Differentiating Dupuytren's Contracture from Rheumatoid Arthritis: A Patient's Guide
Guest authored by Cheryl Green
, PhD, DNP, RN, LCSW, CNL, MAC, FAPA
Dupuytren's contracture and rheumatoid arthritis are two distinct conditions affecting the hands. Both conditions can cause pain, effect joint function, swelling, and disfigurement. This article will explain the differences between the two conditions, empowering patients to advocate for the health and function of their hands.
Diseases of the Hand
Patients that experience diseases of the hand have pain, difficulty writing, washing themselves, working and completing all tasks associated with hand use and mobility. According to the Centers for Disease Control and Prevention (CDC, 2017), between the years 2013 to 2015, approximately 54.4 million adults within the United States had been informed by their healthcare provider, that they had lupus, fibromyalgia, rheumatoid arthritis, or gout. With increasing age, the risk of developing arthritis increases. For example, patients aged 18 to 44 years, 7.1% reported being diagnosed with arthritis, patients aged 45 to 64 years, 29.3% and 65 years and older, 49.6% reported being diagnosed with arthritis (Baker, Barbour, Hemlick, Zack, & Al snih, 2017).
Theis, Roblin, Hemlick, and Luo (2017) in examining work disability statistics amongst 20.1 million adults, noted that persons diagnosed with rheumatoid arthritis or other arthritic conditions in the United States, constitute 18.6%. Comparatively, back and neck problems constitute 30.3%, while anxiety/depression/emotional problems, 21.0%. Persons who were overweight (23%) and obese (31%), had complications associated with arthritis related to excess weight causing stress on the joints and limiting mobility over time (CDC, 2017).
Differentiating Dupuytren's Contracture from Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a medical condition that causes affected persons to have decrease in joint function, tenderness, pain, swelling, and disfigurement of the hand. The condition effects both men and women. Early diagnosing of RA can be difficult because there presently is not a standard for diagnosis. Laboratory tests used during the diagnostic process for RA could include: rheumatoid factor, antibodies against citrullinated peptides test, C-reactive protein, and the erythrocyte sedimentation rate. Joint erosion associated with RA, can be visualized by x-ray. Treatment, depending on the severity of RA can range from the use of disease-modifying antirheumatic drugs, nonsteroidal drugs, anti-inflammatory drugs, tumor necrosis factor inhibitors, and aspirin.
Dupuytren's contracture is a progressive and slowly developing hand deformity that occurs as knots of tissue (palmer fascia) form under the skin. Risk factors for Dupuytren's are being a male over the age of 50 years, northern European descent (occurs most often in men of Scandinavian or Celtic heritage), having diabetes, gout, arthritis, a family history of Dupuytren's, smoking, and alcoholism (Hinkle & Cheever, 2014; Mayo Clinic, 2017). According to DiBenedetti, Nguyen, Zografos, Ziemiecki, & Zhou (2011), "
The prevalence of Dupuytren's disease defined as a self-reported physician diagnosis and/or surgical treatment was estimated as 1% (95% CI = 0.8-1.2), but the estimated prevalence is much higher (7.3%) when including self-reported symptoms of ropelike growth or hard bumps on the hand. The annual incidence proportion was estimated at about 3 cases per 10,000 adults" (p. 149).
Patients effected by Dupuytren's contracture experience a thickening of the skin on the palm. As knotting and tissue thickening progress, typically over a period of years, the patient does not have pain, but the small knots forming under the skin can become sensitive to touch. The functional use of the hand is impacted as the pinky and ring finger start to pull inward toward the palm of the hand.
Healthcare providers currently diagnose Dupuytren's by examining patients' hands and obtaining a health history. For patients that are still able to perform their daily activities using their hands without difficulty, treatment is not needed. If treatment is indicated, the procedure of needling can be used to break a part the tissue cords under the skin of the palm. The enzyme, clostridium histolyticum (Xiaflex) can be injected into the cord to weaken and soften it. For patients with severe hand deformity, surgical removal of the tissue is an option.
Advocating for Yourself and Loved Ones
It is imperative that patients learn to advocate for themselves and their loved ones when interfacing with the health care system and healthcare providers. Learning to differentiate between rheumatoid arthritis and Dupuytren's contracture is an example of how patients can empower themselves with health care knowledge. Remember, you are in charge of your body's health and well-being. Be kind to yourself, you deserve it!
Baker, N.A., Barbour, K.E., Helmick, C.G., Zack, M.M. & Al snih, S. (2017). Arthritis and
cognitive impairment in older adults. Rheumatology International. 37(6), 955-961.
Benedetti, D.B., Nguyen, D., Zografos, L., Ziemiecki, R., & Zhou, X. (2011). Prevalence,
incidence, and treatments of Dupuytren's disease in the United States: results from a
population-based study. Hand, 6, 149-158. doi:10.1007/s11552-010-9306-4
Centers for Disease Control and Prevention. (2017). Arthritis-Related Statistics. Retrieved from
July 1, 2017
Hinkle, J.L. & Cheever, K.H. (2014). Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (13th ed.). Philadelphia, PA: Wolters Kluwer Health| Lippincott Williams &
Mayo Clinic. (2017).
Dupuytren's contracture. Retrieved from
Theis, K.A., Roblin, D., Helmick, C.G., Luo, R., Prevalence and causes of work disability among
working-age US adults, 2011-2013, NHIS. (2017). Disability and Health Journal.