Cherry, L, Blake, A, Alcacer-Pitarch, B, Edwards, C, Hopkinson, N, Teh, LS, Vital, EM and Williams, AE
'Results of a national foot health survey of patients with Systemic Lupus Erythematosus'
, Rheumatology, 55 (Supp.1)
Background: SLE can affect many tissues throughout the body.
Anecdotally, it is suggested that people with SLE experience a range of
complications in the foot and lower limb, including vascular impairment
(e.g. RP), neurological impairment, poor tissue viability (e.g. ulceration),
infection and foot pain. However, to date, the precise prevalence of foot
complications experienced by people with SLE has not been described.
The aim of this survey was to determine self-reported foot and lower
limb complications experienced by people with SLE.
Methods: The survey was developed via patient and practitioner focus
groups. A consensus approach was used to generate items and to
formulate themes, categories, question format and survey structure.
The survey was checked for face and content validity prior to cognitive
debriefing to ensure usability and understanding. Consecutive patients
with a confirmed diagnosis of SLE meeting the inclusion criteria
attending any of seven UK clinical sites or members of Lupus UK were
invited to participate. Ethical approval and participant informed
consent was obtained.
Results: A total of 182 survey responses were completed. For all
responders, the most frequent age range was 40–49 years, mean BMI
was 27 (S.D. 7) and mean disease duration was 15 years (S.D. 10). A
number of vascular complications were reported, including intermittent
claudication [n ¼ 100 (55%)], RP [n ¼ 94 (52%)] and splinter
haemorrhage [n ¼ 39 (21%)]. Overall, 164 patients (90%) reported
experiencing symptoms of peripheral vascular complications.
Symptoms of peripheral neuropathy were reported by 30 patients
(16%), while a fall as a consequence of neuropathic symptoms was
reported by 45 patients (25%). A range of skin and nail complications
were reported, including callus or corns [n ¼ 130 (71%)], onychocryptosis
[n ¼ 69 (38%)], rashes or blistering [n ¼ 62 (34%)] and ulceration
[n ¼ 45 (25%)]. A high prevalence of infection was reported; a history of
viral infection (verrucae pedis) or fungal infection (tinea pedis) was
reported by 77 patients (42%), bacterial infection by 28 patients (15%)
and onychomycosis by 65 patients (36%). Overall, 170 patients (93%)
reported having experienced some form of tissue viability complication.
Foot joint pain, stiffness and swelling was reported by 145 (80%), 136
(75%) and 94 (52%) patients, respectively. Foot-related walking
impairment was reported by 67 patients (37%). Only 60 patients
(33%) reported having ever been asked about their feet by a medical
professional. Seventy-seven patients (42%) reported that they would
benefit from the provision of general foot health care advice.
Conclusion: A large number of people with SLE report vascular
complications, impaired tissue viability, musculoskeletal problems and
foot pain, as well as a range of infections and conditions of the skin
and nails. Despite this, foot health assessment by professionals was
infrequent. These results highlight the need to undertake clinical
studies investigating lower limb pathologies in SLE.
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