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      Patterns of foot complaints in systemic lupus erythematosus: a cross sectional survey

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          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).

          Conclusion

          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.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13047-016-0143-8) contains supplementary material, which is available to authorized users.

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          Most cited references34

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          Systemic lupus erythematosus.

          Systemic lupus erythematosus is an autoimmune connective-tissue disorder with a wide range of clinical features, which predominantly affects women, especially from certain ethnic groups. Diagnosis is based on clinical assessment supported by investigations, including the finding of autoantibodies. Treatments range from antimalarial agents to corticosteroids and immunosuppressive agents. This Seminar draws attention to advances in the epidemiology, genetics, cardiovascular risks, lupus nephritis, CNS disease, the antiphospholipid syndrome, assessment of disease activity and damage, and pregnancy related and quality of life issues. New therapeutic approaches, such as biological agents and mycophenolate mofetil, will also be discussed.
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            The pathogenesis of systemic lupus erythematosus-an update.

            Systemic lupus erythematosus (SLE, lupus) is characterized by a global loss of self-tolerance with activation of autoreactive T and B cells leading to production of pathogenic autoantibodies and tissue injury. Innate immune mechanisms are necessary for the aberrant adaptive immune responses in SLE. Recent advances in basic and clinical biology have shed new light on disease mechanisms in lupus, with this review discussing the recent studies that offer valuable insights into disease-specific therapeutic targets. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Development and validation of a disease-specific health-related quality of life measure, the LupusQol, for adults with systemic lupus erythematosus.

              To develop and validate a disease-specific health-related quality of life (HRQOL) instrument for adults with systemic lupus erythematosus (SLE). The work consisted of 6 stages. Stage 1 included item generation for questionnaire content from semistructured interviews with SLE patients. In stage 2 item selection for the draft questionnaire was performed by thematic analysis of the patient interview transcripts and expert panel agreement. In stage 3 the content validity of the draft questionnaire was assessed by patients completing the questionnaire and providing critical feedback. In stages 4 and 5 construct validity and internal reliability of the 3 versions of the LupusQoL were evaluated using principal component analysis with varimax rotation and Cronbach's alpha coefficients, respectively. In stage 6 discriminatory validity, concurrent validity, and test-retest reliability were evaluated. Stages 1, 2, and 3 resulted in a preliminary instrument containing 63 items. In stage 4, 8 domains were identified. This factor structure, accounting for 82% of the variance, was confirmed in stage 5. The domains and Cronbach's alpha coefficients were physical health (0.94), emotional health (0.94), body image (0.89), pain (0.92), planning (0.93), fatigue (0.88), intimate relationships (0.96), and burden to others (0.94). Discriminant validity was demonstrated for different levels of disease activity (British Isles Lupus Assessment Group Index) and damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). High correlations (r = 0.71-0.79) between comparable domains of the Short Form 36 and the LupusQoL assured acceptable concurrent validity. Good test-retest reliability (r = 0.72-0.93) was demonstrated. The LupusQoL is a validated SLE-specific HRQOL instrument with 34 items across 8 domains defined by patients as being important.
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                Author and article information

                Contributors
                s.otter@brighton.ac.uk
                Sunil.Kumar@middlemore.co.nz
                pgow@middlemore.co.nz
                n.dalbeth@auckland.ac.nz
                Michael.Corkill@waitematadhb.govt.nz
                maheswaran.rohan@aut.ac.nz
                k.a.davies@bsms.ac.uk
                spanthakalam@nhs.net
                krome@aut.ac.nz
                Journal
                J Foot Ankle Res
                J Foot Ankle Res
                Journal of Foot and Ankle Research
                BioMed Central (London )
                1757-1146
                22 March 2016
                22 March 2016
                2016
                : 9
                : 10
                Affiliations
                [ ]Health and Research Rehabilitation Institute and School of Podiatry, AUT University, Auckland, New Zealand
                [ ]Rheumatology Department, Counties Manukau District Health Board, Auckland, New Zealand
                [ ]Department of Rheumatology, Auckland District Health Board and Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
                [ ]Rheumatology Department, Waitemata District Health Board, Auckland, New Zealand
                [ ]Biostatistics Department, AUT University, Auckland, New Zealand
                [ ]Rheumatology Department, Brighton and Sussex Medical School, Brighton, UK
                [ ]Rheumatology Department, East Sussex Healthcare Trust, Eastbourne, UK
                [ ]School of Health Science, University of Brighton, 49 Darley Rd, Eastbourne, BN20 7UR UK
                Article
                143
                10.1186/s13047-016-0143-8
                4802627
                27006702
                2860b37c-14b9-432b-a01a-8201c2685d9e
                © Otter et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 January 2016
                : 12 March 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100008205, Auckland University of Technology, New Zealand;
                Award ID: Dean's Cafe Award
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Orthopedics
                systemic lupus erythematosus,foot,pain,disability,impairment,quality of life
                Orthopedics
                systemic lupus erythematosus, foot, pain, disability, impairment, quality of life

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