gms | German Medical Science

Objectives/Interrogation: The exact natural course of Dupuytren disease (DD) is unknown. This study was aimed to determine the long-term natural course of DD in patients with different disease stages, and to find potential predictors for progression.

Methods: 258 DD patients (63% male, age at inclusion 66.4 SD 10.4 years) were included in this longitudinal cohort study. Measurements took place every 6 months, during 5 years. In total 17.645 observations were available for statistical analyses. Disease extent (surface area) and contracture severity (total passive extension deficit, TPED) were outcomes, and demographic, health-related, genetic, and lifestyle details were registered as potential predictors. Subject-specific mixed-effect models were used to estimate the natural disease course for both outcomes, and stepwise linear regression analyses on the acquired slopes were used to determine covariates associated with progression.

Results and Conclusions: Average yearly increases in disease extent were 0.50 [95% CI 0.41; 0.60] and 0.61 [95% CI 0.49; 0.72] cm2 in area, for dominant and non-dominant hands respectively. An average yearly increase of 5.05 [95% CI 2.75; 7.36] and 14.3 [95% CI 8.8; 19.7] degrees of summed TPED was observed for dominant and non-dominant hands. About 11% to 16% of the participants did not show progression. Model fits ranged between 89.9-94.9% (R2). Several predictors for progression were found (e.g. Ledderhose's disease, first degree relatives, diabetes, and manual labour).

In conclusion, DD is progressive, although the speed of progression is variable across participants. Several suggested predictors for progression were identified, but a consistent view on DD progression across hands and outcomes was not found.