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Abstract Number: 2846

Foot and Lower Limb Characteristics in People with SLE: A Comparison with Age- and Sex-Matched Healthy Control Participants

Sarah Stewart1, Ashok Aiyer2, Nicola Dalbeth3 and Keith Rome4, 1School of Podiatry, Auckland University of Technology, Auckland, New Zealand, 2School of Podiatry, The Auckland University of Technology, Auckland, New Zealand, 3University of Auckland, Auckland, New Zealand, 4School of Clinical Science, Health & Rehabilitation Research Institute, AUT University, Auckland, New Zealand

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: foot, foot disorders, gait and systemic lupus erythematosus (SLE), Lupus

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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.

Table. Difference in foot and lower limb characteristics between controls and SLE

Mean (SD)

P

Control

SLE

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

Ankle lunge, °

43.0 (9.4)

40.8 (9.3)

0.08

Temperature, °C

24.9 (3.0)

25.2 (2.9)

0.44

Pressure time integral, kPa*sa

Heel

48.7 (40.3)

151.6 (40.3)

<0.001

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

Third to fifth metatarsals

59.8 (41.2)

147.0 (41.4)

<0.001

Hallux

35.9 (37.3)

126.0 (37.1)

<0.001

Toes

22.2 (25.6)

60.4 (25.7)

<0.001

Spatiotemporal gait parametersb

Step length, cm

63.5 (9.4)

57.0 (9.4)

<0.001

Swing time, s

0.39 (0.04)

0.42 (0.04)

<0.001

Stance time, s

0.64 (0.11)

0.73 (0.12)

<0.001

Velocity, cm/s

123.4 (18.5)

101.2 (18.5)

<0.001

Cadence, steps/min

116.6 (10.2)

105.6 (10.2)

<0.001

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.


Disclosure: S. Stewart, None; A. Aiyer, None; N. Dalbeth, None; K. Rome, None.

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 .
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