Is Dupuytren's Contracture a Form of Arthritis?

No, Dupuytren's contracture is not a form of arthritis. It is a specific hand condition that affects the connective tissue under the skin in the palm and fingers. Unlike arthritis, which primarily involves inflammation of the joints and affects the bones and cartilage, Dupuytren's contracture affects the hand's connective tissue, making it distinct from other medical conditions.

What is Dupuytren's Disease (DD)?

Dupuytren's disease (DD) is a disabling fibroproliferative disorder of the hand characterized by the formation of nodules, cords, and contractures in the palm. This condition is mistakenly referred to as 'Dupuytren's contracture' and can also be known as 'palmar fibromatosis.' The exact cause is unknown, but it has been linked to various risk factors including smoking, alcohol consumption, and diabetes.

Prevalence and Primary Care Engagement

This condition affects about 5% of the US population, with up to 70% of affected individuals initially seeking treatment from a primary care physician. It is a spectrum of presentations, ranging from nodules to cords to discernible contractures, and it is unknown which patients with early Dupuytren changes will progress to severe contracture.

Signs and Symptoms

The earliest manifestation of DD is painless dimpling of the skin on the palmar surface of the hand. Over time, the underlying fibrosis with increased collagen deposition can progress, leading to the development of nodules and eventually cords. These cords can sometimes be mistaken for flexor tendons.

Palmar Fascia: The Key Connective Tissue

The palmar fascia, a thick, triangular-shaped sheet of dense fibrous collagenous connective tissue, lies deep to the dermis and superficial to the flexor tendons of the hand. Its fibers extend into both the skin and deep tissue. The palmar fascia plays a crucial role in securing the skin during gripping and twisting motions, and it bifurcates into distal extensions called pretendinous bands that overlay and mimic the flexor tendons.

Treatment Options and Prospects

Treatment for Dupuytren's disease is not a one-size-fits-all approach. Collagenase injections and percutaneous fasciotomy are nonsurgical interventions that can be effective in slowing the progression of DD, restoring hand function, and avoiding or delaying surgical intervention. However, because DD is a clinically challenging disorder, treatment in one area may resolve symptoms only to have them recur in that location or another.

Conclusion

Understanding the distinctions between Dupuytren's contracture and arthritis is crucial for accurate diagnosis and effective management. Early recognition of clinical findings and appropriate intervention can significantly improve the quality of life for those affected by Dupuytren's disease.