title: 'Focus on feet'--the effects of systemic lupus erythematosus: a narrative review of the literature.
abstract: BACKGROUND
  The manifestations of systemic lupus erythematosus (SLE) vary between individuals, from the severe and life-threatening renal and central nervous system involvement, to the involvement of skin, musculoskeletal and vascular system, and the complications of infection influencing the quality of life. However, as specific manifestations affecting the lower limb are perceived as receiving little focus, the purpose of this narrative literature review is to identify the specific factors associated with SLE that may have implications for lower limb and foot morbidity.
  
  
  METHODS
  A structured search of databases was conducted. The inclusion was restricted to publications in the English language, those that specifically investigate the feet as affected with SLE. No restriction on year of publication was imposed to reduce publication bias and to capture as many publication in relation to feet.
  
  
  RESULTS
  Eleven papers fulfilled the inclusion criteria. There were seven additional papers that made observations related to the articular or vascular complications of the feet. This narrative review provides some information on how SLE affects the lower limb and foot in relation to the musculoskeletal and vascular systems. However, there is a lack of literature that specifically focuses on all the manifestations of SLE and the complications associated with its management.
  
  
  CONCLUSIONS
  There are indications that SLE affects lower limb and foot morbidity but the scale of these problems is unclear and this is partly because of the absence of research and the lack of a 'gold standard' framework for the assessment of the lower limb and foot. In addition to clinical foot health assessment, ultrasonography may be a useful alternative to plain film radiography or magnetic resonance imaging (MRI) in capturing the extent of articular and extra-articular manifestations. Further, the Ankle Brachial Pressure Index (ABPI) may be useful in identifying those with atherosclerosis and ischaemia.
  
  
  CONCLUSIONS
  There are indications that SLE affects lower limb and foot morbidity but the scale of these problems and effective management of them is unclear. Therefore, further research is warranted in order to better understand the impact of SLE on the foot and lower limb and its impact on quality of life.
authors.affiliation: Directorate of Prosthetics, Orthotics and Podiatry, University of Salford, Manchester, UK. a.e.williams1@salford.ac.uk
authors.forename: A E
authors.initials: AE
authors.lastname: Williams
authors.forename: G
authors.initials: G
authors.lastname: Crofts
authors.forename: L S
authors.initials: LS
authors.lastname: Teh
mesh_terms: D001847:Bone Diseases / Q000209:etiology; D005534:Foot Diseases / Q000209:etiology*; D006801:Humans; D035002:Lower Extremity; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D009017:Morbidity; D009135:Muscular Diseases / Q000209:etiology; D014652:Vascular Diseases / Q000209:etiology
keywords: Musculoskeletal; atherosclerosis; feet; ischaemia; systemic lupus erythematosus