Cortisone shots for Dupuytren's nodules

Cortisone injections have been used for many years as an early treatment for Dupuytren's in the nodular stage of involvement. This approach is based on clinical experience, but what is the actual biology? It may have to do with the finding that tissue matrix as well as the blood vessel cells in Dupuytren's nodules have abnormal amounts of a helper protein, VLA4. VLA4 acts like a doorknob on a door on the blood vessel wall which lets inflammatory cells out of the bloodstream and into the nodule, where they promote inflammation and fibrosis. This study shows that cortisone injected into Dupuytren nodules reduces the activity of VLA4 in Dupuytren's nodules  back toward normal. This is only part of the picture, but provides solid clues to look into further for better treatment options: http://www.dupuytrenfoundation.org/DupPDFs/1999_Meek_1079.pdf, http://www.dupuytrenfoundation.org/DupPDFs/1999_Meek_1581.pdf