Dupuytren’s Contracture is a common hand condition affecting the connective tissue in the palm, causing a progressive inability to straighten the fingers. This disorder, sometimes called Dupuytren’s disease, causes the tissue beneath the skin to thicken and contract over time. Because of this characteristic thickening, many question if the immune system is mistakenly attacking the body, suggesting an autoimmune disorder. This article clarifies the nature and medical classification of Dupuytren’s Contracture.
What is Dupuytren’s Contracture?
Dupuytren’s Contracture is a chronic, progressive fibroproliferative disorder affecting the palmar fascia, the fibrous layer of tissue beneath the skin of the hand. It begins with the formation of small, firm nodules in the palm, usually near the base of the ring and little fingers. This initial stage is typically painless, though some individuals may experience tenderness.
As the disease progresses, these nodules grow into thick, rope-like cords running from the palm into the fingers. This process involves abnormal tissue growth (fibroproliferation) where the tissue shortens and contracts. This shortening gradually pulls the affected fingers into a bent position, resulting in a permanent flexion contracture that makes it difficult or impossible to fully straighten the digits.
Is Dupuytren’s Contracture Autoimmune?
Dupuytren’s Contracture is generally not classified as a classic systemic autoimmune disease. A true autoimmune disorder involves the immune system mistakenly attacking healthy tissues throughout the body, such as in rheumatoid arthritis or lupus. While the exact cause remains unknown, the condition is categorized as a localized fibrosing disorder.
Confusion regarding an autoimmune classification arises because the affected tissue shows signs of inflammation and contains immune cells, specifically dense infiltrates of T-cells. This presence suggests a local immune reaction drives the tissue to thicken and contract. However, this localized inflammatory response is thought to trigger subsequent fibrosis, the core problem, rather than representing a systemic autoimmune attack.
The fundamental issue is the abnormal production and remodeling of collagen by specialized cells, not the body-wide destruction of tissue by autoantibodies. Current scientific consensus views it as a complex disorder of cellular mechanics and tissue remodeling. It is primarily a disorder of connective tissue, similar to Peyronie disease and Ledderhose disease.
Established Causes and Risk Factors
Since Dupuytren’s Contracture is not an autoimmune condition, its etiology is multifactorial, involving a strong genetic predisposition and several environmental factors. At the cellular level, the condition is a myofibroblastic disease. Normal fibroblasts in the palmar fascia transform into highly contractile cells called myofibroblasts, which are responsible for the excessive production of collagen and the resulting tissue contraction.
Genetic Predisposition
A significant portion of affected individuals have a family history of the condition, indicating a hereditary link, often inherited in a dominant pattern. The condition is strongly associated with ancestry, particularly among people of Northern European or Scandinavian descent. This genetic component is why the condition is sometimes colloquially referred to as “Viking disease.”
Non-Genetic Risk Factors
Risk increases with age, typically after 50. Men are significantly more likely to develop the condition and often experience more severe symptoms than women. Co-morbidities like diabetes and epilepsy are associated with a higher incidence, as are lifestyle factors such as excessive alcohol consumption and smoking.
Diagnosis and Management
The diagnosis of Dupuytren’s Contracture is primarily clinical, based on a physical examination of the hand. A healthcare provider will inspect the palm for the characteristic nodules, cords, and skin pitting. They will also measure the extent of the finger contracture to assess the severity of the condition.
A simple diagnostic tool is the “tabletop test,” where a patient attempts to lay their palm flat on a table. If the finger contracture prevents the hand from lying completely flat, the test is considered positive, indicating a level of impairment that may warrant treatment.
Treatment strategies are focused on the fibrotic nature of the disease, aiming to release the contracted cords and restore finger function. Non-surgical treatments include injections of collagenase, an enzyme that dissolves the collagen in the fibrous cords, allowing the fingers to be manually straightened. Needle aponeurotomy is another minimally invasive option where a needle is used to divide the cord without a large incision. For more advanced cases where hand function is severely limited, surgical intervention, such as partial fasciectomy, is performed to remove the thickened, diseased tissue.