HealthWatch: A Helping Hand For Dupuytren's

WCBS-TV—New York, NY—January 12, 2010

Have you ever heard of Dupuytren's? Probably not, but it's an ailment that affects many high profile patients, including Ronald Reagan, George Bush and Margaret Thatcher.

It can render a sufferer's hand almost useless. CBS 2's Dr. Max Gomez has some information about a new injection that can treat the unusual problem.

As many as 27 million people in the United States and Europe suffer from Dupuytren's. It's a contraction or shrinkage of the connective tissue in the palm of the hand that can form cords that can cause the fingers to curl in. Now, an FDA advisory panel has recommended the first alternative to surgery in the form of a simple injection.

Louis Rubenzahl knows first hand the crippling effects of Dupuytren's.

"This finger especially was curled in which was embarrassing when I ever went to shake somebody's hand. And this finger, the cord was growing larger and larger and eventually I could no longer wear my wedding ring," Rubenzahl told Dr. Gomez.

That's how Rubenzahl describes his Dupuytren's; not painful but definitely interfering with his daily activities. Something as simple as washing your face could mean poking yourself in the eye.

"Just a simple thing as putting on a glove, or at a keyboard, trying to type," said patient Anthony Basta.

Basta took the conventional treatment route of surgery, which left him with scars and took weeks to recover from. So when he developed Dupuytren's in his other hand, he sought an alternative called collagenase.

"The idea behind the collagenase, rather than surgically disrupting it, is dissolving it. And dissolving it safely," said Dr. Robert Hotchkiss of the Hospital for Special Surgery.

The problem is that Dupuytren's forms hard scar tissue cords that contract. The collagenase is an enzyme that is injected directly into the cord, partially dissolving and weakening it.

A recent study in the New England Journal of Medicine found that the collagenase injection, brand name Xiaflex, was safe and effective in restoring nearly full extension of the affected fingers.

"It's a tiny amount into the cord, you wait 24 hours, the patient returns, and we push on the joint and it usually just pops open. Sometimes it just opens gently, sometimes they pop on their own," added Dr. Hotchkiss.

Basta says the results are much better.

"I'm happy with it. The hand stays straight."

So is Rubenzahl.

"A week after the last injection, I think everything was done, and it's been a year and my hands are wonderful."

Xiaflex, as the injectable enzyme is called, is not yet FDA approved, although an advisory panel has recommended its approval. The FDA is expected to act on the approval soon. It can take two or three injections to weaken the scar tissue cord enough to straighten the finger, but as the patients in the study said, it's a better alternative to surgery.

Editor's note:  Xiaflex is now approved by the FDA. HSS hand surgeons Drs. Aaron Daluiski, Robert Hotchkiss and Scott Wolfe are now using Xiaflex to treat Dupuytren's Contracture following its use in a clinical trial at HSS.
 

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