Rheumatoid arthritis-associated inflammatory leg ulcers: a new treatment for recalcitrant wounds.

Patients with rheumatoid arthritis may develop leg ulcers of varied aetiologies, including venous disease, infection and inflammation (vasculitis or pyoderma gangrenosum). The leg ulcers in rheumatoid arthritis patients may involve several of these aetiological factors and are often difficult to heal. Both the ulcers and the treatments are often painful, and these ulcers may be present for years. A new oxidised regenerated cellulose and collagen dressing has been developed for slow-to-heal wounds and may have a role in the management of superficial inflammation that may persist in many of these ulcers, although clinically it is difficult to distinguish this from critical colonisation or frank infection. Venous disease requires compression therapy. Deep compartment infection should be treated with systemic antimicrobials, and inflammatory processes extending beyond the superficial wound base require disease-specific systemic anti-inflammatory agents. Four patients with recalcitrant wounds resistant to best practice were treated successfully with this new dressing combined with a strategy to control bacterial burden.