A systematic review of non-surgical treatments for early Dupuytren’s disease
Ball CE., Verjee LS., Izadi D., Nanchahal J.
Introduction There is no approved treatment for early Dupuytren’s disease (DD) to prevent progression of flexion deformities requiring subsequent treatment with invasive procedures. We systematically reviewed the literature to determine the role and efficacy of non-surgical treatments for early DD with the aim of providing an evidence base for the management of these patients. Method Databases were searched using an inclusive search strategy. Titles and abstract of relevant publications of studies, letters and conference abstracts published in English were screened using predefined criteria to identify those reporting outcomes specifically relating to the treatment of early disease. In the absence of a definition of early disease, studies were included if early DD was described clinically, with digital contractures not exceeding 30 degrees, Tubiana grades N to 1, and which reported identifiable early DD data. Studies were excluded if data for early DD patients could not be extracted for analysis. All studies were independently reviewed by 2 authors. Results Eighteen studies covering drug therapies (9), physical therapies (4) and radiotherapy (5) were included. Many publications reported data collected retrospectively using outcome measures that were variable in quality and often subjective preventing statistical evaluation. Narrative descriptions of the data are presented. Intralesional steroid injection and radiotherapy suggested subjective improvement in nodule consistency but lacked rigorous evaluation. Physical therapies investigating the use of ultrasound, splinting and friction massage were the most robustly assessed, using objective measures but the studies were under powered, providing insufficient evidence of efficacy. Early disease was inconsistently defined. Safety was only reported by one study. Conclusion Based on limited data: • Intralesional injection with steroids, and radiotherapy appears to improve nodule consistency • Studies using splintage suggest improved digital extension We recommend: • Clear definition of early disease is agreed • Treatment outcomes measured using objective, reproducible methods • Safety reported in all studies. • Definition of disease recurrence required