Associated

Dupuytren's

 DUPUYTREN'S DISEASE: FREQUENTLY ASKED QUESTIONS
AND LINKS TO PUBLISHED STUDIES: FAQS & FACTS

These pages include answers to frequently asked questions regarding Dupuytren's disease. There is quite a bit known about Dupuytren's, but because we don't yet have all of the pieces of the puzzle, the bits that we do know don't all fit tidily together. There are also a fair number of undocumented urban legends. This page only includes information which has been investigated and published in recognized medical journals - the stuff that doctors read. For verification and more information, this page links to source material at the National Library of Medicine. Browse around! There's quite a bit here to consider.

- Associated Conditions -

What other conditions predispose to Dupuytren's?

RISK FACTOR

AVAILABLE DATA

Genes

Dupuytren's disease is most common in white males of Northern European descent 1810624, 10050242. It is uncommon in blacks 11770364, 9665514, 8074370, and in blacks is more often associated with a history of trauma 8891992. A US Veterans study gave this racial breakdown: the incidence of Dupuytren's in their study was Caucasian: 0.7%; Hispanic: 0.2%; Black: 0.1%; Native American: 0.1%; Asian: 0.07% 10883614. Dupuytren's is six times more common in men than women 10883614, 10473157. Women develop the disease on the average ten years later than men 11357696, 10473157. The disease appears to run in families, and often follows an autosomal dominant inheritance 10050243. Dupuytren's contracture has been reported in in 21% of women and 39% of men over the age of 60 in North-east Scotland. 8501390. Even with a genetic predisposition, presentation is variable, and identical twins with Dupuytrens do not necessarily have identical disease 8345271. There are genetic differences between patients with and without Dupuytren's 12794452, 12783014 , 11924651. Although a genetic pattern of HLA DR antigens has been reported in both Dupuytren's and scleroderma 6334711, a "Dupuytren's gene" has not been identified 11895345.

Age Increasing age increases the risk of developing Dupuytren's 3592873. Although reported in infants 11418917, 3924790 children 12703034 , 11912542 and teenagers 8676015 , this is rare. Other childhood conditions 11117052 may mimic Dupuytren's, such as the benign recurring digital fibroma of childhood or malignant epithelioid sarcoma 11912542, 10612139, 7719607. In Iceland, where it is common, Dupuytren's in men found in 7% in the age group 45-49 years, 40% in those 70-74 years old 10760640. In Norway, 30% of the population over 60 has Dupuytren's 10050243.
Diabetes
 There is a five 7713273 to ten 9382632 times increased risk for diabetics to develop Dupuytren's contracture 8697659, 7722249, 10883614, 2522373, 10760640, related to the duration 3590817, 6343018, presence of diabetic retinopathy 6343018, but not severity of the diabetes 6608923, 6343018, 9002027, 2725939. In diabetics, Dupuytren's is often a less aggressive form, but the radial hand is more often involved 6725338.
Diabetic Limited Joint Mobility Syndrome Patients with this are twice as likely to have Dupuytren's than with diabetes alone 2057690, 2522373, 6608923, 2968881, and relates to the duration of diabetes 4042798. The relationship may be explained by smoking, which predisposes to both conditions 2022177, 2522859
Smoking
 Smokers have increased risk 9119843, 10883614, 2022177, 2522859,  3592873, 10760640, 10760640. Twice the risk of nonsmokers 3225413
Alcoholism
 Increased 2871816, 10883614, although some surveys dispute this 8426337, 11697563 The association may instead be with smoking 9119843 or hyperlipidemia associated with alcoholism 1447259, or alcoholic liver disease 7224858, 190684. Alcoholic liver disease is a risk factor,  nonalcoholic liver disease is not 3592873, although this is also disputed 6672504.

Thyroid disorders

Increased incidence, more for hypothyroidism than hyperthyroidism 12864792

Stretching

Contrary to natural instinct, the act of stretching the skin of the palm appears to aggravate or provoke Dupuytren's contracture 6884845.
Frozen Shoulder
 50% chance of developing Dupuytren's 11307078, 10509873, even more common with diabetes 10509873
Peyronie's Disease
 15 - 25% incidence 7150935, 9636000, 8976282, 80% in familial forms of Peyronie's 6980996.
Lederhosen Disease
 28% chance of having Dupuytren's 10919621
Rheumatoid Arthritis
 Lower chance of developing Dupuytren's 10568426, 6747420, but when present, requires special surgical planning 3336640

Trauma

 Dupuytren's may develop after hand trauma 3592873, 3744141, 4031627, particularly after Colles' wrist fracture (distal radius fracture) 3998585, 9382639, 1588210. One study reported a 40% incidence of Dupuytrens 18 months after Colles' fracture 10372776. Duputren's developing after surgery has also been reported 8856538.
Hyperlipidemia
 Increased 1447259
Vibration exposure
 Increased with vibration exposure 8732927, Patients with vibration white finger syndrome two times as likely to have Dupuytren's  1345125
Epilepsy
 When present, Dupuytrens appears to have a more aggressive character 1588209, although conflicting reports exist  932769. Association may be due to  phenobarbitone  medication rather than epilepsy itself 932769, 10751924 , although this is debatable as well 1588209. There may be an association between Dupuytren's, RSD and antiepileptic drugs 8156963, 2691374.
Gout
 No effect 1588208.

Glucosamine / Chondroitin Sulfate

Glucosamine / Chondroitin sulfate preparations are available as nutritional suppliments with claims of improving joint function. Although no cause and effect relationship has been established, chondroitin sulfate 9517845, 2493650, 6489852 and glycosaminoglycan 6854215 levels are elevated in the tissues affected by Dupuytren's contracture.

Growth hormone therapy

Possibly 8101283
Arcus senilis
 Increased incidence, possibly due to mutual association with hyperlipidemia 1280972

Reflex Sympathetic Dystrophy

 RSD after wrist fracture triples the risk of developing Dupuytren's compared to no RSD 10372776. There may be an association between Dupuytren's, RSD and antiepileptic drugs 8156963 . More common postop in women 2229974 and possibly related to psychological factors 1692417. There may be an association between Dupuytren's, thoracic outlet fibrosis and reflex sympathetic dystrophy 2707653
Hemodialysis
 Increased, although many factors may be at play 3113084
Palmaris longus
 Increased risk if this tendon is present in the wrist 3794480. Excision of the palmaris longus tendon has been reported to reduce recurrence 3740784
Increased serum IgA
 Increased risk 6672504, 6353806
Vascular insufficiency
 Increased risk 8501389

Manual Labor

Increased risk 10760640, 9382639, although controversial 10050242, 8732927, 1834729. Vibration exposure is a risk factor 8732927, 8672800, 1345125

Carpal tunnel syndrome

Although postoperative flare has been reported as more common with simultaneous fasciectomy and carpal tunnel release 7430596, contrary reports exist 2061659.

Vinyl Chloride

 HLA DR antigens have been identified both in Dupuytren's patients and in patients with vinyl chloride exposure related scleroderma 6334711. An increased incidence of  Dupuytren's was reported at a polyvinyl chloride (PVC) manufacturing plant in workers who extensively handled the product 7066227.

HIV infection

Increased risk debated 10050242

Condition If Dupuytren's is present, the risk for this is...
Diabetes
 Increased  7012682, 605747, 6725338.
Hyperlipidemia
 Increased: present over half the time 1280972
Psychological problems
 No association 8583880
Malignancy
 Increased sarcoma 11895346 , cancer 11781116, possibly due to mutual association with smoking and alcohol abuse 10961556.
Mortality
 Increased, especially when presenting under 60 years old 10597922, 11781116
Ulnar neuropathy
 Increased 186961
Cold induced  vasospasm
 Increased 186961
Thin (low triceps skin fold thickness)
 More likely to be thin 8501389 ? associated with smoking
 Does Dupuytren's by itself affect the risk of having other conditions?

 

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