On the course, risk factors, and treatment outcomes of Dupuytren’s disease

This thesis aimed to deepen the understanding of Dupuytren’s disease by investigating disease progression, risk factors, and treatment outcomes. In the first part, we revealed that only a minority of participants have disease progression over a period of seven years. Familial history and ectopic disease increased the risk of progression, while prior hand injury was a risk factor for disease development. The relationship between manual work exposure and Dupuytren’s disease was further explored in a large cohort study, showing an increased risk of Dupuytren’s disease among manual workers. When we looked at the life course of Dupuytren’s disease patients, we found that Dupuytren’s patients had lower mortality in the first five years after diagnosis. In the second part, we compared the outcomes of percutaneous needle fasciotomy (PNF), collagenase clostridium histolyticum (CCH) injections, and limited fasciectomy (LF). All methods showed similar contraction correction, but CCH resulted in more complications, and LF had the lowest recurrence risk up to five years post-treatment. Long-term retreatment risk appeared to be higher after PNF than after LF, as PNF-treated patients required retreatment sooner. However, PNF appeared to be suitable to apply repeatedly, as we found consistent correction effectiveness after multiple treatments. Lastly, we aimed to predict the need for future treatment by using patient-reported hand function. Scores measured around one year before treatment were found to predict treatment necessity, suggesting the potential for remote patient monitoring questionnaires. The findings of this thesis could aid to optimize disease management and improve (individualized) patient care.