Autoimmune diseases may underlie wounds that don’t heal

Wounds that are slow to heal or do not at all may have an underlying autoimmune disease, according to a new study.

The finding represents an unappreciated link that could lead to important new insights in wound healing, say researchers at Georgetown University Medical Center.

The study was sparked by the keen observation of Georgetown rheumatologist Victoria Shanmugam, M.D., who began noticing something rather unusual in her patients with autoimmune diseases — any open wound they had was very slow to heal.

Their recovery was even more protracted than in patients with wounds who have diabetes, a disease that is notoriously damaging to blood vessels and to normal skin repair.

So Shanmugam and her colleagues conducted a chart review of people who sought care at a high-volume wound clinic at Georgetown University Hospital to determine the prevalence of autoimmune diseases. The study included patients with open wounds — usually leg ulcers who were treated during a three-month period in 2009. Of the 340 patients, 49 percent had diabetes, which she says is a typical rate.

“But what was surprising is that 23 percent had underlying autoimmune diseases, and the connection between these relatively rare disorders and wounds that don’t heal is under-recognized,” she says.

Of the 78 patients in the cohort who had autoimmune disease, most had rheumatoid arthritis, lupus or livedoid vasculopathy, a type of vascular disease.

Shanmugam hopes the link she has made between autoimmune diseases and wound healing will make its way into the consciousness of the general practitioner.

The research will be presented at the annual meeting of the American College of Rheumatology in Chicago.