title: Patterns of foot complaints in systemic lupus erythematosus: a cross sectional survey.
abstract: BACKGROUND
  Foot complaints are common in inflammatory arthropathies such as rheumatoid arthritis and cause considerable disability. However, little is published about the nature and extent of foot complaints in systemic lupus erythematosus (SLE). We aimed to explore foot complaints among people with (SLE) and to evaluate the associations between foot pain and self-reported activities of daily living and well-being.
  
  
  METHODS
  We developed and tested a new 40-item item self-administered questionnaire, using a five-stage development process utilising patient involvement throughout to ensure face and content validity. The self-administered instrument was posted to 406 people with SLE attending adult rheumatology clinics across three health boards in Auckland, New Zealand. The questionnaire enquired about symptoms of foot pain, extra-articular features, anatomical distribution of symptoms according to validated foot-mannequins and the impact of foot symptoms on activities of daily living and well-being.
  
  
  RESULTS
  In total, 406 questionnaires were posted, with 131 responses (response rate 32 %). We found 89 % were women, mean (SD) age 51 (15) years, mean (SD) diagnosis 12.5 (11.1) years. Overall, 77 % of those responding to the questionnaire reported foot pain during their SLE, with 45 % reporting current foot pain. All regions of the feet were affected, with the hindfoot (32 %) and ankles (30 %) most troublesome. The most common self-reported extra-articular foot complaints were cold feet, swelling and numbness. Almost two-thirds (61 %) reported foot pain adversely affected their lives; foot pain prevented sleeping in 36 % and had a negative effect on emotions for 33 %. Only 33 % of participants had seen a podiatrist. Significant association was found between foot pain and standing longer than 15 min (p < 0.001), walking (p < 0.001), climbing stairs (p < 0.001) and going shopping (p < 0.001). Pain was the primary symptom to affect quality of life (47/100).
  
  
  CONCLUSIONS
  Foot complaints in SLE are heterogeneous in nature, and may have a substantial negative impact on patient well-being. Foot complaints need to be addressed to reduce the burden of SLE and our findings support the need for wider access to specific foot care services.
authors.affiliation: Health and Research Rehabilitation Institute and School of Podiatry, AUT University, Auckland, New Zealand ; School of Health Science, University of Brighton, 49 Darley Rd, Eastbourne, BN20 7UR UK.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Otter
authors.affiliation: Rheumatology Department, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Rheumatology Department, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Gow
authors.affiliation: Department of Rheumatology, Auckland District Health Board and Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
authors.affiliation: Rheumatology Department, Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Corkill
authors.affiliation: Biostatistics Department, AUT University, Auckland, New Zealand.
authors.forename: Maheswaran
authors.initials: M
authors.lastname: Rohan
authors.affiliation: Rheumatology Department, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Davies
authors.affiliation: Rheumatology Department, East Sussex Healthcare Trust, Eastbourne, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Pankathelam
authors.affiliation: Health and Research Rehabilitation Institute and School of Podiatry, AUT University, Auckland, New Zealand.
authors.forename: Keith
authors.initials: K
authors.lastname: Rome
mesh_terms: D000203:Activities of Daily Living; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires; D064232:Visual Analog Scale
keywords: Disability; Foot; Impairment; Pain; Quality of life; Systemic lupus erythematosus