Clinical relevance of peripheral vascular occlusive disease in patients with rheumatoid arthritis and systemic lupus erythematosus.
BACKGROUND
Peripheral vascular occlusive disease (PVOD) and rheumatologic disease (RD) are common in older patients. The effect that coexistence of these diseases may have on patient health has not been rigorously investigated. The present study was undertaken in an attempt to characterize patients with PVOD plus RD in terms of inflammatory serologic disorders, medications, and procedures, and their relation to limb salvage.


METHODS
Medical records were reviewed retrospectively for all patients with diagnosed coexistent PVOD and non-arteritis RD treated over 15 years at the University of Michigan Hospital. Demographics, operative and medical therapies, and serologic studies were analyzed. Univariate and multivariate analysis and the Kaplan-Meier method were used to assess these variables in relation to limb salvage.


RESULTS
Forty-one patients (34 women, 7 men), with mean age of 67 years, were studied. Mean antinuclear antibody titer was 274, C-reactive protein concentration was 3.1 mg/mL, and sedimentation rate was 49. Twenty-nine percent of patients had claudication, 49% had rest pain, and 32% had tissue loss. Mean ankle brachial index was 0.55. Medications included nonsteroidal anti-inflammatory drugs (67% of patients), corticosteroids (54%), and specific immunosuppressive agents (27%). Operative therapy included aortofemoral bypass grafting (n = 4), infrainguinal bypass grafting (n = 14), embolectomy (n = 4), and primary amputation (n = 7). Overall 5-year limb salvage rate was 70% in patients undergoing bypass surgery. Comparison of surgical with nonsurgical patients showed no significant differences in baseline risk factors, serologic disorders, or anatomic location of vascular disease. Multivariate analysis revealed that rest pain and lack of immunosuppression were significantly predictive of need for revascularization or amputation (P <.05).


CONCLUSIONS
Patients with RD should receive treatment on the basis of standard criteria for limb ischemia, in that surgical revascularization outcomes are satisfactory. Immunosuppressive agents may confer a protective effect against progression of PVOD.
Henke
Peter K
PK
Section of Vascular Surgery and the Jobst Vascular Research Laboratory, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA. henke@umich.edu
Sukheepod
Pasu
P
Proctor
Mary C
MC
Upchurch
Gilbert R
GR
Stanley
James C
JC
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000150:complications / Q000276:immunology* / Q000628:therapy*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications / Q000276:immunology* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D023821:Limb Salvage / Q000379:methods; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications / Q000276:immunology* / Q000628:therapy*; D008297:Male; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000276:immunology; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods
D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D007166:Immunosuppressive Agents