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Carlos A. Charles, MD; Tracy L. Bialy, MD, MPH; Anna F. Falabella, MD; William H. Eaglstein, MD; Francisco A. Kerdel, MD; Robert S. Kirsner, MD

Arch Dermatol. 2004;140:861-864.

Background  The association between pyoderma gangrenosum (PG) and arthritis is well established. We have observed a refractory population of patients with arthritis-associated PG (PGA). We, therefore, tested the hypothesis that differences exist in response to treatment in patients with PGA compared with patients with PG without arthritis.

Observations  We performed a review of patients with PG during a 2-year period. Patients had noninfectious chronic ulcerations clinically typical for PG, exclusion of relevant differential diagnoses, and consistent histopathological features. Outcomes compared between patients with arthritis (PGA) and without arthritis (PG) included complete healing, percentage change in wound size, and duration of therapy. Of 10 PG ulcers, 7 healed, compared with 2 of 8 PGA ulcers. There was a greater mean percentage decrease in wound size in the PG vs the PGA ulcers (78.9% vs 23.4%; P = .10) and a shorter mean duration of treatment (8.7 vs 14.8 months; P = .18).

Conclusions  The ulcers of patients with PGA seem more refractory to treatment than the ulcers of patients with PG alone. Those with PGA ulcers represent a refractory subset of patients, and the ulcers are possibly secondary to unique pathophysiological features.

From the Departments of Dermatology and Cutaneous Surgery (Drs Charles, Falabella, Eaglstein, Kerdel, and Kirsner) and Epidemiology and Public Health (Dr Kirsner), University of Miami School of Medicine, Miami, Fla; the Department of Dermatology, Emory University School of Medicine, Atlanta, Ga (Dr Bialy); and the Veterans Administration Medical Center, Miami (Drs Charles, Falabella, and Kirsner). The authors have no relevant financial interest in this article.

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