Successful treatment of a leg ulcer occurring in a rheumatoid arthritis patient under leflunomide therapy

Abstract

An association between leflunomide intake, occurrence of leg ulcers in RA patients and delayed wound healing should be considered.

Leg Ulceration in Rheumatoid Arthritis – An Underreported Multicausal Complication with Considerable Morbidity: Analysis of Thirty-Six Patients and Review of the Literature

“…In this context, development of vasculitis changes [30] and skin ulcerations [31,32] has been observed in a few RA patients treated with the pyrimidine-synthesis inhibitor leflunomide, suggesting that leflunomide may play a role in the pathogenesis of a specific subset of leg ulcerations.…”

Suppressed Wound Healing In a Patient with Rheumatoid Arthritis Taking Leflunomide (Arava)

“…I did two washouts of LEF with oral cholestyramine, each during a one-week period as described in the literature, and I scheduled a hernia repair with abdominal-wall reconstruction. 4 …”

“…Furthermore, some patients' ulcers healed after LEF washout with cholestyramine. 4 A hypothesis grew: LEF is suppressing our patient's healing; stop it, wash it out, and she may heal. 4 Data for serum LEF level were not available locally; distant results take time.…”

“…4 A hypothesis grew: LEF is suppressing our patient's healing; stop it, wash it out, and she may heal. 4 Data for serum LEF level were not available locally; distant results take time. It seemed imprudent to wait for data on serum level after repeated washout procedures and after the patient had lived with an enlarging hernia for more than two years.…”

“…Unfortunately, hydroxychloroquine, etanercept (Enbrel), and newer DMARDs are now used for her severe RA. Fever, thrombocytosis, leukocytosis, and relapsing polychondritis 10 Potentiation of warfarin 11 Dermatologic "Skin disorder" 59 Skin discoloration 59 Maculopapular rash 59 Skin ulcers [4][5][6]59 Alopecia areata 12 Erythema multiforme 13 Exfoliative dermatitis 14 Lichenoid eruptions 15,16 Cutaneous lupus erythematosus [17][18][19][20] Dermatomyositis 21 Acute necrotizing vasculitis 7,46 Nonhealing surgical wounds 3 Pulmonary Acute interstitial pneumonia, elevated liver enzymes, hypertension 59 Lethal pneumonitis 22 Pulmonary hypertension 23 Pulmonary abscess 24 Pulmonary aspergillosis 25 Mycobacterium abscessus infection 26 Pulmonary tuberculosis 27 Rheumatoid lung nodulosis and osteopathy 28 Atypical Mycobacterium pneumonia 29 …”