Results of a national foot health survey of patients with Systemic Lupus Erythematosus

Background: SLE can affect many tissues throughout the body.Anecdotally, it is suggested that people with SLE experience a range ofcomplications 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 footcomplications experienced by people with SLE has not been described.The aim of this survey was to determine self-reported foot and lowerlimb complications experienced by people with SLE.Methods: The survey was developed via patient and practitioner focusgroups. A consensus approach was used to generate items and toformulate themes, categories, question format and survey structure.The survey was checked for face and content validity prior to cognitivedebriefing to ensure usability and understanding. Consecutive patientswith a confirmed diagnosis of SLE meeting the inclusion criteriaattending any of seven UK clinical sites or members of Lupus UK wereinvited to participate. Ethical approval and participant informedconsent was obtained.Results: A total of 182 survey responses were completed. For allresponders, the most frequent age range was 40–49 years, mean BMIwas 27 (S.D. 7) and mean disease duration was 15 years (S.D. 10). Anumber of vascular complications were reported, including intermittentclaudication [n ¼ 100 (55%)], RP [n ¼ 94 (52%)] and splinterhaemorrhage [n ¼ 39 (21%)]. Overall, 164 patients (90%) reportedexperiencing symptoms of peripheral vascular complications.Symptoms of peripheral neuropathy were reported by 30 patients(16%), while a fall as a consequence of neuropathic symptoms wasreported by 45 patients (25%). A range of skin and nail complicationswere 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 ofviral infection (verrucae pedis) or fungal infection (tinea pedis) wasreported 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 walkingimpairment was reported by 67 patients (37%). Only 60 patients(33%) reported having ever been asked about their feet by a medicalprofessional. Seventy-seven patients (42%) reported that they wouldbenefit from the provision of general foot health care advice.Conclusion: A large number of people with SLE report vascularcomplications, impaired tissue viability, musculoskeletal problems andfoot pain, as well as a range of infections and conditions of the skinand nails. Despite this, foot health assessment by professionals wasinfrequent. These results highlight the need to undertake clinicalstudies investigating lower limb pathologies in SLE