Heavy manual work, exposure to vibration and Dupuytren's disease? Results of a surveillance program for musculoskeletal disorders: Table 1

Descatha, Alexis; Bodin, Julie; Ha, Catherine; Goubault, Pierre; Lebreton, Marine; Chastang, J.-F.; Imbernon, Ellen; Leclerc, Annette; Goldberg, Marcel

doi:10.1136/oemed-2011-100319

Cited by 35 publications

(13 citation statements)

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“…In keeping with our study, relative risks of 2 to 3 (with evidence of a dose-response relationship) were reported in a cross-sectional study of Italian quarry drillers and stone carvers with an average of 17.4 years of exposure to relatively high levels of HTV 13 ; by about fivefold to 11-fold in manual workers employed by private companies in the Pays de Loire region of France 14 ; by almost twofold in male users of powered tools from a different French survey who had been exposed for a median of 10 years 15 ; by twofold to threefold in Italian men from a broad range of occupations (mine driller, stone cutter, stone dresser, building worker, chainsaw user, timber worker, milling worker, grinder, polisher) when exposed for ≥10 years 16 ; and, also, by almost twofold in men claiming vibration-induced white finger when compared with similarly aged men from a general surgical ward of a hospital in England. 17 By contrast, a very large British study, involving over 97 000 miners and ex-miners seeking compensation for Hand-arm Vibration Syndrome, found no relationship with years of exposure to HTV when analysed as a continuous variable.…”

Section: Discussionsupporting

confidence: 88%

Dupuytren's contracture and occupational exposure to hand-transmitted vibration

et al. 2014

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AimsThe relation between Dupuytren's contracture and occupational exposure to hand-transmitted vibration (HTV) has frequently been debated. We explored associations in a representative national sample of workers with well-characterised exposure to HTV.MethodsWe mailed a questionnaire to 21 201 subjects aged 16–64 years, selected at random from the age-sex registers of 34 general practices in Great Britain and to 993 subjects chosen randomly from military pay records, asking about occupational exposure to 39 sources of HTV and about fixed flexion contracture of the little or ring finger. Analysis was restricted to men at work in the previous week. Estimates were made of average daily vibration dose (A(8) root mean squared velocity (rms)) over that week. Associations with Dupuytren's contracture were estimated by Poisson regression, for lifetime exposure to HTV and for exposures in the past week >A(8) of 2.8 ms−2 rms. Estimates of relative risk (prevalence ratio (PR)) were adjusted for age, smoking status, social class and certain manual activities at work.ResultsIn all 4969 eligible male respondents supplied full information on the study variables. These included 72 men with Dupuytren's contracture, 2287 with occupational exposure to HTV and 409 with A(8)>2.8 ms−2 in the past week. PRs for occupational exposure to HTV were elevated 1.5-fold. For men with an A(8)>2.8 ms−2 in the past week, the adjusted PR was 2.85 (95% CI 1.37 to 5.97).ConclusionsOur findings suggest that risk of Dupuytren's contracture is more than doubled in men with high levels of weekly exposure to HTV.

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Section: Discussionsupporting

confidence: 88%

Dupuytren's contracture and occupational exposure to hand-transmitted vibration

et al. 2014

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“…By adding long term follow-up data, our study strengthens the previously reported associations, establishing even a relatively low alcohol overconsumption as a major risk factor for developing DD. Furthermore, several previous studies have proposed manual work as a risk factor for the development of DD 8 , possibly through repeated microtrauma to the hand 30 . We found, however, no such associations in our study, neither among men or women, possibly due to the low number of farmers in the study population.…”

Section: Discussionmentioning

confidence: 99%

Metabolic factors and the risk of Dupuytren’s disease: data from 30,000 individuals followed for over 20 years

Rydberg

Zimmerman

Löfgren

et al. 2021

Sci Rep

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Dupuytren’s disease (DD) is a fibroproliferative disorder affecting the palmar fascia of the hand. Risk factors include diabetes mellitus (DM), whereas a high body mass index (BMI) is associated with a lower prevalence of DD. The aim of this study was to further elucidate risk and protective factors for the development of DD using longitudinal population-based data from the Malmö Diet and Cancer Study (MDCS). During 1991–1996, the inhabitants aged 46–73 years in the city of Malmö, Sweden were invited to participate in the population-based MDCS (41% participation rate). Data on incident DD were retrieved from Swedish national registers. Associations between DM, alcohol consumption, BMI, and serum apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) at baseline were analysed in multivariable Cox regression models adjusted for known confounders. Among 30,446 recruited participants, 347 men and 194 women were diagnosed with DD during a median follow-up time of 23 years. DM (men HR 2.23; 95% CI 1.50–3.30, women HR 2.69; 95% CI 1.48–4.90) and alcohol consumption (men HR 2.46; 95% CI 1.85–3.27, women HR 3.56; 95% CI 1.95–6.50) were independently associated with incident DD in the Cox regression models. Furthermore, inverse associations with incident DD were found for obesity among men, and ApoB/ApoA1 ratio among both sexes. DM and excess alcohol consumption constituted major risk factors for the development of DD. Furthermore, an inverse association between obesity among men and DD, and also between ApoB/ApoA1 ratio and DD was found in both sexes.

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“…16,17 A recent large cohort study conducted in France reported a significant dose-effect relationship between Dupuytren's disease and age, diabetes, high alcohol consumption and long-term exposure to work-related vibration tools. 18 Smoking has also been associated with an increased risk of the disease, and the combination of smoking and high alcohol intake has been reported to increase the risk further. 19 The earliest signs of Dupuytren's disease are changes in the skin, including loss of normal architecture and development of skin pits, caused by small vertical fibres (known as Grapow fibres) that connect the dermis to the palmar fascia.…”

Section: Aetiology Pathophysiology and Clinical Presentationmentioning

confidence: 99%

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Brazzelli

Cruickshank

Tassie

et al. 2015

Health Technol Assess

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BackgroundDupuytren’s disease is a slowly progressive condition of the hand, characterised by the formation of nodules in the palm that gradually develop into fibrotic cords. Contracture of the cords produces deformities of the fingers. Surgery is recommended for moderate and severe contractures, but complications and/or recurrences are frequent. Collagenase clostridium histolyticum (CCH) has been developed as a minimally invasive alternative to surgery for some patients.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of collagenase as an alternative to surgery for adults with Dupuytren’s contracture with a palpable cord.Data sourcesWe searched all major electronic databases from 1990 to February 2014.Review methodsRandomised controlled trials (RCTs), non-randomised comparative studies and observational studies involving collagenase and/or surgical interventions were considered. Two reviewers independently extracted data and assessed risk of bias of included studies. A de novo Markov model was developed to assess cost-effectiveness of collagenase, percutaneous needle fasciotomy (PNF) and limited fasciectomy (LF). Results were reported as incremental cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were undertaken to investigate model and parameter uncertainty.ResultsFive RCTs comparing collagenase with placebo (493 participants), three RCTs comparing surgical techniques (334 participants), two non-randomised studies comparing collagenase and surgery (105 participants), five non-randomised comparative studies assessing various surgical procedures (3571 participants) and 15 collagenase case series (3154 participants) were included. Meta-analyses of RCTs assessing CCH versus placebo were performed. Joints randomised to collagenase were more likely to achieve clinical success. Collagenase-treated participants experienced significant reduction in contracture and an increased range of motion compared with placebo-treated participants. Participants treated with collagenase also experienced significantly more adverse events, most of which were mild or moderate. Four serious adverse events were observed in the collagenase group: two tendon ruptures, one pulley rupture and one complex regional pain syndrome. Two tendon ruptures were also reported in two collagenase case series. Non-randomised studies comparing collagenase with surgery produced variable results and were at high risk of bias. Serious adverse events across surgery studies were low. Recurrence rates ranged from 0% (at 90 days) to 100% (at 8 years) for collagenase and from 0% (at 2.7 years for fasciectomy) to 85% (at 5 years for PNF) for surgery. The results of the de novo economic analysis show that PNF was the cheapest treatment option, whereas LF generated the greatest QALY gains. Collagenase was more costly and generated fewer QALYs compared with LF. LF was £1199 more costly and generated an additional 0.11 QALYs in comparison with PNF. The incremental cost-effectiveness ratio was £10,871 per QALY gained. Two subgroup analyses were conducted for a population of patients with moderate and severe disease and up to two joints affected. In both subgroup analyses, collagenase remained dominated.LimitationsThe main limitation of the review was the lack of head-to-head RCTs comparing collagenase with surgery and the limited evidence base for estimating the effects of specific surgical procedures (fasciectomy and PNF). Substantial differences across studies further limited the comparability of available evidence. The economic model was derived from a naive indirect comparison and was hindered by a lack of suitable data. In addition, there was considerable uncertainty about the appropriateness of many assumptions and parameters used in the model.ConclusionsCollagenase was significantly better than placebo. There was no evidence that collagenase was clinically better or worse than surgical treatments. LF was the most cost-effective choice to treat moderate to severe contractures, whereas collagenase was not. However, the results of the cost–utility analysis are based on a naive indirect comparison of clinical effectiveness, and a RCT is required to confirm or refute these findings.Study registrationThis study is registered as PROSPERO CRD42013006248.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Heavy manual work, exposure to vibration and Dupuytren's disease? Results of a surveillance program for musculoskeletal disorders: Table 1

Abstract: Despite the limited number of cases, occupational exposure, including both vibration exposure and heavy manual work without significant vibration exposure, was associated with Dupuytren's disease.

Cited by 35 publications

References 20 publications

Dupuytren's contracture and occupational exposure to hand-transmitted vibration

Dupuytren's contracture and occupational exposure to hand-transmitted vibration

Metabolic factors and the risk of Dupuytren’s disease: data from 30,000 individuals followed for over 20 years

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

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