Treatment of Dupuytren 's disease
Written by:Xiapex ( collagenase clostridium histolyticum, also known as AA4500 ) was developed as a targeted therapy for the treatment of Dupuytren 's contracture presenting some palpable cord.
Xiapex is composed of two distinct collagenases isolated and purified from the bacteria Clostridium histolyticum. AA4500 pharmacological activity involves the selective lysis of collagen at the site of injection (ie, in the string of Dupuytren ). Therefore, the therapeutic activity is localized AA4500, AA4500 bringing the systemic exposure does not require to be effective.
Both operate in tandem collagenase to hydrolyze collagen chains and disrupting pathological collagen cords causing Dupuytren contracture.
The AUX -I ( collagenase class I) of the end portions of the collagen chain, while AUX -II ( class II collagenase ) of the inner segment collagen chain.
Dupuytren cords are mainly composed of collagen type I and III. Other soft tissues of the hand, including ligaments and tendons, are also susceptible to the action of Xiapex, causing the doctor who used to treat Dupuytren must understand the mechanism of action and the proper procedure for management of Xiapex.
Inclusion and exclusion criteria
Criteria for inclusion
-&ge, 18 years old
Dupuytren -Contractura on at least one finger other than thumb
At least -Contractura 20º and no more than 100º (MF ) or 80º(IFP ) caused by a palpable cord
exclusion criteria
Recent stroke or hemorrhagic Disorders
Sound disorder affecting the hands
-Treatment During the previous 90 days at baseline
-Using Tetracycline derivatives in the previous 14 days
-Using Anticoagulants in the previous 7 days (except low-dose aspirin )
-Alergia To collagenase or its excipients
Systematic infiltration of Xiapex
Once the patient is selected, the daily patient moving infiltration fasting.
It is important to feel the rope and after determining its extent, the rope passes with the needle slowly infiltrating the product. Flange
click on three points with a function rules concerned a metacarpophalangeal or IFP flange.Following the extension of the finger, you can:
-Place A bandage and begin immediate mobilization of the fingers if the affectation is unimportant - Place a plaster splint for a week and keep at night and between exercises for 2-3 months to prevent recurrence and new digital retraction if the affectation is important.
Important
It is a therapeutic procedure that is not without risks. It is important to know the anatomy and the product to optimize results and reduce complications.
If there is a cord that affects the MF and the IFP of the long fingers, 1ºMF will be made monthly and the IFP.
It is a procedure that can be used in recurrent Dupuytren whenever there is a palpable cord.
Do not close doors to a surgery if there is a recurrence of the disease in the future.
Personal Experience
A prospective study of patients treated for Dupuytren disease with collagenase in the period between May 2012 and September 2013.
This is a series of 71 patients affected with a mean age of 63´ 8 anos ( 33-84 years ). 62 men ( 87 %) and 9 women (13% ), with a mean follow-up of 9 months ( 15-3 months). 15 patients are included in a multicenter clinical trial Phase IV. 10 patients had less than 45 years (14´ 1%), the remainder being patients over the age limit ( 61 patients )
.Of the 71 patients enrolled, all were right-handed, and there was no affectation major differences between the right and left hand, as 33 patients had affectation of his right hand ( 46%) and 38 patients of his left hand (54% ). A striking fact is the bilateral, ie the affectation of both hands by Dupuytren (62% ). 38% of patients had a family history of Dupuytren's disease. We value the manual activity of patients and classified into Mild, moderate and high, showing that 35% have a high light activity, 40% moderate and 25%. We appreciate the influential habits as snuff and alcohol, with the following results;Snuff: 73´ 2 % of patients are non-smokers, 15´ 5 % smoke less than 10 cigarettes / day and 11´ 3 % smoke more than 10 cigarettes daily. In relation to alcohol, 38 patients (53´ 5%) were non-drinkers, 24 patients ( 33´ 8% ) mild drinkers and 9 (12´ 7%)., Moderate to major consumers
When valuing predisposing factors we found that 28% of patients with diabetes mellitus, 4% are patients with chronic obstructive pulmonary disease and had no association with liver disease or epilepsy. Regarding the association with other types of fibromatosis, we see that 7% had to lederhoose disease, Peyronie's disease 7% and 4% Garrod nodules.
Of the 71 patients, 4 patients were treated relapse with palpable cord. 23% of patients had undergone prior intervention of Dupuytren's disease in the other hand or another location. In assessing the Dupuytren concomitant pathology (STC, osteoarthritis, finger in spring… ), we see the following findings: 9/71 patients had also STC, 8/71 and 4/71 had had osteoarthritis or had suffered from trigger finger.
When we value duration of disease, we see that 23% had more than 10 years, 32% between 7-10 years, 25% between 3-7 years and 20% within 20 years.
When we value finger affection we see that the most frequently affected is 5ºfinger by 54 %, followed by 4ºby 42 % and 3º4%.
severity of the disease was determined by the classification of Tubiana. Most patients were in stage II / III.
Infiltration was performed in the query, like stretching to 24 h.
28 cases involved only the MTF 11 and 32 only the IFP IFP cases the MTF.
The degree of contracture was higher than IFP MTF ( 65´ 4% VS 35´ 5%, respectively ).
The result of the extension of pure MTF was satisfactory degree of extension keeping low below 5ºper year. However in IFP, so this does not happen. The initial full extension is not obtained with a residual flexion of about 10ºthat is lost gradually.
The results are spectacular in MTF, not so in IFP where because it is the 5ºfinger, and be the worst degree of shrinkage, the results are worse.