The incidence of Dupuytren's disease in patients with rheumatoid arthritis

Some conditions commonly associated with Dupuytren's disease are well-known. No attention has been paid to conditions with a significantly low incidence of Dupuytren's. A large number of patients with rheumatoid arthritis were studied, and were found to have a statistically significantly lower incidence of Dupuytren's disease, than was observed by the same clinicians in age, sex, matched controlled patients.     

Cancer incidence in patients treated surgically for Dupuytren's contracture

Our aim was to study risk factors for Dupuytren's contracture (DC) by assessing cancer morbidity in a group of Swedish patients treated surgically for Dupuytren's contracture. The risk of cancer was determined in 15,212 patients operated on for Dupuytren's contracture, identified in the nationwide Swedish Inpatient Register during the period 1965 to 1994 by means of record linkage to the Swedish Cancer Register. Standardized incidence ratios (SIRs) were computed using age-, sex- and period-specific incidence rates derived from the entire Swedish population. The overall relative risk of cancer was increased by 24%. There were significantly increased risks for malignancies related to smoking such as buccal, oesophageal, gastric, lung and pancreatic cancers. Significantly increased risks were present for both prostate and rectal cancer in men and an increase risk for breast cancer in women was noted 1 year or more after surgery for Dupuytren's contracture. The present study confirms smoking and alcohol abuse as probable risk factors for DC. There are characteristics in patients with DC that alter the risks for other malignancies compared with the general population.     

Prognosis in Dupuytren's disease.

This is a retrospective study of 85 patients with Dupuytren's disease who were treated surgically and followed up for 1 to 7 years (average, 41 months). The overall recurrence after surgery was 34%.     

Osteophyte formation in association with Dupuytren's disease.

Three cases in which there was osteophyte formation on the middle phalanx at the site of insertion of retrovascular cords of Dupuytren's disease are presented.     

Genetic susceptibility in Dupuytren's disease. TGF-beta1 polymorphisms and Dupuytren's disease

Dupuytren's disease is a benign fibroproliferative disease of unknown aetiology. It is often familial and commonly affects Northern European Caucasian men, but genetic studies have yet to identify the relevant genes. Transforming growth factor beta one (TGF-beta1) is a multifunctional cytokine which plays a central role in wound healing and fibrosis. It stimulates the proliferation of fibroblasts and the deposition of extracellular matrix. Previous studies have implicated TGF-beta1 in Dupuytren's disease, suggesting that it may represent a candidate susceptibility gene for this condition. We have investigated the association of four common single nucleotide polymorphisms in TGF-beta1 with the risk of developing Dupuytren's disease. A polymerase chain reaction-restriction fragment length polymorphism method was used for genotyping TGF-beta1 polymorphisms. DNA samples from 135 patients with Dupuytren's disease and 200 control subjects were examined. There was no statistically significant difference in TGF-beta1 genotype or allele frequency distributions between the patients and controls for the codons 10, 25, -509 and -800 polymorphisms. Our observations suggest that common TGF-beta1 polymorphisms are not associated with a risk of developing Dupuytren's disease. These data should be interpreted with caution since the lack of association was shown in only one series of patients with only known, common polymorphisms of TGF-beta1. To our knowledge, this is the first report of a case-control association study in Dupuytren's disease using single nucleotide polymorphisms in TGF-beta1.     

Transglutaminase levels in Dupuytren's disease.

By use of immunoperoxidase staining, tissue transglutaminase and aminopropeptide of collagen type III were localized to fibroblasts running within cords of Dupuytren's fascia. Quantitative analysis of transglutaminase revealed that activity levels were significantly higher in acutely contracting fascia than in chronic contractures. The results show that contractures in Dupuytren's fascia may be reflected by the level of transglutaminase activity in the tissue. Furthermore, it is suggested that isopeptide bond formation, involving collagen type III aminopropeptide moieties, may be the biochemical mechanism by which transglutaminase maintains the contracted state.     

The biochemistry of Dupuytren's disease

The molecular biochemical aspects of Dupuytren's disease have been studied for decades. This article summarizes biochemical influences on myofibroblast contractility, endogenous and exogenous chemical regulation, the influence of growth factors, and the biochemistry of collagen. A clear insight into the biochemistry of Dupuytren's disease may provide a foundation for future clinical interventions.     

Lipids and Dupuytren's disease.

We studied prospectively the relationship between serum lipids and Dupuytren's disease of the hand in 85 patients, 65 men and 20 women. The Dupuytren patients had significantly higher fasting serum cholesterol and triglyceride levels than did the controls (p < 0.001). The raised levels of serum lipids appeared to be associated with the pathogenesis of Dupuytren's disease, and this may help to explain the high incidence of Dupuytren's disease in alcoholic, diabetic and epileptic patients, since these conditions are also associated with raised serum lipid levels.     

Algodystrophy and its association with Dupuytren's disease.

Seventy-two patients were examined 9 weeks after sustaining a Colles' fracture of the wrist for evidence of algodystrophy. They were examined 18 months later for evidence of Dupuytren's disease to determine the incidence of the association between the two conditions. Forty-one per cent of all patients had evidence of Dupuytren's disease at 18 months following Colles' fracture. Sixty-seven per cent of patients with algodystrophy had evidence of Dupuytren's disease compared with 19% of patients who showed no features of algodystrophy.     

Platelet-derived growth factor in Dupuytren's disease.

This study investigated whether platelet-derived growth factor, a potent inducer of cell proliferation, was identifiable in association with myofibroblasts in Dupuytren's disease. Myofibroblasts in the hypercellular disease stages showed a strong reaction to platelet-derived growth factor antibody using light and electron microscopic immunochemical labels. Platelet-derived growth factor may play a role as a cellular signal for myofibroblast proliferation in the formation of the pathognomonic nodule in Dupuytren's disease.     

The early history of Dupuytren's disease

Dupuytren's disease may have originated among the Vikings of northern Europe. Possible association of the disease with the Scottish bagpipe-playing MacCrimmon clan and the Papal Sign of Benediction also are examined. The evolution of pathologic understanding and the advent of surgical treatment of the disease in the late eighteenth and early nineteenth centuries in Europe and North America are reviewed in detail.     

The proximal interphalangeal joint in Dupuytren's disease

A precise excision of the diseased fascia corrects proximal interphalangeal joint deformity in many instances. When excision of the fascia results in a contracture of greater than 30 degrees that has not been corrected to this level by gentle manipulation, then a systematic release of the causative structures is occasionally indicated, paying particular attention to the check rein ligaments of the palmar plate and adherence of shortened collateral and accessory collateral ligaments. Postoperative physical therapy and splinting are necessary, particularly in those cases in which a joint release has been performed. These authors advise against a routine joint release. Ultimately, the failure to regain flexion may be a greater disability than the original loss of extension.     

Dupuytren's disease in patients from the Indian sub-continent. Report of ten cases

We report on ten patients from the Indian sub-continent operated on in our unit for Dupuytren's contracture. Their presentation, operative findings and subsequent course was indistinguishable from Caucasian patients. We believe that Dupuytren's disease among Indians is not so rare as previously thought.     

Dupuytren's disease in blacks

Dupuytren's disease in blacks is believed to be rare. Our recent experience with the disease at the John Cochran Veterans Administration Hospital in St Louis is described, including 2 black patients suffering from the condition. The literature is reviewed and some aspects of pathogenesis are discussed. It is our belief that Dupuytren's disease is more common in blacks than previously reported.