Owrzodzenia kończyn dolnych to jedno z potwierdzonych możliwych powikłań reumatoidalnego zapalenia stawów. Wśród czynników etiologicznych mogą wystąpić nie tylko zaburzenia żylne, ale również infekcje i stany zapalne. Leczenie owrzodzeń rozwijających się na podłożu RZS jest często długotrwałe i utrudnione.
Przyczyny i objawy RZS
Reumatoidalne zapalenie stawów to przewlekłe układowe schorzenie tkanki łącznej o podłożu immunologicznym. Przyczyny RZS nie zostały do końca poznane.
W przebiegu RZS z powodu gromadzenia się płynu tkankowego w objętych procesem zapalnym stawach dochodzi do zniekształceń. RZS wywołuje również inne choroby układowe oraz zmiany chorobowe zlokalizowane poza stawami.
Do powikłań RZS należą m.in. niedokrwistość, nadpłytkowość, białkomocz, osteoporoza.
Owrzodzenia kończyn dolnych a RZS
Według literatury naukowej nawet u 10 proc. pacjentów cierpiących na RZS mogą występować owrzodzenia kończyn dolnych.
Patogeneza owrzodzeń w przebiegu RZS obejmuje wiele czynników. Wymienia się wśród nich m.in. niewydolność żylną i tętniczą, neuropatię, a także zapalenia naczyń.
Jak wskazują eksperci, leczenie RZS z wykorzystaniem steroidoterapii i immunosupresantów ma duże znaczenie dla stanu skóry pacjenta. Skóra chorego staje się cienka, pergaminowa i podatna na uszkodzenia. Może także pękać w wyniku narastania obrzęku. Tkanka podskórna może ulegać zanikowi, zmniejsza się również perfuzja tkankowa w obrębie skóry, co z kolei stwarza utrudnienia w gojeniu. Ze względu na upośledzenie odporności i zwiększoną podatność na infekcje owrzodzenia powstające w przebiegu RZS są ponadto obarczone zwiększonym ryzykiem wytworzenia biofilmu.
Duże znaczenie dla rozwoju owrzodzeń w przebiegu RZS mają także choroby współistniejące związane z wiekiem pacjenta (największą zapadalność na RZS notuje się w grupie wiekowej od 30. do 50. roku życia), takie jak np. cukrzyca.
Leczenie owrzodzeń w przebiegu RZS
Leczenie ran powstałych w przebiegu reumatoidalnego zapalenia stawów powinno się odbywać z zachowaniem tych samych procedur, co w przypadku ran trudno gojących się o innej etiologii. Specjaliści w dziedzinie leczenia ran zalecają postępowanie zgodne ze strategią TIME. W trudnych przypadkach zaleca się włączenie do terapii metod wspomagających (np. ozonoterapia).
Źródła:
Shanmugam, V. K., Angra, D., Rahimi, H., & McNish, S., “Vasculitic and autoimmune wounds”, “Journal of Vascular Surgery. Venous and Lymphatic Disorders” 2017, 5(2), 280–292.
Beninson J, Ensign DC., “Leg ulcers in rheumatoid arthritis: use of pressure-gradient therapy, high-protein diet and other measures produces successful results”, “JAMA” 1961, 175(6): 437–440.
Öien, R. F., Håkansson, A., Hansen, B. U., “Leg ulcers in patients with rheumatoid arthritis—a prospective study of aetiology, wound healing and pain reduction after pinch grafting”, “Rheumatology” 2001, 40(7): 816-820.
Przeczytaj także: Co to jest rana i jak powinien przebiegać proces gojenia?
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