes a new ultrasound-guided surgical technique for aponeurotomy and interphalangeal joint capsular release in patients with Dupuytren's disease and...
This study describes a new ultrasound-guided surgical technique for aponeurotomy and interphalangeal joint capsular release in patients with Dupuytren's disease and analyses the clinical outcomes. We carried out a retrospective review of 70 digits in 35 patients who underwent ultrasound-guided aponeurotomy and interphalangeal joint capsular release, with a minimum follow-up of 2 years. The primary outcome was the correction of the deformity and the QuickDASH questionnaire score after surgery and at 1 and 2 years. The secondary outcome was the presence of residual contracture immediately after surgery. The mean QuickDASH score fell from 28 before surgery to 14 after surgery. A significant decrease of -63° was observed for the global contracture, -35° the metacarpophalangeal joint contracture and -28° for the proximal interphalangeal joint contracture. Ultrasound-guided aponeurotomy and interphalangeal joint capsular and palmar plate releases are highly accurate and safe. IV.
Topics: Dupuytren Contracture; Fasciotomy; Finger Joint; Humans; Joint Capsule Release; Retrospective Studies; Treatment Outcome; Ultrasonography, Interventional
PubMed: 35249414
DOI: 10.1177/17531934221083815