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Leg ulcers in rheumatoid arthritis.
Y L Pun1, D R Barraclough, K D Muirden
1Rheumatology Unit, Royal Melbourne Hospital, Parkville, Vic.
The Medical Journal of Australia
|November 19, 1990
Summary
Rheumatoid arthritis patients often develop leg ulcers due to multiple factors like venous and arterial insufficiency. Management involves prolonged hospital stays and frequent recurrences, highlighting the complexity of these chronic wounds.
Area of Science:
- Rheumatology
- Dermatology
- Vascular Medicine
Background:
- Rheumatoid arthritis (RA) is a chronic inflammatory disease that can lead to various complications.
- Leg ulcers are a significant, yet often underestimated, complication in RA patients, impacting quality of life and increasing healthcare burden.
- Understanding the multifactorial etiology of leg ulcers in RA is crucial for effective management and prevention.
Purpose of the Study:
- To investigate the causes and outcomes of leg ulceration in patients with rheumatoid arthritis.
- To identify common contributing factors, treatment challenges, and recurrence rates associated with RA-related leg ulcers.
- To discuss the diagnostic challenges, particularly for vasculitis, in this patient population.
Main Methods:
- Retrospective study analyzing 33 episodes of leg ulceration in 26 rheumatoid arthritis patients over eight years.
- Review of patient data to determine the multifactorial etiology of ulcers, including venous/arterial insufficiency, trauma, vasculitis, and Felty's syndrome.
- Assessment of treatment outcomes, including skin grafting success rates, duration of hospitalization, and ulcer recurrence.
Main Results:
- The most common causes of leg ulcers were venous insufficiency (45.5%), trauma/pressure (45.5%), and arterial insufficiency (36.4%).
- Vasculitis (18.2%) and Felty's syndrome (12.1%) were less frequent causes; pyoderma gangrenosum was rare.
- High rates of Staphylococcus aureus colonization (69.7%), prolonged hospital stays (mean 47.9 days), and a recurrence rate of 26.9% were observed. Skin grafting had a low complete take rate (42.9%).
Conclusions:
- Leg ulceration in rheumatoid arthritis is multifactorial, often associated with severe RA disease and functional impairment.
- Management is challenging, with prolonged hospitalizations, frequent recurrences, and limited success with skin grafting.
- The diagnosis of vasculitis can be difficult, and the role of biopsy in its confirmation is limited, necessitating a comprehensive clinical approach.