Objective. To cross-culturally adapt a brief selfassessment questionnaire to measure outcome among English-or Spanish-speaking patients with arthritis.Methods. A questionnaire containing the following items was translated to Spanish: the 8 activities of daily living (ADL) questions of the Modified Health Assessment Questionnaire; a question about the duration of morning stiffness; and a 10-point pain scale. Equivalence to the original English, test-retest reliability, and construct, criterian, and discriminant validity were determined on a population of patients from 4 clinical centers.Results. EnglishSpanish equivalence and testretest reliability of the questionnaire were almost perfect (intra-class correlation coefficients [ri] 20.90 for each). Construct validity, measured by comparing questionnaire scores with an occupational therapist's evaluation, was also near-perfect in both languages (ri = 0.93 for English and 0.89 for Spanish). Both versions of the questionnaire correlated well with the physiciandetermined Steinbrocker functional class, as well as with the amount of pain, grip strength, and walking velocity. Patients with systemic lupus erythematosus, rheumatoid arthritis, osteoarthritis, and fibromyalgia differed significantly in their pgin:ADL ratios, in both languages.Conclusion. The items of the Spanish questionnaire that we have adapted are equivalent to the original English versions. This questionnaire is suitable for studying Spanish-speaking subjects with arthritis in the US and elsewhere.A brief self-administered questionnaire is a convenient way of measuring the outcome of arthritis under routine clinical conditions (1). Most of these questionnaires have been developed to study Englishspeaking patients, and their performance in this population is amply documented (2-4). Although a number of these instruments have also been translated and used successfully in other countries ( 5 4 , there have been no studies examining their performance in a routine clinical environment among non-Englishspeaking U.S. populations.One of the obstacles to the widespread application of brief self-assessment questionnaires in the US is the existence of large numbers of non-Englishspeaking subjects in certain areas of the country. Spanish is the most important non-English language in the US, simply because of the numbers involved: census data show that in 1990 there were more than 17,000,000 people older than age 5 years in the US who spoke Spanish at home, and nearly half of them spoke English less than "very well" (9). Because of this, any self-assessment questionnaire that is not available in Spanish will systematically exclude a substantial portion of the population. More importantly, Spanish translations of questionnaires originally developed in

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Tubulointerstitial nephritis (TIN) is the main renal involvement associated with primary Sjögren syndrome (pSS). TIN can manifest as distal renal tubular acidosis (RTA), nephrogenic diabetes insipidus, proximal tubular dysfunction, and others. We present a 31-year-old female with hypokalemic paralysis due to distal RTA (dRTA). She received symptomatic treatment and hydroxychloroquine with a good response. There is insufficient information on whether to perform a kidney biopsy in these patients or not. The evidence suggests that there is an inflammatory background and therefore a potential serious affection to these patients, such as hypokalemic paralysis. We found 52 cases of hypokalemic paralysis due to dRTA in pSS patients. The majority of those patients were treated only with symptomatic medication. Patients who received corticosteroids had stable evolution even though they did not have another symptomatology. With such heterogeneous information, prospective studies are needed to assess the value of adding corticosteroids as a standardized treatment of this manifestation.

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