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Dupuytren's Diathesis Revisited: Evaluation of Prognostic Indicators for Risk of Disease Recurrence

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      Purpose: The purpose of this study was to develop a statistical predictive value for Dupuytren's disease diathesis. The study aimed to examine the four main factors involved in Dupuytren's disease diathesis as well as known risk factors from the environment.
      Method: This was a retrospective, cohort study design conducted at a hospital. A total of 322 white patients with a diagnosis of Dupuytren's disease were identified through surgical records. The group included 262 men (81%) and 60 women (19%). The patients were evaluated for recurrence of the disease four years after surgery. All patients gave consent for the study and participated in a clinical evaluation. The assessment included details of family history of disease, bilateral and ectopic involvement, and gender. Associated risk factors of smoking and alcohol, diabetes, epilepsy, carpal tunnel syndrome, rheumatoid arthritis, history of manual labor, and history of previous hand injury were also documented. True recurrent disease was defined as the development of new nodules where the surgery had been performed. False recurrence was labeled as scar and joint contracture. Extension of Dupuytren's disease was defined as the development of new lesions or nodules outside of the area where the surgery had been performed.
      Analysis and Results: The risk factors and evaluation findings were analyzed to determine what specifically increased the odds ratio for recurrence of Dupuytren's disease after surgery. Of the 322 patients in the study, 141 (44%) had recurrent Dupuytren's disease. The frequency of associated risk factors in all patients was documented. Of note, 143 (44%) patients reported a family history; bilateral involvement was noted in 225 patients (70%); 77 (24%) patients had ectopic lesions; and 154 (47%) had an average age of onset younger than 50 years. The researchers found that male patients with bilateral disease, ectopic lesions, a positive family history, and onset of disease prior to age 50 years had a predictive risk of 71% compared with 23% for patients with none of the above factors present.
      Discussion: Although Dupuytren's diathesis has been previous studied, this new data aimed to modify the current diathesis and suggest more specific factors. In particular, age at onset of disease prior to age 50 years was found to be a significant risk factor in recurrent disease. Ectopic lesions have also been previously considered part of the Dupuytren's disease diathesis. The researchers here were able to further delineate between lesions on the knuckles known as Garrod's pads, and other ectopic lesions, with the presence of Garrod's pads markedly associated with recurrence.
      The researchers found that occupation and hand injury, while previously linked to a greater risk of development of Dupuytren's disease, were not significant factors. They raise questions regarding the use of alcohol and smoking, and recommended further study regarding their role in the diathesis. They also conclude that carpal tunnel syndrome and rheumatoid arthritis are not significant factors in predicting recurrence.
      The researchers stress the importance of patient education on the degree of their individual Dupuytren's disease diathesis, and its significance regarding the risk of recurrence and outcome. They suggest that patients with a high degree of diathesis should be counseled carefully regarding surgery, and perhaps might benefit from a more involved surgical procedure known as dermofasciectomy. As therapists treat these patients following surgery, we welcome the preoperative educational consult and agree with the importance of the well-informed patient with this diagnosis.
      Reviewer Commentary: How many of our postoperative Dupuytren's disease patients run the risk of recurrence of disease? What are the key factors predicting the chance of recurrence? The term diathesis refers to a condition that might predispose a person to a particular illness or disease. Dupuytren's disease diathesis describes specific characteristics of the disease that might indicate a more aggressive course and possibly higher recurrence rate after surgical treatment. Factors previously linked to Dupuytren's disease diathesis include bilateral involvement, family history, lesions of Dupuytren's disease found outside the palmar area (ectopic), and ethnicity.
      Environmental factors have also been associated with Dupuytren's disease and they include a history of smoking, alcohol consumption, epilepsy, diabetes, carpal tunnel syndrome, rheumatoid arthritis, history of manual labor, previous injury to the hand, and others. The degree of Dupuytren's disease diathesis is considered relevant and very important in predicting the recurrence rate of the disease after surgical management. This is not an uncommon problem for both the surgeon and the patient. However, there is no clear data outlining accurate predictive values for the various features of Dupuytren's disease diathesis.
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