Limited progression of subclinical Dupuytren’s disease

Abstract

Aims With novel promising therapies potentially limiting progression of Dupuytren’s disease (DD), better patient stratification is needed. We aimed to quantify DD development and progression after seven years in a population-based cohort, and to identify factors predictive of disease development or progression. Methods All surviving participants from our previous prevalence study were invited to participate in the current prospective cohort study. Participants were examined for presence of DD and Iselin’s classification was applied. They were asked to complete comprehensive questionnaires. Disease progression was defined as advancement to a further Iselin stage or surgery. Potential predictive factors were assessed using multivariable regression analyses. Of 763 participants in our original study, 398 were available for further investigation seven years later. Results We identified 143/398 (35.9%) participants with DD, of whom 56 (39.2%) were newly diagnosed. Overall, 20/93 (21.5%) previously affected participants had disease progression, while 6/93 (6.5%) patients showed disease regression. Disease progression occurred more often in patients who initially had advanced disease. Multivariable regression analyses revealed that both ectopic lesions and a positive family history of DD are independent predictors of disease progression. Previous hand injury predicts development of DD. Conclusion Disease progression occurred in 21.5% of DD patients in our study. The higher the initial disease stage, the greater the proportion of participants who had disease progression at follow-up. Both ectopic lesions and a positive family history of DD predict disease progression. These patient-specific factors may be used to identify patients who might benefit from treatment that prevents progression. Cite this article: Bone Joint J 2021;103-B(4):704–710.

Anti-tumour necrosis factor therapy for early-stage Dupuytren's disease (RIDD): a phase 2b, randomised, double-blind, placebo-controlled trial

“…Consequently, we did not observe a significant change in the extensor deficit of the joint affected by the treated nodule over the course of the study. Approximately 20% of patients with Dupuytren’s disease progressed to the development of finger contractures over 7 years in one study; 3 in another study, progression was reported in about 35% patients over the course of 18 years. 4 Therefore, follow-up for 10 years or more would be required to ascertain whether intranodular injection of adalimumab and the observed significant reduction in nodule hardness and nodule size on ultrasound scan would affect the development of finger deformities and hand function as assessed by patient-reported outcome measures such as MHQ.…”

“…There was also no change in the most restricted activity selected by each participant. Dupuytren’s disease typically progresses over several years 3 , 4 and a limitation of our study is that we only followed patients for 18 months from baseline. Consequently, we did not observe a significant change in the extensor deficit of the joint affected by the treated nodule over the course of the study.…”

“… 1 There is a strong genetic component, with heritability estimated at 80%. 2 The early stages of the disease manifest as nodules; progression to fibrous cords occurred in about 20% of individuals over the course of 7 years in one study; 3 in another study, about 35% of individuals progressed over the course of 18 years. 4 Patients with Dupuytren’s diathesis are considered to have more aggressive disease progression.…”

Treatments for early-stage Dupuytren’s disease: an evidence-based approach

“…More participants in the saline group ( n = 10) had undergone or were awaiting surgery than the adalimumab group ( n = 3); again, the overall numbers were small and precluded statistical analysis. Based on previous studies that estimated that 20% of patients with Dupuytren’s disease experience progression to develop finger contractures over 7 years and 35% over 18 years (Gudmundsson et al., 2001; van den Berge et al., 2021), follow-up for approximately 10 years would be required to ascertain whether intranodular injection of adalimumab and the observed statistically significant reduction in nodule hardness and nodule size on ultrasound scan would impact on the development of finger deformities and impact hand function as assessed by PROMs, such as MHQ. There were no related severe adverse events and there was no difference between the saline and adalimumab groups with respect to minor local injection site reactions (local itching, redness, haematoma, bruising, blistering).…”

“…Not all individuals diagnosed with early-stage disease will develop flexion deformities and impairment of hand function. Van den Berge et al. (2021) found that flexion deformities developed in 20% of affected individuals over 7 years and Gudmundsson et al.…”