Rheumatoid and Systemic Collagenosis Vasculitis

Rheumatoid arthritis (RA) and systemic collagenosis diseases including systemic lupus erythematosus, systemic sclerosis, dermatomyositis, Sjögren’s syndrome, Behcet’s syndrome, and scleroderma are considered to be rheumatic conditions with secondary skin involvement. Rheumatoid vasculitis (RV) is the most severe systemic manifestation of RA or related connective tissue diseases and is almost universally present, especially in RA patients. The frequency of leg ulcers in RA patients with RV can be up to 10%. Patients with RA and systemic collagenosis diseases also had cutaneous vasculitis, skin fragility due to nutritional deficiencies and corticosteroids, peripheral arterial disease, venous insufficiency, minor trauma, foot deformity, peripheral neuropathy, and peripheral edema, all of which contribute to complex ulceration. Systemic vasculitis requires aggressive therapy, such as the combination of high doses of glucocorticoids and a cytotoxic agent. The European League Against Rheumatism developed its first recommendations for the management of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) in 2010. In response to this trend, today it is widely accepted that a treat-to-target (T2T) strategy should be applied when treating patients with RA. On the other hand, 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.