Clarification of the Clinical Characteristics of Autoimmune Disease-Related Ulcers to Improve Treatment Outcomes: A
Min Wei1, Dongyun Xia1, En Takashi2
1Wound Care Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Insights
Autoimmune disease (AID)-related ulcers often present with spontaneous rupture, prolonged duration, multiple wounds, and bacterial infections. Understanding these characteristics is key to improving treatment outcomes for patients with AID-related ulcers.
Area of Science:
- Rheumatology
- Dermatology
- Infectious Diseases
Background:
- Autoimmune diseases (AID) can manifest with complex dermatological conditions, including chronic ulcers.
- Understanding the specific clinical features of AID-related ulcers is crucial for effective management.
Purpose of the Study:
- To delineate the clinical characteristics of autoimmune disease-related ulcers.
- To identify factors influencing treatment outcomes in patients with these ulcers.
Main Methods:
- Retrospective review of 189 patients with AID-related ulcers treated between 2018 and 2022.
- Analysis of patient data including diagnosis, wound characteristics, and treatment regimens.
- Bacterial culture analysis for patients with signs of local infection.
Main Results:
- The majority of patients (77.25%) were female, with rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, and vasculitis being common underlying diagnoses.
- Lower limbs and feet were the most frequent sites for ulcers, which were often multiple, recurrent, and prolonged (median 55 days).
- Bacterial infections were prevalent (75%), with common pathogens including Staphylococcus aureus and Pseudomonas aeruginosa. Most patients received immunosuppressants and hormones.
Conclusions:
- Autoimmune disease-related ulcers are characterized by spontaneous rupture, chronicity, multiplicity, and frequent bacterial infections.
- Recurrence and infection are significant challenges in managing these ulcers.
- Clarifying these clinical features aids in optimizing therapeutic strategies and improving patient outcomes.
Abstract:
AimTo clarify the clinical characteristics of autoimmune disease (AID)-related ulcers to improve treatment outcomes.Materials and MethodsThe medical records of 189 patients treated for AID-related ulcers at two tertiary hospitals in Nanjing, China, from January 1, 2018 to December 31, 2022 were retrospectively reviewed. The relevant clinical data included diagnosis, type and severity of wounds, and prescribed medications.ResultsOf the 189 patients with AID-related ulcers, 146 (77.25%) were female and 43 (22.75%) were male. The top four immunological diagnoses were rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, and vasculitis. The four most common wound sites were the lower limb, foot, hand, and upper limb. Regarding the number of wounds, 81 (42.86%) patients had one ulcer, 43 (22.75%) had two, 30 (15.87%) had three, and 35 (18.52%) had four or more. More than half of the patients (54%, 102/189) were previously treated for AID-related ulcers. Of these 102 patients, 27 (26.47%) had one previous diagnosis, 49 (40.83%) had two, and 26 (25.49%) had three or more. Among all 189 patients, 142 (75%) had clinical symptoms of local infection. Of these 142 patients, bacteria cultures were conducted for 70 (49.30%), of which 63 (90.00%) were positive. The most commonly detected bacteria were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. The median (interquartile range) duration of AID-related ulcers was 55 (39, 90) days. Most patients (87.3%, 165/189) received systemic therapy with immunosuppressants and hormones.ConclusionsThe most common clinical characteristics of AID-associated ulcers were spontaneous rupture, long duration, multiple wounds, bacterial infection, and recurrence. Clarification of the clinical characteristics of AID-associated ulcers can improve treatment outcomes.
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