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Treatment of vasculitic leg ulcers in connective tissue disease with iloprost
D J Veale1, A H Muir, K D Morley
1University Department of Medicine, Dundee Medical School, U.K.
Insights
Iloprost, a prostacyclin analogue, shows promise in treating vasculitic leg ulcers associated with connective tissue diseases (CTDs) like rheumatoid arthritis (RA). This therapy led to complete healing in half of the patients and significant improvement in the others.
Area of Science:
- Rheumatology
- Dermatology
- Vascular Medicine
Background:
- Leg ulcers are a known complication of cutaneous vasculitis in connective tissue diseases (CTDs).
- Iloprost, a prostacyclin analogue, effectively treats Raynaud's phenomenon and digital ulcers in CTDs.
Purpose of the Study:
- To evaluate the efficacy of intravenous iloprost in treating vasculitic leg ulcers in patients with CTDs, specifically rheumatoid arthritis.
Main Methods:
- Eight patients with vasculitic leg ulcers secondary to rheumatoid arthritis and CTDs received intravenous iloprost.
- Treatment involved daily infusions of 6-8 hours for 21-28 days.
- Immunosuppressive therapy was administered to three patients with severe necrotising vasculitis.
Main Results:
- Complete ulcer healing was observed in four patients within six weeks.
- The remaining four patients experienced rapid improvement in their leg ulcers.
- Iloprost was generally well-tolerated, with no adverse events reported.
Conclusions:
- Intravenous iloprost may serve as a beneficial adjunctive therapy for vasculitic leg ulcers in CTDs.
- Further investigation through a double-blind, placebo-controlled study is warranted to confirm these findings.
Abstract:
Leg ulcers are a recognised manifestation of cutaneous vasculitis in connective tissue diseases (CTDs) including rheumatoid arthritis (RA). Iloprost a stable prostacyclin analogue has been successfully used to treat Raynaud's phenomenon and digital ulcers associated with CTD's. Our aim was to assess iloprost in the treatment of vasculitic leg ulcers in CTD. In this paper we describe eight cases of vasculitic leg ulceration in association with RA and CTD, treated with intravenous iloprost. The iloprost was administered for 6-8 hours daily and continued for 21-28 days. Immunosuppressive therapy was required in three patients with severe necrotising vasculitis (RAnv). Complete ulcer healing was achieved in four patients within 6 weeks of commencing therapy while rapid improvement occurred in the other four patients. This suggests that iloprost may be useful as an adjunct to therapy for vasculitic leg ulcers. A double-blind placebo controlled study of iloprost therapy for RA leg ulcers is under way.