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Jahn A, Andersen JH, Descatha A, Dalbøge A. Dupuytren's disease and occupational mechanical exposures: a systematic review and meta-analysis. Occup Environ Med 2024:oemed-2024-109649. [PMID: 39317441 DOI: 10.1136/oemed-2024-109649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/06/2024] [Indexed: 09/26/2024]
Abstract
The risk of developing Dupuytren's disease among workers exposed to occupational mechanical exposures has been reported in few systematic reviews, mainly related to vibration. Expanding the investigation to all occupational mechanical exposures is essential for advancing scientific knowledge, health policies and improving workplace safety. The aim of this systematic review and meta-analysis was to study the association between occupational mechanical exposures and Dupuytren's disease.We conducted a systematic review and meta-analysis using guidelines stated by PRISMA. The systematic literature search was performed in Medline, EMBASE, CINAHL, Cochrane Library and Web of Science databases in April 2023. Inclusion criteria were conducted using the PECOS. Two independent authors conducted the literature screening, data extraction and risk of bias assessment. In the meta-analyses, data was pooled using random-effects models and stratified by the risk of bias and study design. The level of evidence was evaluated using GRADE.The literature search identified 563 unique articles and 15 were deemed eligible for inclusion, categorised into hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. Exposure to hand-transmitted vibration showed an OR of 2.0 (95% CI 1.5 to 2.7, I2=64%), lifting/carrying loads had an OR of 1.5 (95% CI 1.1 to 2.0, I2=77%) and combined mechanical exposures had an OR of 2.1 (95% CI 1.4 to 3.1, I2=94%). When grading the level of evidence, we found moderate evidence for hand-transmitted vibration, while low evidence was found for lifting/carrying loads and combined mechanical exposures.We found an association between hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. The level of evidence was considered moderate for hand-transmitted vibration and low for lifting/carrying loads and combined mechanical exposures.
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Affiliation(s)
- Alexander Jahn
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Johan Hviid Andersen
- Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Regional Hospital Goedstrup, Herning, Denmark
- Aarhus University Department of Clinical Medicine, Aarhus, Denmark
| | - Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, CAPTV CDC, Angers, France
- Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Aarhus University Department of Clinical Medicine, Aarhus, Denmark
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Zimmerman M, Nilsson P, Rydberg M, Dahlin L. Risk of hand and forearm conditions due to vibrating hand-held tools exposure: a retrospective cohort study from Sweden. BMJ Open 2024; 14:e080777. [PMID: 38890140 PMCID: PMC11191761 DOI: 10.1136/bmjopen-2023-080777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 06/02/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES The occurrence of hand and forearm disorders related to vibration exposure, adjusted for relevant background factors, is scarcely reported. We analysed the prevalence of such conditions in a large population cohort, stratified by sex, and associations with exposure to vibrating hand-held tools. DESIGN This is a retrospective cohort study. SETTING Individuals in the Malmö Diet and Cancer Study cohort (MDCS; inclusion 1991-1996; followed until 2018) were asked, 'does your work involve working with vibrating hand-held tools?' (response: 'not at all', 'some' and 'much'). Data were cross-linked with national registers to identify treatment for carpal tunnel syndrome (CTS), ulnar nerve entrapment (UNE), Dupuytren's disease, trigger finger or first carpometacarpal joint (CMC-1) osteoarthritis (OA). Cox regression models, unadjusted and adjusted (age, sex, prevalent diabetes, smoking, hypertension and alcohol consumption), were performed to analyse the effects of reported vibration exposure. PARTICIPANTS Individuals in the MDCS who had answered the questionnaire on vibration exposure (14 342 out of the originally 30 446 individuals in MDCS) were included in the study. RESULTS In total, 12 220/14 342 individuals (76%) reported 'no' exposure, 1392/14 342 (9%) 'some' and 730/14 342 (5%) 'much' exposure to vibrating hand-held tools. In men, 'much' exposure was independently associated with CTS (HR 1.71 (95% CI 1.11 to 2.62)) and UNE (HR 2.42 (95% CI 1.15 to 5.07)). 'Some' exposure was independently associated with UNE in men (HR 2.10 (95% CI 1.12 to 3.95)). 'Much' exposure was independently associated with trigger finger in women (HR 2.73 (95% CI 1.49 to 4.99)). We found no effect of vibration exposure on Dupuytren's disease or CMC-1 OA. 'Much' vibration exposure predicted any hand and forearm diagnosis in men (HR 1.44 (95% CI 1.08 to 1.80)), but not in women. CONCLUSIONS Vibration exposure by hand-held tools increases the risk of developing CTS and UNE and any common hand and forearm conditions in men, whereas women only risk trigger finger and CMC-1 OA. Adjustment for relevant confounders in vibration exposure is crucial.
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Affiliation(s)
- Malin Zimmerman
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden
- Department of Orthopedics, Helsingborgs lasarett, Helsingborg, Sweden
| | | | - Mattias Rydberg
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skånes universitetssjukhus Malmö, Malmo, Sweden
| | - Lars Dahlin
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skånes universitetssjukhus Malmö, Malmo, Sweden
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Maasarani S, Wee CE, Lee CD, Khalid SI, Layon S, Noland SS. Surgical Trigger Finger Release Is Associated With New-Onset Dupuytren Contracture in the Short-Term Postoperative Period: A Matched Analysis. Hand (N Y) 2023; 18:1080-1088. [PMID: 35253506 PMCID: PMC10798206 DOI: 10.1177/15589447221077375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This article compares the rates and time-to-development of new-onset Dupuytren disease in patients with trigger finger treated by steroid injection, surgical release, or both. METHODS PearlDiver's Mariner 30 database was queried to identify patients with trigger finger between January 2010 and June 2019. One-to-one exact matching based on baseline patient demographics allowed us to create 4 identical groups defined by the type of trigger finger intervention received. RESULTS The matched population analyzed in this study consisted of 85 944 patients who were equally represented in the steroid injection cohort (n = 21 486, 25.00%), surgical release cohort (n = 21 486, 25.00%), steroids prior to surgery cohort (n = 21 486, 25.00%), and no intervention (control) cohort (n = 21 486, 25.00%). A new Dupuytren diagnosis after trigger finger treatment occurred in 1 in 128 patients overall, 1 in 156 patients treated with steroid injection, and 1 in 126 patients treated with surgical release. Trigger fingers treated by steroid injection only had the lowest rates of Dupuytren disease overall (n = 137, 0.64%, P = .0424) and treatment with fasciectomy (n = 14, 0.07%, P < .0005). In all, 171 patients in the surgery cohort developed Dupuytren disease 1 year after undergoing surgical trigger finger release. Furthermore, this cohort had the highest rates of fasciectomy (n = 55, 0.26%, P < .0005) and the lowest rates of no intervention (n = 103, 0.48%, P = .0471). Trigger fingers managed by surgical release developed Dupuytren disease (mean, 56.11 days; SD, 80.93 days, log-rank P = .02) and underwent fasciectomy (mean, 49.74 days; SD, 62.27 days; log-rank P < .0005) more quickly than all other cohorts. CONCLUSIONS Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions.
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Affiliation(s)
| | | | | | | | - Sarah Layon
- University of Minnesota Medical School, Minneapolis, USA
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Kida H, Jiang JJ, Matsui Y, Takahashi I, Hasebe R, Kawamura D, Endo T, Shibayama H, Kondo M, Nishio Y, Nishida K, Matsuno Y, Oikawa T, Kubota SI, Hojyo S, Iwasaki N, Hashimoto S, Tanaka Y, Murakami M. Dupuytren's contracture-associated SNPs increase SFRP4 expression in non-immune cells including fibroblasts to enhance inflammation development. Int Immunol 2023; 35:303-312. [PMID: 36719100 DOI: 10.1093/intimm/dxad004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
Dupuytren's contracture (DC) is an inflammatory fibrosis characterized by fibroproliferative disorders of the palmar aponeurosis, for which there is no effective treatment. Although several genome-wide association studies have identified risk alleles associated with DC, the functional linkage between these alleles and the pathogenesis remains elusive. We here focused on two single nucleotide polymorphisms (SNPs) associated with DC, rs16879765 and rs17171229, in secreted frizzled related protein 4 (SFRP4). We investigated the association of SRFP4 with the IL-6 amplifier, which amplifies the production of IL-6, growth factors and chemokines in non-immune cells and aggravates inflammatory diseases via NF-κB enhancement. Knockdown of SFRP4 suppressed activation of the IL-6 amplifier in vitro and in vivo, whereas the overexpression of SFRP4 induced the activation of NF-κB-mediated transcription activity. Mechanistically, SFRP4 induced NF-κB activation by directly binding to molecules of the ubiquitination SFC complex, such as IkBα and βTrCP, followed by IkBα degradation. Furthermore, SFRP4 expression was significantly increased in fibroblasts derived from DC patients bearing the risk alleles. Consistently, fibroblasts with the risk alleles enhanced activation of the IL-6 amplifier. These findings indicate that the IL-6 amplifier is involved in the pathogenesis of DC, particularly in patients harboring the SFRP4 risk alleles. Therefore, SFRP4 is a potential therapeutic target for various inflammatory diseases and disorders, including DC.
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Affiliation(s)
- Hiroaki Kida
- Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Jing-Jing Jiang
- Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
| | - Yuichiro Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Section for Clinical Education, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Ikuko Takahashi
- Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
| | - Rie Hasebe
- Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
- Division of Molecular Neuroimmunology, Department of Homeostatic Regulation, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Aichi, Japan
| | - Daisuke Kawamura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takeshi Endo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Shibayama
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Makoto Kondo
- Department of Orthopaedic Surgery, Hokkaido Orthopedic Memorial Hospital, Sapporo, Japan
| | - Yasuhiko Nishio
- Department of Orthopaedic Surgery, Hokkaido Orthopedic Memorial Hospital, Sapporo, Japan
| | - Kinya Nishida
- Department of Orthopaedic Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Tsukasa Oikawa
- Department of Molecular Biology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shimpei I Kubota
- Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
| | - Shintaro Hojyo
- Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeru Hashimoto
- Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
| | - Yuki Tanaka
- Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
- Group of Quantum immunology, Institute for Quantum Life Science, National Institute for Quantum and Radiological Science and Technology (QST), Chiba, Chiba, Japan
| | - Masaaki Murakami
- Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
- Division of Molecular Neuroimmunology, Department of Homeostatic Regulation, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Aichi, Japan
- Group of Quantum immunology, Institute for Quantum Life Science, National Institute for Quantum and Radiological Science and Technology (QST), Chiba, Chiba, Japan
- Institute for Vaccine Research and Development (HU-IVReD), Hokkaido University, Sapporo, Japan
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Gerger H, Søgaard K, Macri EM, Jackson JA, Elbers RG, van Rijn RM, Koes B, Chiarotto A, Burdorf A. 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. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:257-267. [PMID: 37000463 DOI: 10.1080/15459624.2023.2197634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
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.
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Affiliation(s)
- Heike Gerger
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Karen Søgaard
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erin M Macri
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam Netherlands
| | - Jennie A Jackson
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden
| | - Roy G Elbers
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Rogier M van Rijn
- Codarts Rotterdam, University of the Arts, Rotterdam, the Netherlands
- Performing artist and Athlete Research Lab (PEARL), Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
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van den Berge BA, Wiberg A, Werker PMN, Broekstra DC, Furniss D. Dupuytren's disease is a work-related disorder: results of a population-based cohort study. Occup Environ Med 2023; 80:137-145. [PMID: 36635095 PMCID: PMC9985760 DOI: 10.1136/oemed-2022-108670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Bente A van den Berge
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Akira Wiberg
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, Oxford University, Oxford, UK
| | - Paul M N Werker
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Dieuwke C Broekstra
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, Oxford University, Oxford, UK
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, Oxford University, Oxford, UK
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
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A 12-Year Review of Clinical Practice Patterns in Dupuytren Contracture Based on Continuous Certification by the American Board of Plastic Surgery. Plast Reconstr Surg 2022; 150:127e-135e. [PMID: 35536765 DOI: 10.1097/prs.0000000000009181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The American Board of Plastic Surgery collects data on 20 common plastic surgery operations as part of the Continuous Certification process. The goal of this study was to describe clinical trends in Dupuytren contracture repair since 2008 as they relate to evidence-based medicine articles published in this timeframe. METHODS Cumulative tracer data for Dupuytren contracture were reviewed for the period from February of 2008 to March of 2020 and compared with evidence-based medicine articles published in Plastic and Reconstructive Surgery . Topics were categorized as (1) pearls, addressed in both the tracer data and evidence-based medicine articles, (2) topics only addressed in tracer data, and (3) topics only addressed in evidence-based medicine articles. RESULTS As of March of 2020, 230 cases of Dupuytren contracture had been entered. The median age at time of surgery was 65 years (range, 38 to 91 years). Practice patterns from 2008 through 2014 were compared with those between 2015 and 2020. The most common surgical technique was limited fasciectomy (62 percent of cases). Differences in practice between these time periods included decrease in the use of radical fasciectomy (34 percent versus 16 percent, p = 0.002), increase in percutaneous cordotomy (0 percent versus 13 percent), and increase in the use of collagenase injections (0 percent versus 9 percent, p = 0.001). Use of Bier blocks increased (1 percent versus 7 percent), and tourniquet use decreased (97 percent versus 80 percent). Significant changes were also noted in postoperative management. CONCLUSION By examining American Board of Plastic Surgery tracer data, the authors have described national trends in presentation and surgical techniques for Dupuytren contracture repair over a 14-year period.
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Russell MC. An Overview of Dupuytren's Disease for Perioperative Nurses. AORN J 2021; 115:65-78. [PMID: 34958472 DOI: 10.1002/aorn.13574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 11/11/2022]
Abstract
Dupuytren's disease is a fibroproliferative condition that causes shortening, thickening, and fibrosis of the palmar fascia and a flexion deformity of metacarpophalangeal and proximal interphalangeal joints. Although the etiology is unknown, a variety of risk factors, such as age greater than 50 years, male sex, family history, or tobacco and alcohol use may lead to disease development. At the present time there is no cure and symptoms may recur; however, surgical procedures (eg, limited fasciectomy) and nonsurgical treatment (eg, needle aponeurotomy, injection of collagenase clostridium histolyticum) can help patients manage the disease's symptoms. Patients may experience wound-healing complications after fasciectomy and skin fissures after needle aponeurotomy. Recurrence rates for needle aponeurotomy and collagenase clostridium histolyticum injection are similar. Perioperative nurses should provide individualized patient care during procedures, participate in effective team communication regarding patient needs, and provide patient education throughout the perioperative continuum.
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Ruettermann M, Hermann RM, Khatib-Chahidi K, Werker PMN. Dupuytren's Disease–Etiology and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:781-788. [PMID: 34702442 DOI: 10.3238/arztebl.m2021.0325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The worldwide prevalence of Dupuytren's disease (DD) is 8%. DD is a chronic disease for which there is no cure. Various treatments are available. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and Embase. RESULTS Genetic factors account for 80% of the factors involved in causing this disease. Diabetes mellitus, hepatic diseases, epilepsy, and chronic occupational use of vibrating tools are also associated with it. Limited fasciectomy is the most common treatment and is considered the reference standard. Possible complications include persistent numbness in areas where the skin has been elevated, cold sensitivity, and stiffness, with a cumulative risk of 3.6 -39.1% for all complications taken together. The recurrence rate at 5 years is 12-73%. Percutaneous needle fasciotomy is the least invasive method, with more rapid recovery and a lower complication rate than with limited fasciectomy. 85% of patients have a recurrence after an average of 2.3 years. Radiotherapy can be given before contractures arise in patients with high familial risk, or postoperatively in selected patients with a very high individual risk of recurrence. CONCLUSION Although DD is not curable, good treatments are available. Recurrences reflect the pathophysiology of the disease and should not be considered complications of treatment. When counseling patients about the available treatment options, particularly the modalities and timing of surgery, the physician must take the patient's degree of suffering into account. Nowadays, fast recovery from surgery and less postoperative pain are a priority for many patients. Different surgical methods can be used in combination. It remains difficult to predict the natural course and the time to postoperative recurrence in individual patients; these matters should be addressed in future studies.
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Current Concepts in the Management of Dupuytren Disease of the Hand. J Am Acad Orthop Surg 2021; 29:462-469. [PMID: 33651754 DOI: 10.5435/jaaos-d-20-00190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/11/2021] [Indexed: 02/01/2023] Open
Abstract
Dupuytren disease is a fibroproliferative disorder of the palmar fascia of the hand. Little agreement and remarkable variability exists in treatment algorithms between surgeons. Because the cellular and molecular etiology of Dupuytren has been elucidated, ongoing efforts have been made to identify potential chemotherapeutic targets that could modulate the phenotypic expression of the disease. Although these efforts may dramatically alter the approach to treating this disease in the future, these approaches are largely experimental at this point. Over the past decade, the mainstay nonsurgical options have continued to be percutaneous needle aponeurotomy and collagenase Clostridium hystoliticum, and the most common surgical option is limited fasciectomy.
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Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren's disease an occupational illness? Occup Med (Lond) 2021; 71:28-33. [PMID: 33420499 DOI: 10.1093/occmed/kqaa211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is growing evidence for the risk of Dupuytren's disease (DD) from occupational exposure. For workers exposed to hand-transmitted vibrations (HTVs) and heavy manual work (HMW) who develop the disease, the inclusion of DD in hand-arm vibration syndrome and diseases of skeletal muscle overload could be beneficial for compensation purposes. AIMS To assess the risk of DD in workers exposed to HTVs and HMW, and to evaluate the length of exposure times that may significantly affect the development of DD. METHODS This study included male workers in Košice, Slovak Republic. Participants were divided into three groups: those exposed to HTVs, those exposed to HMW and controls. We evaluated the association between DD and HTVs, HMW, cardiovascular diseases, metabolic diseases, epilepsy, smoking and alcohol consumption for all groups. We also compared the length of exposure time to HTV and HMW between workers with and without DD. RESULTS The sample was comprised of 515 men, with 13% suffering from DD. Significant associations were found between DD and HTVs (OR 4.59 [95% CI 2.05-10.32]) and HMV (OR 3.10 [95% CI 1.21-7.91]). Highly significant associations were found between DD and older ages and alcohol consumption as well. No associations were found for the other variables. Exposure times greater than 15 years significantly increased the risk for DD (P < 0.01). CONCLUSIONS This study confirms a significant association between DD and both HTVs and HMW after long exposures. We suggest that DD should be considered as an occupational disease.
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Affiliation(s)
- L Murínová
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Safarik University and the L. Pasteur University Hospital, Kosice, Slovak Republic
| | - S Perečinský
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Safarik University and the L. Pasteur University Hospital, Kosice, Slovak Republic
| | - A Jančová
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Safarik University and the L. Pasteur University Hospital, Kosice, Slovak Republic
| | - P Murín
- Department of Cardiology, East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Kosice, Slovak Republic
| | - Ľ Legáth
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Safarik University and the L. Pasteur University Hospital, Kosice, Slovak Republic
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Abstract
BACKGROUND Dupuytren's disease is a common complex disease caused by genetic and nongenetic factors. The role of many nongenetic risk factors is still unclear and debatable. This study aimed to systematically review the association between Dupuytren's disease and nongenetic risk factors. METHODS A search strategy was developed based on the Population, Exposure, Comparison, Outcomes and Study framework. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature search was conducted in MEDLINE, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to November of 2018. Title and abstract and then full-text screening against eligibility criteria was performed independently by two reviewers, and consensus was achieved by a third reviewer. The Effective Public Health Practice Project and the Oxford Centre for Evidence Based Medicine tools were used to assess study quality and to evaluate the level of evidence of included studies, respectively. RESULTS Reviewers identified 4434 studies, of which 54 were included in the analysis. There was strong evidence for the association between Dupuytren's disease and advanced age, male sex, family history of Dupuytren's disease, and diabetes mellitus. Furthermore, heavy alcohol drinking, cigarette smoking, and manual work exposure showed a significant dose-response relationship. The quality of the included studies was mainly low or moderate, and most studies were level 3 or 4 on the Oxford Centre for Evidence Based Medicine scale. CONCLUSIONS The study results show a strong association between Dupuytren's disease and advanced age, male sex, family history of Dupuytren's disease, diabetes mellitus, heavy alcohol drinking, cigarette smoking, and manual work exposure. Further studies are required to explain the causal relationship of these associations.
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13
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Williams LM, McCann FE, Cabrita MA, Layton T, Cribbs A, Knezevic B, Fang H, Knight J, Zhang M, Fischer R, Bonham S, Steenbeek LM, Yang N, Sood M, Bainbridge C, Warwick D, Harry L, Davidson D, Xie W, Sundstrӧm M, Feldmann M, Nanchahal J. Identifying collagen VI as a target of fibrotic diseases regulated by CREBBP/EP300. Proc Natl Acad Sci U S A 2020; 117:20753-20763. [PMID: 32759223 PMCID: PMC7456151 DOI: 10.1073/pnas.2004281117] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Fibrotic diseases remain a major cause of morbidity and mortality, yet there are few effective therapies. The underlying pathology of all fibrotic conditions is the activity of myofibroblasts. Using cells from freshly excised disease tissue from patients with Dupuytren's disease (DD), a localized fibrotic disorder of the palm, we sought to identify new therapeutic targets for fibrotic disease. We hypothesized that the persistent activity of myofibroblasts in fibrotic diseases might involve epigenetic modifications. Using a validated genetics-led target prioritization algorithm (Pi) of genome wide association studies (GWAS) data and a broad screen of epigenetic inhibitors, we found that the acetyltransferase CREBBP/EP300 is a major regulator of contractility and extracellular matrix production via control of H3K27 acetylation at the profibrotic genes, ACTA2 and COL1A1 Genomic analysis revealed that EP300 is highly enriched at enhancers associated with genes involved in multiple profibrotic pathways, and broad transcriptomic and proteomic profiling of CREBBP/EP300 inhibition by the chemical probe SGC-CBP30 identified collagen VI (Col VI) as a prominent downstream regulator of myofibroblast activity. Targeted Col VI knockdown results in significant decrease in profibrotic functions, including myofibroblast contractile force, extracellular matrix (ECM) production, chemotaxis, and wound healing. Further evidence for Col VI as a major determinant of fibrosis is its abundant expression within Dupuytren's nodules and also in the fibrotic foci of idiopathic pulmonary fibrosis (IPF). Thus, Col VI may represent a tractable therapeutic target across a range of fibrotic disorders.
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Affiliation(s)
- Lynn M Williams
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Fiona E McCann
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Marisa A Cabrita
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Thomas Layton
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Adam Cribbs
- Botnar Research Centre, National Institute for Health Research Oxford Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford OX3 7LD, United Kingdom
| | - Bogdan Knezevic
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Hai Fang
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Julian Knight
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Mingjun Zhang
- Biotherapeutics Department, Celgene Corporation, San Diego, CA 92121
| | - Roman Fischer
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, United Kingdom
| | - Sarah Bonham
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, United Kingdom
| | - Leenart M Steenbeek
- Department of Plastic Surgery, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Nan Yang
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Manu Sood
- Department of Plastic and Reconstructive Surgery, Broomfield Hospital, Mid and South Essex National Health Service Foundation Trust, Chelmsford CM1 4ET, Essex, United Kingdom
| | - Chris Bainbridge
- Pulvertaft Hand Surgery Centre, Royal Derby Hospital, University Hospitals of Derby and Burton National Health Service Foundation Trust, Derby DE22 3NE, United Kingdom
| | - David Warwick
- Department of Trauma and Orthopaedic Surgery, University Hospital Southampton National Health Service Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Lorraine Harry
- Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital National Health Service Foundation Trust, East Grinstead RH19 3DZ, United Kingdom
| | - Dominique Davidson
- Department of Plastic and Reconstructive Surgery, St. John's Hospital, Livingston, West Lothian EH54 6PP, United Kingdom
| | - Weilin Xie
- Biotherapeutics Department, Celgene Corporation, San Diego, CA 92121
| | - Michael Sundstrӧm
- Structural Genomics Consortium, Karolinska Centre for Molecular Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Marc Feldmann
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford OX3 7FY, United Kingdom;
| | - Jagdeep Nanchahal
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford OX3 7FY, United Kingdom;
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Samulėnas G, Rimdeika R, Braziulis K, Fomkinas M, Paškevičius R. Dupuytren's Contracture: Incidence of Injury-Induced Cases and Specific Clinical Expression. ACTA ACUST UNITED AC 2020; 56:medicina56070323. [PMID: 32629785 PMCID: PMC7404801 DOI: 10.3390/medicina56070323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Gediminas Samulėnas
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Eivenių str.2, LT 50009 Kaunas, Lithuania;
- Correspondence: (G.S.); (R.R.)
| | - Rytis Rimdeika
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Eivenių str.2, LT 50009 Kaunas, Lithuania;
- Correspondence: (G.S.); (R.R.)
| | - Kęstutis Braziulis
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Eivenių str.2, LT 50009 Kaunas, Lithuania;
| | - Mantas Fomkinas
- Faculty of Medicine, Lithuanian University of Health Sciences, Eivenių str. 2, LT 50009 Kaunas, Lithuania; (M.F.); (R.P.)
| | - Rokas Paškevičius
- Faculty of Medicine, Lithuanian University of Health Sciences, Eivenių str. 2, LT 50009 Kaunas, Lithuania; (M.F.); (R.P.)
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15
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Vukicevic D, Tatovic S, Zah V, Hurley D, Imro M. The burden of productivity loss of U.S. commercially insured patients diagnosed with Dupuytren's disease undergoing collagenase versus fasciectomy treatment. Expert Rev Pharmacoecon Outcomes Res 2020; 21:127-136. [PMID: 32408788 DOI: 10.1080/14737167.2020.1770085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: We conducted a comparative assessment of the productivity loss associated with the two different treatment options for Dupuytren's disease: collagenase and fasciectomy. Methods: The retrospective claims analysis was performed using the data from IBM MarketScan® Commercial (CD) and Health and Productivity Management (HPM) Databases over five years (2012-2016). We identified two cohorts of patients who underwent either collagenase or fasciectomy in the CD. Propensity-score matched patients were linked to their productivity loss claims in the HPM database. Productivity loss measures were assessed over a 12-month follow-up period. Results: Out of 702 collagenase and 999 fasciectomy propensity score-matched patients in the CD, there were 147 collagenase and 273 fasciectomy patients in the HPM database. Over the follow-up period, collagenase-treated patients were significantly less likely to use short-term disability (STD) leave (9.7% vs. 20.2%; P = 0.009), reflecting in the lower average number of absent STD days (mean, 2.8 vs. 8.1; P = 0.002) in comparison to fasciectomy-treated. The mean indirect STD cost was considerably lower in the collagenase vs. fasciectomy group ($375 vs. $1,108; P = 0.002). Conclusion: This study indicates that collagenase vs. fasciectomy treatment may be related to a lower rate of workplace absence and lower indirect cost in a year following the treatment.
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Affiliation(s)
- Djurdja Vukicevic
- HEOR Department, ZRx Outcomes Research Inc , Mississauga, ON, Canada
| | - Simona Tatovic
- HEOR Department, ZRx Outcomes Research Inc , Mississauga, ON, Canada
| | - Vladimir Zah
- HEOR Department, ZRx Outcomes Research Inc , Mississauga, ON, Canada
| | - David Hurley
- Medical Department, Endo Pharmaceuticals Inc , Malvern, PA, USA
| | - Martina Imro
- HEOR Department, ZRx Outcomes Research Inc , Mississauga, ON, Canada
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16
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Mathieu S, Naughton G, Descatha A, Soubrier M, Dutheil F. Dupuytren's Disease and exposure to vibration: Systematic review and Meta-analysis. Joint Bone Spine 2020; 87:203-207. [PMID: 32061740 DOI: 10.1016/j.jbspin.2020.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Dupuytren's Disease (DD) occurs frequently in the entire population. Several risk factors are well known, including diabetes, alcohol, and age. In this meta-analysis, we assessed the role of occupational vibration exposure in the risk of DD, an issue currently under debate. METHODS We searched PubMed, Google Scholar, and the Cochrane Library to find references up to June 2019. DD prevalence was calculated using meta-proportion analysis. Differences in characteristics between DD patients and controls were expressed as standardized mean differences using the inverse of variance method or percentages using also meta-proportion analysis. We performed meta-regression analyses to assess the effects of alcohol, smoking, age, and sex on the DD incidence for the patients with DD that were exposed to vibrations. RESULTS We included 9 studies, comprising a total of 60,570 patients, including 1,804 DD patients. Prevalence of DD was 9.8% (95%CI: 5.9-14.4%). Compared with controls, patients with DD were older, more diabetic, more smokers and with a higher consumption of alcohol. Meta-analysis of the nine longitudinal studies comparing DD occurrence between patients exposed to vibration (626 of 6825) or not (1220 of 52,502) revealed a significantly increased DD incidence among patients with vibration exposure compared with controls (OR=2.87; 95%CI: 1.41-5.84). In metaregression we found no significant influence of all parameters on DD. CONCLUSION Age and environmental factors had no effect on DD prevalence among patients exposed to vibrations, despite a 10% prevalence in this group. Using vibration tools at work should be recognized as an important risk factor of developing DD.
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Affiliation(s)
- Sylvain Mathieu
- Service de Rhumatologie, CHU Clermont-Ferrand, Université Clermont Auvergne, France.
| | - Geraldine Naughton
- Department of Educational Studies, Macquarie University, Sydney, New South Wales, Australia, and the Department of Health and Medical Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Alexis Descatha
- Université Angers, UMR_S1085, CHU Angers, Université Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Angers, France; UVSQ, U1168 (VIMA: Aging and chronic diseases, Epidemiological and public health approaches), UMS 011 (Population-based Epidemiologic Cohorts Unit), Versailles St-Quentin Univ, Paris Sud Univ, Paris Saclay Univ, Inserm, Villejuif, France
| | - Martin Soubrier
- Service de Rhumatologie, CHU Clermont-Ferrand, Université Clermont Auvergne, France
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational and Preventive Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France
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17
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Carr L, Michelotti B, Brgoch M, Hauck R, Ingraham J. Dupuytren Disease Management Trends: A Survey of Hand Surgeons. Hand (N Y) 2020; 15:97-102. [PMID: 30043624 PMCID: PMC6966290 DOI: 10.1177/1558944718787281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Indication for intervention in Dupuytren disease is influenced by many factors, including location and extent of disease, surgeon preference, and comfort level with different treatment techniques. The aim of this study was to determine current Dupuytren disease management trends. Methods: A questionnaire was sent through the American Society for Surgery of the Hand to all members. In addition to demographic data, questions focused on indications for different procedural interventions based on location of disease, age, and activity level of the patient. Results: Approximately 24% of respondents completed the survey. Respondents were mostly orthopedic surgeons in private practice who do not work with residents or fellows. Respondents preferred collagenase over needle aponeurotomy and limited fasciectomy for primary Dupuytren disease involving only the metacarpophalangeal (MCP) joint. Limited fasciectomy was the preferred treatment for primary Dupuytren disease involving the MCP and proximal interphalangeal joints. For a patient amenable to any treatment option, the majority would use collagenase, although 87.1% felt that fasciectomy offered the longest disease-free interval. Furthermore, given the option of a young, working patient, 42.7% would use collagenase, while plastic and general surgeons were more likely to treat this patient with limited fasciectomy. More plastic surgeons (vs orthopedic) believe that limited fasciectomy yields the longest disease-free interval. For a patient amenable to any surgical option, orthopedic surgeons prefer collagenase, whereas plastic hand surgeons prefer a limited fasciectomy. Conclusion: There are several procedural options for the treatment of Dupuytren disease. This study details current practice patterns among hand surgeons and reveals the increasingly prevalent use of collagenase.
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Affiliation(s)
- Logan Carr
- The Pennsylvania State University,
Hershey, USA
| | | | | | - Randy Hauck
- The Pennsylvania State University,
Hershey, USA
| | - John Ingraham
- The Pennsylvania State University,
Hershey, USA,John Ingraham, College of Medicine, The
Pennsylvania State University, Division of Plastic Surgery, H071, 500 University
Drive, Hershey, PA 17033, USA.
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18
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Fadel M, Leclerc A, Evanoff B, Dale AM, Ngabirano L, Roquelaure Y, Descatha A. Association between occupational exposure and Dupuytren's contracture using a job-exposure matrix and self-reported exposure in the CONSTANCES cohort. Occup Environ Med 2019; 76:845-848. [PMID: 31405909 DOI: 10.1136/oemed-2019-105912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although several studies highlighted an association between occupational exposure and Dupuytren's contracture (DC), they were often limited by the highly selected population. We aimed to study this association using a job-exposure matrix (JEM) and self-reported exposure in a large cohort. METHODS From CONSTANCES, a French population-based prospective cohort, we retrieved sex, age, social position, alcohol/tobacco intake and diabetes. Lifetime exposures were assessed by two different methods: with the biomechanical JEM 'JEM Constances', we assessed exposure to vibration and/or forearm rotation for participants whose work history was available, and from a self-administered questionnaire, we retrieved self-reported exposure to arduous work and/or carrying heavy loads. Surgery for DC was collected from the French Health Administrative database from 2009 to 2016. Multivariate logistic regression models adjusted for confounders were built to assess association between surgery for DC and occupational exposures. RESULTS Work history was retrieved for 23 795 subjects among whom 98 underwent surgery for DC. Adjusted OR (aOR) was 2.08 (1.03-4.2) for being ever exposed to vibration and/or forearm rotation for subjects <60 years and 1.20 (0.69-2.08) for subjects ≥60 years. Data for self-reported exposure were available for 81 801 participants among whom 367 underwent surgery for DC. aOR for being exposed more than 20 years to arduous work and/or carrying heavy loads was 2.01 (1.32-3.04) for subjects <60 years and 1.04 (0.7-1.54) for subjects ≥60. CONCLUSIONS Manual work is associated with surgery for DC among younger subjects. Monitoring exposed workers is important to prevent future functional limitations.
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Affiliation(s)
- Marc Fadel
- Unité Hospitalo-Universitaire de Santé professionnelle Hôpitaux Universitaires de Paris Ile-de-France Ouest, site Raymond Poincaré, AP-HP, UVSQ, IIMTPIF, Garches, France .,UVSQ, U1168 (VIMA: Aging and chronic diseases. Epidemiological and public health approaches), UMS 011 (Population-based Epidemiologic Cohorts Unit), Versailles St-Quentin Univ, Paris Sud Univ, Paris Saclay Univ, Inserm, Villejuif, France
| | - Annette Leclerc
- UVSQ, U1168 (VIMA: Aging and chronic diseases. Epidemiological and public health approaches), UMS 011 (Population-based Epidemiologic Cohorts Unit), Versailles St-Quentin Univ, Paris Sud Univ, Paris Saclay Univ, Inserm, Villejuif, France
| | - Bradley Evanoff
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Ann-Marie Dale
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Laure Ngabirano
- Univ Angers, UMR_S1085, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Angers, France
| | - Yves Roquelaure
- Univ Angers, UMR_S1085, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Angers, France
| | - Alexis Descatha
- Unité Hospitalo-Universitaire de Santé professionnelle Hôpitaux Universitaires de Paris Ile-de-France Ouest, site Raymond Poincaré, AP-HP, UVSQ, IIMTPIF, Garches, France.,UVSQ, U1168 (VIMA: Aging and chronic diseases. Epidemiological and public health approaches), UMS 011 (Population-based Epidemiologic Cohorts Unit), Versailles St-Quentin Univ, Paris Sud Univ, Paris Saclay Univ, Inserm, Villejuif, France.,Univ Angers, UMR_S1085, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Angers, France
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19
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Abstract
Dupuytren contracture (DC) is predominantly an autosomal dominant disorder characterized by hypertrophy and contraction of the palmar fascia that results in tethered flexion of the affected digits. It has its highest prevalence in the North European population or in people of Viking descent, and its incidence is growing with age. DC shares a common inheritance mode, predisposing factors, comorbidities, pathophysiology, and evolution with Ledderhose disease, Garrod knuckle pads, and Peyronie disease. Nonmelanoma skin cancer also has a higher incidence in the population of North European phenotype and apparently a common genetic polymorphism. Psoriasis shares many risk factors and comorbidities with DC and has a higher prevalence in patients with DC. We suggest a close relationship among DC, some skin malignancies, and psoriasis. Regular monitoring for those skin diseases in all patients with DC is highly recommended.
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Affiliation(s)
- Ivan Bogdanov
- Acibadem CitiClinic Tokuda Hospital, Sofia, Bulgaria.
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20
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Molenkamp S, van Straalen RJM, Werker PMN, Broekstra DC. Imaging for Dupuytren disease: a systematic review of the literature. BMC Musculoskelet Disord 2019; 20:224. [PMID: 31101038 PMCID: PMC6525391 DOI: 10.1186/s12891-019-2606-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/30/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As treatment of Dupuytren disease (DD) is expected to shift towards prevention of progression, the use of imaging in patients with DD becomes more important. In this systematic review an overview is given of the different methods for and applications of imaging for DD that have been described. METHODS The MEDLINE and EMBASE databases were searched for articles reporting the use of imaging in patients with DD, published before May 17, 2018. Studies were systematically examined in two rounds by two observers according to the PRISMA systematic. All studies containing original data on imaging for DD were considered for inclusion. RESULTS Three hundred and seven unique studies were identified, of which 23 were included in the study. Only studies on the use of ultrasound (US) and magnetic resonance imaging (MRI) were identified. Broadly, articles could be divided into 5 categories. Seven studies were found on diagnosis, two on measurement of disease extent, four on measurement of disease activity, seven on guidance of minimally invasive procedures and five studies on evaluation of treatment. According to the Oxford CEBM, the levels of evidence were low, ranging from level 3 to 5. CONCLUSIONS A variety of applications for US and MRI for patients with DD has been described. Based on the results of this review, the largest value for imaging lies in the measurement of disease activity and the follow-up of treatment of patients with early stage disease. Unfortunately, the overall level of evidence of the available literature was low. Future research is necessary to define the exact value of US and MRI in the management of patients with DD.
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Affiliation(s)
- Sanne Molenkamp
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Roel J M van Straalen
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Paul M N Werker
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Dieuwke C Broekstra
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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21
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Factors predicting the 1-year outcome of collagenase treatment for Dupuytren's disease. Arch Orthop Trauma Surg 2019; 139:583-588. [PMID: 30673868 DOI: 10.1007/s00402-019-03120-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Several studies have investigated the clinical outcome after collagenase treatment for Dupuytren's disease in terms of range of motion of the affected finger. However, good objective clinical outcome defined by a small remaining flexion contracture does not necessarily translate into satisfactory patient-subjective hand function. The aim of the present study was to identify predictors of patient-reported as well as objective clinical outcome in patients 1 year after collagenase treatment for Dupuytren's disease. MATERIALS AND METHODS Socio-demographic and disease-related data of 92 Dupuytren patients were collected prior to the intervention. Flexion contracture of the most affected finger was measured at baseline and 1 year after treatment. Patients also completed the brief Michigan Hand Outcomes Questionnaire (brief MHQ) before the intervention and at 1-year follow-up. First, univariate correlations using Pearson's correlation coefficient of the baseline variables with the two target variables were investigated. All variables with r > 0.35 were selected for a multivariate linear stepwise backwards regression model. RESULTS The mean brief MHQ score increased between baseline (72 ± 14) and the 1-year follow-up (85 ± 15) (p ≤ 0.001) and baseline flexion contracture decreased from 76° (± 26) to 33° (± 31) (p ≤ 0.001). Higher hand function at baseline (R2 = 0.31) and less flexion contracture (R2 = 0.46) were identified as positive predictors for the outcome 1 year after collagenase treatment for Dupuytren's disease. Other variables such as age, gender, manual work and if the MCP or PIP joint was affected did not determine outcome in our patient series. CONCLUSIONS Collagenase treatment resulted in considerable improvement in flexion contracture as well as patient-reported hand function at the 1-year follow-up. Clinicians can expect better outcome after collagenase infiltration in patients with less flexion contracture and in patients showing good initial self-reported hand function.
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22
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Association between Stenosing Tenosynovitis and Dupuytren's Contracture in the Hand. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2088. [PMID: 30859045 PMCID: PMC6382223 DOI: 10.1097/gox.0000000000002088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 12/31/2022]
Abstract
Background: Both stenosing tenosynovitis and Dupuytren’s contracture are common conditions encountered in hand surgery. Connections between 2 diseases have been suggested in literature. The purpose of this study was to examine whether there’s an association between the 2 processes. Methods: A retrospective chart review was performed to include all patients seen by a single surgeon between 2014 and 2017 with the diagnosis of either trigger finger or Dupuytren’s contracture in the same hand. Patients’ demographics, medical history, social and surgical histories are recorded. Univariate and multivariate analysis were conducted. Results: A cohort of 238 patients was identified. One hundred ninety-two patients were diagnosed with trigger finger. Eighty-nine patients were diagnosed with Dupuytren’s contracture. Forty-three patients carried both diagnoses. Median age was 61.6 (56–72). Half were male (50.4%) and 66.8% reported current alcohol intake. Other factors include history of former or current tobacco use (52.9%), diabetes (23.9%), and manual labor (31.1%). In the univariate model, trigger finger, sex, and age were significantly associated with the diagnosis of Dupuytren’s contracture, and Dupuytren’s contracture and sex were significantly associated with the trigger finger diagnosis. Diabetes, manual labor, use of alcohol and tobacco were not significant. In the multivariate model, age and trigger finger were significantly associated with Dupuytren’s contracture. Conclusions: Significant association between stenosing tenosynovitis and Dupuytren’s contracture was identified in our patient cohort. Patients with stenosing tenosynovitis may be at an increased risk of developing Dupuytren’s contracture or vice versa.
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Shchudlo N, Varsegova T, Stupina T, Dolganova T, Shchudlo M, Shihaleva N, Kostin V. Assessment of palmar subcutaneous tissue vascularization in patients with Dupuytren’s contracture. World J Orthop 2018; 9:130-137. [PMID: 30254969 PMCID: PMC6153130 DOI: 10.5312/wjo.v9.i9.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/14/2018] [Accepted: 05/31/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the structural and functional characteristics of palmar hypodermal tissue vascularization in Dupuytren’s contracture patients of different age groups.
METHODS Eighty-seven Dupuytren’s contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old (Y-group, n = 22); the others were 55 and older (O-group, n = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.
RESULTS Frequency of cases with rapid development of contracture (less than 5 years) was 13.6% in the Y-group and 40% in the O-group, P < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels (more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.
CONCLUSION Compared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.
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Affiliation(s)
- Nathalia Shchudlo
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Tatyana Varsegova
- Laboratory of Morphology of Federal State Budget Institution, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Tatyana Stupina
- Laboratory of Morphology of Federal State Budget Institution, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Tamara Dolganova
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Michael Shchudlo
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Nathalia Shihaleva
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Vadim Kostin
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
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Mansur HG, Oliveira ERD, Gonçalves CB. Análise epidemiológica dos pacientes com doença de Dupuytren. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2016.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Epidemiological analysis of patients with Dupuytren's disease. Rev Bras Ortop 2017; 53:10-14. [PMID: 29367900 PMCID: PMC5771785 DOI: 10.1016/j.rboe.2017.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/22/2016] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the risk factors and analyze the characteristics of patients and lesions in Dupuytren's disease. Methods Retrospective analysis of patients diagnosed with Dupuytren's disease in a hand surgery clinic in 2013. The authors evaluated parameters associated with the patient profiles and risk factors, the form and severity of involvement, and characteristics of the lesions. Results 58 patients were evaluated, totaling 79 hands, with bilateral involvement in 46% of cases. The involvement of the ulnar fingers of the hand represented 78%, 44% being the ring finger. In 55% of cases, the patients had cords, while 45% showed only nodules. As for related factors, they were found most commonly in men (55%), whites (93%), and the elderly. Of coexisting diseases, the following were present: diabetes mellitus (49%), especially in the insulin-dependent (62%), hypertension (55.2%), and dyslipidemia (19%). With regard to lifestyle, 22% were smokers and 9% were alcohol consumers. Conclusion It was observed a higher incidence of Dupuytren's disease was observed among men, whites, and the ulnar fingers of the hand, especially the ring finger. The most common associated diseases were diabetes mellitus and hypertension.
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Haines A, Levis C, Goldsmith CH, Kaur M, Duku E, Wells R, Walter SD, Rook C, Stock S, Liss G, Murphy J, Thoma A. Dupuytren's contracture and handwork: A case-control study. Am J Ind Med 2017; 60:724-733. [PMID: 28692190 DOI: 10.1002/ajim.22736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of this study was to examine the association between Dupuytren's contracture (DC), repetitive handwork (RHW), heavy handwork (HHW), and/or vibration exposure. METHODS Frequency and intensity of the three types of handwork were collected and compared between DC patients and controls. Hours of work were weighted by average "frequency," for RHW, and average "intensity," for HHW and use of vibrating tool. Logistic regression was used to evaluate risk of developing DC associated with the above-mentioned factors. RESULTS Data from 129 cases (74 clinical, 106 controls) was analyzed. Family history, male gender and age (decades) were associated with increased risk of DC. Results indicate that the risk becomes substantial after about 30 years of steady RHW. Independent effects of intensity-weighted HHW and vibrating exposure were not established. CONCLUSIONS Frequency-weighted RHW increases DC risk. Additionally, a strong association between DC, male gender and heredity was found.
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Affiliation(s)
- Alfred Haines
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
- Department of Family Medicine; McMaster University; Hamilton ON Canada
| | - Carolyn Levis
- Department of Surgery; McMaster University; Hamilton ON Canada
| | - Charles H. Goldsmith
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
- Surgical Outcomes Research Centre (SOURCE); McMaster University; Hamilton ON Canada
- Simon Fraser University; Faculty of Health Sciences; Burnaby BC Canada
| | - Manraj Kaur
- Department of Surgery; McMaster University; Hamilton ON Canada
- Surgical Outcomes Research Centre (SOURCE); McMaster University; Hamilton ON Canada
| | - Eric Duku
- Offord Centre for Child Studies; Hamilton Health Sciences (Chedoke Site); Hamilton ON Canada
| | - Richard Wells
- Department of Kinesiology; Faculty of Applied Health Sciences; University of Waterloo; Waterloo ON Canada
- Institute for Work and Health; Toronto ON Canada
| | - Stephen D. Walter
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
- Department of Mathematics and Statistics; McMaster University, Hamilton; ON Canada
| | - Cheryl Rook
- Occupational Health Clinic for Ontario Workers Inc.; Toronto ON Canada
| | - Susan Stock
- Department of Social and Preventive Medicine; University of Montreal; Research Centre (CR-CHUM); Montreal QC Canada
| | - Gary Liss
- Gage Occupational and Environmental Health Unit; University of Toronto; Toronto ON Canada
- Ontario Ministry of Labour; Toronto ON Canada
| | - Jessica Murphy
- Department of Surgery; McMaster University; Hamilton ON Canada
- Surgical Outcomes Research Centre (SOURCE); McMaster University; Hamilton ON Canada
| | - Achilleas Thoma
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
- Department of Surgery; McMaster University; Hamilton ON Canada
- Surgical Outcomes Research Centre (SOURCE); McMaster University; Hamilton ON Canada
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Evidence-Based Medicine: Options for Dupuytren's Contracture: Incise, Excise, and Dissolve. Plast Reconstr Surg 2017; 139:240e-255e. [PMID: 28027258 DOI: 10.1097/prs.0000000000002857] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand updates in the basic science, epidemiology, and treatment of Dupuytren's disease. 2. Understand treatment with needle aponeurotomy, collagenase, and fasciectomy. 3. Understand advanced needle techniques for Dupuytren's contracture. 4. Understand the safety and effectiveness of a new treatment, collagenase. SUMMARY The literature on Dupuytren's disease encompasses many specialties. Its treatment is generally by perforating, excising, or dissolving the affected tissues. This article reviews the changing understanding of this disease and treatment options.
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Shen SC, House RA. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e160-e165. [PMID: 28292812 PMCID: PMC5349735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objectif Permettre aux médecins de famille de comprendre l’épidémiologie, la pathogenèse, les symptômes, le diagnostic et la prise en charge de la maladie des vibrations, une maladie professionnelle importante et courante au Canada. Sources d’information Une recherche a été effectuée sur MEDLINE afin de relever les recherches et comptes rendus portant sur la maladie des vibrations. Une recherche a été effectuée sur Google dans le but d’obtenir la littérature grise qui convient au contexte canadien. D’autres références ont été tirées des articles relevés. Message principal La maladie des vibrations est une maladie professionnelle répandue touchant les travailleurs de diverses industries qui utilisent des outils vibrants. La maladie est cependant sous-diagnostiquée au Canada. Elle compte 3 éléments : vasculaire, sous la forme d’un phénomène de Raynaud secondaire; neurosensoriel; et musculosquelettique. Aux stades les plus avancés, la maladie des vibrations entraîne une invalidité importante et une piètre qualité de vie. Son diagnostic exige une anamnèse minutieuse, en particulier des antécédents professionnels, un examen physique, des analyses de laboratoire afin d’éliminer les autres diagnostics, et la recommandation en médecine du travail aux fins d’investigations plus poussées. La prise en charge consiste à réduire l’exposition aux vibrations, éviter les températures froides, abandonner le tabac et administrer des médicaments. Conclusion Pour assurer un diagnostic rapide de la maladie des vibrations et améliorer le pronostic et la qualité de vie, les médecins de famille devraient connaître cette maladie professionnelle courante, et pouvoir obtenir les détails pertinents durant l’anamnèse, recommander les patients aux cliniques de médecine du travail et débuter les demandes d’indemnisation de manière appropriée.
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Affiliation(s)
- Shixin Cindy Shen
- Résidente au Département de médecine familiale et communautaire à l'Hôpital St Michael et au Programme de résidence en santé publique et médecine préventive à l'Université de Toronto, en Ontario.
| | - Ronald A House
- Spécialiste en médecine du travail au Département de santé professionnelle et environnementale à l'Hôpital St Michael et professeur émérite agrégé au Département de santé professionnelle et environnementale à l'Université de Toronto
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Shen SC, House RA. Hand-arm vibration syndrome: What family physicians should know. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:206-210. [PMID: 28292796 PMCID: PMC5349719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To provide family physicians with an understanding of the epidemiology, pathogenesis, symptoms, diagnosis, and management of hand-arm vibration syndrome (HAVS), an important and common occupational disease in Canada. SOURCES OF INFORMATION A MEDLINE search was conducted for research and review articles on HAVS. A Google search was conducted to obtain gray literature relevant to the Canadian context. Additional references were obtained from the articles identified. MAIN MESSAGE Hand-arm vibration syndrome is a prevalent occupational disease affecting workers in multiple industries in which vibrating tools are used. However, it is underdiagnosed in Canada. It has 3 components-vascular, in the form of secondary Raynaud phenomenon; sensorineural; and musculoskeletal. Hand-arm vibration syndrome in its more advanced stages contributes to substantial disability and poor quality of life. Its diagnosis requires careful history taking, in particular occupational history, physical examination, laboratory tests to rule out alternative diagnoses, and referral to an occupational medicine specialist for additional investigations. Management involves reduction of vibration exposure, avoidance of cold conditions, smoking cessation, and medication. CONCLUSION To ensure timely diagnosis of HAVS and improve prognosis and quality of life, family physicians should be aware of this common occupational disease and be able to elicit the relevant occupational history, refer patients to occupational medicine clinics, and appropriately initiate compensation claims.
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Affiliation(s)
- Shixin Cindy Shen
- Resident in the Department of Family and Community Medicine at St Michael's Hospital and in the Public Health and Preventive Medicine Residency Program at the University of Toronto in Ontario.
| | - Ronald A House
- Occupational medicine specialist in the Department of Occupational and Environmental Health at St Michael's Hospital and Associate Professor Emeritus in the Department of Occupational and Environmental Health at the University of Toronto
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Abstract
Dupuytren's disease is a chronic disease of the elderly. Assuming that life expectancy will increase considerably in the coming decades, Dupuytren's disease will gain more medical and socioeconomic relevance. In addition to well-known familial and genetic causes, other environmental factors (nicotine, diabetes, alcohol, trauma, work) are discussed. Knowledge of all factors and their influence on the onset and severity of the disease is important for diagnosis, therapy, and prevention of the disease.
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Affiliation(s)
- P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74206, Bad Rappenau, Deutschland.
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Teixeira M, Arce Filho J, Dal Bosco D, Silva A, Meireles B, Ribeiro S. DOENÇA DE DUPUYTREN EM PACIENTE COM MÚLTIPLOS FATORES DE RISCO: DIABETES DESCOMPENSADA, USO DE ANTICONVULSIVANTE E TRABALHO OCUPACIONAL. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Broekstra DC, van den Heuvel ER, Lanting R, Harder T, Smits I, Werker PMN. Dupuytren disease is highly prevalent in male field hockey players aged over 60 years. Br J Sports Med 2016; 52:1327-1331. [PMID: 27660370 DOI: 10.1136/bjsports-2016-096236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Dupuytren disease is a fibroproliferative hand condition. The role of exposure to vibration as a risk factor has been studied with contradictory results. Since field hockey is expected to be a strong source of hand-arm vibration, we hypothesised that long-term exposure to field hockey is associated with Dupuytren disease. METHODS In this cross-sectional cohort study, the hands of 169 male field hockey players (IQR: 65-71 years) and 156 male controls (IQR: 59-71 years) were examined for signs of Dupuytren disease. Details about their age, lifestyle factors, medical history, employment history and leisure activities were gathered. Prior to the analyses, the groups were balanced in risk factors using propensity score matching. The association between field hockey and Dupuytren disease was determined using a subject-specific generalised linear mixed model with a binomial distribution and logit link function (matched pairs analysis). RESULTS Dupuytren disease was observed in 51.7% of the field hockey players, and in 13.8% of the controls. After propensity score matching, field hockey playing as dichotomous variable, was associated with Dupuytren disease (OR=9.42, 95% CI 3.01 to 29.53). A linear dose-response effect of field hockey (hours/week x years) within the field hockey players could not be demonstrated (OR=1.03, 95% CI 0.68 to 1.56). DISCUSSION We found that field hockey playing has a strong association with the presence of Dupuytren disease. Clinicians in sports medicine should be alert to this less common diagnosis in this sport.
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Affiliation(s)
- Dieuwke C Broekstra
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edwin R van den Heuvel
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rosanne Lanting
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Surgery, Martini Hospital, Groningen, The Netherlands
| | - Tom Harder
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Emergency Medicine, Ommelander Hospital, Winschoten, The Netherlands
| | - Inge Smits
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Plastic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Becker K, Siegert S, Toliat MR, Du J, Casper R, Dolmans GH, Werker PM, Tinschert S, Franke A, Gieger C, Strauch K, Nothnagel M, Nürnberg P, Hennies HC. Meta-Analysis of Genome-Wide Association Studies and Network Analysis-Based Integration with Gene Expression Data Identify New Suggestive Loci and Unravel a Wnt-Centric Network Associated with Dupuytren's Disease. PLoS One 2016; 11:e0158101. [PMID: 27467239 PMCID: PMC4965170 DOI: 10.1371/journal.pone.0158101] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/12/2016] [Indexed: 11/18/2022] Open
Abstract
Dupuytren´s disease, a fibromatosis of the connective tissue in the palm, is a common complex disease with a strong genetic component. Up to date nine genetic loci have been found to be associated with the disease. Six of these loci contain genes that code for Wnt signalling proteins. In spite of this striking first insight into the genetic factors in Dupuytren´s disease, much of the inherited risk in Dupuytren´s disease still needs to be discovered. The already identified loci jointly explain ~1% of the heritability in this disease. To further elucidate the genetic basis of Dupuytren´s disease, we performed a genome-wide meta-analysis combining three genome-wide association study (GWAS) data sets, comprising 1,580 cases and 4,480 controls. We corroborated all nine previously identified loci, six of these with genome-wide significance (p-value < 5x10-8). In addition, we identified 14 new suggestive loci (p-value < 10−5). Intriguingly, several of these new loci contain genes associated with Wnt signalling and therefore represent excellent candidates for replication. Next, we compared whole-transcriptome data between patient- and control-derived tissue samples and found the Wnt/β-catenin pathway to be the top deregulated pathway in patient samples. We then conducted network and pathway analyses in order to identify protein networks that are enriched for genes highlighted in the GWAS meta-analysis and expression data sets. We found further evidence that the Wnt signalling pathways in conjunction with other pathways may play a critical role in Dupuytren´s disease.
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Affiliation(s)
- Kerstin Becker
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases, University of Cologne, Cologne, Germany
| | - Sabine Siegert
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | | | - Juanjiangmeng Du
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases, University of Cologne, Cologne, Germany
| | - Ramona Casper
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Guido H. Dolmans
- University of Groningen and University Medical Center Groningen, Dept. of Plastic Surgery, Groningen, the Netherlands
| | - Paul M. Werker
- University of Groningen and University Medical Center Groningen, Dept. of Plastic Surgery, Groningen, the Netherlands
| | - Sigrid Tinschert
- Div. of Human Genetics and Dept. of Dermatology, Medical University of Innsbruck, Innsbruck, Austria
- Inst. of Clinical Genetics, Dresden University of Technology, Dresden, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christian Gieger
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Epidemiologie II, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michael Nothnagel
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases, University of Cologne, Cologne, Germany
| | - Hans Christian Hennies
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases, University of Cologne, Cologne, Germany
- Div. of Human Genetics and Dept. of Dermatology, Medical University of Innsbruck, Innsbruck, Austria
- Dept. of Biological Sciences, University of Huddersfield, Huddersfield, United Kingdom
- * E-mail:
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Abstract
Occupational exposures to vibration come in many guises, and they are very common at a population level. It follows that an important minority of working-aged patients seen by medical services will have been exposed to this hazard of employment. Vibration can cause human health effects, which may manifest in the patients that rheumatologists see. In this chapter, we identify the health effects of relevance to them, and review their epidemiology, pathophysiology, clinical presentation, differential diagnosis and vocational and clinical management. On either side of this, we describe the nature and assessment of the hazard, the scale and common patterns of exposure to vibration in the community and the legal basis for controlling health risks, and we comment on the role of health surveillance in detecting early adverse effects and what can be done to prevent the rheumatic effects of vibration at work.
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Affiliation(s)
- Keith T Palmer
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, ARUK-MRC Centre for Work and Musculoskeletal Heath, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Massimo Bovenzi
- Clinical Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste 34100, Italy.
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Werker PM. Dupuytren disease. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Patterns of Dupuytren disease in fingers: studying correlations with a multivariate ordinal logit model. Plast Reconstr Surg 2014; 134:483-490. [PMID: 24804640 DOI: 10.1097/prs.0000000000000429] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dupuytren disease affects fingers in a variable fashion. Knowledge about specific disease patterns (phenotype) based on location and severity of the disease is lacking. METHODS In this cross-sectional study, 344 primary affected hands with Dupuytren disease were physically examined. The Pearson correlation coefficient between the coexistence of Dupuytren disease in pairs of fingers was calculated, and agglomerative hierarchical clustering was applied to identify possible clusters of affected fingers. With a multivariate ordinal logit model, the authors studied the correlation on severity, taking into account age and sex, and tested hypotheses on independence between groups of fingers. RESULTS The ring finger was most frequently affected by Dupuytren disease, and contractures were seen in 15.1 percent of affected rays. The severity of thumb and index finger, middle and ring fingers, and middle and little fingers was significantly correlated. Occurrences in pairs of fingers were highest in the middle and ring fingers and lowest in the thumb and index finger. Correlation between the ring and little fingers and a correlation between fingers from the ulnar and radial sides could not be demonstrated. CONCLUSIONS Rays on the ulnar side of the hand are predominantly affected. The middle finger is substantially correlated with other fingers on the ulnar side, and the thumb and index finger are correlated; however, there was no evidence that the ulnar side and the radial side were correlated in any way, which suggests that occurrence on one side of the hand does not predict Dupuytren disease on the other side of the hand. CLINCIAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Becker K, Tinschert S, Lienert A, Bleuler PE, Staub F, Meinel A, Rößler J, Wach W, Hoffmann R, Kühnel F, Damert HG, Nick HE, Spicher R, Lenze W, Langer M, Nürnberg P, Hennies HC. The importance of genetic susceptibility in Dupuytren's disease. Clin Genet 2014; 87:483-7. [PMID: 24749973 DOI: 10.1111/cge.12410] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
Dupuytren's disease (DD) is a progressive fibromatosis that causes the formation of nodules and cords in the palmar aponeurosis leading to flexion contracture of affected fingers. The etiopathogenesis is multifactorial with a strong genetic predisposition. It is the most frequent genetic disorder of connective tissues. We have collected clinical data from 736 unrelated individuals with DD who underwent surgical treatment from Germany and Switzerland. We evaluated a standardised questionnaire, assessed the importance of different risk factors and compared subgroups with and without positive family history. We found that family history clearly had the strongest influence on the age at first surgery compared to environmental factors, followed by male sex. Participants with a positive family history were on average 55.9 years of age at the first surgical intervention, 5.2 years younger than probands without known family history (p = 6.7 × 10(-8) ). The percentage of familial cases decreased with age of onset from 55% in the 40-49 years old to 17% at age 80 years or older. Further risk factors analysed were cigarettes, alcohol, diabetes, hypertension, and epilepsy. Our data pinpoint the importance of genetic susceptibility for DD, which has long been underestimated.
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Affiliation(s)
- K Becker
- Cologne Center for Genomics; Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases, University of Cologne, Cologne, Germany
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A systematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries. Plast Reconstr Surg 2014; 133:593-603. [PMID: 24263394 DOI: 10.1097/01.prs.0000438455.37604.0f] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dupuytren disease is a fibroproliferative disease of palmar fascia of the hand. Its prevalence has been the subject of several reviews; however, an accurate description of the prevalence range in the general population--and of the relation between age and disease--is lacking. METHODS Embase and PubMed were searched using database-specific Medical Subject Headings; titles and abstracts were searched for the words "Dupuytren," "incidence," and "prevalence." Two reviewers independently assessed the articles using inclusion and exclusion criteria, and rated the included studies with a quality assessment instrument. In a meta-analysis, the median prevalence, as a function of age by sex, was estimated, accompanied by 95 percent prediction intervals. The observed heterogeneity in prevalence was investigated with respect to study quality and geographic location. RESULTS Twenty-three of 199 unique identified articles were included. The number of participants ranged from 37 to 97,537, and age ranged from 18 to 100 years. Prevalence varied from 0.6 to 31.6 percent. The quality of studies differed but could not explain the heterogeneity among studies. Mean prevalence was estimated as 12, 21, and 29 percent at ages 55, 65, and 75 years, respectively, based on the relation between age and prevalence determined from 10 studies. CONCLUSIONS The authors describe a prevalence range of Dupuytren disease in the general population of Western countries. The relation between age and prevalence of Dupuytren disease is given according to sex, including 95 percent prediction intervals. It is possible to determine disease prevalence at a certain age for the total population, and for men and women separately.
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Descatha A, Carton M, Mediouni Z, Dumontier C, Roquelaure Y, Goldberg M, Zins M, Leclerc A. Association among work exposure, alcohol intake, smoking and Dupuytren's disease in a large cohort study (GAZEL). BMJ Open 2014; 4:e004214. [PMID: 24477316 PMCID: PMC3913034 DOI: 10.1136/bmjopen-2013-004214] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In view of the debate of factors in Dupuytren's disease, we aimed to describe its relationship with certain occupational factors, alcohol intake and smoking. SETTING The French GAZEL cohort (employees of Electricité de France and Gaz de France). PARTICIPANTS Participants of the cohort who answered a questionnaire in 2012, that is, 13 587 participants (73.7% of the questionnaire sent). In 2007, self-assessed lifetime occupational biomechanical exposure was recorded (carrying loads, manipulating a vibrating tool and climbing stairs), as well as alcohol intake, smoking and diabetes mellitus. Analyses were performed on high alcohol intake, smoking and duration of relevant work exposure, stratified by gender. PRIMARY AND SECONDARY OUTCOME MEASURES From a specific question on Dupuytren's disease assessed in 2012, the outcome measures were self-reported Dupuytren's disease (yes/no) and disabling Dupuytren's disease (including surgery). RESULTS A total of 10 017 men and 3570 women, aged 64-73 years, were included; the mean age for men was 68 years and for women was 65 years. Among men, the following were significantly associated with Dupuytren's disease: age (OR 1.03 (1.00; 1.06)), diabetes (OR 1.31 (1.07; 1.60)), heavy drinking (OR 1.36 (1.10; 1.69)) and over 15 years of manipulating a vibrating tool at work (OR 1.52 (1.15; 2.02)); except for diabetes, the association with these factors was stronger for disabling Dupuytren's disease (or surgery), with OR 1.07 (1.03; 1.11), 1.71 (1.25; 2.33) and 1.98(1.34; 2.91), respectively, for age, heavy drinking and over 15 years of manipulating a vibrating tool at work. Among the 3570 women included, 160 reported Dupuytren's disease (4.5%). The number of cases in the group of women was too low to reach conclusions, although the findings seemed similar for age, diabetes and vibration exposure. CONCLUSIONS In this large French cohort study, Dupuytren's disease in men was associated with high levels of alcohol consumption and exposure to hand-transmitted vibration. It is likely that the same applied to women.
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Affiliation(s)
- Alexis Descatha
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
- AP-HP, Occupational Health Unit/EMS (Samu92), University Hospital of Paris West Suburb, Garches, France
| | - Matthieu Carton
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
| | - Zakia Mediouni
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
- AP-HP, Occupational Health Unit/EMS (Samu92), University Hospital of Paris West Suburb, Garches, France
| | - Christian Dumontier
- Plastic and Hand Department, Nice University, St Roch Hospital, Nice, France
| | - Yves Roquelaure
- Laboratory of Ergonomics and Epidemiology in Occupational Health, LUNAM University, University of Angers, Angers, France
| | - Marcel Goldberg
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
| | - Marie Zins
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
| | - Annette Leclerc
- Université de Versailles St-Quentin, Versailles, France
- Centre for Research in Epidemiology and Population Health (CESP), U1018, “Population-Based Epidemiological Cohorts” Research Platform, INSERM, Villejuif, France
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Palmer KT, D'Angelo S, Syddall H, Griffin MJ, Cooper C, Coggon D. Dupuytren's contracture and occupational exposure to hand-transmitted vibration. Occup Environ Med 2014; 71:241-5. [PMID: 24449599 PMCID: PMC3963601 DOI: 10.1136/oemed-2013-101981] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS The relation between Dupuytren's contracture and occupational exposure to hand-transmitted vibration (HTV) has frequently been debated. We explored associations in a representative national sample of workers with well-characterised exposure to HTV. METHODS We mailed a questionnaire to 21 201 subjects aged 16-64 years, selected at random from the age-sex registers of 34 general practices in Great Britain and to 993 subjects chosen randomly from military pay records, asking about occupational exposure to 39 sources of HTV and about fixed flexion contracture of the little or ring finger. Analysis was restricted to men at work in the previous week. Estimates were made of average daily vibration dose (A(8) root mean squared velocity (rms)) over that week. Associations with Dupuytren's contracture were estimated by Poisson regression, for lifetime exposure to HTV and for exposures in the past week >A(8) of 2.8 ms(-2) rms. Estimates of relative risk (prevalence ratio (PR)) were adjusted for age, smoking status, social class and certain manual activities at work. RESULTS In all 4969 eligible male respondents supplied full information on the study variables. These included 72 men with Dupuytren's contracture, 2287 with occupational exposure to HTV and 409 with A(8)>2.8 ms(-2) in the past week. PRs for occupational exposure to HTV were elevated 1.5-fold. For men with an A(8)>2.8 ms(-2) in the past week, the adjusted PR was 2.85 (95% CI 1.37 to 5.97). CONCLUSIONS Our findings suggest that risk of Dupuytren's contracture is more than doubled in men with high levels of weekly exposure to HTV.
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Affiliation(s)
- Keith T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Tajika T, Kobayashi T, Kaneko T, Tsunoda D, Tsunoda K, Sutou T, Yamamoto A, Takagishi K. Epidemiological study for personal risk factors and quality of life related to Dupuytren's disease in a mountain village of Japan. J Orthop Sci 2014; 19:64-70. [PMID: 24129389 DOI: 10.1007/s00776-013-0478-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 09/20/2013] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan,
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Frisch M, Nielsen NM, Pedersen BV. Same-sex marriage, autoimmune thyroid gland dysfunction and other autoimmune diseases in Denmark 1989-2008. Eur J Epidemiol 2013; 29:63-71. [PMID: 24306355 DOI: 10.1007/s10654-013-9869-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 11/28/2013] [Indexed: 01/05/2023]
Abstract
Autoimmune diseases have been little studied in gay men and lesbians. We followed 4.4 million Danes, including 9,615 same-sex married (SSM) persons, for 47 autoimmune diseases in the National Patient Registry between 1989 and 2008. Poisson regression analyses provided first hospitalization rate ratios (RRs) comparing rates between SSM individuals and persons in other marital status categories. SSM individuals experienced no unusual overall risk of autoimmune diseases. However, the risk of autoimmune thyroid dysfunction was increased, notably Hashimoto's thyroiditis (women(SSM), RR = 2.92; 95% confidence interval (CI) 1.74-4.55) and Graves' disease (men(SSM), RR = 1.88; 95% CI 1.08-3.01). There was also an excess of primary biliary cirrhosis (women(SSM), RR = 4.09; 95% CI 1.01-10.7), and of psoriasis (men(SSM), RR = 2.48; 95% CI 1.77-3.36), rheumatic fever (men(SSM), RR = 7.55; 95% CI 1.87-19.8), myasthenia gravis (men(SSM), RR = 5.51; 95% CI 1.36-14.4), localized scleroderma (men(SSM), RR = 7.16; 95% CI 1.18-22.6) and pemphigoid (men(SSM), RR = 6.56; 95% CI 1.08-20.6), while Dupuytren's contracture was reduced (men(SSM), RR = 0.64; 95% CI 0.39-0.99). The excess of psoriasis was restricted to same-sex married men with HIV/AIDS (men(SSM), RR = 10.5; 95% CI 6.44-15.9), whereas Graves' disease occurred in excess only among same-sex married men without HIV/AIDS (men(SSM), RR = 1.99; 95% CI 1.12-3.22). Lesbians and immunologically competent gay men in same-sex marriage face no unusual overall risk of autoimmune diseases. However, the observed increased risk of thyroid dysfunction in these lesbians and gay men deserves further study.
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Affiliation(s)
- Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, 5 Artillerivej, DK-2300, Copenhagen S, Denmark,
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Barton JC, Barton JC. Dupuytren's Contracture in Alabama HFE Hemochromatosis Probands. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2012; 5:67-75. [PMID: 22952417 PMCID: PMC3431974 DOI: 10.4137/cmamd.s9935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dupuytren's contracture (DC) and HFE hemochromatosis occur in some of the same at-risk populations and present with similar comorbid conditions. METHODS We estimated DC prevalence in two cohorts of white Alabama hemochromatosis probands (294 C282Y homozygotes, 67 C282Y/H63D compound heterozygotes) in a retrospective study. We performed logistic regressions on DC using the following independent variables: age, body mass index, heavy ethanol consumption, serum ferritin, elevated serum AST/ALT, non-alcoholic fatty liver disease, viral hepatitis, cirrhosis, and diabetes. RESULTS One man and two women with C282Y homozygosity had DC (prevalence 1.02%; 95% CI 0.35%-2.96%). A man with C282Y/H63D had DC (prevalence 1.49%; 95% CI 0.26%-7.98%). DC occurred as an autosomal dominant trait in his kinship. In regression analyses, no single variable predicted DC. We observed no new DC cases after the diagnosis of hemochromatosis (mean follow-up 12.9 ± 7.5 years (1 SD), and 9.0 ± 5.1 years, respectively). CONCLUSIONS Our prevalence estimates of DC in white Alabama hemochromatosis probands are similar to those found in the white US population cohorts. DC risk was unrelated to the variables we studied.
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Affiliation(s)
- James C Barton
- Southern Iron Disorders Center, Birmingham, Alabama, USA
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Picardo NE, Khan WS. Advances in the understanding of the aetiology of Dupuytren's disease. Surgeon 2012; 10:151-8. [PMID: 22297148 DOI: 10.1016/j.surge.2012.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 01/12/2012] [Indexed: 12/12/2022]
Abstract
Dupuytren's disease is a fibroproliferative disease of the palmar fascia which has been described for centuries, yet the aetiology and pathophysiology remain poorly understood. Surgery and collagenase injections comprise the main therapeutic options but disease recurrence is common. We explore the evidence underlying the current disease theories and outline other potential therapeutic options.
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Descatha A, Bodin J, Ha C, Goubault P, Lebreton M, Chastang JF, Imbernon E, Leclerc A, Goldberg M, Roquelaure Y. Heavy manual work, exposure to vibration and Dupuytren's disease? Results of a surveillance program for musculoskeletal disorders. Occup Environ Med 2012; 69:296-9. [PMID: 22213840 DOI: 10.1136/oemed-2011-100319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION This study aimed to determine the prevalence of Dupuytren's disease in men and its relationship with work exposure, particularly heavy manual work with and without significant use of vibrating tools, using data from a surveillance program for musculoskeletal disorders. METHOD This cross-sectional study was conducted in France between 2002 and 2005. Dupuytren's disease was diagnosed clinically by one of 83 occupational physicians. Exposure in relation to work status and occupational risk factors was assessed with a self-administered questionnaire, and categorised according to vibration exposure (defined as use of vibrating tools for ≥2 h/day), heavy manual work without vibration exposure (defined as use of hand tools for ≥2 h/day (use of vibrating tools for ≥2 h/day excluded) and Borg scale ≥15/20) and no such exposure. Bivariate and multivariate associations using logistic models were recorded in men and in those with >10 years in the same job. RESULTS Of 2161 men, 1.3% (n=27) had Dupuytren's disease (mean age 47.1±6.7 years). Heavy manual work without vibration exposure was significantly associated with the condition (adjusted OR (aOR) 3.9; 95% CI 1.3 to 11.5) adjusted on age and diabetes), as was use of vibrating tools (aOR 5.1; 2.1 to 12.2). These associations remained significant among subjects with >10 years in the same job, with increases in aOR of 6.1 (1.5 to 25.0) and 10.7 (3.4 to 34.6), respectively. CONCLUSION Despite the limited number of cases, occupational exposure, including both vibration exposure and heavy manual work without significant vibration exposure, was associated with Dupuytren's disease.
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Affiliation(s)
- Alexis Descatha
- Université de Versailles St-Quentin, UMRS 1018, Centre for Research in Epidemiology and Population Health, Population-Based Epidemiological Cohorts Research Platform, Villejuif, France.
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Affiliation(s)
- Alexis Descatha
- UVSQ AP-HP, U1018-Inserm, Population-Based Epidemiological Cohorts, Research Platform, Occupational Health Unit SAMU92, Garches, France
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