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It is unclear whether patients use alternative medicine because of psychological distress associated with their disease or philosophical congruence with this form of treatment. Therefore, we have studied why patients with systemic lupus erythematosus (SLE) employ alternative medicine. We interviewed 192 consecutive Chinese SLE outpatients in a tertiary-care rheumatology centre. We recorded their demographic data, usage of traditional Chinese medication, the predominant form of alternative medicine in this group, and the Rheumatology Attitudes Index score. We distinguished two types of alternative medicine users: those who use it with intent to treat SLE (disease-specific users; 73 users, 38.0%) and those who use it for cultural and other reasons (general-health users; 55 users, 28.6%). Users regarded their disease as mild compared to nonusers. Disease-specific users were distinguished from nonusers by having Chinese as a first language (odds ratio, 2.14-8.83), greater learned helplessness (odds ratio, 1.02-1.29), and an earlier age of diagnosis (odds ratio, 0.92-0.98 for older age). In conclusion, the majority of our lupus patients have used alternative medicine. The motivations of general-health and disease-specific users are different. The patients' first language and perceived helplessness influenced the disease-specific users, while general-health users were subject to neither of these.

We sought to test our clinical impression that using a low dose methylprednisolone pulse (MEP; µ1500 mg over 3 days) in treating flares of systemic lupus erythematosus (SLE) was effective and associated with fewer serious infections. We retrospectively studied SLE patients who received MEP between 1989 and 2000. A ‘low dose’ group of 26 patients who had received 1–1.5 g and a ‘high dose’ group of 29 patients who received 3–5 g of MEP were identified. SLEDAI scores and prednisolone doses were recorded at the time of MEP pulses and 6 months later. All serious infections (requiring admission and i.v. antibiotics) occurring during this 6 month period and their outcomes were recorded. Both groups had similar demographic data, initial SLEDAI scores, i.v. cyclophosphamide use, and SLE organ involvement. Despite high-and low-dose MEP being efficacious in controlling disease activity (lowering of SLEDAI scores and subsequent prednisolone dose) there were only nine episodes of serious infection in seven patients in the low-dose group compared with 20 episodes in 17 patients from the high-dose group (P ^ 0.04). In both groups a majority of infections (75 and 77% in the high-and low-dose groups) occurred in the first month after MEP. Those with a low serum albumin (< 20 g/l) had an increased risk of mortality (OR 44, 90% CI 6.19–312.98) and a trend towards greater numbers of infections. Low-dose MEP was effective in controlling SLE flares and associated with fewer serious infections than traditional high-dose MEP.

Objective: To study the accuracy of medical record scoring of the SLICC/ACR Damage Index (DI) for SLE. Methods: Medical record DI (MDI) scoring of 60 SLE patients by one physician was compared with prospective direct DI (DDI) scoring a median of 2 y earlier. Agreement between DDI and MDI total and organ system scores was compared using Cohen's kappa, the degree of misclassification by MDI and the significance of differences between DDI and MDI scores. Results: The mean duration of SLE at DDI scoring was 5.2 y. The median/mean (SD) DDI and MDI total scores were 0=0.78 (1.38) and 0=0.85 (1.44). Damage was present on DDI and MDI scoring in 36.7% (22=60) and 38.3% (23=60) of patients. Qualitative MDI and DDI total scores (damage present/absent) showed good agreement (kappa ‘ 0.61, 95% CI ‘ 0.40–0.82, 18.3% misclassification). Quantitative MDI and DDI total scores (degree of damage) showed moderate agreement (kappa ‘ 0.47, 95% CI ‘ 0.28–0.66, 36.7% misclassification). 9 of 12 MDI organ system scores misclassified < 10% of subjects. There was no statistically significant difference between DDI and MDI total or organ system scores. Conclusion: MDI total scoring is a good qualitative and moderate quantitative reflection of SLE related damage. MDI organ system scores are more accurate than MDI total scores.

Objective: To validate the Medical Outcomes Study Family and Marital Functioning Measures (FMM and MFM) in a multi-ethnic, urban Asian population in Singapore. Methods: English speaking Chinese, Malay or Indian SLE patients (n ‘ 120) completed a selfadministered questionnaire containing the FFM and MFM at baseline, after 2 weeks and after 6 months. Lupus activity, disease-related damage and quality of life were assessed using the British Isles Lupus Assessment Group (BILAG), Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index and SF-36 Health Survey respectively. Scale psychometric properties were assessed through factor analysis, Cronbach's a, quantifying test-retest differences and known-groups construct validity. Results: Factor analysis of scores obtained at baseline and after 6 months identified 3 factors corresponding to the FFM (1 factor) and the MFM (2 factors). Both scales showed acceptable internal consistency, with Cronbach's a of 0.95 for the FFM and 0.70 for the MFM. Mean (s.d.) test-retest differences were 7 0.31 (3.82) points for the FFM and 7 0.70 (4.26) points for the MFM. Eleven out of 13 a priori hypotheses relating both the FFM and MFM to demographic, disease and quality of life variables were confirmed, supporting the construct validity of these scales. Conclusion: The FFM and MFM are valid and reliable measures of family and marital functioning in a multi-ethnic cohort of Asian SLE patients in Singapore.

Patients with systemic lupus erythematosus (SLE) frequently have gastrointestinal (GI) symptoms. These are usually self-limiting and related to treatment side-effects or concurrent illness. However, abdominal pain may be due to bowel ischaemia which can lead to infarction and perforation. The likelihood of these serious events is increased in individuals with pain severe enough to require assessment in hospital or a SLEDAI score > 5. This paper describes a group of patients with active SLE and GI symptoms severe enough to require admission to hospital using a retrospectivereview of 52 SLE patients admitted to hospital with acute abdominal symptoms. The results showed that abdominal pain (87%), vomiting (82%) and diarrhoea (67%) had been present for a mean of 4.4 + 6.5 days and SLEDAI score was ≥4 in 83% of patients. CT scanning showed evidence of serositis and bowel involvementin 63% of patients who underwent this investigation.Intravenous(iv) fluids were used in 87%, parenteral steroids in 90% and iv cyclophosphamidein 31%. Most (n 51) were discharged well. Recurrence of GI symptoms occurred in 12 patients. The conclusions are that active SLE may manifest as an acute gastrointestinal syndrome. Early diagnosis, bowel rest, supportive medical therapy and treatment with corticosteroids and/or immunosupressives can result in a good outcome.

Despite the prognostic importance of learned helplessness (LH) in rheumatic diseases, there are no validated measures of LH in Chinese or other Asian languages. We therefore assessed the validity of a Chinese translation of the Rheumatology Attitudes Index (CRAI; a widely used measure of LH) and its Helplessness (CHS) and Internality (CIS) subscales in patients with SLE. Chinese-speaking SLE patients (n = 69) completed identical, self-administered questionnaires containing the CRAI and assessing demographic/socio-economic variables twice within 2 weeks. SLE activity, damage and quality of life were assessed using the BILAG, SLICC/ACR Damage Index and SF-36 respectively. Scale psychometric properties were assessed through Cronbach's α, intra-class correlations, quantifying test–retest differences, factor analysis and known-groups construct validity. Internal consistency and reliability were acceptable, with Cronbach's α for the CHS, CIS and CRAI being 0.70, 0.69 and 0.74, respectively. Mean differences in test–retest scores spanned 1.6–2.4% of possible scale ranges and intra class correlations ranged from 0.72 to 0.88. Factor analysis identified two major factors corresponding to the CHS and CIS subscales of the CRAI. Eight of 10 a priori hypotheses relating the CRAI and CHS to demographic, disease and quality of life variables were confirmed, supporting the construct validity of these scales. The CRAI and its helplessnesssubscale are valid and reliable measures of learned helplessness in Chinese-speaking SLE patients.