Ronald Reagan and Margaret Thatcher shared more than the same political philosophy. Both of them also suffered from a benign but potentially crippling condition of the hand known as Dupuytren’s disease. Pronounced DOO-puh-trens, the disease affects the connective tissue under the skin of the palm. Typically, it starts with a tiny nodule in the palm, which initially may not cause problems. As the disease progresses — it usually develops slowly, over decades — the nodules eventually form thick, rope-like cords that can pull one or more fingers into a bent position that can’t be relaxed or completely straightened. This can make it difficult to type, shake hands, wear gloves, reach into a pocket, or perform other daily tasks.
Until recently, surgery to break up the cords was the only treatment. But in 2010, the FDA approved an injectable drug called Xiaflex that usually eliminates the need to go under the knife. “The drug is an enzyme, called collagenase, that breaks down and weakens the excessive collagen in the knots and cords,” says Dr. Stuart Elkowitz, a hand surgeon with Somers Orthopaedic Surgery & Sports Medicine Group in Carmel. “We give the shots into the hand and follow up the next day by manipulating the finger to release the cords and straighten the fingers.” Usually one shot in each affected joint does the trick, but up to three shots per joint have been approved.
Dupuytren’s disease affects hundreds of thousands of people in this country every year; Dr. Elkowitz sees about 50 local patients with the condition annually. It cannot be cured, so future injections may be needed for flare-ups. But shots beat surgery any day, for safety and recovery reasons. “This is a game-changer,” Dr. Elkowitz says.