The Intra- and Interobserver Agreement on Diagnosis of Dupuytren Disease, Measurements of Severity of Contracture, and Disease Extent

This agreement study aimed to determine the intra- and interobserver agreement of four variables for diagnosing DD, determining severity of contracture, and disease extent. One of them is a new measurement on the area of nodules and cords, to be able to determine disease extent in early cases without flexion deformities. Intra-observer agreement was slightly higher on average than interobserver agreement. Overall, the intra- and interobserver agreement in diagnosing DD and determining the severity of flexion contracture is high. Also, the newly introduced variable area of nodules and cords has high intra- and interobserver agreement, indicating that it is suitable to measure disease extent

Disease course of primary Dupuytren’s disease:5-year results of a prospective cohort study

Background: Predicting progression of Dupuytren disease becomes relevant in an upcoming era with progression-preventing treatment. This study aimed to determine the course of Dupuytren disease and identify factors associated with progression. Methods: Two hundred fifty-eight patients with Dupuytren disease participated in this prospective cohort study, obtaining 17,645 observations in 5 years. Outcomes were disease extent (surface area) and contracture severity (total passive extension deficit). Demographics, lifestyle, health status, exposure to manual work, and genetic risk scores were gathered as potential predictors. Subject-specific, mixed-effects models were used to estimate disease course, and logistic regression with least absolute shrinkage and selection operator was used to evaluate factors associated with the presence of progression. Results: On average, Dupuytren disease was progressive in all finger rays with regard to area [yearly increase, 0.07 cm(2) (95% CI, 0.02 to 0.13 cm(2)) to 0.25 cm(2) (95% CI, 0.11 to 0.39 cm(2))]. Progression in total passive extension deficit was only present on the small finger side [yearly increase, 1.75 degrees (95% CI, 0.30 to 3.20 degrees) to 6.25 degrees (95% CI, 2.81 to 9.69 degrees)]. Stability or regression in area and total passive extension deficit was observed in 11 and 13 percent and 16 and 15 percent (dominant and nondominant hands), respectively. Smoking, cancer, genetic risk score, and hand injury were univariate associated with progression in area, but after multivariate variable selection, none of these associations remained. No predictors for progression in total passive extension deficit were found. Conclusions: Dupuytren disease is progressive, especially with respect to disease extent. Progression in contracture severity is mainly present on the small finger side of the hand. None of the traditional risk and diathesis factors were associated with progression, indicating that new hypotheses about Dupuytren disease progression might be needed.</p

A systematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries

Background: Dupuytren disease is a fibroproliferative disease of palmar fascia of the hand. Its prevalence has been the subject of several reviews; however, an accurate description of the prevalence range in the general population—and of the relation between age and disease—is lacking. Methods: Embase and PubMed were searched using database-specific Medical Subject Headings; titles and abstracts were searched for the words Dupuytren, incidence, and prevalence. Two reviewers independently assessed the articles using inclusion and exclusion criteria, and rated the included studies with a quality assessment instrument. In a meta-analysis, the median prevalence, as a function of age by sex, was estimated, accompanied by 95 percent prediction intervals. The observed heterogeneity in prevalence was investigated with respect to study quality and geographic location. Results: Twenty-three of 199 unique identified articles were included. The number of participants ranged from 37 to 97,537, and age ranged from 18 to 100 years. Prevalence varied from 0.6 to 31.6 percent. The quality of studies differed but could not explain the heterogeneity among studies. Mean prevalence was estimated as 12, 21, and 29 percent at ages 55, 65, and 75 years, respectively, based on the relation between age and prevalence determined from 10 studies. Conclusions: The authors describe a prevalence range of Dupuytren disease in the general population of Western countries. The relation between age and prevalence of Dupuytren disease is given according to sex, including 95 percent prediction intervals. It is possible to determine disease prevalence at a certain age for the total population, and for men and women separately

Measurement properties of the Dutch Unite Rhumatologique des Affections de la Main and its ability to measure change due to Dupuytren's disease progression compared with the Michigan Hand outcomes Questionnaire

Data of a prospective longitudinal cohort study including 233 Dupuytren’s patients was used to determine: (1) whether the Unité Rhumatologique des Affections de la Main scale and Michigan Hand outcomes Questionnaire can detect change in hand function due to Dupuytren’s disease progression and to compare their abilities; (2) the concurrent validity, reliability, responsiveness and interpretability of the Dutch Unité Rhumatologique des Affections de la Main. The Unité Rhumatologique des Affections de la Main and Michigan Hand outcomes Questionnaire had comparable measurement properties, and were both able to distinguish participants with disease progression from those without progression (resp. U = 1252.5, p = 0.008, and U = 1086.0, p < 0.001), but only at a group level. Individual cases of progression could not be detected using these outcome measures, as indicated by the fact that the smallest detectable change was larger than the minimal important change, and area under the receiver operating curve (AUC) values of 0.75 for Michigan Hand outcomes Questionnaire and 0.67 for Unité Rhumatologique des Affections de la Main. Level of evidence: I

In the palm of your hand: prevalence, disease patterns and natural course of Dupuytren Disease

De ziekte van Dupuytren is een aandoening van de bindweefselplaat in de hand en vingers, waarbij knobbels en strengen in de handpalm voorkomen. Dit kan leiden tot een kromstand van de vingers en op dit moment zijn er geen mogelijkheden om de ziekte van Dupuytren te genezen of te voorkomen. Met ons onderzoek hebben we ontdekt dat de ziekte van Dupuytren voorkomt bij 0.6-31.6% van de gezonde bevolking in Westerse landen. In Nederland komt Dupuytren voor bij 22.1% van de 50-plussers. Mannen hebben de aandoening vaker dan vrouwen en het voorkomen neemt toe met de leeftijd. Andere risicofactoren voor het ontwikkelen van de ziekte van Dupuytren zijn: overmatig alcoholgebruik, handletsel in het verleden, familiair voorkomen van de ziekte van Dupuytren en de aanwezigheid van de ziekte van Ledderhose. De ziekte van Dupuytren kan in verschillende vingers voorkomen en het was onbekend of hierin bepaalde patronen bestaan op basis van de locatie en de ernst van de ziekte. De ringvinger is het meest frequent aangedaan. Verder blijkt dat de ziekte van Dupuytren vaak in de volgende vingers tegelijkertijd voorkomt: duim en wijsvinger, middelvinger en ringvinger, en middelvinger en pink. Het beloop de ziekte van Dupuytren verschilt per persoon. Het korte termijn beloop hebben we gedurende 1,5 jaar elke 3-6 maanden onderzocht in een groep van 247 patiënten. Hieruit blijkt dat de ziekte bij sommige mensen toeneemt, maar dat de ziekte bij het grootste deel van de mensen stabiel is. Ook is er een groep bij wie de aandoening op korte termijn zelfs verbetert

Clusters in Short-term Disease Course in Participants With Primary Dupuytren Disease

Purpose The course of Dupuytren disease (DD) is thought to be progressive; however, the course differs for each patient. The purpose of this study was to study the rate and pattern of progression of DD. Methods We prospectively analyzed the course of DD at intervals of 3 to 6 months in 247 Dutch participants with primary DD by measuring the surface area of nodules and cords and the total passive extension deficit. The association between surface area and Tubiana stage was tested with generalized estimating equations. Latent class models were used to study different clusters in changes regarding the course of the disease. Results The variance in disease course between participants was large. Regarding the change in surface area (in all fingers) and total passive extension deficit (in the ring and little finger), different clusters were observed. Progression of disease was seen but there were also signs of stability and even regression. Patients with a smaller surface area at baseline were more likely to exhibit regression. Conclusions This study showed that DD is not always progressive and that up to 75% of patients have a different short-term disease course, such as stability or even regression of disease. This should be taken into account when evaluating the effects of treatment for early-phase DD and in the design of future studies. Furthermore, this information may be useful when counseling patients. (Copyright (C) 2016 by the American Society for Surgery of the Hand. All rights reserved.

Intra- and inter-observer agreement on diagnosis of Dupuytren disease, measurements of severity of contracture, and disease extent

Introduction. Dupuytren disease (DD) is a fibrosing disease affecting the palmar aponeurosis, and is mostly treated by surgery based on measurement of severity of flexion contracture of the fingers. Literature concerning the measurement reliability is scarce. This study aimed to determine the intra- and inter-observer agreement of four variables for diagnosing DD, determining severity of contracture, and disease extent. One of them is a new measurement on the area of nodules and cords for measuring the disease extent in early disease stages. Methods. An agreement study (n = 54) was performed by two trained investigators. Agreement was calculated per finger, based on an intraclass correlation coefficient (ICC) using a latent variable model on subjects for diagnosis and Tubiana stage. For total passive extension deficit (TPED) and the area of nodules and cords, agreement was calculated with an ICC using a one-way random effects model with subject as random effect. Results. Inter-observer agreement was very good for diagnosing DD (ICC: 95.5%–99.9%) and good to very good for classifying Tubiana stage (ICC: 73.5%–94.9%). Agreements for area and TPED were moderate (middle finger) to very good (ICC: 48.4%–98.6% and 45.0%–99.5%, respectively). Intra-observer agreement was slightly higher on average than inter-observer agreement. Conclusion. Overall, the intra- and inter-observer agreement in diagnosing DD, and determining the severity of flexion contracture is high. Also, the newly introduced variable area of nodules and cords has high intra- and inter-observer agreement, indicating that it is suitable to measure disease extent. Keywords: Dupuytren contracture; Range of motion; Articular; Reproducibility of results; Observer variatio

Prevalence of Dupuytren Disease in The Netherlands

Background: Dupuytren disease is a fibroproliferative disease of palmar fascias of the hand. The prevalence of Dupuytren disease and the association with potential risk factors have been the subject of several studies, although there is a paucity of such data from The Netherlands. Methods: To study the prevalence of Dupuytren disease, the authors drew a random sample of 1360 individuals, stratified by age, from the northern part of The Netherlands. Of this sample, 763 individuals aged 50 to 89 years participated in this cross-sectional study. The authors examined both hands for signs of Dupuytren disease, and a questionnaire was conducted to identify potential risk factors. The effects of these risk factors were investigated using logistic regression analysis. Additional analyses were performed to develop a logistic prediction model for the prevalence of Dupuytren disease. Results: The prevalence of Dupuytren disease was 22.1 percent. Nodules and cords were seen in 17.9 percent, and flexion contractures were present in 4.2 percent of the study population. Prevalence increased with age, from 4.9 percent in participants aged 50 to 55 years to 52.6 percent among those aged 76 to 80 years. Men were more often affected than women; 26.4 percent versus 18.6 percent, respectively (p = 0.007). Other significant risk factors were previous hand injury, excessive alcohol consumption, familial occurrence of Dupuytren disease, and presence of Ledderhose disease. Conclusions: The results show a high prevalence of Dupuytren disease in The Netherlands, particularly the nodular form. Using the developed logistic prediction model, the prevalence of Dupuytren disease can be estimated, based on the presence of significant risk factors