Guest guest Posted November 1, 2006 Report Share Posted November 1, 2006 Hi today I went to my rheumy and gave him a list of questions. One of them was the palm skin and when he saw the white, pinched looking crease he pressed the centre of the palm and said that it was being caused by early Dupuytren's contractures. He said Dupuytren's contractures weren't RA related, but that I should keep stretching all fingers of the hand so that they don't start getting pulled inwards. I don't know if it is all (drying skin etc) being caused by the D's contractures, but I'll go and have a look for info. on that. I'd love to go back to my hands being MY hands and not this medical case. LOL Thanks AnneMarie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2006 Report Share Posted November 1, 2006 Hope you don't mind me jumping in but I suffer from Dupuytren's My fingers are beginning to bend inwards.. It is quite painful some days... Hugs Heidi ____________________________________________ Heidi Jaye AKA Lady Magenta Aalotar " Misty G and the insiders " " People are strange, when your'e a stranger " ______________________________________________ -- Re: [ ] skin drying on palm : Hi today I went to my rheumy and gave him a list of questions. One of them was the palm skin and when he saw the white, pinched looking crease he pressed the centre of the palm and said that it was being caused by early Dupuytren's contractures. He said Dupuytren's contractures weren't RA related, but that I should keep stretching all fingers of the hand so that they don't start getting pulled inwards. I don't know if it is all (drying skin etc) being caused by the D's contractures, but I'll go and have a look for info. on that. I'd love to go back to my hands being MY hands and not this medical case. LOL Thanks AnneMarie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2006 Report Share Posted November 2, 2006 AnneMarie, Sorry my response is too late for your appointment. I hope you can reclaim your hands soon, LOL. I've been gathering information on the possibilities, but it's not easy. So many tempting things to read. More than one process may be affecting your hand, but I'm not sure. There is no doubt that Dupuytren's could cause the sort of skin thickening and puckering of your palm you are describing (I'm not sure about the dryness or fissuring though); however, the index finger is not often affected. I could find no evidence of a specific link between Dupuytren's contracture and rheumatoid arthritis. It has an association with, among other things, epilepsy, alcoholism, and diabetes. This source states that the incidence of Dupuytren's is actually lower in those with RA: ***** Postgraduate Medical Journal 2005 " Clinical association of Dupuytren's disease " : http://pmj.bmjjournals.com/cgi/content/full/81/957/425 ***** Trigger finger has a strong association with RA. My mother had this condition unilaterally, but she has type 2 diabetes, not RA. She also has thickened skin with fissuring, but on both hands. The fissuring occurs primarily on her fingers. Below, I've included information with graphics and/or photos, too, on Dupuytren's, trigger finger (stenosing tenosynovitis), and other possibilities. I tried to group them, but there is a lot there, and there is some overlap between topics. You might decide to see a hand specialist (orthopedic hand surgeon) for an opinion about what may be going on, especially if you have concerns about the possibility of developing contractures. In answer to your previous question about psoriasis: there are several types and various presentations of psoriasis. Any time skin thickening, drying, and/or flaking are an issue, psoriasis should probably be considered. Also, psoriasis doesn't have to affect a wide area of skin. It can be localized. ***** National Psoriasis Foundation http://www.psoriasis.org/about/ http://www.psoriasis.org/about/psoriasis/ ***** You said your rheumatologist had some guesses about the rash on your face. Did the dermatologist say anything about it? ********************************************************* ********************************************************* Published Online First: 13 February 2006. doi:10.1136/ard.2005.048934 ls of the Rheumatic Diseases 2006;65:1341-1345 © 2006 by BMJ Publishing Group Ltd & European League Against Rheumatism -------------------------------------------------------------------------- EXTENDED REPORT Cutaneous abnormalities in rheumatoid arthritis compared with non-inflammatory rheumatic conditions Background: Cutaneous abnormalities are common in rheumatoid arthritis, but exact prevalence estimates are yet to be established. Some abnormalities may be independent and coincidental, whereas others may relate to rheumatoid arthritis or its treatment. Objectives: To determine the exact nature and point prevalence of cutaneous abnormalities in patients with rheumatoid arthritis compared with those in patients with non-inflammatory rheumatic disease. Methods: 349 consecutive outpatients for rheumatology (205 with rheumatoid arthritis and 144 with non-inflammatory rheumatic conditions) were examined for skin and nail signs by a dermatologist. Histories of rheumatology, dermatology, drugs and allergy were noted in detail. Results: Skin abnormalities were reported by more patients with rheumatoid arthritis (61%) than non-inflammatory controls (47%). More patients with rheumatoid arthritis (39%) than controls (10%) attributed their skin abnormality to drugs. Cutaneous abnormalities observed by the dermatologist were also more common in patients with rheumatoid arthritis (76%) than in the group with non-inflammatory disease (60%). Specifically, bruising, athlete's foot, scars, rheumatoid nodules and vasculitic lesions were more common in patients with rheumatoid arthritis than in controls. The presence of bruising was predicted only by current steroid use. The presence of any other specific cutaneous abnormalities was not predicted by any of the variables assessed. In the whole group, current steroid use and having rheumatoid arthritis were the only important predictors of having any cutaneous abnormality. Conclusions: Self-reported and observed cutaneous abnormalities are more common in patients with rheumatoid arthritis than in controls with non-inflammatory disease. These include cutaneous abnormalities related to side effects of drugs or to rheumatoid arthritis itself and other abnormalities previously believed to be independent but which may be of clinical importance. http://ard.bmjjournals.com/cgi/content/abstract/65/10/1341 ********************************************************* ********************************************************* Medscape Dermatology Clinic " Fissuring Dermatitis on the Hands " : http://www.medscape.com/viewarticle/405531 ********************************************************* ********************************************************* The Doctor's Doctor " Keratodermas " : http://www.thedoctorsdoctor.com/diseases/keratodermas.htm ***************************** Dermatology Image Atlas palmoplantar keratoderma: http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-1236837384 ***************************** eMedicine.com " Keratosis Palmaris et Plantaris " : http://www.emedicine.com/derm/topic589.htm ********************************************************* ********************************************************* Supplement to the June 2005 Skin & Aging Winter Clinical Dermatology Conference Proceedings http://www.skinandaging.com/SA/supplements/pdf/SAJuneWinterClinical.pdf (see page 4 on chronic hyperkeratotic skin disease) ********************************************************* ********************************************************* CUTIS September 11, 2003 " Successful Treatment of Recalcitrant Palmoplantar Psoriasis With Etanercept " : http://www.dms.moph.go.th/inderm/Journal/Cutis/2003/vol72%20no5%20Nov/vol72%20no\ 5%20p396.pdf (good photos of palmoplantar psoriasis) **************************** DermNet NZ Last updated: September 16, 2006 " Psoriasis of the palms and soles " : http://dermnetnz.org/scaly/palmoplantar-psoriasis.html **************************** Acta Dermato-Venereologica Publisher: & Francis Issue: Volume 82, Number 3 / May 01, 2002 " Palmoplantar Lesions in Psoriasis: A Study of 3065 Patients " : Abstract: Although palmoplantar psoriasis can be severely disabling, there are very few large clinico-epidemiological studies on this condition. Our purpose was to study the morphology and pattern of lesions in Indian patients with palmoplantar psoriasis and to elucidate the role of occupation in the incidence/localization of these lesions. All patients attending our Psoriasis Clinic from 1993 to 2000 were screened for palmoplantar lesions and their demographic characteristics, occupation and the exact localization of the lesions were noted. Out of 3,065 patients screened, 532 had palm and/or sole involvement. Plantar lesions were seen in 91.9% and palmar lesions in 55.6% of these patients. Four distinct patterns of lesion localization were noted on the palms and 5 patterns on the soles. Almost half of the men involved in regular manual labor had palmar lesions restricted to areas exposed to pressure, whereas only a quarter of other men had this type of lesion pattern. All patients with unilateral palmar lesions had them on their dominant hand and these patients were involved in regular manual labor. In our patients, the prevalence of plantar lesions was much higher than that of palmar lesions. The possible role of occupational trauma in lesion localization in Indian patients with palmoplantar psoriasis is discussed. http://taylorandfrancis.metapress.com/(21tsit55hkvpna55c5bvjw45)/app/home/contri\ bution.asp?referrer=parent & backto=issue,7,22;journal,25,58;linkingpublicationres\ ults,1:102094,1 ********************************************************* ********************************************************* Dermatology, February 2002 Journal Scan Journal of the American Academy of Dermatology January 2002 (Volume 46, Number 1) " Topical Tacrolimus (FK506) and Mometasone Furoate in Treatment of Dyshidrotic Palmar Eczema: A Randomized, Observer-Blinded Trial " : http://www.medscape.com/viewarticle/424917_3 ************************************ eMedicine.com " Vesicular Palmoplantar Eczema " : http://www.emedicine.com/derm/topic608.htm ********************************************************* ********************************************************* eMedicine.com " Tinea " : http://www.emedicine.com/emerg/topic592.htm ********************************************************* ********************************************************* HandWorld e-Hand.com " Dupuytren's Contracture " : http://www.e-hand.com/hw/hw009.htm **************************** Wheeless' Textbook of Orthopaedics " Dupuytren's Contracture " : http://www.wheelessonline.com/ortho/dupuytrens_contracture **************************** J Hand Surg [br]. 2005 Dec;30(6):551-6. Epub 2005 Oct 3. Non-Dupuytren's disease of the palmar fascia. Orthopedic Surgery Department and Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA. ouhsgmr@... The typical Dupuytren's disease patient is of Northern European descent with bilateral progressive multiple digital contractures and is genetically predisposed, with a family history. Palmar fascial proliferations sometimes present as a different entity without the typical Dupuytren's disease characteristics. We identified 39 patients (20 women and 19 men) over a 4-year period with " Non-Dupuytren's palmar fascial disease " , with unilateral involvement, without family history or ectopic manifestations. Twenty-three patients presented with unrelated complaints and were discovered, incidentally, to have the condition. In 28 patients, prior ipsilateral hand surgery or trauma precipitated the condition. Other related factors were diabetes mellitus and cardiovascular disease. Ten patients had skin tethering and subcutaneous thickening akin to Dupuytren's nodules and 29 had palmar fascial thickening into ill-defined pretendinous cords. The diseased tissue was in the line of the ring finger in 30 patients. The time from insult to onset of contracture averaged 3.6 months and from onset to follow-up averaged 5.3 years. The condition was non-progressive, or partially regressive, in 33 patients. Seven patients had operations for unrelated conditions and underwent simultaneous fasciectomy without recurrence. Environmental factors, especially trauma, surgery and diabetes, are important in the pathogenesis of Non-Dupuytren's palmar fascial disease, but these patients do not appear to be genetically predisposed for Dupuytren's disease. Typical Dupuytren's disease and Non-Dupuytren's palmar fascial disease are two clinical entities that run different courses and do not share a similar prognosis. This should be taken into account in future epidemiological and outcome studies. PMID: 16203068 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\ ctPlus & list_uids=16203068 ********************************************************* ********************************************************* HandWorld e-Hand.com " Trigger Finger " : http://www.e-hand.com/hw/hw100.htm **************************** WebMD Last updated: February 2006 " Arthritis: Trigger Finger " : http://www.webmd.com/content/article/78/95630.htm **************************** Wheeless' Textbook of Orthopaedics " Trigger Finger / Tenosynovitis " : http://www.wheelessonline.com/ortho/trigger_finger_tenosynovitis **************************** American College of Rheumatology ACR/ARHP 2005 Annual Scientific Meeting 2005 Abstracts Title: Comparison of US and Gadolinium Enhanced MRI for the Detection of Flexor Tenosynovitis and Peri-Extensor Tendon Inflammatory Changes of the Fingers of Patients with Early Untreated Rheumatoid Arthritis (RA) Category: 16. Imaging of rheumatic diseases Author(s): J. Wakefield, Philip G. Conaghan, Philip J. O'Connor, Brown, Emery. Leeds University, Leeds, United Kingdom Presentation Number: 213 Poster Board Number: 213 Purpose: The prevalence of tendon disease of the hand is poorly described in patients with early RA. Prolonged tenosynovitis or peri-tendinous inflammation may predispose to tendon rupture, therefore early identification and suppression may prevent rupture and subsequent functional disability. As clinical examination is difficult for assessing these structures, more accurate methods such as MRI and US have been sought. The aim of this study, in a group of untreated, early RA patients was first, to determine the prevalence of tenosynovitis in the fingers, second, to compare grey scale US with MRI and third, to assess the distribution of abnormalities between finger joints. Method: Consecutive early, steroid and DMARD naive patients with RA underwent grey scale US and gadolinium enhanced MRI of the dominant hand 2-5th MCPJ on the same day. US was performed using an HDI 3000 machine employing a 10-5 MHz linear array 'hockey stick' transducer. MRI-Gad was performed using an 1.5 T Gyroscan ACS NT (Philips Medical Systems, Best, The Netherlands) whole body MRI system with image acquisition. The presence of flexor tenosynovitis and peri-extensor tendon inflammatory changes (the extensor tendon has no formal tendon sheath) were recorded and subsequently compared using each modality. Results: 50 patients were recruited (disease duration 5.5 months, range 1.5-11, 29 female, 27 RF+) and 200 MCPJ subsequently examined. Flexor tenosynovitis was detected in 41(82%) patients in 128 (64%) flexor tendon sheaths on MRI compared to 24 (48%) in 55 (27.5%) using US. Peri-tendinous change around the extensor tendons was seen on MRI in 37 (74%) patients corresponding to 81 (40.5%) extensor tendons compared to 9 (18%) and 14 (7%) detected with US. Using MRI as a gold standard, the sensitivity, specificity, NPV and PPV of US for the detection of flexor tenosynovitis was 0.42, 0.99, 0.49 and 0.98. The corresponding figures for the extensor tendons were 0.15, 0.98, 0.63 and 0.86. The distribution of pathology between fingers was similar for both modalities with less involvement around the 4th and 5th joints for both tendons. Conclusion: This study for the first time describes the prevalence of tenosynovitis in the fingers in an untreated group of RA patients. It confirms the high prevalence of tenosynovitis in these patients. MRI is the more sensitive technique compared to US, with this difference being particularly apparent for the extensor tendons. Despite the lower sensitivities achieved by US, the specificities and PPV were high suggesting US could be used as a screening tool. The sensitivity of US may have increased with a higher frequency transducer or if the tendon had been examined along its whole length. The distribution of tendon abnormalities in the hand may explain the position of deformities seen later in the disease. ********************************************************* ********************************************************* Not an MD I'll tell you where to go! Mayo Clinic in Rochester http://www.mayoclinic.org/rochester s Hopkins Medicine http://www.hopkinsmedicine.org Re: [ ] skin drying on palm : > Hi > today I went to my rheumy and gave him a list of questions. One of them > was > the palm skin and when he saw the white, pinched looking crease he pressed > the centre of the palm and said that it was being caused by early > Dupuytren's contractures. > He said Dupuytren's contractures weren't RA related, but that I should > keep > stretching all fingers of the hand so that they don't start getting pulled > inwards. > I don't know if it is all (drying skin etc) being caused by the D's > contractures, but I'll go and have a look for info. on that. > > I'd love to go back to my hands being MY hands and not this medical case. > LOL > Thanks > AnneMarie Quote Link to comment Share on other sites More sharing options...
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