‘Focus on feet’ – the effects of systemic lupus erythematosus:
a narrative review of the literature

Williams, AE; Crofts, GS; Teh, LS

Abstract

Background: The manifestations of systemic lupus erythematosus (SLE) vary between individuals,
from the severe and life-threatening renal and central nervous system involvement, to
the involvement of skin, musculoskeletal and vascular system, and the complications of infection
influencing the quality of life. However, as specific manifestations affecting the lower limb
are perceived as receiving little focus, the purpose of this narrative literature review is to
identify the specific factors associated with SLE that may have implications for lower limb
and foot morbidity. Method: A structured search of databases was conducted. The inclusion
was restricted to publications in the English language, those that specifically investigate the
feet as affected with SLE. No restriction on year of publication was imposed to reduce publication
bias and to capture as many publication in relation to feet. Results: Eleven papers
fulfilled the inclusion criteria. There were seven additional papers that made observations
related to the articular or vascular complications of the feet. This narrative review provides
some information on how SLE affects the lower limb and foot in relation to the musculoskeletal
and vascular systems. However, there is a lack of literature that specifically focuses on
all the manifestations of SLE and the complications associated with its
management. Discussion: There are indications that SLE affects lower limb and foot morbidity
but the scale of these problems is unclear and this is partly because of the absence of
research and the lack of a ‘gold standard’ framework for the assessment of the lower limb and
foot. In addition to clinical foot health assessment, ultrasonography may be a useful alternative
to plain film radiography or magnetic resonance imaging (MRI) in capturing the extent of
articular and extra-articular manifestations. Further, the Ankle Brachial Pressure Index
(ABPI) may be useful in identifying those with atherosclerosis and ischaemia. Conclusion:
There are indications that SLE affects lower limb and foot morbidity but the scale of these
problems and effective management of them is unclear. Therefore, further research is warranted
in order to better understand the impact of SLE on the foot and lower limb and its
impact on quality of life

Citation

a narrative review of the literature. Lupus, 22(10), 1017-1023. https://doi.org/10.1177/0961203313498805

• Journal Article Type: Article
• Publication Date: Sep 1, 2013
• Deposit Date: Jun 20, 2014
• Journal: Lupus
• Print ISSN: 0961-2033
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 22
• Issue: 10
• Pages: 1017-1023
• DOI: https://doi.org/10.1177/0961203313498805
• Publisher URL: http://dx.doi.org/10.1177/0961203313498805
• Related Public URLs: http://www.uk.sagepub.com/journals/Journal201819