07:07am Friday 18 August 2017

Collagenase injections can obviate surgery in certain cases of Dupuytren’s disease

This ailment, characterised by the retraction of the fingers, can be incapacitating for a number of daily activities of persons.

This involves a clinical trial in its last (the IV) phase, and in which 23 centres from six different countries (six Spanish) are participating. In concrete, the University Hospital is the first Spanish centre to initiate the study. “Pharmacological treatment using collagenase injections in certain cases of Dupuytren’s disease was approved in Europe just over a year ago, although it has been applied in the USA previously. Until then, the only treatment for this pathology was surgery – fasciectomy”, explained the person responsible for the trials, doctor Santiago Amillo Garayoa, director of the Department of Orthopaedic Surgery and Traumatology at the University of Navarra Hospital. The main goals of the study “have to do with the safety of both treatments and evaluating the results and, as a secondary objective, with describing the reasons why one is better than another”.

Out-of-control cell growth produces the collagen

“Dupuytren’s disease”, explained doctor Amillo, “in a fibromatosis or benign tumour, involves disordered growth of cells that produce collagen in the palm of the hand. This collagen forms the structure that maintains the firmness of the palm and enables us, for example, to pick up objects. The disordered proliferation of the cells causes the retraction of the fingers”.

While not causing pain, the Hospital specialist pointed out, the disease means limitations for the patient: “It impedes washing oneself normally, putting your hand in your pocket, shaking hands, and so on”.

It is an ailment ten times more frequent in men than women and its prevalence is about 10% amongst the over 45s, but rises to 25% in the over 75s. Family history has an equal influence, about 65% of sufferers estimated to have a genetic predisposition to having this illness. “It affects the fourth or fifth finger more and is frequently bilateral, i.e. it appears in both hands. Apart from family history, other factors favouring its onset are: alcohol, smoking, diabetes, micro-traumatisms, certain pharmaceutical drugs, and so on”, explained doctor Amillo.

Injection and subsequent digital extension of affected hand

As regards the research, pointed out the hospital specialist, the medical treatment is carried out by the single application of “a collagenase injection in various zones of the hand as the surgeon deems necessary. This enzyme breaks or weakens the net of collagen created by the disordered growth of cells. The next day the surgeon manipulates the patient’s hand, under anaesthesia, in order to stretch and break the stringy tissue that has formed, in order for the fingers to return to their normal position”.

The principal advantage of this treatment, added doctor Amillo, is that it does not require “opening the palm of the hand with surgery in order to eliminate the unhealthy tissue”. He recognised, however, that side effects are likely, as in any therapy: “there could be an allergic reaction to collagenase, as well as haematomas and oedemas arising from the injection”.
In general, the patient only has to return to the Hospital for an annual check-up over a period of five years – the time fixed for the monitoring of the trial.

Persons suffering from Dupuytren’s disease and who are interested in participating in this research can request an initial appointment at the Hospital in order to assess the most suitable treatment for their case – by calling telephone number 948 255 400.

Contact:
Jesús Zorrilla Ruiz
Clínica Universidad de Navarra
Contact details:
jzorrilla@unav.es
(+34) 948-296.497 / 948-255.400

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