Options for severe recontracture: recurrent Dupuytren contracture

The worst and unsolved part of Dupuytren contracture is recontracture after treatment, and then recontracture after retreatment. Most people don't have this problem, but when they do, the most common joint to have this problem is the small (pinky) finger PIP joint - the joint in the middle of the finger.

Recontracture after a minimally invasive treatment is often treated with fasciectomy (the most common open surgery), but what are the options when there is severe recontracture after fasciectomy? There are 3 traditional options recommended by hand surgeons.

1. Dermofasciectomy. This operation involves removing Dupuytren tissue and old scar tissue and replacing the skin of the front (palm) half of the finger with skin graft. It has the best chance of long term control, but has 3 potential problems:

• The complication rate is higher than for fasciectomy, but this is actually because the complication rate goes up with every redo surgery, and dermofasciectomy is often done as the second or third operation. The fewer operations before dermofasciectomy, the better.
• The previously operated finger may have so much scarring of the blood vessels that when the surgeon releases everything and tries to straighten the finger, it may start to cut off the circulation. If that happens, it limits how much improvement the surgery can give.
• PIP joint (the knuckle you use to knock on a door) contractures greater than 60 degrees tend to stretch out the tendons on the back of the knuckle which straighten the joint and at the same time shrink the ligaments on the front side of the joint. These issues are hard to perfectly correct even with surgery: the finger may be brought back to a straight position in the operating room, but relapse over the weeks that follow into a stiff bend, despite everything the surgeon, patient and therapist can do. Frustrating.

2. PIP joint fusion. Fusion (or arthrodesis) is removing the joint and making the two bones grow together to form one bone. It's usually done through a cut on the back of the finger, avoiding the battleground of the previous surgery to reduce the risk of nerve and circulatory injuries. The advantage is that the joint will not contract again. The disadvantage is that the joint won't bend again. Normally, the PIP joint is fused in a partial bend - as bent as it can be without catching on things, which really depends on how bent the next joint back is - the MCP joint (the knuckle you use to punch something). There are 3 issues with this operation:

• There's no perfect angle for a fused PIP - you have to choose between not catching it on things or not making a fist. Some people see fusing the joint bent as not much better than what they already have.
• It shortens the finger quite a bit, because the flesh on the palm side of the finger won't stretch out. It doesn't bring the finger back out to its original length.
• It makes a strange grip, because the joint doesn't bend where it used to.

Amputation. Only a consideration if requested by the patient because they have just had it with the finger and want to move on. If you're not at this point, amputation isn't for you. 

I'll review two newer procedures in the next post. 

Radiation and Dupuytren disease

Radiation treatment of Dupuytren disease has been reported in medical journals since the 1930s. It's difficult to study because Dupuytren disease is so unpredictable and progresses so slowly.

Radiation is primarily recommended to prevent contracture in those who do not yet have contracture. The outcome of any preventative treatment has to be compared to the outcome of no treatment, what's called the natural history of the condition. There's very little data on the natural history of progression from Dupuytren nodules to contractures: only two published studies report specifically on this: 
http://Dupuytrens.org/DupPDFs/2001_Gudmundsson.pdf
http://Dupuytrens.org/DupPDFs/2005_Reilly_1022.pdf
Data from these studies would predict that for people with a Dupuytren nodule but no contracture, one out of ten would eventually see their nodule go away without any treatment and less than two out of one hundred would progress to contracture each year. Many patients with Dupuytren disease never need treatment for Dupuytren contracture.

These numbers are essential to evaluation of the outcome of preventative radiation treatment for Dupuytren disease. Published studies on outcomes of radiation for early Dupuytren disease study report progression rates similar to or greater what was found in the above studies of no treatment.
http://Dupuytrens.org/DupPDFs/2012_Seegenschmeidt.pdf
http://Dupuytrens.org/DupPDFs/2010_Betz.pdf

There's much anecdotal experience that radiation for Dupuytren disease reduces itching, tenderness, firmness of nodules, but, whether this translates to changes in rates of contracture progression - the bigger issue - is unclear. The lack of solid evidence despite many years of experience may have more to do with statistical difficulty studying Dupuytren disease than any lack of effect, but the reality is that available data does not show a strong difference comparing treated versus untreated outcomes. The logic behind radiation for Dupuytren disease is also complicated: the early effects of radiation are helpful for inflammatory, proliferative conditions such as the nodular stage of Dupuytren disease, but late effects stimulate fibrosis - exactly the opposite of what you would want for a fibrotic condition. In addition, Betz reported minor, but chronic issues of skin thinning and peeling in about one third of patients undergoing radiation for Dupuytren disease.

In 2015, doctors simply don't have enough data for an evidence based recommendation regarding radiation as a routine prophylactic treatment to influence the rate of progression of Dupuytren contracture - one way or the other. Ultimately, it's the patient's choice. This choice depends on risk tolerance answering this question: which is more important - doing everything possible, or avoiding treatment which might have complications and no benefit? This is the essential question of consenting to any medical treatment. For some treatments (antibiotics for pneumonia), the answer is straightforward because treatment is very predictably low risk and high yield compared to no treatment. For others, such as radiation for early Dupuytren disease, the answer remains unclear. 

Therametrics: Possible Dupuytren Drugs

Therametrics (http://Therametrics.com)  has a novel approach to therapeutic drug discovery which may fit well with efforts to find a cure for Dupuytren disease. Studying Dupuytren disease is difficult because the biology is amazingly complicated. Many different types of drugs might be helpful - too many for any one person to sort through. It's also difficult because it progresses slowly and unpredictably - not good for testing by trial and error. This is a perfect problem for computer analysis - to sort through millions of scientific publications across many different fields of biology, and find hidden clues to what might work. This is what Therametrics software does - sifts through the internet, cross referencing drugs and biology: http://www.therametrics.com/pages-40-drr.html.

Therametrics has been kind enough to demonstrate some of the power of their tools for the Dupuytren Foundation by running an analysis on possible drugs to treat Dupuytren disease. The goal is to identify existing drugs whose effects overlap those of Dupuytren biology. For example, some drug already available for high blood pressure, baldness, or other conditions might also hold the key to help Dupuytren biology. Rather than reinventing the wheel, this approach finds a whole range of existing wheels. A summary of what they found is available at http://Dupuytrens.org/DupPDFs/TherametricsDupuytren.pdf. Pretty complicated, but very exciting. This is the tipping point between "I wonder if this will do anything?" to "Here's why this should work.". This is a giant leap forward, not just for Dupuytren disease research, but for any condition in need of a better medical treatment.

Dupuytren Foundation Interviews: What research needs to be done?

Hand surgeons answer the question: "What research needs to be done to help people with Dupuytren disease?" https://www.youtube.com/watch?v=cr4dKa37hus&list=PLSEyPqK1WriRbR54v3EBxfXkjCzsYFJuN&index=3

Google Glass and Dupuytren Procedures

A neat use of Google Glass to record procedures for Dupuytren disease:
http://glasshandsurgery.blogspot.com/2014/11/google-glass-used-in-hand-surgery.html
Next step is to miniaturize the view and track down the culprit molecules!

Dupuytren Foundation Matching Gift Opportunity

We will Double your Dupuytren Donation Dollars thru December!

Dupuytren Foundation matching gift details here.

Donate here!. 

Big data editorial

The path to understanding Dupuytren disease is being built on evolving technologies: patient crowdsourcing; genetic analysis; big data. We're not alone. This editorial discusses the impact of big data on medical research:http://www.amjorthopedics.com/uploads/media/ajo043090399.pdf.

Dupuytren Minute Message: Sports and exercise 3

Tread Lightly on Your Palms

Dupuytren biology involves myofibroblasts, provoked by mechanical forces, among other things; nice review article here: http://goo.gl/3XSOkp. Stretching fingers backward - intuitive, logical ...and probably the exact wrong thing to do for Dupuytren. Pushups? Use pushup handles or fist pushups on padding; same for yoga downward dog position. Adapt and keep going! 

Video Interviews: What would hand surgeons want for their own Dupuytren disease?

Rolling out the second video from a series of interviews at this year's annual meeting of the American Society for Surgery of the Hand. Each video features  surgeons answering one question about Dupuytren disease. Twenty hand surgeons answer the question "What's your plan if you get Dupuytren disease?" http://youtu.be/94JHxC-FZW0

Stay tuned for more videos in coming weeks:subscribe to the Dupuytren Foundation YouTube channel: http://Dupuytren.tv  #Dupuytren

Dupuytren Minute Message: Sports and Exercise 2

Rock Climbing and Dupuytren Disease

Rock climbing increases risk of Dupuytren contracture. Read the full article here:  http://goo.gl/Ns2xOE

The more hours spent, the greater the risk. Why? Dupuytren biology is fed by mechanical stress. Stress alone won't give you Dupuytren disease, but with genetic Dupuytren risk, stressing your palms might start it early. Probably same for handball, rowing, BMX: all stress the palm. Be nice to your hands.  #Dupuytren

Two treats:

 1. Watch the first video in an upcoming series of interviews at this year's annual meeting of the American Society for Surgery of the Hand. Each video features  surgeons answering one question about Dupuytren disease: http://youtu.be/UMcH32yrY2c

Stay tuned for more videos in coming weeks at:

http://www.youtube.com/user/DupuytrenFoundation

 2. Advance the understanding of Dupuytren disease and related conditions in just one minute. We're gearing up for the 2015 International Conference on Dupuytren disease and want to survey as many people with Dupuytren and Ledderhose disease as possible.  Please take a minute to fill this out even if you don't have Ledderhose or Dupuytren - we need your input. http://esurv.org/?u=DupLed .

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Support the Dupuytren foundation while shopping on Amazon; It's easy!  AmazonSmile will make a donation to the Dupuytren Foundation for every eligible Amazon.com purchase  with no extra cost to you if you click here to shop Amazon4Dup.com

Dupuytren Minute Message: Sports and Exercise:

Mind Your Grip

Sports and Exercise:

Dupuytren biology is provoked by mechanical stress. If you have Dupuytren disease, don't stop exercising, but look into ways to reduce the stress on your palms when you work out. You can cushion or shield your palms with workout gloves, pull up hooks, or pull up pads. Also, anything which increases the diameter of your grip reduces the amount of shearing stress on your palm when you grip. Take advantage of this by using padded gloves (welder's gloves are good), larger grips on weights, golf clubs and tennis racquets. 

International Dupuytren Society Survey Now Available

Do you or does someone you know have either Dupuytren Disease, Ledderhose Disease, or both? Here's a message from the International Dupuytren Society:

"The International Dupuytren Society, the Ledderhose Blog, and the British Dupuytren Society have jointly developed a questionnaire targeting patients suffering from Dupuytren and/or Ledderhose disease. Please share your experience with these diseases, treatments and consultations! 

The questionnaire is available at  http://eSurv.org?u=DupLed  

The individual results are strictly confidential and the summary results will be used to evaluate patients' experience with treatments and patients' needs. Researchers often speak about what patients need but this is rarely evaluated. Please help us to document patients' experience and needs! "

I've taken the survey. It's painless and fun. Online surveys are increasingly important in understanding conditions such as Dupuytren and Ledderhose disease, which can vary so much from person to person. Results of this survey will be presented at the 2015 International Conference on Dupuytren Disease http://DupuytrenSymposium.com

 - Charlie Eaton

Dupuytren Foundation August 2013
The Dupuytren Foundation may have seemed quiet, but there's been quite a bit of internal activity reorganizing and streamlining for the last several months. This newsletter marks a milestone of consolidating all of our electronic resources into one system, which will make it easier for you to stay in touch and easier for us to work together.

Dupuytren YouTube Channel: it's growing!
Dupuytren related videos produced by the Dupuytren Foundation now have a home: http://www.youtube.com/DupuytrenFoundation
These videos include:

• All presentations from the 2010 International Symposium on Dupuytren's Disease
• Technical videos on the treatment of Dupuytren Disease
• A new section: the Dupuytren Foundation Two Minute Video Series, which are short educational videos covering a growing range of topics relevant to Dupuytren Disease and the issues which are important in the search for a cure.

The latest addition to this collection is "Measurement of Dupuytren Disease", reviewing the problems and potential of simple measurement techniques needed to better study progress and outcomes of treatment. Explore the issue yourself with the interactive online Dupuytren Finger Angle Measurer, (works on all modern browsers other than Internet Explorer; we're working on it!).

Physical Location: We now have a home.
Timothy Eaton has generously donated use of conference and event space at Eaton Fine Art, located in historic downtown West Palm Beach, Florida: 435 Gardenia Street West Palm Beach, FL 33401.

This location will be used to host a series of support and strategic planning meetings by the Dupuytren Foundation to promote education and collaborative research toward a cure for Dupuytren Disease.

Special Thanks
Thanks to donors who continue to pave the way for Foundation work. Fundraising is critical to our ongoing goal of providing research grants supporting work to crack the Dupuytren code. Particular thanks go to my mentor, Robert W Beasley MD, whose New York based Foundation for Hand Research recently underwent dissolution and made a generous distribution of assets to the Dupuytren Foundation. Large or small, financial support is both appreciated and necessary for Dupuytren Foundation work to continue.


Charles Eaton MD

Botox and Dupuytren Disease?

Botox may have a use in the treatment of Dupuytren disease.

Right now, it's untested, but it has a scientific basis. Botox is not just the botulinium toxin. It's a biologic extract which contains a number of unique molecules. One of these is C3 transferase, an enzyme which blocks several steps in the pathway of fibrosis. Botox has been reported as a potential treatment for keloid scars and has been shown to reduce contracture, adhesions and fibrosis after experimental surgical wounds:

• Dendritic Fibroblasts in Three-dimensional Collagen Matrices 
• Novel Use of Botulinum Toxin to Ameliorate Arthrofibrosis: An Experimental Study in Rabbits 
• RAC Activity in Keloid Disease 
• Effect of Botulinum Toxin Type A on a Rat Surgical Wound Model 
• Innovative Therapies in the Treatment of Keloids and Hypertrophic Scars 
• The actin cytoskeleton in myofibroblast differentiation: Ultrastructure defining form and driving function

There is a large clinical experience to support the use of Botox in humans for treatment of benign disease.

C3 transferase based treatment of Dupuytren disease would be directed at prevention rather than correction. Current thought is that nodules, not cords, are the main location of biologic activity which results in contractures, and nodules are a logical starting study focus.

One type of study would be treatment of patients with nodules - and then following outcomes. The problem with this is that many people with only nodules may not develop contractures for decades:

• Eighteen years follow-up study of the clinical manifestations and progression of Dupuytren’s disease

Another option for study would be to add C3 transferase treatment as an adjunct to patients who are undergoing a procedure to correct Dupuytren contracture. The advantage of this would be that patients who are treated for contracture are likely to have recurrent contracture progression in a more predictable and shorter period of time than those who simply have nodules. This would shorten the needed study time and would give more statistical validity. Selection of patients with risk factors for early recurrence (positive family history, both hands involved, onset earlier than 50 years old, knuckle pads, Ledderhose and others) would similarly improve study analysis logistics. This approach has been applied to cortisone injection and perioperative Tamoxifen with encouraging results:

• Steroid Injection and Needle Aponeurotomy for Dupuytren Contracture:A Randomized, Controlled Study 
• Recurrence After Surgery For Dupuytren's Disease: A Randomised Controlled Trial With Double Blinding, Combining Segmental Fasciectomy With Placebo Or With Neo-Adjuvant Oral Tamoxifen

Interest in coordinating a Botox Dupuytren study may be directed to the Dupuytren Foundation: info@Dupuytrens.org

Charles Eaton MD

Articles referenced above are provided for purely educational use and as such are allowed for as fair use as defined by Title 17, Section 107 Of The Copyright Act.

Dupuytren Foundation Annual Report

Update from  Dupuytren Foundation President, Charles Eaton MD

It's been a year of growth and change for the Dupuytren Foundation.

• The Dupuytren Foundation has reorganized its website Dupuytrens.org 
• The Dupuytren Foundation has a new address:
  1732 S Congress Ave Suite # 348
  Palm Springs FL 33461
  Phone 949-CURE-DUP (949-287-3387)
  FAX 561-828-0494
  email: info@Dupuytrens.org
• I have closed my clinical practice to work full time on organizing Dupuytren Foundation projects of public education, fund raising, and support of medical research. 

However, the problem of Dupuytren's has not changed:

• 2012 didn't bring the end of the world, but unfortunately, didn't bring an end to Dupuytren's, either. We still need a cure. Work goes on, but only 76 papers - studies, reports and reviews - were published on Dupuytren's this year in peer-reviewed scientific journals: http://goo.gl/skZ0W.

 The good news:

• There were 50 percent more papers published on Dupuytren's in 2012 compared to 2002. One third of the 2012 publications were research papers focused on genetics, cell biology, and the type of  basic science needed to develop a cure for Dupuytren's, compared to only one out of five in 2002. Progress!
• 2012 saw the publication of a new multidisciplinary textbook on Dupuytren's, Dupuytren's Disease and Related Hyperproliferative Disorders: Principles, Research, and Clinical Perspectives which has had enthusiastic reviews: http://goo.gl/YKu0d.
• Awareness of Dupuytren's is growing, thanks to efforts of the Dupuytren Foundation, the International Dupuytren Society, the British Dupuytren's Society, social media groups such as the Facebook Dupuytren Contracture group, and advertising by the pharmaceutical industry for Xiaflex® enzyme injection treatment for Dupuytren's.
• The list of famous personalities known to be afflicted with Dupuytren's has grown: President Ronald Reagan; Prime minister Margaret Thatcher; pianist Misha Dicter; authors James Barrie (Peter Pan) and Samuel Beckett (Waiting for Godot); singer Frank Sinatra; actors Paul Newman, Bill Nighy and David McCallum; painter Andrew Wyeth, and hand surgeon Marc Iselin, who authored the first comprehensive book on hand surgery and was an influential Dupuytren's surgeon.These are just a few of the many millions who have or have had Dupuytren's worldwide.

The better news:

• This year marked the inaugural award of  Dupuytren Foundation Research Grants. The two $10,000 2012 Dupuytren Foundation research grant recipients are:
• In the category of Clinical Research: The Philadelphia Hand Center for the proposed study "Development of a reliable and valid patient rated questionnaire specific for Dupuytren’s disease"
• In the category of Laboratory Research: UCLA Psychiatry & Biobehavioral Sciences for the proposed study "Discovery of gene causing familial Dupuytren's Disease". 

The best news:

• These research grants were only possible because of  financial contributions from people like you. You can make a real difference in the quest for a cure by supporting the Dupuytren Foundation. You have several ways to show your support. It's not too late to be listed on the Foundation web site as an important donor in 2012! You can:
• Make a secure cash donation here, right now: http://goo.gl/jPWtH
• Make a charitable contribution through the mail
• Donate using your company's matching contribution plan
• Donate stock
• Include the Foundation in your retirement plan, will or estate plan
• You can be assured that your contributions will go where they will do the most good, because the Dupuytren Foundation's organization as a volunteer run public charity provides no salaries: zero administrative overhead.
• A patient advisory board will be formalized in 2013 as a strategy to grow the Foundation. We are actively recruiting members of the Dupuytren community to apply for positions on the Dupuytren Foundation patient advisory board. It's time to pull together and work for 2013 events and research grants. Please contact info@Dupuytrens.org if you have experience with
• Foundation work
• Fund raising
• Grant writing
• Event planning
• Promotions and advertising

 Thanks for making this a great year - this is still just the beginning!

Have a great 2013 and support efforts to find a cure -

Charles Eaton MD

2012: New Dupuytren's Textbook Publication

Inspired by the exchange of new ideas at the 2010 International Symposium on Dupuytren's Disease, the symposium's faculty worked for a year and a half to publish a comprehensive textbook on Dupuytren's disease. Dupuytren's Disease and Related Hyperproliferative Disorders: Principles, Research, and Clinical Perspectives, published this year by Springer, covers the spectrum of issues from basic biology and genetics, anatomy, current treatment options and perspectives for the future. This book is available from the publisher in both hardcover and e-book format, and individual chapters can be purchased for download. The book's preface, introduction, author information and table of contents can be viewed here. The book is also available through all major booksellers such as Amazon, Barnes and Noble, Abe Books and others.
Although this represents both a publication milestone and a symbol of determination and interest, it is still just a starting point. It will take more than just a textbook to make inroads on the treatment of Dupuytren's. It will require funding, teamwork, inspiration and luck.  This is the goal of the Dupuytren Foundation by supporting research, education and global collaboration to find a cure.

2012 Dupuytren Foundation Research Grants now available!

As part of its core commitment to support efforts to develop better options for patients affected by Dupuytren's disease and related conditions, the Dupuytren Foundation will award two $10,000 research grants in 2012 for work designed to advance understanding and/or treatment of Dupuytren’s Disease.

One grant will be awarded for basic science research and one grant for clinical research.

Instructions and this form are available at http://Dupuytrens.org/dfgrants.htm

Applications must be submitted via email prior to 12/12/2012 for consideration.

Want to make a difference for Dupuytren's? If you are a researcher, apply for a 2012 Dupuytren Foundation Research Grant. If not, please make a donation so that more research can be funded. Either way, your effort may be the one which brings us closer to a cure.

A new Dupuytren's research project has launched!

After much preparation, a collaborative effort is underway between Professor Paul Werker at Groningen University Medical Center in The Netherlands and Dr. Charles Eaton at The Hand Center in Jupiter, FL. This retrospective study will follow the long term outcomes of patients who have had Dupuytren's treated with Needle Aponeurotomy, and will take a fresh look at demographics, risk factors and patterns of involvement. Gronigen University medical student Alix Matton has traveled from the Netherlands to Jupiter to work on this project. After reviewing charts, she has begun the long process of contacting and interviewing patients for the study. This will take a while, but the plan is to reveal the results early next year. One more stepping stone in the path to find a cure. 

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.