Home // Latest News // Exploring treatments for Dupuytren’s contracture

Exploring treatments for Dupuytren’s contracture

Associate Professor David Hunter-Smith and Brent Coulson.

Around five per cent of people in Frankston and the Mornington Peninsula have Dupuytren’s disease, a progressive disease which causes a person’s fingers to curl downwards, deforming the fingers and potentially restricting how they can use their hands.

“Pain is not a common complaint for people with Dupuytren’s disease, but it certainly can affect their ability to function normally at home and at work,” explains Peninsula Health plastic surgeon Associate Professor David Hunter-Smith.

Traditionally the treatment for Dupuytren’s disease has been surgical. However, Associate Professor Hunter-Smith and his team at Peninsula Health have recently started using Clostridial collagenase histolyticum treatment, which is far less invasive for patients than traditional surgery.

Brent Coulson had the new collagenase treatment earlier this year.

“The utility of my hand is quite good – I’m able to put my hand in my pocket now and I couldn’t do that before,” says Brent.

“It’s quite a good result.”

The team are currently conducting a study to evaluate the impact this new treatment has on patients’ lives and whether it should be used as a viable choice for treatment of Dupuytren’s disease across the Australian public health system.

“There’s the traditional surgical approach where we make cuts down the fingers, peel back the skin and take out the disease,” explains Associate Professor Hunter-Smith.

“For many patients surgery can be very effective, however a significant number of patients have a very prolonged recovery that can be quite traumatic.”

The alternative treatment consists of collagenase being injected under local anaesthetic, and doesn’t require any hospitalisation. When Associate Professor Hunter-Smith set up a dedicated Dupuytren’s Clinic at Frankston Hospital in February 2016, Peninsula Health became the first public health service in the country to have a dedicated clinic that treats patients with Dupuytren’s disease with collagenase.

“We know that collagenase is safe and effective in releasing contracture,” says Associate Professor Hunter-Smith.

“What hasn’t been well studied is ‘patient reported outcome measures’ – what the patients actually describe as their experience of the new treatment and its physical outcome, versus patients having the traditional surgery. We know that we can correct the contracture angles of the finger, but we don’t know if that actually translates to a functional difference to people’s lives.”

“We want to focus on the whole patient and what matters to them, not just the contracture – it’s all about person-centred care.”

Associate Professor Hunter-Smith and associate investigators Associate Professor Warren Rozen, Dr Bethany Reynolds and Dr Vicky Tobin have started following patients who are treated with collagenase in the clinic.

“We’re using three different Patient Reported Outcome Measures: URAMS, Southampton and the Patient Set – where the patient actually sets their own concerns,” explains Associate Professor Hunter-Smith.

“When a patient comes in we ask what their three biggest concerns are – for example washing their face, playing golf, or getting dressed – then we treat them and ask them how well we did at fixing their specific issues, rather than using a set of broad questions that may not relate to what is important in their life.”

Three new patients are treated with collagenase in the clinic every week and will be followed up by the team at six weeks, three months and six months post procedure with plans to follow people for 18 months.

The research team is using the REDCap data collection application to securely store more than 600 fields of information about each participant.

“We are already collaborating internationally and will be in a strong position moving forward to contribute significantly to the global understanding of how to best manage Dupuytren’s disease, which will be fantastic,” says Associate Professor Hunter-Smith.

“By undertaking these studies we’re making sure our patients have access to the best available contemporary care in the public health sector.”

WHAT IS DUPUYTREN’S CONTRACTURE?

  • A common condition that causes a thickening and shortening of the tissue in the palm, resulting in a progressive clawing or contracture.
  • The cause is unknown, but 80% of patients have a family history and northern European ancestors. The Genome Wide Association (GWAS) study has identified over 20 genes associated with the condition and much research is underway globally.
  • Treatment options include radiation (very early stages), needle release (fasciotomy), Collagenase injections and surgery.
  • Dupuytren’s contracture is named after Baron Guillaume Dupuytren – who first discovered the disease in the early 1800s.

This story was first published in the Peninsula Health 2017 Research Report. You can view more stories from the report online here.

 

 

Jessica Mills JMills@phcn.vic.gov.au