Arthritis drugs can cure hand deformity

A condition which causes deformity of the hand leading to impairment and disability can now be successfully treated by using drugs developed in recent years for the treatment of different forms of arthritis.

Dupuytren’s Disease is a common and progressive fibroproliferative disorder of the hand, causing usually the little or ring finger to be pulled in towards the palm of the hand.

The deformity can impair hand movement to the extent it limits daily activities severely, including self-care and employment, reducing health-related quality of life.

There are no approved treatments for the early stages of the disease and a high recurrence in late-stage disease when therapies including surgery and injection therapy which work for only a limited length of time.

Across the UK, the prevalence of the disease is approximately 20 per cent.

In Scotland the prevalence is much higher – 40 per cent of the population - and in Scandinavian countries, it affects around 30 per cent of men over 60. This is because the disease is genetic; Scots are affected more than other parts of the UK because more people carry Celtic or Irish genes.

Now, however, a team led by Mr Neal Millar, Clinical Senior Lecturer in Orthopaedic Surgery in the University of Glasgow’s Institute of Infection, Immunity and Inflammation, has discovered that two drugs developed in recent years for the treatment of different forms of arthritis can block the fibrotic response found in Dupuytren’s Disease.

The drugs are: Cytokine inhibitors which has been used for treating rheumatoid and other forms of arthritis for around 15 years and JAK inhibitors which became available around five years ago, and is also used for the treatment of inflammatory arthritis.

Mr Millar said: “Our work using patient samples from Dupuytren’s Disease has discovered a key role for these drugs.

“We were able to reverse these fibrotic changes in human cells. Until now, there has been nothing out there for these patients.”

The two arthritis drugs are licensed for use in the treatment of that disease but under drug regulations, they must undergo further testing for use in the treatment of a different disease.

Mr Millar and his team have submitted a patent for the discovery of the new use of the drugs. They have also been awarded a grant from the Medical Research Council to conduct experimental therapeutic trials which he anticipates could start in a year’s time.

CASE STUDY

Retired teacher Andrew Tod from Edinburgh has lived with Dupuytren’s Disease for the past 40 years and has undergone two operations on each hand.

He said: “Anything that publicises this condition is going down the right lines.

“I developed it without knowing what it was.

“I just assumed like a pain in the ankle or something that it would just disappear and then it gradually got a little bit worse and a little bit worse in both hands.

“So, that when I was working they would give me the nickname of ‘the claw’.

“Basically it got worse and I did nothing about it - then I had two operations on one hand and two on the other.

“To be honest it was really too late by that point.

“I remember one of the surgeons asking me if I’d ever heard of something called the bell curve?

“It said my hands were off the radar for this measurement - so in other words I had neglected them all these years.

“They’re no better now but they’re no worse.

“I’ve got one finger on the left hand that works OK and one that’s fine on the right, so typing is not a problem - I only use two fingers anyway. I can type and I can brush my teeth and perform the health measures.

“My father had muscular dystrophy and I learnt from him that if you have a disability you have to adapt, it may take longer for you to do things but you just adapt.

“I’ve had no pain of any kind with it at all - all I’ve had is inconvenience.

“I’m delighted they’ve found drugs that could be effective and if someone gets the symptoms in their 30s and that means they can then be prepared for life as a professional pianist then splendid.”

The condition is also known as the ‘Curse of the MacCrimmons’ who were the 16th century pipers for the chieftains of Clan MacLeod on the Isle of Skye.

Folklore has it a curse was put on them for revealing piping secrets and it was foretold they would cease to be the official pipers to the MacLeods and would leave the Isle of Skye forever.

So, it came to pass. The fingers of the MacCrimmon men bent so far into their palms they became unable to play the bagpipes any more. Any piper who suffers from Dupuytren’s Contracture as it is also known will tell you he has been affected by the ‘Curse of the MacCrimmons’.

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