Nice to meet you all.

I'm 28 and have seen I think rapidly developing Dupuytren's Contracture on my right little finger. Starting off as a barely noticeable lump close to my palm I first noticed 3 years ago (it runs in my family so I was quick to notice I think), over the last year and half the middle knuckle has gone from 30 degrees over extension to 25 degrees the opposite way in a contracture. I would like to know what the best course of action is, but it is complicated due to me being in Japan for the next couple of years. I am originally from the UK.

Of course, like everyone, I want the most effective and safe and preventative treatment. Should I wait 2 years to be back in Europe, or can someone recommend somewhere good in Japan or Asia close by where I could easily go for followup treatment? I also have no idea which would be the best course of treatment, if any?

I'm also worried about the cost of treatment in Japan, and whether it would be covered on the national health insurance. The UK's NHS may be a better bet? My father had 3(?) courses of surgery during his life on the NHS but the results seemed mixed and not very pretty and I would prefer a non-surgical/preventative solution. He has always been shy about talking about his condition with me though.

Thank you so much for your time and community.

Hello Ben

It sounds like your current contracture could be treated with NA, available on the NHS in the UK, but you need to find an experienced surgeon; or Xiapex available only in a few places in the UK on the NHS (Scotland, Wales, some hospitals) but not generally since it's not approved by NICE. Xiapex is available privately in the UK.

Maybe you can wait, only you can judge based on the rate of progression, but I would not leave it too long (like years) as changes to joints and tendons with contractures may occur, sometimes irreversibly.

I think your difficulty is the referral and queuing system in the UK, so a short series of visits would have to be done, maybe expensive in time and travel. Your next holiday spent in Paris would be an option, if affordable, as private NA is a relatively modest cost, €100 or so. Doctors are listed on this website.

I wouldn't know where to start looking in Japan, but we have an active set of users from Australia on this board and both NA and Xiaflex treatments have been reported.

Your only pro-active choice for prevention, if life style changes are not a factor and make no difference anyway is RT. Again this is NOT available in the UK on the NHS in general, but is available privately. Timing on this is important since it only has any effect during a phase of activity and proliferation. You would need to keep a record of symptoms and changes to demonstrate this. Here is a a potential holiday to Hamburg in Germany! I think prevention is the wrong term to use since RT is not performed as a prophylactic but 'treats' an existing and active condition.

Best wishes
SB

Edited 11/20/14 00:06

I recall from Dr. Eaton's old website there were a number of hand surgeons from Japan who traveled to Florida to learn NA from Dr. Eaton. It was surprising to me the disease would be prevalent enough in Japan for this to take place. You might do some web searches to check on this. Dr. Kazuki Kuniyoshi is one name I found. Eaton's old website has been taken down.

The bottom pic is Dr. Eaton with Dr. Kazuki Kuniyoshi and others.
http://www.chiba-orthopaedics.com/societ.../assh_2011.html