Recognition, diagnosis and referral of patients with Dupuytren’s disease: a review of current concepts for general practitioners in Europe

Abstract

Background:

Dupuytren’s disease (DD) is a fairly prevalent yet under-recognised disorder of the palmar fascia, resulting in fixed-flexion contractures of joints in the hand. Numerous population-based studies have been conducted in countries around the world, and published prevalence estimates vary widely. Nevertheless, most studies have shown that the prevalence of DD increases with age. Because the global population is aging, the prevalence of DD will also continue to increase.

Scope:

Patients with DD typically present to a variety of physicians, generalists and specialists alike. Thus, it is critical that providers have clear guidance on the early recognition of signs and symptoms, comprehensive evaluation of potential risk factors, differential diagnosis and when to refer a patient for treatment. Treatment options range from minimally invasive injections with collagenase to surgery.

Findings:

Results from a large-scale study of the surgical management of DD in Europe indicate that most DD diagnoses and referrals are made by general practitioners, but there is much inter-country variation. Different patient- and physician-based factors affect diagnosis rates and referral pathways. Different healthcare systems and regulations are also influential. A simple management algorithm is provided herein and explained.

Conclusion:

It is important for generalists to understand the natural history of DD and the potential benefits of early referral and treatment. General practitioners should diagnose and/or refer patients with DD to a specialist as early as possible to optimise disease management and treatment outcomes.

Keywords::

• Algorithm
• Diagnosis
• Dupuytren’s disease
• Primary care physicians
• Referrals

Transparency

Declaration of funding

Medical writing support was funded by Pfizer Inc.

Declaration of financial/other relationships

D.v.D. and P.F. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. P.M.N.W. serves as a consultant for Pfizer. R.A.G. and P.P.S. are employed by and own stock in Pfizer Inc. and Pfizer Ltd, respectively.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

Medical writing support was provided by Linda Goldstein of UBC Envision Group and was funded by Pfizer Inc.