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 or the ulcers was founded on the clinical picture and measurements of the ankl e-brachial pressure index. To detect vasculitis, skin biopsies were taken f or 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. F ifteen 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 pa in reduction after pinch grafting. Conclusion. The causation of leg ulcers in patients with RA was found to be multi factorial, with vasculitis and venous insufficiency as the main dete rminants. Pinch grafting seems to be a good alternative to conservative tre atment for minor leg ulcers for these patients, regarding both wound healin g and pain relief.