Document Detail

Lower extremity ulcers in rheumatoid arthritis: features and response to immunosuppression.
MedLine Citation:
PMID:  21340497     Owner:  NLM     Status:  MEDLINE    
Lower extremity ulcers are a recognized complication of rheumatoid arthritis (RA). Their prevalence has not been assessed since the advent of more aggressive disease modifying antirheumatic therapies. The purpose of this study was to establish the period prevalence of lower extremity ulcers in a modern-day unselected cohort of patients with RA, and to report the features associated with ulcer development and response to therapy. Between June 2007 and June 2010, 366 RA patients were evaluated at the Georgetown Division of Rheumatology. Data were collected and analyzed retrospectively on demographics, antibody and prothrombotic profile, comorbidities, disease activity, and outcomes. The period prevalence of ulcers in this cohort of 366 patients with RA followed over 3 years was 4.37%. Patients with ulcers were predominantly female (81.25%) and more commonly African American (56.2%). The mean disease duration at ulcer development was 25.9 years. All patients with ulcers had erosive disease and 63% were seropositive. Only five patients (31.25%) healed over a mean follow-up of 22.8 months. However, in this small sample, treatment with anti-tumor necrosis factor-α (anti-TNFα) therapy was associated with significantly higher likelihood of healing (p = 0.039). In this modern-day cohort of patients with RA, we found a prevalence of lower extremity ulcers of 4.37% over 3 years. Only 31.25% of patients healed after a mean 22.8 months of follow-up. However, treatment with a biologic agent was associated with a significant increased likelihood of healing (RR 3.27, 95% CI 0.59-18.29, p = 0.039).
Victoria K Shanmugam; David M DeMaria; Christopher E Attinger
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-02-22
Journal Detail:
Title:  Clinical rheumatology     Volume:  30     ISSN:  1434-9949     ISO Abbreviation:  Clin. Rheumatol.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-25     Completed Date:  2011-09-22     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  8211469     Medline TA:  Clin Rheumatol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  849-53     Citation Subset:  IM    
Division of Rheumatology, Immunology and Allergy, Georgetown University Hospital, NW Washington, DC 20007, USA.
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MeSH Terms
African Continental Ancestry Group
Antibodies, Anticardiolipin / blood
Antibodies, Antiphospholipid / blood
Antirheumatic Agents / pharmacology,  therapeutic use*
Arthritis, Rheumatoid / blood,  complications*,  ethnology
Cohort Studies
European Continental Ancestry Group
Follow-Up Studies
Immunosuppressive Agents / pharmacology,  therapeutic use*
Leg Ulcer / drug therapy*,  epidemiology,  etiology*
Middle Aged
Retrospective Studies
Treatment Outcome
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Wound Healing / drug effects
Grant Support
Reg. No./Substance:
0/Antibodies, Anticardiolipin; 0/Antibodies, Antiphospholipid; 0/Antirheumatic Agents; 0/Immunosuppressive Agents; 0/Tumor Necrosis Factor-alpha

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