Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ): a patient-based evaluation tool for hip-joint disease. The Subcommittee on Hip Disease Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association.

BACKGROUND: The Japanese Orthopaedic Association Hip Score is widely used in Japan, but this tool is designed to reflect the viewpoint of health-care providers rather than that of patients. In gauging the effect of medical therapies in addition to clinical results, it is necessary to assess quality of life (QOL) from the viewpoint of patients. However, there is no tool evaluating QOL for Japanese patients with hip-joint disease. METHODS: With the aim of more accurately classifying QOL for Japanese patients with hip-joint disease, we prepared a questionnaire with 58 items for the survey derived from 464 opinions obtained from approximately 100 Japanese patients with hip-joint disease and previously devised evaluation criteria. In the survey, we collected information on 501 cases, and 402 were subjected to factor analysis. From this, we formulated three categories-movement, mental, and pain-each comprising 7 items, for a total of 21 items to be used as evaluation criteria for hip-joint function. RESULTS: The Cronbach's α coefficients for the three categories were 0.93, 0.93, and 0.95, respectively, indicating the high reliability of the evaluation criteria. The 21 items included some related to the Asian lifestyle, such as use of a Japanese-style toilet and rising from the floor, which are not included in other evaluation tools. CONCLUSIONS: This self-administered questionnaire may become a useful tool in the evaluation of not only Japanese patients, but also of members of other ethnic groups who engage in deep flexion of the hip joint during daily activities.

Pseudogout attack induced during etidronate disodium therapy.

We report the first case of pseudogout attack in the distal interphalangeal (DIP) joints during etidronate disodium therapy. A 64-year-old woman had intermittent administration of etidronate disodium (Didronel; Sumitomo, Osaka, Japan) alone because of osteoporosis. Each cycle consisted of a daily dose of 200 mg for 2 weeks, repeating every 12 weeks. Two weeks after completing the third cycle, severe pain and swelling occurred in the DIP joints of the right middle, ring, and left ring finger; and skin ulcer formation was observed on the dorsal side of the DIP joints of the right middle and ring fingers as well as the left ring finger. Because monoclinic calcium pyrophosphate crystals were detected in the synovial fluid from the DIP joints of the right middle finger, we diagnosed these symptoms as induced by pseudogout attack. Oral loxoprofen sodium at a daily dose of 180 mg resulted in rapid symptom resolution. A decrease in function of calcium metabolism in elderly persons has been reported to be a cause of pseudogout attack. On the other hand, distal interphalangeal joint arthritis presenting as Heberden's nodes is a common condition in elderly patients. Therefore, pseudogout attack should be considered as an adverse drug reaction when administering bisphosphonate in elderly patients with Heberden's nodes.