Letter to the Editor
Rheumatic Polymyalgia With Pleuropericardial Effusion: An Uncommon Association
Polimialgia reumática con derrame pleuropericárdico: una asociación infrecuente
Melania Martínez-Morillo
, Samantha Rodríguez-Muguruza, Anne Riveros-Frutos, Alejandro Olivé
Corresponding author
Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
Read
5972
Timeswas read the article
2609
Total PDF
3363
Total HTML
Share statistics
array:23 [ "pii" => "S2173574314001488" "issn" => "21735743" "doi" => "10.1016/j.reumae.2014.02.014" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "702" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2013" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Reumatol Clin. 2015;11:123-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1415 "formatos" => array:3 [ "EPUB" => 42 "HTML" => 1118 "PDF" => 255 ] ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S1699258X14001521" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2014.02.014" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "702" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Reumatol Clin. 2015;11:123-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4658 "formatos" => array:3 [ "EPUB" => 143 "HTML" => 3289 "PDF" => 1226 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Polimialgia reumática con derrame pleuropericárdico: una asociación infrecuente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "123" "paginaFinal" => "124" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Rheumatic polymyalgia with pleuropericardial effusion: An uncommon association" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Melania Martínez-Morillo, Samantha Rodríguez-Muguruza, Anne Riveros-Frutos, Alejandro Olivé" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Melania" "apellidos" => "Martínez-Morillo" ] 1 => array:2 [ "nombre" => "Samantha" "apellidos" => "Rodríguez-Muguruza" ] 2 => array:2 [ "nombre" => "Anne" "apellidos" => "Riveros-Frutos" ] 3 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Olivé" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574314001488" "doi" => "10.1016/j.reumae.2014.02.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314001488?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14001521?idApp=UINPBA00004M" "url" => "/1699258X/0000001100000002/v5_201706020244/S1699258X14001521/v5_201706020244/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173574314001737" "issn" => "21735743" "doi" => "10.1016/j.reumae.2014.07.007" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "704" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Reumatol Clin. 2015;11:124-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2357 "formatos" => array:3 [ "EPUB" => 46 "HTML" => 1873 "PDF" => 438 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Schnitzler Syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "124" "paginaFinal" => "125" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Schnitzler" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 654 "Ancho" => 994 "Tamanyo" => 132855 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous maculopapular lesions, non-painful or itchy, at trunk level.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jesica Gallo, Sergio Paira" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Jesica" "apellidos" => "Gallo" ] 1 => array:2 [ "nombre" => "Sergio" "apellidos" => "Paira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X14001545" "doi" => "10.1016/j.reuma.2014.07.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14001545?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314001737?idApp=UINPBA00004M" "url" => "/21735743/0000001100000002/v2_201502230158/S2173574314001737/v2_201502230158/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173574314001506" "issn" => "21735743" "doi" => "10.1016/j.reumae.2014.04.005" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "679" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "subdocumento" => "sco" "cita" => "Reumatol Clin. 2015;11:121-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4817 "formatos" => array:3 [ "EPUB" => 51 "HTML" => 4523 "PDF" => 243 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Acromioclavicular Synovial Cyst With Rotator Cuff Integrity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "122" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Quiste sinovial acromioclavicular con integridad del manguito rotador" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1328 "Ancho" => 1300 "Tamanyo" => 217666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) External appearance of the tumor. (B) Shoulder CT, through the acromioclavicular joint, in which communication between the joint and the tumor (arrow) is seen. (C) Coronal section through the acromioclavicular joint with capsular distension.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Antonio Guillén Astete, Cristina de la Casa Resino" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carlos Antonio" "apellidos" => "Guillén Astete" ] 1 => array:2 [ "nombre" => "Cristina" "apellidos" => "de la Casa Resino" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X1400093X" "doi" => "10.1016/j.reuma.2014.04.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1400093X?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314001506?idApp=UINPBA00004M" "url" => "/21735743/0000001100000002/v2_201502230158/S2173574314001506/v2_201502230158/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Rheumatic Polymyalgia With Pleuropericardial Effusion: An Uncommon Association" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "123" "paginaFinal" => "124" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Melania Martínez-Morillo, Samantha Rodríguez-Muguruza, Anne Riveros-Frutos, Alejandro Olivé" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Melania" "apellidos" => "Martínez-Morillo" "email" => array:1 [ 0 => "melaniamm@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Samantha" "apellidos" => "Rodríguez-Muguruza" ] 2 => array:2 [ "nombre" => "Anne" "apellidos" => "Riveros-Frutos" ] 3 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Olivé" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Polimialgia reumática con derrame pleuropericárdico: una asociación infrecuente" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have carefully read the article by Sánchez Ruiz-Granados et al. Published in your journal and which touched upon a case of Polymyalgia Rheumatica (PMR) and a pleuropericardial effusion.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It described the case of an 80-year-old male with joint pain on the scapular and pelvic girdles, with constitutional signs, who presented a pleuropericardial effusion and an elevation of acute phase reactants. Among other diagnosis, elderly onset rheumatoid arthritis (<span class="elsevierStyleItalic">EORA</span>) was ruled out due to the affection of the scapular and pelvic girdles and rheumatoid factor negativity. This conclusion led to our unease and we would like to comment on a series of facts.</p><p id="par0010" class="elsevierStylePara elsevierViewall">PMR is an inflammatory disease of elderly patients characterized by pain and morning stiffness in the cervical region as well as the scapular and pelvic girdles and elevated erythrocyte sedimentation rate. Immunological testing is typically negative and X-rays show no alterations. Due to the absence of specific tests, its excellent response to steroids is considered part of the diagnosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Recent echographic and magnetic resonance tests have shown the almost constant presence of extra-articular inflammation in the form of subacromial bursitis or bicipital tendinitis, leading to the inclusion of these alterations in the new diagnostic criteria for PMR.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> As may be understood, the diagnostic difficulty for PMR is inherent in its definition and the absence of specific testing. Therefore, in the differential diagnosis the clinician must take into account other rheumatic and non-rheumatic diseases that may simulate PMR.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> Among non-rheumatic causes one finds some infections and tumors that in the case at hand were reasonably ruled out. However, among the rheumatic causes, EORA stands out and we consider that it cannot be ruled out. EORA differs from rheumatoid arthritis of younger patients because it affects women with less frequency, has a more acute onset of disease, is more commonly accompanied by constitutional symptoms and, frequently, affects large joints, especially the shoulders, simulating PMR, with less affection of metacarpophalangeal joints. It presents with high erythrocyte sedimentation rate and the percentage of patients with positive rheumatoid factor is reduced in relation to younger patients. Due to these characteristics, its onset may be undistinguishable from PMR.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the case at hand, although the patient has PMR criteria, the presence of a pleuropericardial effusion leads to doubts on the diagnosis. The literature describes the association of PMR and pleuropericardial effusion rarely,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–13</span></a> as commented on by the authors, while the association of EORA –both seronegative and seropositive –with the presence of pleural or pericardial effusion, has been widely described.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">On the other hand, as has been commented, a girdle syndrome similar to PMR is seen with relative frequency in EORA due to shoulder affection as a presenting manifestation, along with constitutional syndrome and elevation of acute phase reactants. The good response to steroids is also one of the characteristics shared with PMR.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> Therefore, contrary to what is commented by the case authors, the clinical presentation is perfectly compatible with an EORA diagnosis. Lastly, it is important to remember that negativity for anti-cyclic citrullinated peptide antibody negativity is also important (ACPA) is also useful to rule out EORA, something not reported by the authors. In any case, the absence of rheumatoid factor (RF) or ACPA would not rule out EORA either, because seronegative forms exist.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, we believe that it is risky to diagnose PMR in the patient described due to its clinical similarity with EORA. It would be important to know if there was peripheral arthritis, ACPA titers and echographic or magnetic resonance evaluation of the patients’ shoulders in order to rule out one entity or the other. Obviously, clinical follow up will also contribute fundamental data for a final diagnosis because, in many cases of elderly onset arthritis, disease evolution is the only key to reach a concrete diagnosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez-Morillo M, Rodríguez-Muguruza S, Riveros-Frutos A, Olivé A. Polimialgia reumática con derrame pleuropericárdico: una asociación infrecuente. Reumatol Clin. 2015;11:123–124.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presentación de un caso de derrame pleurocárdico en un paciente diagnosticado de polimialgia reumática" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Sánchez Ruiz-Granados" 1 => "M. del Castillo Madrigal" 2 => "M.J. Romero Jiménez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2012.10.017" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2013" "volumen" => "9" "paginaInicial" => "376" "paginaFinal" => "378" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23453662" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Provisional classification criteria for polymyalgia rheumatica: a European League against rheumatism/American College of Rheumatology collaborative initiative" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Dasgupta" 1 => "M.A. Cimmino" 2 => "H.M. Kremers" 3 => "W.A. Schmidt" 4 => "M. Schirmer" 5 => "C. Salvarani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.34356" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "943" "paginaFinal" => "954" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22389040" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of the new 2012 EULAR/ACR classification criteria for polymyalgia rheumatica: comparison with the previous criteria in a single-centre study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Macchioni" 1 => "L. Boiardi" 2 => "M. Catanoso" 3 => "G. Pazzola" 4 => "C. Salvarani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2013-204167" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2014" "volumen" => "73" "paginaInicial" => "1190" "paginaFinal" => "1193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24297384" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arthritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.T. Pease" 1 => "G. Haugeberg" 2 => "A.W. Morgan" 3 => "B. Montague" 4 => "E.M. Hensor" 5 => "B.B. Bhakta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Rheumatol" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "1043" "paginaFinal" => "1046" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15940765" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1529943013012230" "estado" => "S300" "issn" => "15299430" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia manifestations in different conditions mimicking polymyalgia reumatica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. González-Gay" 1 => "C. García-Porrúa" 2 => "C. Salvarani" 3 => "I. Olivieri" 4 => "G.G. Hunder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2000" "volumen" => "18" "paginaInicial" => "755" "paginaFinal" => "759" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11138344" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedades que simulan polimialgia reumática" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Ceccato" 1 => "C. Uña" 2 => "M. Regidor" 3 => "O. Rillo" 4 => "S. Babini" 5 => "S. Paira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2010.09.001" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2011" "volumen" => "7" "paginaInicial" => "156" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21794806" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Artritis reumatoide del anciano" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Olivé Marqués" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Reumatol" "fecha" => "2003" "volumen" => "30" "paginaInicial" => "66" "paginaFinal" => "70" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elderly-onset rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. van Schaardenburg" 1 => "F.C. Breedveld" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "1994" "volumen" => "23" "paginaInicial" => "367" "paginaFinal" => "378" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7939723" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica and pericardial effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Bohan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1984" "volumen" => "101" "paginaInicial" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6732086" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica and pericardial effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Cobo" 1 => "Z. Zubera-Salibarria" 2 => "J. Muñoz-Sánchez" 3 => "J.M. Santamaría-Jauregui" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1991" "volumen" => "8" "paginaInicial" => "362" "paginaFinal" => "363" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica as an unusual cause of pleural and pericardial effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.B. Malone" 1 => "G.M. McCarthy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2005" "volumen" => "11" "paginaInicial" => "59" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16357699" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1529943013019657" "estado" => "S300" "issn" => "15299430" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica and pericardial tamponade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Brucato" 1 => "G. Brambilia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2002" "volumen" => "61" "paginaInicial" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11830449" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pericardial tamponade in a patient with polymyalgia rheumatica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Calvo" 1 => "E. Becerra" 2 => "F.J. López-Longo" 3 => "F.J. Cabrera" 4 => "L. Carreño" 5 => "A. Paravisini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2009" "volumen" => "1" "paginaInicial" => "S83" "paginaFinal" => "S85" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart involvement in rheumatoid arthritis: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Corrao" 1 => "S. Messina" 2 => "G. Pistone" 3 => "L. Calvo" 4 => "R. Scaglione" 5 => "G. Licata" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2012.05.057" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2013" "volumen" => "167" "paginaInicial" => "2031" "paginaFinal" => "2038" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22703938" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rheumatoid pleural effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Balbir-Gurman" 1 => "M. Yigla" 2 => "A.M. Nahir" 3 => "Y. Braun-Moscovici" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2006.03.002" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2006" "volumen" => "35" "paginaInicial" => "368" "paginaFinal" => "378" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16765714" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early rheumatoid arthritis: the performance of the 2010 ACR/EULAR criteria for diagnosing RA" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.D. Mjaavatten" 1 => "V.P. Bykerk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.berh.2013.09.001" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Rheumatol" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "451" "paginaFinal" => "466" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24315048" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001100000002/v2_201502230158/S2173574314001488/v2_201502230158/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001100000002/v2_201502230158/S2173574314001488/v2_201502230158/en/main.pdf?idApp=UINPBA00004M&text.app=https://www.reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314001488?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 50 | 35 | 85 |
| 2024 September | 56 | 23 | 79 |
| 2024 August | 65 | 46 | 111 |
| 2024 July | 48 | 54 | 102 |
| 2024 June | 43 | 44 | 87 |
| 2024 May | 53 | 56 | 109 |
| 2024 April | 54 | 49 | 103 |
| 2024 March | 50 | 47 | 97 |
| 2024 February | 34 | 40 | 74 |
| 2024 January | 43 | 32 | 75 |
| 2023 December | 24 | 35 | 59 |
| 2023 November | 30 | 38 | 68 |
| 2023 October | 43 | 42 | 85 |
| 2023 September | 61 | 39 | 100 |
| 2023 August | 46 | 37 | 83 |
| 2023 July | 33 | 37 | 70 |
| 2023 June | 31 | 53 | 84 |
| 2023 May | 39 | 36 | 75 |
| 2023 April | 29 | 30 | 59 |
| 2023 March | 43 | 55 | 98 |
| 2023 February | 28 | 46 | 74 |
| 2023 January | 36 | 58 | 94 |
| 2022 December | 36 | 71 | 107 |
| 2022 November | 42 | 44 | 86 |
| 2022 October | 53 | 42 | 95 |
| 2022 September | 40 | 43 | 83 |
| 2022 August | 26 | 44 | 70 |
| 2022 July | 29 | 71 | 100 |
| 2022 June | 26 | 48 | 74 |
| 2022 May | 48 | 62 | 110 |
| 2022 April | 33 | 64 | 97 |
| 2022 March | 41 | 64 | 105 |
| 2022 February | 38 | 76 | 114 |
| 2022 January | 47 | 67 | 114 |
| 2021 December | 34 | 53 | 87 |
| 2021 November | 32 | 47 | 79 |
| 2021 October | 45 | 57 | 102 |
| 2021 September | 41 | 46 | 87 |
| 2021 August | 31 | 42 | 73 |
| 2021 July | 25 | 33 | 58 |
| 2021 June | 35 | 36 | 71 |
| 2021 May | 38 | 48 | 86 |
| 2021 April | 120 | 95 | 215 |
| 2021 March | 56 | 27 | 83 |
| 2021 February | 36 | 35 | 71 |
| 2021 January | 27 | 33 | 60 |
| 2020 December | 47 | 17 | 64 |
| 2020 November | 43 | 20 | 63 |
| 2020 October | 28 | 12 | 40 |
| 2020 September | 43 | 24 | 67 |
| 2020 August | 24 | 16 | 40 |
| 2020 July | 27 | 15 | 42 |
| 2020 June | 38 | 22 | 60 |
| 2020 May | 31 | 20 | 51 |
| 2020 April | 29 | 15 | 44 |
| 2020 March | 17 | 13 | 30 |
| 2018 May | 6 | 1 | 7 |
| 2018 April | 47 | 7 | 54 |
| 2018 March | 91 | 3 | 94 |
| 2018 February | 26 | 4 | 30 |
| 2018 January | 74 | 7 | 81 |
| 2017 December | 25 | 7 | 32 |
| 2017 November | 29 | 4 | 33 |
| 2017 October | 25 | 8 | 33 |
| 2017 September | 21 | 5 | 26 |
| 2017 August | 16 | 12 | 28 |
| 2017 July | 18 | 7 | 25 |
| 2017 June | 46 | 11 | 57 |
| 2017 May | 33 | 10 | 43 |
| 2017 April | 24 | 5 | 29 |
| 2017 March | 29 | 2 | 31 |
| 2017 February | 17 | 3 | 20 |
| 2017 January | 26 | 10 | 36 |
| 2016 December | 57 | 17 | 74 |
| 2016 November | 32 | 3 | 35 |
| 2016 October | 46 | 7 | 53 |
| 2016 September | 50 | 9 | 59 |
| 2016 August | 32 | 9 | 41 |
| 2016 July | 23 | 4 | 27 |
| 2015 December | 2 | 0 | 2 |
| 2015 November | 1 | 15 | 16 |
| 2015 October | 1 | 16 | 17 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 22 | 6 | 28 |
| 2015 June | 21 | 4 | 25 |
| 2015 May | 74 | 17 | 91 |
| 2015 April | 104 | 26 | 130 |
| 2015 March | 89 | 13 | 102 |
| 2015 February | 8 | 3 | 11 |
Show all
