Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


A Higher Than Expected Prevalence of Autoimmune Disease in a Cohort of Patients with Recalcitrant Leg Ulcers.

Shanmugam1,  Victoria K., Schilling1,  Amber, Germinario1,  Anthony, Mete2,  Mihriye, Attinger3,  Christopher

Georgetown University Hospital, Washington, DC
MedStar Health Research Institute, Hyattsville, MD
Georgetown Universtiy Hosptial, Washington, DC

Background/Purpose:

Wound healing is a highly regulated process progressing through hemostasis, inflammation, proliferation and maturation regardless of the inciting etiology of the wound. Arrest of the wound in the inflammatory stage is a recognized cause of delayed healing, but the role autoimmune diseases play in this process is unknown. The purpose of this study was to determine the prevalence of autoimmune diseases in a cohort of patients presenting to a tertiary wound healing center, and to compare time to healing and graft outcomes.

Methods:

Retrospective chart review was completed on consecutive patients scheduled in the Center for Wound Healing between January 1 and March 31, 2009. Subjects who did not attend and those without an open wound were excluded.

Baseline demographic and descriptive data including ulcer location, duration and size were recorded. Presence of comorbid conditions including autoimmune diseases, diabetes and vascular disease was documented. Time to healing and outcome of surgical interventions were recorded.

Data was analyzed using unpaired t-test for continuous variables, and Mann Whitney U test and Chi-square test for categorical variables using GraphPad Prism (GraphPad Software, CA).

Results:

Of the 520 patients scheduled for appointments in the study period, 340 were eligible for inclusion. The remaining 180 patients either did not attend, or did not have an open ulcer.

Prevalence of diabetes, venous and arterial disease was as expected, with diabetes present in 168 patients (49%), venous disease in 120 (35%) and arterial disease in 118 (35%). However, the prevalence of autoimmune disease was much higher than expected with 78 of 340 patients (23%) having associated autoimmune disease, including rheumatoid arthritis (28%), systemic lupus erythematosus (14%), livedoid vasculopathy (14%), scleroderma (11%), vasculitis (10%), seronegative arthritis (8%), and inflammatory bowel disease (7%).

Autoimmune disease-associated wounds were significantly larger at the first visit, and were associated with higher pain scores (Table 1). While there was no significant difference in number of wounds that healed, autoimmune disease-associated wounds took significantly longer to heal (10.31 compared to 14.58 months, p=0.01).

Table 1.

 Non-Autoimmune Wounds n= 262Autoimmune Wounds n=78p
Age, years (Mean +/- SEM)63.89+/-1.067.77+/-1.890.07
Race   
  Caucasian136 (52%)40 (51%)0.92
  AA106 (40%)32 (41%)0.92
  Hispanic6 (2.3%)2 (2.6%)0.88
  Other14 (5.3%)4 (5.1%)0.94
Sex   
  Male143 (55%)25 (32%)0.0005
  Female119 (45%)53 (68%) 
Wound Size, cm2(Mean +/- SEM)22.5+/-3.933.4+/-7.80.02
Pain Score (Mean +/- SEM)2.48+/-0.23.32+/-0.40.07
Wound healed over followup period107 (41%)31 (40%)0.90
Time to healing, months (Mean +/- SEM)10.31+/-0.614.58+/-2.270.01

Surgical skin graft and skin graft substitute data was available on 163 grafts from 50 subjects. Outcome was categorized into response (>50% graft take at 30 days) or no response (<50% graft take at 30 days). Only 39% of grafts to autoimmune-associated wounds demonstrated response compared to 49% of grafts to non-autoimmune associated wounds (p=0.29)

Conclusion:

The 23% prevalence of autoimmune disease in this cohort is higher than in the general population, and higher than previously reported. Autoimmune-associated wounds were larger and took longer to heal than non-immune wounds, suggesting these wounds may provide important insights in to pathogenesis of delayed wound healing.

To cite this abstract, please use the following information:
Shanmugam, Victoria K., Schilling, Amber, Germinario, Anthony, Mete, Mihriye, Attinger, Christopher; A Higher Than Expected Prevalence of Autoimmune Disease in a Cohort of Patients with Recalcitrant Leg Ulcers. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1953
DOI:

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