The Foot and Systemic Lupus Erythematosus

Wikis > Rheumatology > Connective Tissue Disorders > Systemic Lupus Erythematosus > The Foot and Systemic Lupus Erythematosus

Involvement of foot:
• Similar pattern of symmetric polyarthritis as rheumatoid arthritis – but not severe enough to cause erosions (Jaccoud’s arthropathy) – the deformities are passively correctable .
• Feet are often ‘tender’ with HAV and flat feet.
• Sensory (sometimes motor) peripheral neuropathy is infrequent, but can occur early.
• Purpura may occur in feet as result of cutaneous vasculitis.
• Hypertrophic lesions can occur on plantar surface of feet.
• Higher risk of stress fractures (due to osteoporosis). Other bone lesions in feet include small well defined radiolucent areas subchondrally surrounded by normal or sclerotic bone in small joints of hands and feet – ‘periarticular cystic lesions’ . Avascular necrosis of talus and Friebergs infarction of metatarsals can also occur
• Also get nail dystrophies (in up to 25%), osteonecrosis, nailfold capillary abnormalities, chilblains, Raynauds phenomena, vasculitis and peripheral vascular disease  gangrene.
• Chilblain lupus erythematosus (Hutchinson’s) is a more chronic form with chilblains on digits, calves and heels – chilblains often persistent and a high number of this type go on to full SLE – treatment of the chilblains associated with the LE are difficult.
• Peripheral neuropathy occurs in 5-27% - mostly a progressive sensorimotor axonopathy of the longer nerves. Nerve conduction velocities fluctuate over time .
• Case has been reported of a sudden onset of drop foot and hyperesthesia in lower extremity (similar to Guillain-Barre syndrome) as presenting feature of SLE .
• Another case has been reported of initial presenting feature being painful plantar lesions.
• Two cases of ulcerating plantar keratoderma’s and fissures that were resistant to treatment

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