Foot problems in patients with systemic lupus erythematosus; under-reported and under-treated?

Background
Foot pathology is common in inflammatory arthritis and
the role of the podiatrist in the multidisciplinary care
team is well established. However, in systemic lupus
erythematosus; (SLE) the need for foot health services
and service provision for foot disease is unknown. We
set out to determine the perceived need and uptake of
foot care services.
Methods
A 40-item self-administered postal questionnaire was
posted to patients with SLE attending adult rheumatology
clinics at Auckland and Counties Manukau District Health
Boards, Auckland, New Zealand. The questionnaire
enquired about the occurrence of foot symptoms and their
frequency of assessment, the availability of podiatric
services and the usefulness of interventions.
Results
In total, 107 patients responded with 79% reporting foot
pain caused by their SLE. Half (51%) of the patients had
discussed foot pain with their general practitioner or rheumatologist,
and a third (33%) had difficulty with basic foot
care. Respondents reported there was no significant difference
in the frequency with which their hands and feet
were examined. However, only 33% had been seen by a
podiatrist. Insoles had only been prescribed to a quarter of
respondents (25%) but only half of those receiving insoles
were continuing to wear them and merely two respondents
indicated their foot symptoms had been resolved by
their insoles. None of the subjects reported that they had
been provided with specialist footwear.
Conclusion
These data suggest that foot problems are common and
under-reported in patients with SLE. Health care professionals
need to consider a comprehensive foot care plan
as part of the holistic management of people with SLE.