Session Information
Date: Tuesday, October 23, 2018
Title: 5T099 ARHP Abstract: Clinical Aspects & Outcomes Research–ARHP II (2844–2849)
Session Type: ARHP Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: People with SLE report joint pain and swelling, impaired circulation, cutaneous lesions and foot deformity. Foot- and lower-limb-related functional impairment has also been described in SLE. However, objectively assessed measures of foot function, including muscle strength and gait characteristics have not been evaluated in people with SLE. This study aimed to identify foot and lower limb characteristics in people with SLE compared to age-and sex-matched controls.
Methods: The study included 54 people with SLE (all fulfilling the 1997 ACR classification criteria) and 56 age- and sex-matched healthy control participants (mean (SD) age: 52 (14) SLE vs 48 (14) controls, 93% females in both groups), who attended a study visit designed to comprehensively assess foot function. Assessment of patient-reported foot and lower limb pain and disability was measured using: Manchester Foot Pain & Disability Index; Lower Limb Task Questionnaire; and 100 mm foot pain VAS. Isometric muscle force for ankle plantarflexion, dorsiflexion, inversion and eversion was assessed using dynamometry; foot joint motion was assessed using goniometry; foot type was assessed using the Foot Posture Index (FPI); foot problems were assessed using the Foot Problem Score (FPS); neurological evaluation included vibration perception thresholds (VPT) and presence of protective sensation. Temperature and Ankle Brachial Index (ABI) were also assessed. Dynamic function was assessed using plantar pressure and spatiotemporal gait analysis. Data were analysed using regression models.
Results: Participants with SLE had a mean (SD) disease duration of 15 (12) years and a SLEDAI-2K score of 13 (10). Differences in foot characteristics are presented in the Table. Participants with SLE reported greater foot and lower limb pain and disability in all questionnaires. Compared to control participants, those with SLE had significantly reduced muscle strength for ankle plantarflexion, dorsiflexion, inversion, and eversion. Participants with SLE had higher FPI (3.6 vs 5.4, P = 0.007) and FPS (11 vs 16, P = 0.001), VPT (8.9 vs 13.2, P = 0.001) and prevalence of abnormal ABI (odds ratio (95% CI) 3.13 (1.03, 9.49), P = 0.044). No differences were observed between groups for joint motion, protective sensation, or temperature. Participants with SLE exhibited higher pressure time integrals for all regions of the plantar foot and walked significantly slower with reduced step length and greater swing and stance times compared to control participants.
Conclusion: People with SLE report a wide-range of foot complaints related to pain, disability and activity limitation. People with SLE also exhibit objective evidence of foot and ankle disease, including reduced foot and ankle muscle strength, and altered plantar pressure and gait patterns when compared to matched controls.
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Table. Difference in foot and lower limb characteristics between controls and SLE |
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Mean (SD) |
P |
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Control |
SLE |
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|
Foot pain VAS, mm |
4.5 (24.3) |
25.7 (23.9) |
<0.001 |
|
MFPDI, total |
1.3 (2.6) |
11.6 (8.4) |
<0.001 |
|
LLTQ activities of daily living |
39.2 (1.4) |
34.7 (5.6) |
<0.001 |
|
LLTQ recreational activities |
35.7 (11.0) |
24.9 (6.2) |
<0.001 |
|
Plantarflexion force, N |
231.1 (67.5) |
188.5 (63.3) |
<0.001 |
|
Dorsiflexion force, N |
178.8 (49.7) |
144.8 (49.8) |
<0.001 |
|
Inversion force, N |
103.0 (38.6) |
79.3 (38.3) |
<0.001 |
|
Eversion force, N |
88.1 (30.7) |
65.6 (31.3) |
<0.001 |
|
1MTP dorsiflexion ROM, ° |
82.5 (22.2) |
80.2 (21.6) |
0.44 |
|
STJ inversion ROM, ° |
35.3 (12.5) |
35.1 (12.4) |
0.89 |
|
STJ eversion ROM, ° |
14.1 (7.9) |
13.8 (7.9) |
0.76 |
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Ankle lunge, ° |
43.0 (9.4) |
40.8 (9.3) |
0.08 |
|
Temperature, °C |
24.9 (3.0) |
25.2 (2.9) |
0.44 |
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Pressure time integral, kPa*sa |
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Heel |
48.7 (40.3) |
151.6 (40.3) |
<0.001 |
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Midfoot |
29.4 (25.3) |
66.7 (25.3) |
<0.001 |
|
First metatarsal |
51.6 (46.1) |
117.7 (46.3) |
<0.001 |
|
Second metatarsal |
73.7 (45.1) |
170.9 (45.3) |
<0.001 |
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Third to fifth metatarsals |
59.8 (41.2) |
147.0 (41.4) |
<0.001 |
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Hallux |
35.9 (37.3) |
126.0 (37.1) |
<0.001 |
|
Toes |
22.2 (25.6) |
60.4 (25.7) |
<0.001 |
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Spatiotemporal gait parametersb |
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Step length, cm |
63.5 (9.4) |
57.0 (9.4) |
<0.001 |
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Swing time, s |
0.39 (0.04) |
0.42 (0.04) |
<0.001 |
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Stance time, s |
0.64 (0.11) |
0.73 (0.12) |
<0.001 |
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Velocity, cm/s |
123.4 (18.5) |
101.2 (18.5) |
<0.001 |
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Cadence, steps/min |
116.6 (10.2) |
105.6 (10.2) |
<0.001 |
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VAS = Visual Analogue Scale; MFPDI = Manchester Foot Pain and Disability Index; LLTQ = Lower Limb Task Questionnaire; 1MTP = first metatarsophalangeal joint; STJ = subtalar joint; ROM = range of motion; Diff. = difference between controls and SLE; CI = Confidence Interval. aAdjusted for BMI and gait velocity. bAdjusted for BMI. Bolded P values indicate significant difference at P < 0.05. |
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To cite this abstract in AMA style:
Stewart S, Aiyer A, Dalbeth N, Rome K. Foot and Lower Limb Characteristics in People with SLE: A Comparison with Age- and Sex-Matched Healthy Control Participants [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/foot-and-lower-limb-characteristics-in-people-with-sle-a-comparison-with-age-and-sex-matched-healthy-control-participants/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/foot-and-lower-limb-characteristics-in-people-with-sle-a-comparison-with-age-and-sex-matched-healthy-control-participants/