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The use of treatments for early-stage disease, such as intralesional steroid injections or radiotherapy which lack a clear biological basis or evidence of effectiveness based robust randomized, double blind, placebo-controlled trials, highlights the desire of patients to access treatments before they develop significant flexion contractures. A detailed understanding of the cellular landscape and molecular signalling in nodules of early-stage disease would permit the identification of potential therapeutic targets. This approach led to the identification of tumour necrosis factor (TNF) as a target. A phase 2a clinical trial identified 40\u2009mg in 0.4\u2009mL adalimumab as the most efficacious dose and a subsequent randomized, double blind, placebo-controlled phase 2b trial showed that four intranodular injections at 3-month intervals resulted in decrease in nodule hardness and size on ultrasound scan at 12 months, and both parameters continued to decrease further at 18 months, 9 months after the final injection. This type of approach provides clinicians with a robust evidence base for advising their patients.<\/jats:p>","DOI":"10.1177\/17531934221131373","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T13:39:28Z","timestamp":1673617168000},"page":"191-198","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Treatments for early-stage Dupuytren\u2019s disease: an evidence-based approach"],"prefix":"10.1177","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9579-9411","authenticated-orcid":false,"given":"Jagdeep","family":"Nanchahal","sequence":"first","affiliation":[{"name":"Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K.-K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,1,13]]},"reference":[{"key":"bibr1-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1007\/PL00002371"},{"key":"bibr2-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-73595-y"},{"key":"bibr3-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1007\/s12570-012-0092-z"},{"key":"bibr4-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-016-1200-y"},{"key":"bibr5-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2021.07.005"},{"key":"bibr6-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(89)90430-3"},{"key":"bibr7-17531934221131373","first-page":"391","volume":"21","author":"Corsi M.","year":"1966","journal-title":"Friuli Med"},{"key":"bibr8-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1713-z"},{"key":"bibr9-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1302\/2633-1462.311.BJO-2022-0103.R2"},{"key":"bibr10-17531934221131373","author":"DEPART","year":"2018","journal-title":"Australian New Zealand Clinical Trials Registry"},{"key":"bibr11-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1101029"},{"key":"bibr12-17531934221131373","first-page":"222","volume":"2","author":"Dupuytren G.","year":"1834","journal-title":"Lancet"},{"key":"bibr13-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1038\/nm939"},{"key":"bibr14-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(53)90669-2"},{"key":"bibr15-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-28-335-610"},{"key":"bibr16-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000008420"},{"key":"bibr17-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1111\/1754-9485.12178"},{"key":"bibr18-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1080\/030097401750065292"},{"key":"bibr19-17531934221131373","first-page":"6337","volume":"31","author":"Hesselkamp J","year":"1981","journal-title":"Therapiewoche"},{"key":"bibr20-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1007\/s11552-008-9160-9"},{"key":"bibr21-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1016\/0266-7681(93)90250-J"},{"key":"bibr22-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.aay0370"},{"key":"bibr23-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(96)00421-X"},{"key":"bibr24-17531934221131373","doi-asserted-by":"publisher","DOI":"10.1053\/jhsu.2000.18493"},{"key":"bibr25-17531934221131373","author":"Knobloch K","year":"2021","journal-title":"Lasers Med Sci"},{"key":"bibr26-17531934221131373","first-page":"851","volume":"25","author":"Kohler AH.","year":"1984","journal-title":". 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