The Feet In Systemic Lupus Erythematosus; Are We Underestimating Their Involvement And Functional Impact?
The main objective of this cross-sectional study was to comprehensively evaluate biomechanical and musculoskeletal ultrasound (US) abnormalities in a population of systemic lupus erythematosus (SLE) patients as compared with controls, both with and without foot complaints.
The secondary objective was to assess the relationship between biomechanical and US abnormalities and SLE activity, and the presence of auto-antibodies in these patients.
Fifty-four consecutive female patients with SLE (with and without foot pain) and sixty female controls (30 with foot pain and 30 without foot pain) were recruited.
Data on demographics, SLE duration and current treatment, presence of arthritis at onset or during disease course, disease-related auto-antibodies, rheumatoid factor (RF), and anti-citrullinated peptide antibodies (ACPAs) were collected from the Autoimmune Systemic Rheumatic Diseases Electronic Registry of the Department of Rheumatology.
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All SLE patients and controls underwent a complete podiatric investigation by a Doctor in Podiatric Medicine (DPM).
Musculoskeletal US assessment consisted of a systematic longitudinal and transverse multiplanar examination.
SLE activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).
Foot pain was found to be predominantly inflammatory or mixed in SLE patients, possibly due to the inflammatory nature of joint involvement in this disease whereas foot pain was observed to be mostly mechanical in controls.
MTP joints were the most common location for pain in SLE patients and for B-mode synovitis on US in total and painful feet of SLE patients.
There were no significant differences in these variables between SLE patients and controls and between painful and painless feet in SLE patients.
A strong association between having SLE and the presence of tibiotalar B-mode US synovitis as well as between having foot pain in SLE patients and again the presence of tibiotalar B-mode US synovitis and a limited mobility of this joint.
SLE patients showed more biomechanical and US feet abnormalities than controls without SLE.
Biomechanical and ultrasound feet abnormalities were not captured by standardised assessment of disease activity.
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References:
- Morales-Lozano, R., Martínez-Barrio, J., González-Fernández, M. L., López-Longo, F. J., Ovalles-Bonilla, J. G., Valor, L., Janta, I., Nieto, J. C., Hernández-Flórez, D., González, C. M., Monteagudo, I., Garrido, J., Carreño, L., Naredo, E. (2016) The Feet In Systemic Lupus Erythematosus; Are We Underestimating Their Involvement And Functional Impact? Clinical and Experimental Rheumatology: 2016, Vol. 34, pp. 609-617
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