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Rheumatology Advance Access originally published online on November 20, 2006
Rheumatology 2007 46(2):192-199; doi:10.1093/rheumatology/kel388
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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Thromboangiitis obliterans or Buerger's disease: challenges for the rheumatologist

X. Puéchal and J.-N. Fiessinger1

Rheumatology Department, Le Mans General Hospital, Le Mans and 1Vascular Medicine Department, Paris 5 University, European Georges Pompidou Hospital, Paris, France.

Correspondence to: Dr X Puéchal, Service de Rhumatologie, Centre Hospitalier du Mans, 194 avenue Rubillard, 72037 Le Mans Cedex 9, France. E-mail: xpuechal{at}ch-lemans.fr


  Abstract

Thromboangiitis obliterans (Buerger's disease)—a type of vasculitis in young, mostly male subjects—remains strangely linked to smoking, which determines its occurrence, progression and prognosis by currently unknown mechanisms. It affects the small and medium-sized arteries and veins of the limbs. Despite the usual absence of systemic signs and symptoms, initially intermittent arthritis, even if not observed in all cases, confer on this disease the status of a systemic vasculitis. Diagnosis requires the elimination of many other diseases. The severity of the disease lies in the need for amputation in more than a quarter of all patients. Complete cessation of smoking remains the cornerstone of therapy. Local care is the second essential element of treatment. Prostacycline analogues can be used to help the patient through critical ischaemia. Blockade with antagonists of cannabinoid or endothelin receptors and the use of gene- or cell-based therapy to induce therapeutic angiogenesis have opened up new possibilities for treatment.

Submitted 22 August 2006; revised version accepted 20 October 2006.
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