Collagenase Management of Multicord Dupuytren's Disease under Intravenous Sedation: A Prospective Cohort Study

Sensitivity and Specificity of the Unité Rhumatologique Des Affections De La Main (URAM) Scale for Dupuytren Contracture: A Systematic Review and Meta-Analyses

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 Clostridium histolyticum (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.

Molecular Mechanisms and Current Pharmacotherapy of Peyronie's Disease: A Review

Peyronie’s disease (PD) is a localized fibrotic lesion of the penis that has adverse effects on men’s health. In this review, we summarized the molecular mechanisms and pharmacotherapies of PD. A literature search was conducted using PubMed and Cochrane Library during 2001–2020. Although no oral or topical medication demonstrated efficacy in monotherapy of PD, several intralesional medications have yielded promising results. Currently, the effective strategy in management of PD should be combined modality therapy, including but not limited to pharmacotherapy, mechanical therapy, and psychotherapy. Meanwhile, basic research is still necessary to facilitate the development of novel and more reliable treatments. In future, more attention should be given simultaneously to epigenetic changes, inflammatory cytokines, the abnormal wound-healing process, and profibrotic and anti-fibrotic factors to provide more options for this refractory disease.

contribution of Australian research to Dupuytren’s disease

Introduction: While the history and epidemiology of Dupuytren's disease (DD) is well documented, its aetiology and risk factors, pathogenesis and treatment to this day are still being studied. This paper explores and summarises the significant contributions Australian researchers have made to the understanding of DD and its treatment methodologies.  Methods: We performed a systematic search on EMBASE from 1947 until March 2019 to identify all English literature using keywords: ‘Dupuytren/Dupuytrens/Dupuytren’s disease’ and ‘Australia/Australian/Australasian’. Relevant articles were also identified through bibliographic links. A separate search was conducted using Google Scholar, Research Gate and PubMed using the same keywords. In total, 40 articles were identified. A library search was also conducted, with one book identified with an Australian author. The Royal Australasian College of Surgeons Journal of Surgery was also analysed for published abstracts pertaining to DD from conference presentations between 2014 to 2019. Results and discussion: We present a narrative discussion of Australian research that has contributed to the understanding of DD from its aetiology to treatment methodologies.  Conclusion: Numerous Australians have made significant contributions to the understanding of DD, its pathogenesis, development and multiple treatment modalities, both non-surgical and surgical. Dupuytren’s disease is a progressive disease that reoccurs despite our best efforts and will continue to be a topic of focus for some time to come.