Poor Prognosis of Arthritis-Associated Pyoderma Gangrenosum

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Abstract
Background The association between pyoderma gangrenosum (PG) and arthritis is well established. We have observed a refractory population of patients with arthritis-associatedPG (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, exclusionof 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. Therewas 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 meanduration 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 refractorysubset of patients, and the ulcers are possibly secondary to unique pathophysiological features.