Otter Simon J, Kumar Sunil, Gow Peter, Dalbeth Nicola, Corkill Michael, Rohan Maheswaran, Davies Kevin A, Pankathelam Sam, Rome Keith
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.
Rheumatology Department, Counties Manukau District Health Board, Auckland, New Zealand.
J Foot Ankle Res. 2016 Mar 22;9:10. doi: 10.1186/s13047-016-0143-8. eCollection 2016.
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.
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.
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).
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.
足部问题在类风湿关节炎等炎性关节病中很常见，并会导致严重残疾。然而，关于系统性红斑狼疮（SLE）患者足部问题的性质和程度，相关报道较少。我们旨在探究SLE患者的足部问题，并评估足部疼痛与自我报告的日常生活活动及幸福感之间的关联。
我们通过五个阶段的开发过程，在整个过程中让患者参与，以确保表面效度和内容效度，从而开发并测试了一份新的40项自填式问卷。该自填式问卷被寄给了新西兰奥克兰三个健康委员会下属成人风湿病诊所的406名SLE患者。问卷询问了足部疼痛症状、关节外特征、根据经过验证的足部模型确定的症状解剖分布，以及足部症状对日常生活活动和幸福感的影响。
总共寄出了406份问卷，收到131份回复（回复率32%）。我们发现89%为女性，平均（标准差）年龄51（15）岁，平均（标准差）确诊时间12.5（11.1）年。总体而言，77%的问卷回复者报告在患SLE期间有足部疼痛，其中45%报告目前有足部疼痛。足部的所有区域均受到影响，后足（32%）和脚踝（30%）问题最为突出。最常见的自我报告的关节外足部问题是脚部发冷、肿胀和麻木。近三分之二（61%）的人报告足部疼痛对他们的生活有不利影响；足部疼痛导致36%的人无法入睡，对33%的人的情绪有负面影响。只有33%的参与者看过足病医生。发现足部疼痛与站立超过15分钟（P<0.001）、行走（P<0.001）、爬楼梯（P<0.001）和购物（P<0.001）之间存在显著关联。疼痛是影响生活质量的主要症状（47/100）。
SLE患者的足部问题性质各异，可能对患者的幸福感产生重大负面影响。需要解决足部问题以减轻SLE的负担，我们的研究结果支持更广泛地获得特定足部护理服务的必要性。
