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. 2025 Feb 7;42(2):cmae065.
doi: 10.1093/fampra/cmae065.

The presentation and treatment of Dupuytren's disease in Dutch general practitioner care

Roel J M van Straalen  1 , Dieuwke C Broekstra  1 , Paul M N Werker  1 , Michiel R de Boer  2
Affiliations

The presentation and treatment of Dupuytren's disease in Dutch general practitioner care

Roel J M van Straalen et al. Fam Pract. .

Abstract

Background: When research and management of Dupuytren's disease (DD) shift from symptom relief to preventing contractures, general practitioner (GP) care may become more central to treatment. However, the presentation and course of DD in GP care are underexplored and this has been recognized as a knowledge gap that hinders effective treatment decisions. This study is the first to map the trajectory of DD patients in GP care.

Methods: Using electronic health records from Dutch general practices in a regional research network, we conducted a registration-based cohort study in a dynamic population. Descriptive statistics detailed patient demographics, number of contacts, and symptoms per contact. The time and number of contacts before diagnosis were also analysed. Sankey diagrams illustrated the relationship between management options and symptoms.

Results: Over a 16-year period, 84% of patients with a DD diagnosis had visited their GP for this reason, with 73% only having one GP contact. The diagnosis was made at first contact for 93% of patients. Initial contacts often reported a lump (57.3%), but this symptom was less frequent in subsequent visits. 'Daily life impairment' increased after the first contact. The most common management options were referral to secondary care (37.7%) and watchful waiting (35.1%).

Conclusion: The diagnosis and management of DD in GP care are in line with the current guidelines. Less than half of the DD patients were referred to secondary care during follow-up. This may give room for preventive treatment that limits progression. Future studies should focus on the accuracy of diagnosis and the feasibility of effective treatments in GP care.

Keywords: Dupuytren’s contracture; epidemiology; primary care; symptoms; treatment.

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Conflict of interest statement

PW is a member of the Data Monitoring Committee of Fidia Ltd, Milan, Italy. PW is a member of the scientific advisory board of the International Dupuytren Society, and PW and DB are or were both members of the scientific advisory board of the Dutch Dupuytren Society. These interests are not related to the submitted work. All other authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
In-/Exclusion chart of registered persons and DD patients.
Figure 2.
Figure 2.
Registered management options in numbers and percentages.
Figure 3.
Figure 3.
Sankey-flow diagram* of first three contacts. *The length of each ‘bar’ corresponds with the number of participants in each group and the width of each ‘flow’ represents the number of participants in this flow. The grey bars on the left represent the (combination of) symptoms at the initial contact. Note that the Sankey diagram illustrates the symptom ‘lump’, signifying the absence of descriptions for the symptoms curvature, DLI, or pain.
See this image and copyright information in PMC

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