[Alprostadil (PGE 1) and cyclosporin A in treatment of vasculitis in rheumatoid arthritis].

A 56-year old female patient with rheumatoid arthritis and histologically verifiable vasculitis with necrosis around the nail bed and distal phalanx gangrene on both hands as well as skin ulcers on both thighs was treated over 16 weeks with Cyclosporin A, glucocorticoids and Alprostadil. This immunosuppressive therapy resulted in a clinically relevant improvement of acral microperfusion with complete remission of nail bed necrosis and of gangrenous distal phalanxes. Due to improved tissue perfusion the deep ulcers on both thighs could granulate and were closed by proliferative connective tissue, and the high-positive immunological parameters CIC, CRP and the number of activated T-cells normalized.