Rheumatoid and systemic collagenosis vasculitis

Abstract

Rheumatoid arthritis (RA) and systemic connective tissue diseases including systemic lupus erythematosus, systemic sclerosis, dermatomyositis, Sjgren's syndrome, Behcet's syndrome, and scleroderma are considered to be rheumatic conditions with secondary skin involvement. Rheumatoid vasculitis (RV) is the most serious systemic disease manifestation of RA and manifests almost exclusively in patients with RA. The frequency of leg ulceration in patients with RA may be up to 10 %. Ulcers in RA are usually multifactorial in etiology. Cutaneous vasculitis, skin fragility due to poor nutrition and corticosteroids, peripheral arterial disease, venous insufficiency, minor trauma, foot deformity, peripheral neuropathy, and peripheral edema are all factors to develop complex ulceration. Systemic vasculitis requires aggressive therapy, such as the combination of high doses of glucocorticoids and a cytotoxic agent. Topical wound treatments of ulcers in association with RA can be developed by use of the principle of “wound bed preparation”. When infectious signs are noted, cleansing, wet–to–dry dressing or irrigation, and surgical debridement if necessary should be performed. Combination treatment with fibroblast growth factor, artificial dermis, and negative pressure wound therapy promotes preparing a favorable wound bed. When a wound is covered with suitable granulation, split–thickness autologous skin grafts should be performed as soon as possible.