A safe and approved drug originally meant to treat rheumatoid arthritis and Crohn’s disease has been found to reverse an incurable disease that deforms the hand by bending the fingers into the palm, as long as the drug is administered early on.
The newly announced breakthrough offers a glimmer of hope for patients with Dupuytren’s disease, a common disease that oddly enough not many people are aware exists. Although official physician records suggest that 1% of the US population has a form of the condition, the actual number may be over 7%, according to the Dupuytren Foundation.
Luckily, not all patients with Dupuytren’s disease have bent fingers. About 20% of patients that have this condition end up developing abnormal thickening of the skin in the palm of the hand at the base of the fingers that grows severe enough to develop into a hard lump or thick band. Over time, this abnormal growth can cause one or more fingers to curl, pull sideways, or towards the palm. Usually, the disease mainly affects the ring and little fingers and some people have it in both hands at the same time.
The loss of tactile mobility caused by rigidly bent fingers can dramatically affect a person’s quality of life. Simple things like driving, fitting gloves, or putting your hand in your trouser pocket can be a nuisance.
The disease is named after French surgeon Baron Guillaume Dupuytren, who was one of the personal physicians of Napoleon Bonaparte. In a paper published in 1833, the Baron outlined the pathology of the disease for the first time and the results of the first successful operation. To this day, the treatment of severe cases, which affects around 1 in 20 with Dupuytren’s disease, involves surgery to remove the diseased tissue. However, recurrence rates are rather high and in extreme cases amputation of the fingers may be required.
Dupuytren’s disease is believed to be inherited, with risk factors including diabetes, alcohol, and tobacco use. It mainly affects those over the age of 55. Men are eight times more likely to develop Dupuytren’s than women.
There is no proper treatment for early-stage Dupuytren’s, so most patients wait until their condition worsens to the point that they can qualify for surgery. But thanks to recent research out of the University of Oxford that may finally change.
Researchers gave volunteers with early Dupuytren’s one injection of adalimumab, a drug commonly used to treat rheumatoid arthritis, every three months for a year. As a result of the treatment, the patients’ lumps shrank and continued to decrease in size even nine months after the last injection. It is likely that patients need to take regular shots of the drug to keep the excess tissue at bay.
Dupuytren’s is an inflammatory condition and the fibrotic scar tissue that can cause bent fingers is produced by immune cells in the hand. The drug blocks specific chemical messengers that instruct immune cells to produce the fibrotic tissue. These are very early results though and more follow-up research is needed to fully capture how effective this treatment really is in the long run.
“Although these are early results, this is an exciting and important project because it addresses cell biology,” Professor David Warwick, a hand surgeon specializing in Dupuytren’s at University Hospital Southampton, told The Guardian.
“Needles are simple and usually effective for a while, but the cord comes back. Surgery is usually successful but it takes a while to recover and occasionally there are problems. But supposing we can treat Dupuytren’s before it ever gets that far by addressing the cell biology? Now that would really change the world of Dupuytren’s.”
The findings appeared in the journal Lancet Rheumatology.Lancet Rheumatology