The fibromyalgia impact questionnaire (FIQ) is a 10-item, patient-reported outcome measure to capture the total spectrum of symptoms and problems related to fibromyalgia. The original version of the questionnaire was developed in English and psychometrically validated. It has been translated into 8 languages and used worldwide as the only disease-specific questionnaire for measuring patient’s fibromyalgia status. In order to develop a Japanese version of the FIQ, we translated the original into Japanese and performed a linguistic validation of the translated questionnaire. The translation and evaluation were performed in a standard manner to ensure conceptual equivalence between the original and its translation: 1) forward-translation by two independent Japanese translators (English to Japanese); 2) back-translation by an English native translator (English to Japanese); and 3) a pilot testing for comprehension in patients with fibromyalgia. The original developer and two Japanese clinicians were involved throughout the validation process. As a result of the evaluation, the translation of daily activities such as “walking several blocks” and “doing yard work” proved challenging. Cultural difference was the main cause in finding equivalents. The numerical rating scales were not always completed properly; therefore, detailed scale instructions were attached to the front page of the questionnaire. Through multiple procedures, a linguistically validated Japanese version of the FIQ (JFIQ) has been successfully developed.
Objective: Development of an enzyme immunoassay for N-methyl-D-aspartate Receptor subunit NR2 antibodies (anti-NR2), using the synthetic 10-amino-acid sequence peptide DWEYSVWLSN conjugated to human serum albumin, and to explore the association of anti-NR2 in sera and cerebrospinal fluid (CSF) from patients with neuropsychiatric manifestations in systemic lupus erythematosus (NP-SLE).
Method: Paired serum and CSF specimens were obtained from 66 patients with NP-SLE and 12 control patients with non-inflammatory neurological diseases. In addition, sera from patients with rheumatoid arthritis, chronic progressive neuro-Behçet disease, SLE patients without neuropsychiatric manifestations and healthy individuals were also obtained. Of 66 patients with NP-SLE, 43 patients had diffuse psychiatric/neuropsychological syndromes (diffuse NP-SLE), 23 patients had neurologic syndromes (focal NP-SLE), as defined in nomenclature of American College of Rheumatology in 1999.IgG anti-NR2 were measured by enzyme-linked immunosorbent assay.
Result: Serum anti-NR2 were significantly elevated in diffuse NP-SLE patitents compared with those with neuro-Behçet disease, those with SLE without neuropsychiatric manifestations and healthy individuals. However there was no difference between patients with focal NP-SLE and those with diffuse NP-SLE. In addition, CSF anti-NR2 significantly elevated in patients with diffuse NP-SLE compared with patients with focal NP-SLE and those with non-inflammatory neurological diseases.
Conclusion: These results indicate that anti-NR2 in serum and CSF are associated with neuropsychiatric manifestation in SLE. Especially, quantitative determination of anti-NR2 in CSF is a useful tool for diagnosis NP-SLE.
<Case 1> 68-year-old female, who had ten years history of rheumatoid arthritis. She was hospitalized with renal insufficiency. The diagnosis of amyloidosis was made by the gastric biopsy and started hemodialysis. Two months later, pyrexia developed. <Case 2> 70-year-old female, who had four years history of polyarteritis nodosa. She was hospitalized with a recurrence of mononeuritis multiplex. The dosage of prednisolone was increased from 10 mg to 60 mg, and cyclophosphamide was used. Although, neurological signs improved, pyrexia developed. We were not able to identify pleural effusion in CT scans in either of the two cases. Ga scintigraphy showed the strong accumulation in both lung fields, and we diagnosed this as pleurisy. Since the antituberculous drugs was effective, tuberculosis pleurisy was highly suspected. In these cases, the diagnosis of pleuritis was difficult, due to a lack of pleural effusion. Ga scintigraphy was useful for diagnosis.
We report the case of a 60-year-old woman who presented with pneumatosis intestinalis and pneumomediastinum associated with polymyositis. She was admitted because of muscle weakness and she was diagnosed as polymyositis from muscle biopsy findings.
We administrated corticosteroids (prednisolone 1 mg/kg, 35 mg daily), but her dysphagia progressed due to polymyositis. She needed a temporary feed via nasogastric tube for her dysphagia. In the course of her disease, we inadvertently found intraperitoneal free gas on the abdominal x-ray examination. We performed an abdominal CT immediately, and we found an abnormality, which indicated pneumatosis intestinalis, pneumomediastinum, and pneumoperitoneum with retroperitoneal typical free air. Multiple and widespread emphysematosa disappeared gradually only with bed rest and corticosteroids therapy. Her prednisolone dose was tapered to 12 mg daily, when she was discharged. This case showed very unique complications, which appeared free air in mediastinum and retroperitonium by polymyositis. These complications might relate with polymyositis itself.