Early Recognition and Institution of Treatment is Associated with a Good Prognosis in Peripheral Ischemic Lesions in Rheumatic Diseases

Abstract

Introduction: Peripheral ischemic lesions in rheumatic diseases have variable presentations, prognoses and outcomes that have not been well studied in published literature. The present study aimed to investigate the clinical presentation, aetiology, prognosis and outcomes of peripheral ischemic lesions in rheumatic diseases. Material and methods: A medical records review of all patients who presented with peripheral ischemic lesions was conducted in the Department of Clinical Immunology and Rheumatology of a tertiary care institution in Northern India. Data from March 2013 to December 2017 was collected in the form of demographic and clinical details, investigations, treatment and outcomes. Results: Of 103 patients that presented with peripheral ischemic lesions, 80 (77.6%) had an underlying rheumatic disease. In the group with rheumatic causes, the mean age was 29.31 years, and the majority (87%) presented in the winter season. The most common rheumatic cause was vasculitis (55%) followed by systemic sclerosis (17.5%), systemic lupus erythematosus (15%) and primary antiphospholipid antibody syndrome (6, 7.5%). Amputation (either surgical or auto-amputation) was observed in 55% of the cases, while the remaining recovered completely or near completely with medical treatment. Conclusions: Peripheral ischemic lesions may present as the initial or predominant manifestation of rheumatic disease with vasculitis being the most common cause. Late referral or presentation to the hospital, delayed specific management and presentation as gangrene resulted in poorer outcomes in these patients.

The Importance of Prompt Diagnosis and Management of Digital Gangrene Associated with Rheumatic Diseases

“…A few other studies had also evaluated the aetiologies of gangrene in the context of rheumatic diseases (summarised in Table 1). [1][2][3][4] The prevalence and prognosis of peripheral gangrene vary with the underlying rheumatic disease. As an example, in patients with systemic sclerosis, data from the EUSTAR cohort reveal that nearly a tenth of patients experience digital gangrene.…”