Nearly 6.5 million Americans have wounds that take months or even years to heal. Many of these wounds are a consequence of diabetes, which damages blood vessels and interferes with normal skin repair. But new research from Georgetown University Medical Center in Washington, DC, points to another cause: autoimmune diseases such as rheumatoid arthritis, or RA, and lupus.   

The research was presented at meeting of the American College of Rheumatology in Chicago, by rheumatologist and lead author Victoria Shanmugam, MD. It has been accepted for publication in the International Wound Journal.

Dr. Shanmugam had noticed an unusual number of nonhealing wounds – mostly leg ulcers – in people with autoimmune disorders. "What I saw clinically was that people who had autoimmune disease did not respond as well to the usual wound care treatments. I wanted to try to understand the reason for this by comparing healing times and [skin] graft outcomes," she says.

Treatment for nonhealing wounds depends on the wound, but might include special dressings, hyperbaric oxygen, growth factors, bioengineered skin substitutes and skin grafts. If treatment doesn’t work, the patient faces amputation.

Dr. Shanmugam and her colleagues reviewed the charts of 340 patients who sought care at Georgetown’s Center for Wound Healing and Hyperbaric Medicine during a three-month period in 2009. Only those with open wounds that hadn't healed after at least three months of normal therapy were included.  

Forty-nine percent of these patients had diabetes (both type 1, which is itself an autoimmune condition, or type 2). This isn't unusual – diabetes accounts for about half of all chronic wounds. Others had vascular or arterial diseases that typically cause poor wound healing. What surprised Dr. Shanmugam was that 23 percent had autoimmune disorders – a far greater rate than had been expected or previously reported. The most prevalent autoimmune diseases were RA (28 percent), lupus (14 percent) and livedoid vasculopathy, a vascular disease that causes ulcers on the lower legs (also 14 percent).

Dr. Shanmugam then looked at how the people with underlying autoimmune disease responded to therapy. "These patients had larger wounds at the first visit, had higher pain scores and took significantly longer to heal – 14-and-a-half months compared to just over 10 months for other patients,” she explains. "Clearly, there is something in the autoimmune milieu that is inhibiting wound healing," says Dr. Shanmugam.