Saturday, September 24, 2011

Medical research: I have nodules but no contractures. What can I do?

I have nodules but no contractures. What can I do?

The question "What can I do to keep my Dupuytren's from getting worse or from coming back after treatment?" is the holy grail for Dupuytren's. Dupuytren's is not cured by surgery, and there is not an effective medical treatment to stop or slow progression. This makes it easy for people to make unfounded claims, recommedations and sales pitches. However, there are some interesting leads which may be worth pursuing and which have some published scientific basis. Links listed will connect you to abstracts of the source publications through the National Library of Medicine.
  1. Dupuytren's is probably aggravated by mechanical forces 19505772, particularly stretching or shearing forces on the palm. From this, it would be logical to try to reduce the amount of stretching and shearing forces on the palm if you have Dupuytren's. For example, when doing pushups or the downward dog position in Yoga, use pushup handles or hold on to light dumbells to bear weight and avoid stretching the wrist and fingers back. When possible, use gel padded gloves for heavy work or sports to reduce shearing forces on the palm. Increase the grip size of tennis racquet, golf club or other handles used in sports.
  2. Dupuytren's may be helped by silicone rubber and by night time splinting 21935846. There is anecdotal evidence that Dupuytren's may be slowed or even improved by wearing a hand splint while sleeping. There are two points to this. The first is that many people hold their hands in a fist while sleeping, and that this may contribute to Dupuytren's contracture. The second is that silicone rubber may have a beneficial effect to soften, flatten and calm the biology of areas affected by Dupuytren's. From this, it would be logical to wear a simple hand splint while sleeping with a silicone rubber insert contacting the palm. This may be made as a do-it-yourself project by combining a drugstore hand splint with over the counter adhesive gel sheeting (such as Pedifix Visco-gel Moleskin® or similar products) or professionally by a hand therapist using a special silicone rubber moulded to the palm. The point of wearing a splint while sleeping is not to force the fingers backward, but to support the fingers comfortably straight so that you don't sleep with your hand in a fist.
  3. Dietary changes may help. There is also a growing body of evidence to look at diet and dietary supplements as a way to slow progression of Dupuytren's. Biologically, Dupuytren's is a type of fibrosis, like scar tissue, and seems to be provoked by a protein called tumor growth factor beta (TGF beta). Studies have shown therapeutic effects of TGF-beta-related fibrosis by curcumin (in turmeric) (12890714, 15200418), ginsan (in ginseng) 20945375, fish oil 21370451, flaxseed oil 18981722, quercetin (flavonoid found in green tea and a number of fruits and vegetables) 15580028. It may be helpful to increase awareness and intake of these items. A recent laboratory cell biology study higlighted the possible benefit in Dupuytren's of increasing cyclic AMP levels in tissue 21612641. Caffeine (in coffee) and theobromide (in tea) are known to increase cyclic AMP levels. What is not known is how effective they might be out of the lab and in the body. Excessive caffeine may be harmful - this is not a recommendation to overdo it with coffee, tea, and energy drinks! Caffeine containing creams and lotions are sold as treatments for cellulite and bags under the eyes - might they be helpful used on a Dupuytren's palm? More research is needed.
  4. Lifestyle changes may help. There is overlap in risk factors for Dupuytren's and for cardiovascular disease. This is not a surprise, because both involve the biology of fibrosis. TGF-beta-mediated fibrosis is aggravated both by excessive dietary salt 9843472 and dietary cholesterol 9214456. Smoking and chronic heavy drinking also increase the likelihood of Dupuytren's 15485739, and smoking increases the likelihood of recurrence after treatment for Dupuytren's. Here's your reason to quit!
  5. What can my doctor do at this stage? Cortisone injections 11119679 or low dose radiation treatment 20127225 have benefit for burning, tender or itching Dupuytren nodules. These interventions are most effective when used before actual contractures develop - they have no effect on contractures themselves. They may help slow the progression from nodules to contractures, but are unpredictable.

All of these ideas need further research. If you have experience with these, good or bad, please share your story to help build a database for more work to be done! The ultimate goal of the Dupuytren Foundation is to push to find a cure.

15 comments:

  1. Hi just been diagnosed with this as a possible condition, a quick question has there been any studies on ultra sound and the tissue, cab the ultrasound break down the tissue or reduce nodes. Look forward to any thoughts or if progress has been made in a cure.

    Many thanks.

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  2. I have had this for the last 10 years and I just turned 37. I have it in both hands and my feet it's worse on my left side then it Is on my right and painfully for me most days.can anyone tell me if its known to affect people my age?

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  3. I may have this. Haven't been diagnosed yet. I was very curious as to what causes this condition in the first place.

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  6. Others swear that massage and streching is beneficial. Very confusing

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