Wounds Can Turn Serious With Arthritis

Updated by Linda Rath | July 7, 2023

Slow-healing wounds, including leg and foot ulcers, can be a complication of autoimmune inflammatory diseases, such as rheumatoid arthritis (RA), lupus and scleroderma. Normally, even serious wounds heal in three months or less, but for many people with arthritis, healing can take much longer. Some wounds never move beyond the inflammatory stage and become chronic.

One serious complication of RA that can affect healing is vasculitis – inflammation of the small blood vessels in the skin. If the wound is related to underlying systemic inflammation from arthritis, vasculitis compounds the inflammation, making healing even more difficult. Other factors that may play a role in slow wound healing include trauma related to joint deformity, nerve damage, and poor blood circulation, often from diabetes or obesity.
 

Do Arthritis Drugs Help or Hurt Healing?

In early studies, treatment with biologic medications seemed to help wounds heal. But some recent research suggests the opposite – that treatment with drugs that suppress the immune system can delay healing.

In a study published in 2021, Japanese researchers reviewed the medical records of 187 RA patients treated with biologics who had orthopedic surgery. After examining – and eliminating – multiple factors that might negatively influence healing, researchers found that foot or ankle surgery and treatment with a biologic called tocilizumab (Actemra) were the main reasons wounds didn’t heal.  

A year later, a larger study compared patients who stopped arthritis medication before surgery to those who didn’t. This time, researchers found no real difference in wound healing or surgical infections between the two groups. But the study came under fire from other researchers, who said it was too small and flawed to reach any real conclusions.

Still, some experts think the best approach is aggressive treatment with medications to bring inflammation under control. Right now, the role of immune-suppressing drugs in delayed wound healing isn’t clear. It’s important to note, though, that since the immune system regulates how wounds repair themselves, simply having an autoimmune disease raises the risk of poor healing.

According to Victoria Shanmugan, MD, a rheumatologist associated with George Washington University Hospital in Great Falls, Virginia, people with autoimmune diseases tend to have more serious wounds that don’t respond as well to the usual wound care treatments.

“[In our study], these patients had larger wounds at the first visit, had higher pain scores and took significantly longer to heal – 14.5 months compared to just over 10 months for other patients. “Clearly, there is something in the autoimmune milieu that is inhibiting wound healing,” she says.
 

Autoimmune Diseases Linked to Leg Ulcers

Most leg ulcers result from vascular problems, but around 20% are related to autoimmune diseases. Some years ago, Mayo Clinic researchers reported that the likelihood of RA-related leg ulcers increased the longer someone had the disease. Five years after diagnosis, 5% of participants in the Mayo study had developed a leg ulcer, and by 25 years, 26% of patients had one. Non-healing leg ulcers can be serious; a small percentage of these chronic wounds result in amputation.
 

What To Do If You Have a Wound

If you develop a small leg wound or ulcer, follow these steps:

• Gently cleanse the wound with saline or a cleanser your doctor recommends.
• Apply a sterile wound dressing and wrap with gauze.
• Change the dressing at least every other day.
• Avoid getting the dressing wet in the shower, especially with soap or shampoo.
• Increase your protein intake to help with healing. Protein powder and smoothies can be good ways to increase your dose.

Contact your doctor right away if you notice any signs of infection, such as:

• Persistent, increased pain in the area of the wound
• Discoloration of the wound near its edges – often a dark or bluish color
• Increased drainage from the wound
• Redness or swelling around or spreading away from the wound
• A foul odor coming from the wound

Depending on how serious the wound is, your doctor may refer you to a wound clinic for specialized care that may include debridement, collagen dressings, hyperbaric oxygen, growth factors and bioengineered skin substitutes or grafts. Negative pressure therapy, which intermittently applies pressure to the wound and has been successful in healing leg ulcers in RA patients, may also be an option.