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Rheumatoid arthritis and pyoderma gangrenosum: a population-based case-control study

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Abstract

Background

The association between pyoderma gangrenosum (PG) and rheumatoid arthritis (RA) was not investigated in the setting of controlled studies. The risk of PG among patients with RA is not established.

Objective

The study aims to evaluate the magnitude of the association between RA and the subsequent development of PG. Additionally, we aimed to characterize patients with RA-associated PG relative to other patients with PG.

Methods

A population-based case-control study was conducted comparing PG patients (n = 302) with age-, sex-, and ethnicity-matched control subjects (n = 1497) with respect to the presence of RA. Logistic regression models were utilized for univariate and multivariate analyses.

Results

The prevalence of RA was greater in patients with PG than in control subjects (4.7% vs. 1.5%, respectively; P < 0.001). More than threefold increase in the odds of PG with RA (OR, 3.29; 95% CI, 1.66–6.50) was noted. This association retained its statistical significance following a sensitivity analysis excluding RA cases diagnosed up to 2 years prior to PG (OR, 2.72; 95% CI, 1.25–5.91) and after adjusting for confounding factors (adjusted OR, 2.80; 95% CI, 1.23–5.86). RA preceded the diagnosis of PG in the majority of patients by a mean (SD) latency of 9.2 (7.4) years. Patients with RA-associated PG were older relative to the remaining patients with PG (62.2 [15.0] vs. 53.4 [20.9] years, respectively; P = 0.006).

Conclusions

RA increases the odds of developing PG by more than threefold. Physicians managing patients with RA should be aware of this increased burden. Patients with RA may be advised to avoid additional precipitating factors of PG.

Key Points

• The odds of developing PG are increased by more than threefold in patients with RA.

• PG followed the diagnosis of RA in the majority of patients with these coexistent conditions by an average latency of 9.2 years.

• Patients with RA-associated were older relative to other patients with PG at the onset of PG.

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Author notes

  1. Khalaf Kridin and Giovanni Damiani contributed equally to this work.

Authors and Affiliations

  1. Lübeck Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany

    Khalaf Kridin

  2. Young Dermatologists Italian Network, GISED, Bergamo, Italy

    Giovanni Damiani

  3. Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Giovanni Damiani

  4. Clalit Health Services, Tel-Aviv, Israel

    Arnon D. Cohen

Authors
  1. Khalaf Kridin
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  2. Giovanni Damiani
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  3. Arnon D. Cohen
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Corresponding author

Correspondence to Khalaf Kridin.

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The ethical committee of Ben-Gurion University approved the current study in accordance with the declaration of Helsinki.

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Kridin, K., Damiani, G. & Cohen, A.D. Rheumatoid arthritis and pyoderma gangrenosum: a population-based case-control study. Clin Rheumatol 40, 521–528 (2021). https://doi.org/10.1007/s10067-020-05253-7

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  • DOI: https://doi.org/10.1007/s10067-020-05253-7

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