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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Spondyloarthritis &#40;SpA&#41; is a chronic inflammatory disease that encapsulates a group of conditions sharing similar clinical and radiological characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">1</span></a> They involve the axial skeleton and sacroiliac joints as well as peripheral joints&#46; The course of SpA is usually progressive&#44; characterized by chronic pain&#44; spinal deformity&#44; and mobility impairment&#44; leading to disability&#44; reduced quality of life &#40;QoL&#41;&#44; anxiety&#44; and depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">2&#44;3</span></a> SpA usually affects the young population when body image&#44; social relationships&#44; career&#44; leisure&#44; and social roles are prominent&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">1</span></a> Therefore&#44; SpA patients have challenges in maintaining positive self-esteem and community reintegration&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Self-esteem is a term used in psychology to describe a person&#39;s perception of their own worth&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">4</span></a> It is the overall positive or negative judgment that a person makes about himself&#46; Self-esteem has been identified as a determinant of well-being&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">4</span></a> In fact&#44; positive self-esteem was found to be significantly associated with emotional stability and better QoL&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">5&#44;6</span></a> Few studies investigated the relationship between rheumatic diseases and self-esteem&#46; Jorge et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">7</span></a> demonstrated that self-esteem was significantly lower in patients with rheumatoid arthritis compared to control group&#46; Studies on self-esteem among patients with SpA are rare&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">8</span></a> However&#44; it is an important outcome to investigate in order to improve the QoL of SpA patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other side&#44; community reintegration is defined as full participation in community&#46; It involves social relationships&#44; work&#44; leisure&#44; and daily activities&#46; Community reintegration is a commonly used concept to evaluate participation after a debilitating illness&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">9&#8211;11</span></a> Patients with SpA reported more difficulties when participating in roles compared to control group&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to investigate the associated factors with lower self-esteem and restriction in community reintegration among SpA patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study was a cross-sectional study conducted over a 6-month period &#91;September 2021&#8211;March 2022&#93;&#44; involving patients diagnosed with SpA &#40;either peripheral or axial&#41; based on the criteria of the Assessment of Spondyloarthritis International Society &#40;ASAS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">13&#44;14</span></a> The study was approved by the local hospital ethical committee&#46; Written informed consent was obtained from participants after the aims of the research had been explicitly explained to each patient&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patients aged 18&#8211;50 years were consecutively recruited from the rheumatology outpatient and&#47;or daycare hospital&#46; Non-inclusion criteria were&#58; history of psychotic illness&#44; alcohol and&#47;or drug abuse&#44; current treatment with psychotropics&#44; comorbidities &#40;diabetes mellitus&#44; cardiovascular disease&#44; active or chronic infection&#44; and cancer&#41;&#44; or other concomitants chronic or inflammatory diseases&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data collection</span><p id="par0035" class="elsevierStylePara elsevierViewall">Socio-demographic data&#58; age&#44; gender&#44; marital status&#44; number of children&#44; educational level &#40;illiterate&#44; primary&#44; secondary&#44; university&#41;&#44; employment status&#44; and living arrangement &#40;urban or rural areas&#41; were collected&#46; Disease-specific information including age at onset of SpA&#44; disease duration&#44; axial or peripheral form&#44; coxitis&#44; and extra-articular features were recorded&#46; The presence of articular or axial deformity was recorded by a &#8216;yes&#8217; or &#8216;no&#8217; answer based on physical examination at the time of enrollment&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patient-Reported Outcomes &#40;PRO&#41; were measured&#58; duration of morning stiffness&#44; number of nocturnal awakenings&#44; Patient Global Assessment &#40;PGA&#41;&#44; and intensity of pain and fatigue&#46; Each patient recorded the severity of pain and fatigue on a visual analog scale &#40;VAS&#41; from 0 to 10 &#40;0&#58; no pain&#47;fatigue&#44; 10&#58; worst imaginable pain&#47;fatigue&#41;&#46; Disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index &#40;BASDAI&#41;&#44; Ankylosing Spondylitis Disease Activity Score &#40;ASDAS&#41;&#44; and C-Reactive Protein &#40;CRP&#41; level&#46; The impact of SpA on quality of Life and functional ability were assessed using the Ankylosing Spondylitis Quality of Life &#40;ASQoL&#41; Scale&#44; and the Bath Ankylosing Spondylitis Functional Index &#40;BASFI&#41;&#44; respectively&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Medications were determined from participants&#8217; self-reports&#58; non-steroidal anti-inflammatory drugs &#40;NSAIDs&#41;&#44; conventional disease-modifying antirheumatic drugs &#40;csDMARDs&#41;&#44; and tumor necrosis factor inhibitors &#40;TNFi&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Measurements</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Self-esteem</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Rosenberg Self-Esteem Scale &#40;RSES&#41;</span>&#58; the Arabic version of RSES was used to assess the level of self-esteem among SpA patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">4&#44;15</span></a> Each item is rated on a 4-point scale &#40;1&#58; strongly disagree&#44; 4&#58; strongly agree&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The questionnaire consisted of 10 items&#44; 5 of which assessed positive self-esteem and 5 assessed negative self-esteem &#40;items 3&#44; 5&#44; 8&#44; 9&#44; and 10&#41;&#46; The scale was computed by rescaling the negative questions &#40;reverse scored&#41; and then adding the ten scores&#46; The total self-esteem score ranges from 10 to 40&#44; with higher values indicating higher self-esteem levels&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Community reintegration</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Reintegration to Normal Living Index &#40;RNLI&#41;</span>&#58; is a patient-reported outcome that measures the degree to which individuals achieve reintegration to normal social activities&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">16</span></a> The RNLI is an 11-item scale&#44; with 2 areas of assessment&#58; daily functioning &#40;the first 8 items&#41; and perceptions of self &#40;the remaining 3 items represent&#41;&#46; The RNLI assessed 8 domains&#58; indoor mobility&#44; community&#47;distance mobility&#44; self-care&#44; daily activities &#40;work and school&#41;&#44; recreational and social activities&#44; family roles&#44; personal relationships&#44; and presentation of self to others&#46; Each item is rated on a 10-point VAS&#44; with a score of 0 indicating &#8220;no reintegration&#8221; and 10 indicating &#8220;full reintegration&#8221;&#46; The sum of the scores was normalized to 100&#59; the minimum possible total score is 0 and the maximum is 100&#44; indicating no or full integration&#44; respectively&#46; The higher the score&#44; the better the patient-perceived community reintegration was&#46; RNLI score &#60;60 reflected severe restrictions in self-perceived community reintegration&#46; The RNLI has been recommended for use in measuring participation restriction among people with different illnesses&#44; and has demonstrated excellent validities and reliabilities with high utility&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">17&#44;18</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Anxiety and depression</span><p id="par0065" class="elsevierStylePara elsevierViewall">Anxiety and depression were screened using the two subscales of Hospital Anxiety and Depression Scale &#40;HADS&#41;&#58; HADS-A and HADS-D&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">19</span></a> Each subscale contains seven items on a four-point Likert scale &#40;ranging from 0 to 3&#41; to assess anxiety and depression&#46; The total score ranges from 0 to 21 points for each subscale&#44; and a score of 11 or higher indicates the presence of anxious or depressive disorders&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Pain interference</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Brief Pain Inventory &#40;BPI&#41;</span> was used to assess the level of pain interference &#40;PI&#41; in the past week on the following 7 domains&#58; general activity&#44; mood&#44; walking&#44; work&#44; relations with others&#44; sleep&#44; and enjoyment of life&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">20</span></a> Pain interference &#40;PI&#41; describes the influence of pain on daily living and is distinct from pain severity and other characteristics of pain&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Fibromyalgia</span><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fibromyalgia Rapid Screening Test &#40;FiRST&#41;</span>&#58; is a self-report questionnaire containing six questions&#46; A score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#47;6 indicates positive screening test for fibromyalgia&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Data were analyzed using the Statistical Software for the Social Sciences &#40;SPSS&#41; version 25&#46; Baseline descriptive of the SpA cohort was expressed as frequencies&#44; percentages&#44; median with interquartile range between the 25th and 75th percentiles &#40;IQR&#41;&#46; Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test and Kruskal&#8211;Wallis <span class="elsevierStyleItalic">H</span> test were used to compare two variables&#44; and more than 3 variables&#44; respectively&#46; Correlation between patients&#47;disease-related parameters and RLNI&#47;self-esteem was assessed using Spearman&#39;s correlation&#46; Multiple linear regression was performed to identify the associated factors with low scores of self-esteem and community reintegration among our SpA-patients sample&#46; We used the &#8220;Enter&#8221; method&#59; variables with a significance level of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;2 in univariate linear regression were selected into the multiple linear regression model&#46; The final model was selected on the basis of a good quality of the regression model &#40;a good <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> with significant <span class="elsevierStyleItalic">p</span>-values&#41;&#44; and after checking the collinearity between variables&#46; Model validation was conducted with the Durbin&#8211;Watson residual study&#46; The confidence interval was estimated at 95&#37; and statistical significance was indicated by a <span class="elsevierStyleItalic">p</span> value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 72 patients &#40;sex-ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;88&#41; participated in the present study&#44; with a median &#40;IQR&#41; age was 39 years &#40;28&#46;25&#8211;46&#41;&#46; The Median &#40;IQR&#41; number of children was 0 &#40;0&#8211;2&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> illustrates patients&#8217; baseline socio-demographic characteristics&#46; Median &#40;IQR&#41; disease duration was 10 &#40;6&#8211;14&#41; years&#46; Among enrolled patients&#44; 27&#46;3&#37; and 65&#37; had active disease according to BASDAI and ASDAS-CRP&#44; respectively&#46; Disease characteristics are detailed in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Median &#40;IQR&#41; HAD-A and HAD-D were 3 &#40;2&#8211;8&#41; and 5 &#40;3&#8211;8&#41;&#44; respectively&#46; According to HAD&#44; 10&#37; of SpA patients presented anxiety disorders and 11&#37; presented depression&#46; Ten percent had positive screening for fibromyalgia&#46; Median &#40;IQR&#41; total self-esteem score was 30 &#40;23&#46;25&#8211;34&#41;&#46; Median &#40;IQR&#41; RNLI score was 83 &#40;53&#46;25&#8211;93&#46;25&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; and 15&#46;5&#37; of patients indicated severe restrictions in self-perceived community reintegration&#46;</p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Bivariate analysis &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a>&#41;</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Self-esteem</span><p id="par0095" class="elsevierStylePara elsevierViewall">Correlation between RSES and patient-related parameters revealed negative correlation with marital status &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;287&#41;&#44; number of children &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;039&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;259&#41;&#44; HAD anxiety &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;379&#41; and HAD depression &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;46&#41;&#46; Single patients had higher RSES scores&#46; Regarding disease related parameters&#44; RSES was negatively correlated with VAS pain &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;239&#41;&#44; BASDAI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;034&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;254&#41;&#44; ASQoL &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;363&#41; and BASFI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;035&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;258&#41;&#46; Median RSES was higher among SpA patients treated with TNFi compared with those who were treated with NSAIDs &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;044&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Among the pain interference items&#44; mood and ability to work normally items were negatively correlated with RSES &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;271&#44; and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;351&#44; respectively&#41;&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Community reintegration &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a>&#41;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Concerning disease-related parameters&#44; RNLI score was significantly lower in SpA with inflammatory bowel disease &#40;IBD&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">RLNI was negatively correlated with ASQoL &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;464&#41;&#44; HAD anxiety &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;377&#41;&#44; HAD depression &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;588&#41;&#44; First test &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;479&#41;&#44; and the following domains of PI&#58; general activity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;377&#41;&#44; mood &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;38&#41;&#44; relations with others &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;036&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;276&#41;&#44; sleep &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;442&#41;&#44; and enjoyment of life &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;354&#41;&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Multivariate analysis &#40;<a class="elsevierStyleCrossRefs" href="#tbl0025">Tables 5 and 6</a>&#41;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Multivariate regression showed that the combination of the domain &#8220;work&#8221; of PI&#44; VAS pain&#44; HAD anxiety&#44; PGA&#44; marital status&#44; and morning stiffness explained 47&#46;7&#37; of the variance of RSES&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Reintegration community variance could be explained in 64&#46;8&#37; by the following associated factors&#58; IBD&#44; VAS pain&#44; FIRST&#44; deformity&#44; enjoyment of life&#44; and HAD depression&#46; The presence of IBD was the strongest associated factor with severe restriction in community reintegration&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">In the present study&#44; median &#40;IQR&#41; RSES and RNLI scores were 30 &#40;23&#46;25&#8211;34&#41;&#44; and 83 &#40;53&#46;25&#8211;93&#46;25&#41;&#44; respectively&#46; Severe restrictions in self perceived community reintegration were seen in 15&#46;5&#37;&#46; Associated factors with decreased self-esteem and restrictions in community reintegration were disease-related parameters &#40;prolonged morning stiffness&#44; the presence of articular&#47;axial deformity&#44; and IBD&#41;&#44; psychological factors &#40;anxiety and depressive disorders&#44; fibromyalgia&#41;&#44; severe pain intensity and interference &#40;enjoyment of life&#44; pain in work&#41;&#44; and social factors &#40;divorced status&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Studies on self-esteem among patients with SpA are sparse&#46; In line with our results&#44; Solmaz et al&#46; and Durmus D et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">8&#44;22</span></a> observed lower self-esteem score in ankylosing spondylitis group compared to control group&#46; In fact&#44; patients with chronic rheumatic disease face challenges in maintaining positive self-esteem&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">7&#44;23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Concerning perceived participation&#44; different self-reported questionnaires can be used&#46; The RLNI is a brief questionnaire developed for assessing reintegration to normal living after a disabling illness&#46; The concept of reintegration was used to evaluate perceived participation&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a> Studies in the literature used the social role participation questionnaire &#40;SRPQ&#41; to evaluate social role participation among patients with SpA across two dimensions &#40;experienced physical difficulties and satisfaction with performance&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">12&#44;25&#8211;29</span></a> Van Genderen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">12</span></a> noted that patients with SpA were less satisfied with their performance in roles and had more difficulties when participating in roles compared to control group&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">When looking at associated factors with declined self-esteem and severe restriction in community reintegration identified in our study&#44; mental health symptoms appeared to explain low self-acceptance&#46; Anxiety and depression are frequent psychological disorders in SpA patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">30&#44;31</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">As previously reported in the literature&#44; depression was correlated with low satisfaction in participation&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">25&#44;27&#44;28</span></a> Both experienced physical difficulties and satisfaction with role performance were significantly associated with the mental health item of the Short Form-36 Health Survey &#40;SF-36&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Moreover&#44; studies that have focused on body image among patients with SpA demonstrated a strong link between a positive body image and a high self-esteem&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">8&#44;23&#44;32</span></a> A Chinese study showed a significant association between self-esteem and anxiety through the impact of body image disturbance on anxiety&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">33</span></a> Best predictors for impaired health-related QoL in the dimension self-esteem were social isolation and depression&#47;anxiety in children and adolescents with juvenile idiopathic arthritis and reactive arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">34</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the first study to identify a high FiRST score as an associated factor with restricted community reintegration&#46; In a recent meta-analysis&#44; the prevalence of fibromyalgia was 16&#46;4&#37; among a total of 5214 SpA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">35</span></a> It has been proven that fibromyalgia among SpA patients negatively affects disease activity&#44; functional status&#44; pain level&#44; QoL and mental health&#46;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">36&#8211;38</span></a> Thus&#44; fibromyalgia may impact community reintegration through mental health symptoms&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Regarding pain&#44; severe pain intensity and interference were associated factors with low self-esteem and restriction in community reintegration&#46; This was consistent with the literature findings&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">23&#44;39</span></a> Bagcivan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">39</span></a> confirmed the negative impact of chronic pain on restricted participation including daily life activities&#44; family responsibilities&#44; and work in SpA patients&#46; Patients living with chronic pain are more likely to suffer from anxiety&#44; depression&#44; emotional distress and low self-esteem&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">39</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Work item of PI was an associated factor with lower self-esteem&#44; which can be explained by the decline of work productivity due to the impact of chronic pain&#46; Self-esteem may be disrupted in the context of lost employment&#44; as showed Barlow JH et al&#46; that work disability was associated with anxious and depressed mood and lower self-esteem in SpA&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">40</span></a> In fact&#44; SpA can be the cause of low work productivity and impairment leading to limitation in career progress in some patients and therefore to low self-esteem&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">41&#8211;43</span></a> Work productivity and impairment were correlated to disease status&#44; QoL&#44; and intensity of pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">41&#44;42</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">When looking at disease-related parameters&#44; prolonged morning stiffness&#44; axial&#47;peripheral deformity&#44; and IBD were the associated factors with a low self-esteem and community reintegration&#46; The presence of IBD was the strongest associated factor with severe restriction in community reintegration&#46; IBD are characterized by the occurrence of abdominal pain with diarrhea and a relapsing clinical course&#46; In a recent systematic review and meta-analysis&#44; QoL scores were lower in patients with IBD compared to control group&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">44</span></a> Patients with IBD presented as well high rates of anxiety and depression&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">45</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Physical deformity may affect the patient&#39;s self-esteem and community participation through its impact on body image and mental health symptoms&#46; These finding was reported in RA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">46</span></a> Patients with physical deformity &#40;axial skeleton or peripheral joint&#41; tried to conceal their deformity especially in work and social situations&#46; Masking and concealing illness from others produced negative feelings as of shame and guilt around various aspects of self-managing the condition&#46; Self-confidence may be reduced when the person compares their current and past functioning or participation&#44; his social activity progressively decreases&#44; which alters their community reintegration&#46; Therefore&#44; social and emotional learning must be an important part of the work of self-management for patients with rheumatic inflammatory diseases&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In concordance with our results&#44; Bode et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a> noted a significant correlation of self-esteem with functional impairment among patients with rheumatic diseases including SpA and rheumatoid arthritis&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">RSES was significantly higher among patients with TNFi&#46; In fact&#44; TNFi are very effective and lead to improvement in pain&#44; disease activity&#44; spinal mobility&#44; and thus the QoL of patients with SpA&#46;<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">47&#44;48</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">This is the first study to investigate the associated factors with self-esteem and community reintegration among patients with SpA&#46; However&#44; this study has some limitations&#46; The single-center study design may not be representative of SpA in our country&#46; A multi-centric study is required to generalize our findings&#46; The cross-sectional design of the study and the lack of a control group do not allow to prove the causality&#46; Besides&#44; despite being significative&#44; some correlations were quite poor&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclusion</span><p id="par0195" class="elsevierStylePara elsevierViewall">In summary&#44; pain intensity and interference&#44; deformities&#44; extra-articular manifestations &#40;IBD&#41; and deterioration of mental health were associated with low self-esteem and severe restriction in community reintegration among patients with SpA rather than inflammatory parameters&#46; These results suggest a relevant role of psychosocial aspects in SpA patient outcome&#44; which should alert physicians to the need of a holistic approach of the patient&#46; Specific management of different pain components is required to improve health-related quality of life&#46; Screening of mental health symptoms enables us to refer SpA patients for a personalized personal development program with social and emotional learning to enhance self-esteem&#44; self-acceptance and promote community reintegration&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Funding</span><p id="par0205" class="elsevierStylePara elsevierViewall">None to declare&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflict of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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    "fechaAceptado" => "2022-11-17"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to identify the associated factors with lower self-esteem and restriction in community reintegration in SpA patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study was a cross-sectional study including SpA patients &#40;ASAS criteria&#41; aged 18&#8211;50 years&#46; The level of self-esteem was assessed using the Rosenberg Self-Esteem Scale &#40;RSES&#41;&#46; The Reintegration to Normal Living Index &#40;RNLI&#41; evaluated the degree of reintegration to normal social activities&#46; Anxiety&#44; depression&#44; and fibromyalgia were screened by the Hospital Anxiety and Depression Scale &#40;HADS&#41;-A&#44; HADS-D&#44; and FiRST&#44; respectively&#46; Statistical analysis was performed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 72 patients were enrolled &#40;sex-ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;88&#41;&#44; with median &#40;IQR&#41; age of 39 years &#40;28&#46;25&#8211;46&#41;&#46; Median &#40;IQR&#41; disease duration was 10 &#40;6&#8211;14&#41; years&#46; Median &#40;IQR&#41; BASDAI and ASDAS were 3 &#40;2&#46;1&#8211;4&#46;7&#41; and 2&#46;7 &#40;1&#46;9&#8211;3&#46;48&#41;&#44; respectively&#46; Anxiety symptoms were screened in 10&#37; of SpA patients&#44; depression in 11&#37;&#59; and fibromyalgia in 10&#37;&#46; Median &#40;IQR&#41; RSES and RNLI scores were 30 &#40;23&#46;25&#8211;34&#41;&#44; and 83 &#40;53&#46;25&#8211;93&#46;25&#41;&#44; respectively&#46; Multivariate regression analysis identified the domain &#40;work&#41; of pain interference&#44; VAS pain&#44; HAD anxiety&#44; PGA&#44; marital status&#44; and morning stiffness as factors associated with lower self-esteem&#46; Restriction in the reintegration community was predicted by the presence of IBD&#44; VAS pain&#44; FIRST&#44; deformity&#44; enjoyment of life&#44; and HAD depression&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pain intensity and interference&#44; deformities&#44; extra-articular manifestations&#44; and deterioration of mental health were associated with low self-esteem and severe restriction in community reintegration among patients with SpA rather than inflammatory parameters&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue identificar el factor asociado a la baja autoestima y la restricci&#243;n en la reintegraci&#243;n comunitaria en pacientes con espondiloartritis &#40;EspA&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudio fue un estudio transversal llevado a cabo incluyendo a pacientes con EspA &#40;criterios ASAS&#41; de entre 18 y 50 a&#241;os de edad&#46; El nivel de autoestima se evalu&#243; mediante la Rosenberg Self-Esteem Scale &#40;RSES&#41;&#46; El Reintegration to Normal Living Index &#40;RNLI&#41; evalu&#243; el grado de reintegraci&#243;n a las actividades sociales normales&#46; La ansiedad&#44; la depresi&#243;n y la fibromialgia se evaluaron mediante la Hospital Anxiety and Depression Scale &#40;HADS&#41;-A&#44; HADS-D y FIRST&#44; respectivamente&#46; Se realiz&#243; un an&#225;lisis estad&#237;stico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se inscribieron 72 pacientes &#40;raz&#243;n por sexo&#58; 1&#44;88&#41;&#44; con una mediana &#40;IQR&#41; de edad de 39 a&#241;os &#40;28&#44;25-46&#41;&#46; La IQR de la duraci&#243;n de la enfermedad fue de 10 &#40;6-14&#41; a&#241;os&#46; La IQR de BASDAI y ASDAS fue de 3 &#40;2&#44;1-4&#44;7&#41; y 2&#44;7 &#40;1&#44;9-3&#44;48&#41;&#44; respectivamente&#46; Se detectaron s&#237;ntomas de ansiedad en el 10&#37; de los pacientes con EspA&#44; depresi&#243;n en el 11&#37; y fibromialgia en el 10&#37;&#46; La IQR de las puntuaciones RSES y RNLI fue de 30 &#40;23&#44;25-34&#41; y 83 &#40;53&#44;25-93&#44;25&#41;&#44; respectivamente&#46; El an&#225;lisis de regresi&#243;n multivariante identific&#243; el dominio &#40;trabajo&#41; de la interferencia del dolor&#44; el dolor VAS&#44; la ansiedad HAD&#44; la PGA&#44; el estado civil y la rigidez matinal como factores asociados a una menor autoestima&#46; La restricci&#243;n en la comunidad de reintegraci&#243;n se predijo por la presencia de EII&#44; el dolor VAS&#44; la herramienta FIRST&#44; la deformidad&#44; el disfrute de la vida y la depresi&#243;n HAD&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La intensidad y la interferencia del dolor&#44; las deformidades&#44; las manifestaciones extra-articulares y el deterioro de la salud mental se asociaron a una baja autoestima y de una severa restricci&#243;n en la reintegraci&#243;n a la comunidad entre los pacientes con EspA m&#225;s que los par&#225;metros inflamatorios&#46;</p></span>"
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Marital status</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Single&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Married&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Divorced&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupation</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Student&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unemployed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Housekeeper&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Civil&#47;private sector&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Self-employed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Location</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urban&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Educational level</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Illiterate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Secondary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spondyloarthritis form</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Axial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Axial and peripheral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peripheral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deformity articular&#47;axial</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Psoriasis</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inflammatory Bowel disease</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coxitis</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NSAIDs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TNFi&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ASDAS&#58; Ankylosing Spondylitis Disease Activity Score&#59; BASDAI&#58; Bath Ankylosing Spondylitis Disease Activity index&#59; BASFI&#58; Bath Ankylosing Spondylitis functional index&#59; CRP&#58; C reactive protein&#59; Max&#58; maximum&#59; Min&#58; minimum&#59; PGA&#58; patient global assessment&#59; VAS&#58; visual analog scale&#59; SpA&#58; spondyloarthritis&#59; ASQoL&#58; Ankylosing Spondylitis Quality of Life Scale&#59; RSES&#58; Rosenberg Self-Esteem Scale&#59; RLNI&#58; The Reintegration to Normal Living Index&#59; HADS&#58; Hospital Anxiety and Depression Scale&#59; BPI&#58; The Brief Pain Inventory&#59; FiRST&#58; Fibromyalgia Rapid Screening Test&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median &#40;IQR 25&#8211;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Age at onset of SpA &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;18&#8211;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Disease duration &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;6&#8211;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">VAS pain</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#46;5&#8211;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">PGA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">VAS fatigue</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Morning stiffness &#40;minutes&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;1&#8211;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Number of nocturnal awakenings</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">BASDAI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;1&#8211;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">ASDAS CRP</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7 &#40;1&#46;9&#8211;3&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">BASFI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5 &#40;1&#46;8&#8211;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">ASQoL</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">CRP &#40;mg&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">257&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">HADS anxiety</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">HADS depression</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Walking&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3 &#40;2&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;23&#46;25&#8211;34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83 &#40;53&#46;25&#8211;93&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">110&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3327172.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient and disease parameters &#40;quantitative data&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ASDAS&#58; Ankylosing Spondylitis Disease Activity Score&#59; BASDAI&#58; Bath Ankylosing Spondylitis Disease Activity index&#59; BASFI&#58; Bath Ankylosing Spondylitis functional index&#59; CRP&#58; C reactive protein&#59; VAS&#58; visual analog scale&#59; SpA&#58; spondyloarthritis&#59; ASQoL&#58; Ankylosing Spondylitis Quality of Life Scale&#59; RSES&#58; Rosenberg Self-Esteem Scale&#59; RLNI&#58; The Reintegration to Normal Living Index&#59; HADS&#58; Hospital Anxiety and Depression Scale&#59; BPI&#58; The Brief Pain Inventory&#59; FiRST&#58; Fibromyalgia Rapid Screening Test&#46;</p>"
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                  \t\t\t\t\ttable-entry\n
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                  """
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                        "tituloSerie" => "Rheum Dis Clin North Am"
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