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.
