Leg ulcers in patients with rheumatoid arthritis--a prospective study of aetiology, wound healing and pain reduction after pinch grafting.
OBJECTIVE
To study the aetiology of leg ulcers in patients with rheumatoid arthritis (RA) and to study healing and pain relief after pinch grafting.


METHODS
Twenty patients with RA and leg ulcers were studied. Diagnosis of the ulcers was founded on the clinical picture and measurements of the ankle-brachial pressure index. To detect vasculitis, skin biopsies were taken for immunohistochemistry and histopathology. Pain severity was assessed pre- and post-operatively using a visual analogue scale.


RESULTS
Ten of the 20 patients had ulcers with multifactorial aetiology. Fifteen had signs of venous insufficiency, 11 had histopathological evidence of vasculitis, four had reduced arterial circulation and two patients had diabetes. Healing after pinch grafting was found in eight patients, all of whom had an ulcer area less than 15 cm(2). Eleven out of 18 patients had pain reduction after pinch grafting.


CONCLUSIONS
The causation of leg ulcers in patients with RA was found to be multifactorial, with vasculitis and venous insufficiency as the main determinants. Pinch grafting seems to be a good alternative to conservative treatment for minor leg ulcers for these patients, regarding both wound healing and pain relief.
Oien
R F
RF
Lyckeby Health Centre, S-371 62 Lyckeby, and Department of Community Medicine, Malmö University Hospital, S-205 02 Malmö, Sweden.
Håkansson
A
A
Hansen
B U
BU
D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000473:pathology / Q000601:surgery; D003925:Diabetic Angiopathies / Q000150:complications / Q000473:pathology; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000601:surgery*; D010147:Pain Measurement; D011446:Prospective Studies; D016038:Skin Transplantation; D019737:Transplants; D016896:Treatment Outcome; D014657:Vasculitis / Q000150:complications / Q000473:pathology; D014689:Venous Insufficiency / Q000150:complications / Q000473:pathology; D014945:Wound Healing