ACTA1 and Dupuytren Contracture: We have previously shown that Dupuytren’s disease is a low-grade localised inflammatory disorder and the myofibroblast phenotype characterised by expression of α-SMA and collagen type I, and contractility is critically dependent on the production of low concentrations of TNF locally.15,16 It is possible that the intermittent local administration of a relatively high dose of adalimumab could be sufficient to significantly affect the relatively small pool of cycling myofibroblasts14 or promote myofibroblast apoptosis.