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Rheumatology 2001; 40: 816-820
© 2001 British Society for Rheumatology

Original Papers

Leg ulcers in patients with rheumatoid arthritis—a prospective study of aetiology, wound healing and pain reduction after pinch grafting

R. F. Öien1,2,, A. Håkansson2 and B. U. Hansen3

1 Lyckeby Health Centre, S-371 62 Lyckeby,
2 Department of Community Medicine, Malmö University Hospital, S-205 02 Malmö and
3 Department of Internal Medicine, Section of Rheumatology, Karlskrona Central Hospital, S-371 85 Karlskrona, Sweden

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 cm2. Eleven out of 18 patients had pain reduction after pinch grafting.

Conclusion. 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.

KEY WORDS: Rheumatoid arthritis, Leg and foot ulcers, Vasculitis, Pinch grafting, Pain relief.

Correspondence to: R. F. Öien, Lyckeby Health Centre, S-371 62 Lyckeby, Sweden.


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