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Home , Callus, Lupus erythematosus

Letters to the Editors

Foot involvement in Nearly one-third of participants reported Address correspondence to: systemic erythematosus: intermittent claudication (n=9, 31%), and Prof. Keith Rome, nearly two-thirds reported Raynaud’s phe- Auckland University of Technology, more than disease? Health & Rehabilitation Research Institute, nomenon (n=18, 62%). Two participants Faculty of Health and Environmental Sciences, (7%) reported previous ulceration and Private Bag 92006, Auckland 1142, Sirs, one participant (3%) reported having a cur- New Zealand. We read with great interest the study pub- rent digital . The most common type E-mail: [email protected] lished recently in Clinical and Experimen- of footwear were flip-flops (n=9, 31%) and Competing interests: none declared. tal by Morales-Lozano et al. sandals (n=9, 31%). These findings provide (1) on foot and ankle disease in people with further insight into the spectrum of foot- References systemic (SLE). The related complications. 1. MORALES-LOZANO R, MARTÍNEZ-BARRIO J, analysis of the results demonstrated that an The assessment and management of the GONZÁLEZ-FERNÁNDEZ ML et al.: The feet in systemic lupus erythematosus; are we underestimat- association was found between reduced foot foot in people with SLE has been given lit- ing their involvement and functional impact? Clin function and ultrasound lesions (1). Another tle consideration. Assessment of the foot Exp Rheumatol 2016; 34: 609-17. important finding of this study was the in- in SLE needs to capture not just joint dis- 2. OTTER S, KUMAR S, GOW PJ et al.: Patterns of foot volvement of the ankle joint detected by ease, but also and vascular pathology. disease in systemic lupus erythematosus: a cross clinical and ultrasound assessments. This is The lack of an assessment protocol in the sectional survey. J Foot Ankle Res 2016; 9: 10. of a great relevance as foot and ankle char- context of assessing people with this com- 3. MUKHERJEE S, CHERRY L, ZARROUG J et al.: A pilot investigation of the prevalence of US-de- acteristics in SLE are poorly understood. plex multi-morbid pathology may mean that tectable forefoot joint pathology and reported foot- Only recently has foot and ankle involve- the opportunity for early identification and related disability in participants with systemic lupus ment in SLE been identified as heterogene- management is missed (8). Understanding erythematosus. J Foot Ankle Res 2016; 9: 27. ous in nature and appears to have a substan- the impact of the disease and foot problems 4. ERDOZCAIN JG, VILLAR I, NIETO J, RUIZ-IRAS- tial negative impact on participants’ mobil- is crucial in developing a suitable non-sur- TORZA G: Peripheral arterial disease in systemic ity, quality of life and well-being (2, 3). Of gical management strategy (9). The aims lupus erythematosus: prevalence and risk factors. J Rheumatol 2014; 41: 310-7. note, the burden of disease in SLE has also of a management strategy is to reduce pain, 5. TLACUILO-PARRA A, GUEVARA-GUTIERREZ E, been reported to be associated with , maintain function and improve quality of MAYORGA J, GARCIA-DE LA TORRE I, SALAZAR- skin and vascular disease (4-6). Although life utilising specific interventions. These PARAMO M: in systemic lupus ery- Morales and colleagues (1) have reported interventions may include palliative treat- thematosus: a case control study. J Rheumatol 2003; important findings on foot and ankle joint ment for the nails and skin, prescribed foot 30: 1491-4. 6. PAVLOV-DOLIJANOVIC S, DAMJANOV NS, VU- disease, based upon on our experience in the orthoses specialised footwear, management JASINOVIC-STUPAR NZ, MARCETIC DR, SEFIK- field, we would like to raise some comments and prevention of foot ulceration with the BUKILICA MN, PETROVIC RR: Is there a differ- that we feel are of potential interest in ad- need for education and information in all ence in systemic lupus erythematosus with and dressing this intriguing issue. aspects of foot health. without Raynaud’s phenomenon? Rheumatol Int In an attempt to establish a better under- 2013; 33: 859-65. 7. GARROW AP, PAPAGEORGIOU AC, SILMAN standing of skin, nail and vascular disease K. ROME1 AJ, THOMAS E, JAYSON MI, MACFARLANE GJ: N. DALBETH2,3 we conducted a cross-sectional, observa- Development and validation of a questionnaire to tional study on 29 participants with lupus P. JARRETT4,5 6 assess disabling foot pain. Pain 2000; 85: 107-13. erythematosus based in Auckland, New S. KUMAR 8. WILLIAMS AE, CROFTS G, TEH LS: ‘Focus on feet’ 1 M. CARROLL the effects of systemic lupus erythematosus: a narra- Zealand. The majority (n=17, 59%) of par- 1 ticipants were European females with a A. CLENDON tive review of the literature. Lupus 2013; 22: 1017- P. GOW6 mean (SD) age of 56.7 (14.3) years with a 23. 1AUT University, Health and Rehabilitation 9. WILLIAMS AE, DAVIES S, GRAHAM A et al.: disease duration of 5.2 (3.7) years. We found Guidelines for the management of the foot health moderate levels of foot pain using with a Research Institute and Department of , Auckland, New Zealand; problems associated with rheumatoid . Mus- culoskeletal Care mean (SD) of 37 (33) using a 100 mm visual 2Bone and Joint Research Group, Department 2011; 9: 86-92. analogue scale. Moderate levels of disabil- of Medicine, University of Auckland; ity with a mean (SD) of 12 (11) using the 3Auckland District Health Board, Rheumatology Manchester Foot Pain and Disability Index Department, Greenlane Hospital, New Zealand. (7) were observed. Nail pathologies were 4Department of Medicine, Faculty of Medical observed in 17 (59%) participants and plan- and Health Sciences, The University of Auckland, New Zealand; tar corns and in 14 (48%). The pres- 5Department of , and ence of cold feet was observed in nearly 6Department of Rheumatology, Counties two-thirds of the participants (n=18, 62%) Manukau District Health Board, Middlemore and chilblains in 11 participants (38%). Hospital, Auckland, New Zealand.

550 Clinical and Experimental Rheumatology 2017