Autoimmune Diseases Linked to Wounds That Don’t Heal

A new study shows that autoimmune diseases may be an underlying cause in patients with wounds that don’t heal. Although most wounds that don’t heal are typically associated with diabetes, the findings represent an overlooked link that could lead to new insights in wound healing.

Victoria Shanmugam, MD, a Georgetown University Hospital rheumatologist, began the study after she noticed that open wounds in her patients with autoimmune disorders healed even more slowly than open wounds in her patients with diabetes.

Shanmugam and colleagues at Georgetown University Medical Center conducted a chart review of patients at a wound clinic at Georgetown University Hospital to determine the prevalence of autoimmune diseases. The study included patients with open wounds, usually leg ulcers, which were treated during a 3-month period in 2009. Of the 340 patients, 49% had diabetes, which she said is a typical rate.

“But what was surprising is that 23% had underlying autoimmune diseases, and the connection between these relatively rare disorders and wounds that don’t heal is under-recognized,” she said in a press release.

Of the 78 patients who had an autoimmune disease, most had rheumatoid arthritis, lupus or livedoid vasculopathy, a type of vascular disease.

These non-healing wounds can be “incredibly emotionally draining and financially costly,” Shanmugam said, because they require numerous doctor visits and represent a risk of serious infections. While some infections can lead to surgery and the amputation of limbs, most usually require skin grafts or use of skin substitutes. However, that still may not solve the problem, because Shanmugam’s study found that skin grafts were more likely to fail in patients with autoimmune disease-associated wounds.

Shanmugam suggested that general practitioners should be more aware of the link between autoimmune diseases and wound healing. Although it is too invasive and costly to recommend that all patients with wounds be tested for autoimmune diseases, “If a doctor has a patient with a leg ulcer that won’t heal after 3 or 4 months, and they have done all the appropriate treatments, I hope they will look for the presence of an autoimmune disorder,” she said

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