Subclinical synovitis and tenosynovitis by ultrasonography (US) 7 score in patients with rheumatoid arthritis treated with synthetic drugs, in clinical remission by DAS28

array:23 ["pii" => "S1699258X1730270X" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2017.10.011" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1147" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2019;15:e5-e9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 764 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 277 "PDF" => 444 ] ] "itemSiguiente" => array:19 [ "pii" => "S1699258X17302784" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2017.11.004" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1155" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2019;15:e10-e13" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 663 "formatos" => array:3 [ "EPUB" => 67 "HTML" => 317 "PDF" => 279 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original breve" "titulo" => "Reumatología privada ambulatoria, estudio descriptivo en la Comunidad de Madrid" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e10" "paginaFinal" => "e13" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Private Rheumatology in the Community of Madrid, Spain: Descriptive Study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1072 "Ancho" => 1512 "Tamanyo" => 65871 ] ] "descripcion" => array:1 [ "es" => "Relación de pacientes atendidos en la consulta ambulatoria privada según la compañía de seguro." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Carlos Nieto González" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Nieto González" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574318301771" "doi" => "10.1016/j.reumae.2018.12.007" "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/S2173574318301771?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302784?idApp=UINPBA00004M" "url" => "/1699258X/0000001500000005/v1_201910230648/S1699258X17302784/v1_201910230648/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1699258X17302723" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2017.10.013" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1149" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2019;15:e1-e4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 609 "formatos" => array:3 [ "EPUB" => 36 "HTML" => 199 "PDF" => 374 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Validation of fragility fractures in primary care electronic medical records: A population-based study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e1" "paginaFinal" => "e4" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación de las fracturas por fragilidad en la historia clínica informatizada de atención primaria: un estudio poblacional" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "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" => 1203 "Ancho" => 1500 "Tamanyo" => 89630 ] ] "descripcion" => array:1 [ "en" => "Population flow-chart." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniel Martinez-Laguna, Alberto Soria-Castro, Cristina Carbonell-Abella, Pilar Orozco-López, Pilar Estrada-Laza, Xavier Nogues, Adolfo Díez-Perez, Daniel Prieto-Alhambra" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Daniel" "apellidos" => "Martinez-Laguna" ] 1 => array:2 [ "nombre" => "Alberto" "apellidos" => "Soria-Castro" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Carbonell-Abella" ] 3 => array:2 [ "nombre" => "Pilar" "apellidos" => "Orozco-López" ] 4 => array:2 [ "nombre" => "Pilar" "apellidos" => "Estrada-Laza" ] 5 => array:2 [ "nombre" => "Xavier" "apellidos" => "Nogues" ] 6 => array:2 [ "nombre" => "Adolfo" "apellidos" => "Díez-Perez" ] 7 => array:2 [ "nombre" => "Daniel" "apellidos" => "Prieto-Alhambra" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302723?idApp=UINPBA00004M" "url" => "/1699258X/0000001500000005/v1_201910230648/S1699258X17302723/v1_201910230648/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Subclinical synovitis and tenosynovitis by ultrasonography (US) 7 score in patients with rheumatoid arthritis treated with synthetic drugs, in clinical remission by DAS28" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e5" "paginaFinal" => "e9" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lucio Ventura-Ríos, Guadalupe Sánchez Bringas, Cristina Hernández-Díaz, Esteban Cruz-Arenas, Rubén Burgos-Vargas" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Lucio" "apellidos" => "Ventura-Ríos" "email" => array:1 [ 0 => "venturarioslucio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Guadalupe" "apellidos" => "Sánchez Bringas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Cristina" "apellidos" => "Hernández-Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Esteban" "apellidos" => "Cruz-Arenas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Rubén" "apellidos" => "Burgos-Vargas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Laboratorio de ultrasonido musculoesquelético y articular, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Jefa de Departamento de Embriología, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Vigilancia Epidemiológica Hospitalaria-Investigación Sociomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México City, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Director de Investigación, Hospital General de México “Eduardo Liceaga”, México City, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sinovitis y tenosinovitis subclínica evaluada por índice ultrasonográfico 7 en pacientes con artritis reumatoide tratados con fármacos sintéticos en remisión clínica por DAS-28" ] ] "textoCompleto" => "IntroductionThe aim of treatment in rheumatoid arthritis (RA) is to suppress the disease activity and induce remission as quickly and for as long as possible, to prevent joint damage and loss of function.<a class="elsevierStyleCrossRef" href="#bib0150">1</a> The assessment of disease activity relies on composite indexes that include clinical findings. However, several reports have shown that a high percentage of patients categorized on remission by clinical methods may develop radiographic progression (irreversible structural damage) throughout follow up because of subclinical synovitis that is not detectable with simple X-ray.<a class="elsevierStyleCrossRef" href="#bib0155">2</a> Magnetic Resonance Imaging (MRI) is perhaps the best tool to assess subclinical synovitis and early loss of the articular cartilage and erosions development, but its high cost and sometimes the need for enhancing medium to evaluate synovitis among others limit its accessibility.<a class="elsevierStyleCrossRef" href="#bib0160">3</a>In this context, US is a highly useful technique low cost, multiplanar, and non-invasive technique that does no produce any radiation, does not require contrast medium, and can be repeated as many times as necessary. Grayscale (GS) and power Doppler (PD) may show subclinical synovitis in patients with RA in remission achieved by the use of synthetic or biologic disease-modifying antirheumatic drugs (DMARDs).<a class="elsevierStyleCrossRef" href="#bib0165">4</a> GS synovitis suggest the development or worsening of bone erosions<a class="elsevierStyleCrossRef" href="#bib0170">5</a> and the presence of PD signal increases at least >1 the probability of flare up in clinical remission.<a class="elsevierStyleCrossRef" href="#bib0175">6</a>US is superior to clinical examination in detecting joint inflammation in undifferentiated arthritis, and in established RA.<a class="elsevierStyleCrossRef" href="#bib0180">7</a> Joint exploration by US has been used to reclassify patients who clinically have fewer inflamed joints by showing synovitis in those which are apparently normal.<a class="elsevierStyleCrossRef" href="#bib0180">7</a> Also, it has validity comparable to MRI with contrast medium and arthroscopy to detect synovitis, and is superior to simple X-ray to detect erosions.<a class="elsevierStyleCrossRef" href="#bib0185">8</a> There are different scales to evaluate joint inflammation. Today, it has been shown that the US 7 scale is equally sensitive as the 78-joint scale to evaluate changes in grayscale and PD.<a class="elsevierStyleCrossRef" href="#bib0190">9</a>The importance of proper monitoring of the disease is that timely modifications of treatment can be made, which may really change the course of the disease, by preventing structural damage and permanent disability.<a class="elsevierStyleCrossRef" href="#bib0195">10</a> It is therefore that the objective of this investigation was to evaluate the presence of inflammatory activity, by means of the US 7 scale, in patients with RA treated with synthetic DMARDs who were clinically in remission according to the DAS28 score.Material and methodsWe conducted a prospective, cross-sectional, observational phase IV study between March, 2013, and June, 2014 in three centers in México City. Ninety-four patients over 18 years of age with RA<a class="elsevierStyleCrossRef" href="#bib0200">11</a> receiving treatment with synthetic DMARDs (methotrexate, hydroxychloroquine, chloroquine, leflunomide, sulfasalazine) (either as monotherapy or combined therapy), without corticosteroid and treatment without modifications in clinical remission by DAS28 score (<2.6) at least for 6 months before they were included in the study. Only subjects whose treatment remained stable for 6 months before entering the study were included. We excluded patients who had received glucocorticoid infiltration during 6 months prior to inclusion in the study. All patients agreed to participate in the study and signed an informed consent form. Patients currently or past treated with anti-TNFs such as infliximab, adalimumab, certolizumab pegol and golimumab, or with circulating receptor fusion proteins like etanercept, were not included in the study. The National Bioethics Committee for clinical research approved the protocol.The sample included 100 patients of whom 94 patients completed the two visits planned for the study. At visit 1 (days −10 to 0), informed consent was presented to patients and signed by those who accepted their participation; then, inclusion and exclusion criteria were checked; and data on clinical evaluation and therapeutic history was collected. One experimented rheumatologist conducted clinical evaluation. At visit 2 (days 1–7), patients were sent to only one of the centers to underwent the US 7 scale (grayscale and PD) joint evaluation<a class="elsevierStyleCrossRef" href="#bib0190">9</a> performed by a rheumatologist, who was blinded to clinical findings. The average time for each evaluation was 15min.US studies were carried out with a Esaote MyLab 25® US equipment (Biomedica, Genoa, Italy) equipped with a 10–18MHz linear transducer; PD was adjusted according to the following parameters: frequency, 8.0, PRF, 0.500, wall filter, 3, gain between 50 and 70. PD gain was set to a level below its appearance from cortical bone.<a class="elsevierStyleCrossRef" href="#bib0205">12</a> The US 7 scale included the wrist, 2nd, and 3rd metacarpophalangeal (MCP) joints, 2nd and 3rd proximal interphalangeal (PIP) joints, and 2nd and 5th metatarsophalangeal (MTP) joints on the clinically dominant side,<a class="elsevierStyleCrossRef" href="#bib0190">9</a> according to EULAR US guidelines.<a class="elsevierStyleCrossRef" href="#bib0210">13</a>OMERACT definitions were used to describe synovitis, tenosynovitis, and erosions. Synovitis is seen as effusion defined as abnormal, hypoechoic or anechoic, compressible, displaceable intraarticular material, without PD signal, and synovial hypertrophy as abnormal hypoechoic, poorly compressible intra-articular tissue that may exhibit PD signal.<a class="elsevierStyleCrossRef" href="#bib0215">14</a> Tenosynovitis: abnormal, hypoechoic or anechoic (relative to tendon fibers) tendon sheath widening which can be related both to the presence of abnormal tenosynovial fluid and/or hypertrophy<a class="elsevierStyleCrossRef" href="#bib0220">15</a> thickened, hypoechoic or anechoic tissue with or without fluid in the tendon sheath. Erosion: an intraarticular discontinuity of the bone surface visible in 2 perpendicular planes.<a class="elsevierStyleCrossRef" href="#bib0220">15</a> Also, the presence of paratenonitis, was evaluated, and defined as a hypoechoic halo around the tendon with or without the presence of PD.<a class="elsevierStyleCrossRef" href="#bib0190">9</a> Tenosynovitis or paratenonitis, and erosions were reported as present or absent (1 or 0).Grayscale synovitis was evaluated semi-quantitatively: 0 absent, 1 mild, 2 moderate, and 3 severe. Grade 1 describes a hypoechoic or anechoic area which does not extend beyond the joint capsule interline; in grade 2, the joint capsule is raised parallel to the articular area; and grade 3 shows notable widening of the joint capsule.<a class="elsevierStyleCrossRef" href="#bib0190">9</a> The presence of PD was graduated as follows: grade 0 without intra-articular signal; grade 1, up to 3 signals in the joint area; grade 2, more than 3 signals in less than 50% of the intraarticular area; grade 3, more than 50% of the intraarticular area.<a class="elsevierStyleCrossRef" href="#bib0225">16</a> US evaluation was performed only by one ultrasonographer. Intra and inter-reading exercise were done by 2 ultrasonographers.Statistical analysisMedian, standard deviation (SD), and percentages were used to describe patients’ clinical characteristics and US findings. Intra and Inter-reader reliability were calculated by the Cohen's kappa coefficient. Kappa values were assigned the following designations: below 0.20 as poor, 0.21–0.40 as fair, 0.41–0.60 as moderate, 0.61–0.80 as good, and 0.81–1 as excellent. The analyses were performed using the SPSS ver. 21.0 statistical computer software (SPSS, Inc., Chicago, IL, USA).ResultsClinical and demographic data are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Ninety-four patients were included; six were excluded for failing to meet the criterion of DAS28 below 2.6. As expected, most patients were women. Disease duration was 27.5+31.8 months and DAS28 was 1.9+0.66.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the prevalence of elementary lesions in all joints evaluated. In grayscale we observed a high prevalence of synovitis in 94% (88 patients), although in almost 90% changes were mild and moderate in only 12.5%; there were no severe lesions found in the study. Only 12 (13%) of the 94 patients had PD signal and in all it was mild. Tenosynovitis was observed in 9 (9.6%) in grayscale and with PD only 2 (2.1%). Paratenonitis was not observed in any case. Erosions were found in 34 (36%) patients.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the frequency of elementary lesions by US grayscale in most affected regions. The prevalence was high in metatarsal joints, followed by MCP and carpal joints (88.6%, 60.8%, and 51.5% respectively). On the other hand, tenosynovitis was more common in hand flexors in MCP joints than in the carpus (8.2% vs. 1%). Erosions were more common in metatarsal heads than in metacarpal joints (29.9% vs. 16.5%).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> presents the distribution of elementary lesions with PD signal. The highest prevalence was in MCP joints, then in wrists, and the lowest in MTP joints (8.2%, 5.1%, and 1.0% respectively). In only 1% of patients, PD was observed in tenosynovitis of finger flexors at the metacarpal level and 1% in carpus. None of the erosions showed PD signal.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The intra and inter-reading kappa value were respectively 0.77, p<0.003 (CI 95%, 0.34–0.81) and 0.81, p<0.0001 (CI 95%, 0.27–0.83).DiscussionIn this study the prevalence of subclinical synovitis, in grayscale was high and low by PD, similar as shown by a systematic review of the literature, where percentages ranging from 73% to 95% and from 8.5% to 62%.<a class="elsevierStyleCrossRef" href="#bib0180">7</a> Thus, in turn, corroborates the discrepancy between the criterion of clinical remission used and US findings. Some studies have reported that, regardless of the specific criteria of remission used, when evaluated by US, synovitis active is detected in 60–80% of patients.<a class="elsevierStyleCrossRef" href="#bib0230">17</a> The use of US to monitor patients in clinical remission can help to predict those likely to suffer flare-up or structural damage.<a class="elsevierStyleCrossRefs" href="#bib0230">17,18</a> Because some studies have demonstrated high percentage of synovial hypertrophy on US in patients considered to be in remission, this state should be defined only in the absence of synovitis by this technique.<a class="elsevierStyleCrossRef" href="#bib0240">19</a>The sites of greatest prevalence of synovitis are the carpal and the MCP joints.<a class="elsevierStyleCrossRef" href="#bib0215">14</a> However, in our study, we observed more synovitis in the metatarsal joints, which correlates with reports indicating that the feet are affected in around 90% of patients during the course of the disease, 91% in women and 85% in men.<a class="elsevierStyleCrossRef" href="#bib0245">20</a> Additionally, this is the region that conditions the highest rates of disability,<a class="elsevierStyleCrossRef" href="#bib0250">21</a> which underscores the importance of including such joints in scanning for synovitis. In relation to PD, multiple studies have reported that a signal was present in around 50% of patients in clinical remission in MCP and carpal joints of the dominant hand. Our findings are some similar, since we detected a lower percentage of activity, perhaps of the longer remission time in our group.<a class="elsevierStyleCrossRefs" href="#bib0225">16,22</a>The prevalence of tenosynovitis in long term RA ranges from 5% to 55%.<a class="elsevierStyleCrossRef" href="#bib0260">23</a> We found tenosynovitis in less than 10% of patients, predominantly in the third flexor of the dominant hand. This finding may be related to biomechanical factors due to the high range of movement of that tendon compared with others.<a class="elsevierStyleCrossRef" href="#bib0260">23</a> Tenosynovitis may be very important for monitoring RA, because could conditioned tendon damage and consequently disability.<a class="elsevierStyleCrossRef" href="#bib0265">24</a> Lillegraven et al. have demonstrated that tenosynovitis assessed by US predicts the development of erosive joint damage in a cohort of early RA patients.<a class="elsevierStyleCrossRef" href="#bib0270">25</a> Two studies have shown that tenosynovitis is not present in true remission, suggesting the high value of its assessment by US.<a class="elsevierStyleCrossRefs" href="#bib0275">26,27</a> Furthermore, damaged tendon as assessed by US correlates very well with bone structural damage assessed by X-ray.<a class="elsevierStyleCrossRef" href="#bib0280">27</a> Today, however, there is neither established scale nor which tendons should be included in US evaluation for monitoring.<a class="elsevierStyleCrossRef" href="#bib0265">24</a>Bone erosions including in this score pertain to the realm of structural damage. In this study, around 30% had erosions in the MTP joints and 16% in the MCP joints. For patients with established diagnosis of RA, perhaps bone erosions have not great value, and may be more useful in patients with suspected early-stage RA. However, some data suggest that bone erosions may sensitive to change.<a class="elsevierStyleCrossRef" href="#bib0285">28</a>To the best of our knowledge, this is the first study that applied US 7 scale to detect any residual inflammatory activity in clinical remission, in joint and tendon level with vantage of consuming less time than more extended count joint and had been used to evaluate response to treatment.<a class="elsevierStyleCrossRef" href="#bib0290">29</a>LimitationsWe considered another method, such as magnetic resonance imaging (MRI) was needed to compare the findings, but MRI is not a feasible technique to evaluate multiple joints at the same time. Additionally, control group was absence.ConclusionsThe prevalence of synovitis and tenosynovitis assessed by US 7 score is low in patients with rheumatoid arthritis in clinical remission by DAS28 during long time of disease remission. The US 7 score is useful because add additional value to detect tenosynovitis that appear other instruments to measure real remission state.FundingThe present work was supported by unrestricted AbbVie grants.Conflicts of interestThe authors declare have not conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres1257083" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1164563" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1257084" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1164562" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Limitations" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 13 => array:2 [ "identificador" => "xack430964" "titulo" => "Acknowledgements" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-27" "fechaAceptado" => "2017-10-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1164563" "palabras" => array:4 [ 0 => "Rheumatoid arthritis" 1 => "Remission" 2 => "Ultrasonography" 3 => "Disease-modifying antirheumatic drugs" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1164562" "palabras" => array:4 [ 0 => "Artritis reumatoide" 1 => "Remisión" 2 => "Ultrasonografía" 3 => "Fármacos antirreumáticos modificadores de la enfermedad sintética" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo identify synovitis and tenosynovitis active by using the Ultrasound 7 (US 7) scoring system in patients with rheumatoid arthritis (RA) in clinical remission induced by synthetic disease-modifying antirheumatic drugs (DMARDs). MethodsThis is a multicentric, cross-sectional, observational study including 94 RA patients >18 years old who were in remission as defined by the 28-joints disease activity score (DAS28) <2.6 induced by synthetic DMARD during at least 6 months. Patients with a previous or current history of biologic DMARD treatment were not included in the study. Demographic and clinical data were collected by the local rheumatologist; the US evaluation was performed by a calibrated rheumatologist, who intended to detect grayscale synovitis and power Doppler (PD) using the 7-joint scale. Intra and inter-reader exercises of images between 2 ultrasonographers were realized. ResultsPatients’ mean age was 49.1±13.7 years; 83% were women. The mean disease duration was 8±7 years and remission lasted for 27.5±31.8 months. The mean DAS28 score was 1.9±0.66. Grayscale synovitis was present in 94% of cases; it was mild in 87.5% and moderate in 12.5%. Only 12.8% of the patients had PD. The metatarsophalangeal, metacarpophalangeal, and carpal joints of the dominant hand were the joints more frequently affected by synovitis. Tenosynovitis by grayscale was observed in 9 patients (9.6%). The intra and inter-reading kappa value were 0.77, p<0.003 (CI 95%, 0.34–0.81) and 0.81, p<0.0001 (CI 95%, 0.27–0.83) respectively. ConclusionsLow percentage of synovitis and tenosynovitis active were founded according to PD US by 7 score in RA patients under synthetic DMARDs during long remission. This score has benefit because evaluate tenosynovitis, another element of subclinical disease activity." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoIdentificar la sinovitis y tenosinovitis activa mediante el uso de ultrasonido en un índice de 7 articulaciones (US7) en pacientes con artritis reumatoide (AR) en remisión clínica inducida por fármacos antirreumáticos modificadores de la enfermedad sintética (DMARD). MétodosSe trata de un estudio observacional multicéntrico, transversal, que incluyó a 94 pacientes con AR mayores de 18 años que estaban en «remisión de acuerdo a DAS-28<2,6 inducida por DMARD sintético durante al menos 6 meses». Los pacientes con antecedentes previos o actuales de tratamiento biológico no fueron incluidos en el estudio. Los datos demográficos y clínicos fueron recogidos por el reumatólogo tratante; la evaluación de US fue realizada por un reumatólogo experimentado, para detectar sinovitis en escala de grises y power Doppler (PD) utilizando la escala de 7 articulaciones. Se realizaron ejercicios intra e inter-lector de imágenes entre 2 ultrasonografistas. ResultadosLa edad media de los pacientes fue de 49,1±13,7 años; el 83% eran mujeres. La duración media de la enfermedad fue de 8±7 años y la remisión duró 27,5±31,8 meses. La media de DAS-28 fue de 1,9±0,66. La sinovitis en escala de grises estuvo presente en el 94% de los casos; fue leve en el 87,5% y moderada en el 12,5%. Solo el 12,8% de los pacientes tenían PD. Las articulaciones metatarsofalángicas, metacarpofalángicas y carpales de la mano dominante fueron las articulaciones más frecuentemente afectadas por la sinovitis. La tenosinovitis en escala de grises se observó en 9 pacientes (9,6%). El valor de kappa intra e inter-lector fue 0,77, p<0,003 (CI 95%: 0,34-0,81) y 0,81, p<0,0001 (CI 95%: 0,27-0,83), respectivamente. ConclusionesSe observó un bajo porcentaje de sinovitis y tenosinovitis activa de acuerdo a PD por US7 en pacientes con AR tratados con DMARD sintéticos. Esta escala tiene ventaja porque evalúa tenosinovitis, otro elemento de la actividad inflamatoria subclínica." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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">n=94 \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">Value \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">Mean age, years (±SD) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.1±13.7 \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">Sex female/male, n (%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (88)/11 (12) \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">AR seropositive, n (%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 (80.8%) \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">AR erosive, n (%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (47.8) \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">Mean disease duration, years (±SD) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8±7 \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">Mean duration of disease remission by DAS28 in months (±SD) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.5±31.8 \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">Mean DAS28 score (±SD) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9±0.66 \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">Mean CPR, mg/dL (±SD) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.02±1.76 \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">Mean ESR, mm (±SD) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.1±9.8 \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">Mean Pain Visual Analogue Scale (±SD) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.7+13.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2149835.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <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">Treatment \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">No. (%) of patients \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">Methotrexate \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">87 (92.5) \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">Sulfasalazine \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 (28.7) \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">Leflunomide \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">14 (14.9) \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">Hydroxychloroquine \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">14 (14.9) \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">Patients with methotrexate plus another DMARD \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">42 (44.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2149832.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical and demographic data for patients." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NA=not applicable." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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 " colspan="6" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage of patients with elementary lesions observed by ultrasound</th></tr><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Disease activity \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 " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grayscale (n=94)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Power Doppler (n=94)</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \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">Synovitisn (%) \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">Tenosynovitisn (%) \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">Erosionn (%) \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">Synovitisn (%) \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">Tenosynovitisn (%) \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">Present \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">88 (94) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (9.6) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (36) \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">12 (13) \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">2 (2.1) \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="6" align="left" valign="\n \t\t\t\t\ttop\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="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade</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">Mild \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 (88.5) \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 " rowspan="3" align="left" valign="middle">NA</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">NA</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">12 (100) \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">2 (100) \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">Moderate \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 (12.5) \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 (0) \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 (0) \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">Severe \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 (0) \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 (0) \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 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2149833.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of elementary lesions in all joints evaluated by US 7 score." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NA=not applicable." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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">Anatomical region \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">Synovitis \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">Tenosynovitis \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">Erosions \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">Carpal \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">50 (51.5%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.0%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \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">Metacarpophalangeal \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">59 (60.8%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (8.2%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (16.5%) \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">Metatarsophalangeal \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">86 (88.6%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (29.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2149834.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Frequency of elementary lesions by US grayscale in most affected regions." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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">Anatomical regions \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">Synovitis \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">Tenosynovitis \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">Erosions \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">Carpal \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 (5.1%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1%) \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 (0%) \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">Metacarpophalangeal \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 (8.2%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1%) \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 (0%) \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">Metatarsophalangeal \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 (1%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \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 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2149831.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Frequency of elementary lesions with PD signal in most affected regions." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.M. Verstappen" 1 => "J.W. Jacobs" 2 => "M.J. Van der Veen" 3 => "A.H.M. Heurkens" 4 => "Y. Schenk" 5 => "E.J. Borg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2007.071092" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "1443" "paginaFinal" => "1449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17519278" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0155" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MRI in early rheumatoid arthritis: synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Bøyesen" 1 => "E.A. Haavardsholm" 2 => "M. Østergaard" 3 => "D. Van der Heijde" 4 => "S. Sesseng" 5 => "T.K. Kvien" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2009.123950" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "428" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20810395" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0160" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MRI and musculoskeletal ultrasonography as diagnostic tools in early arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Keen" 1 => "A. Brown" 2 => "R. Wakefield" 3 => "P. Conhagan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheum Dis Clin N Am" "fecha" => "2005" "volumen" => "31" "paginaInicial" => "699" "paginaFinal" => "714" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0165" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disease remission state in patients treated with the combination of tumor necrosis factor blockade and methotrexate or with disease-modifying antirheumatic drugs: a clinical and imaging comparative study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Saleem" 1 => "A.K. Brown" 2 => "H. Keen" 3 => "S. Nizam" 4 => "J. Freeston" 5 => "Z. Karim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.24596" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2009" "volumen" => "60" "paginaInicial" => "1915" "paginaFinal" => "1922" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19565512" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0170" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can flare be predicted in DMARD treated RA patients in remission, and is it important? A cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Saleem" 1 => "A.K. Brown" 2 => "M. Quinn" 3 => "Z. Karim" 4 => "E.M. Hensor" 5 => "P. Conaghan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2011-200548" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2012" "volumen" => "71" "paginaInicial" => "1316" "paginaFinal" => "1321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22294638" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0175" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Power Doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Foltz" 1 => "F. Gandjbakhch" 2 => "F. Etchepare" 3 => "C. Rosenberg" 4 => "M.L. Tanguy" 5 => "S. Rozenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.33312" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "67" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21904998" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0180" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis – a systematic review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.F. Ten Cate" 1 => "J.J. Luime" 2 => "N. Swen" 3 => "A.H. Gerards" 4 => "M.H. De Jager" 5 => "N.M. Basoski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/ar4132" "Revista" => array:5 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "R4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23298444" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0185" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.K. Brown" 1 => "M.A. Quinn" 2 => "Z. Karim" 3 => "P.G. Conaghan" 4 => "C.G. Peterfy" 5 => "E. Hensor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.22190" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2006" "volumen" => "54" "paginaInicial" => "3761" "paginaFinal" => "3773" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17133543" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0190" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Backhaus" 1 => "S. Ohrndorf" 2 => "H. Kellner" 3 => "J. Strunk" 4 => "M. Backhaus" 5 => "W. Hartung" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2009" "volumen" => "61" "paginaInicial" => "1194" "paginaFinal" => "1201" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0195" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.B. Hammer" 1 => "T.K. Kvien" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2011" "volumen" => "27" "paginaInicial" => "R78" "itemHostRev" => array:3 [ "pii" => "S1470204507702450" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0200" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disease flare in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I.M. Markusse" 1 => "L. Dirven" 2 => "A.H. Gerards" 3 => "J.H. van Groenendael" 4 => "H.K. Ronday" 5 => "P.J. Kerstens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13075-015-0730-2" "Revista" => array:5 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "232" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26321751" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0205" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of a short four-joint ultrasound test for gout diagnosis: a pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Peiteado" 1 => "E. de Miguel" 2 => "A. Villalba" 3 => "M.C. Ordonez" 4 => "C. Castillo" 5 => "E. Martin Mola" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "830" "paginaFinal" => "837" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23020889" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0210" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for musculoskeletal ultrasound in rheumatology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Backhaus" 1 => "G.R. Burmester" 2 => "T. Gerber" 3 => "W. Grassi" 4 => "K.P. Machold" 5 => "W.A. Swen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.60.7.641" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2001" "volumen" => "60" "paginaInicial" => "641" "paginaFinal" => "649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11406516" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0215" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Musculoskeletal ultrasound including definitions for ultrasonographic pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Wakefield" 1 => "P. Balint" 2 => "M. Skudlarek" 3 => "E. Filippuci" 4 => "M. Backhaus" 5 => "M.A. D’Agostino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheum" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "2485" "paginaFinal" => "2487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16331793" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0220" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Naredo" 1 => "M.A. DAgostino" 2 => "R.J. Wakefield" 3 => "I. Möller" 4 => "P.V. Balint" 5 => "E. Filippucci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2012-202092" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2013" "volumen" => "72" "paginaInicial" => "1328" "paginaFinal" => "1334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22984169" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0225" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrast-enhanced power Doppler ultrasonography of the metacarpophalangeal joints in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Szkudlarek" 1 => "M. Court-Payen" 2 => "C. Strandberg" 3 => "M. Klarlund" 4 => "T. Klausen" 5 => "M. Ostergaard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00330-002-1459-2" "Revista" => array:5 [ "tituloSerie" => "Eur Radiol" "fecha" => "2003" "volumen" => "13" "paginaInicial" => "163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12541125" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0230" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonographic predictors for the development of joint damage in rheumatoid arthritis patients: a single joint prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Macchioni" 1 => "M. Magnani" 2 => "R. Mulé" 3 => "S. Galletti" 4 => "M. Catanoso" 5 => "E. Pignotti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Rheum" "fecha" => "2013" "volumen" => "31" "paginaInicial" => "8" "paginaFinal" => "17" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0235" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.C. Arnett" 1 => "S.M. Edworthy" 2 => "D.A. Bloch" 3 => "D.J. McShane" 4 => "J.F. Fries" 5 => "N.S. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1998" "volumen" => "31" "paginaInicial" => "315" "paginaFinal" => "324" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0240" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. D’Agostino" 1 => "L. Terslev" 2 => "R. Wakefield" 3 => "M. Ostergaard" 4 => "P. Balint" 5 => "E. Naredo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2016" "paginaInicial" => "1" "paginaFinal" => "7" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0245" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Saleem" 1 => "A.K. Brown" 2 => "H. Keen" 3 => "S. Nizam" 4 => "J. Freeston" 5 => "R. Wakefield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2010.134445" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "792" "paginaFinal" => "798" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21242236" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0250" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The foot: still the most important reason for walking incapacity in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Grondal" 1 => "B. Tengstrand" 2 => "B. Nordmark" 3 => "P. Wretenburg" 4 => "A. Stark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/17453670710015067" "Revista" => array:6 [ "tituloSerie" => "Acta Orthop" "fecha" => "2008" "volumen" => "79" "paginaInicial" => "257" "paginaFinal" => "261" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18484253" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0255" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of US to show subclinical joint abnormalities in asymptomatic feet of RA patients compared to healthy controls" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Sant’Ana Petterle" 1 => "J. Natour" 2 => "K. Rodriguez da Luz" 3 => "F. Soares Machado" 4 => "M.F. dos Santos" 5 => "A. da Rocha Correa Fernandes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Rheum" "fecha" => "2013" "volumen" => "31" "paginaInicial" => "904" "paginaFinal" => "912" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0260" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Kawashiri" 1 => "T. Suzuki" 2 => "Y. Nakashima" 3 => "Y. Horai" 4 => "A. Okada" 5 => "N. Iwamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/ket405" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2014" "volumen" => "53" "paginaInicial" => "562" "paginaFinal" => "569" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24319104" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0265" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Hamamouchi" 1 => "R. Bahiri" 2 => "N. Srifi" 3 => "S. Aktaou" 4 => "Abouqal" 5 => "N. Hajjaj-Hassouni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMC Musculoskelet Dis" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "91" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0270" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Lillegraven" 1 => "P. Bøyesen" 2 => "H.B. Hammer" 3 => "M. Østergaard" 4 => "T. Uhlig" 5 => "S. Sesseng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2011.151316" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "2049" "paginaFinal" => "2050" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21515919" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0275" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Vlad" 1 => "F. Berghea" 2 => "M. Micu" 3 => "L. Varzaru" 4 => "M. Bojinca" 5 => "M. Milicescu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.11152/mu.2013.2066.173.viv" "Revista" => array:6 [ "tituloSerie" => "Med Ultrason" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "352" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26343085" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0280" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Structural damage in rheumatoid arthritis: comparison between tendon damage evaluated by ultrasound and radiographic damage" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Janta" 1 => "D. Stanciu" 2 => "M. Hinojosa" 3 => "J.C. Nieto-González" 4 => "L. Valor" 5 => "N. Bello" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/kew020" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2016" "volumen" => "55" "paginaInicial" => "1042" "paginaFinal" => "1046" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26945055" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0285" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound joint inflammation in rheumatoid arthritis in clinical remission: how many and which joints should be assessed?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Naredo" 1 => "L. Valor" 2 => "I. De la Torre" 3 => "L. Martínez-Estupiñán" 4 => "J.C. Nieto" 5 => "J.G. Ovalles-Bonilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2013" "volumen" => "65" "paginaInicial" => "512" "paginaFinal" => "517" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0290" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound 7 versus ultrasound 12 in monitoring the response to infliximab in patients with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Leng" 1 => "W. Xiao" 2 => "Z. Xu" 3 => "X. Zhu" 4 => "Y. Liu" 5 => "D. Zhao" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Rheum" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "587" "paginaFinal" => "594" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack430964" "titulo" => "Acknowledgements" "texto" => "The authors thank Angel Mario Coll Muñoz, Senior Operations Manager Clinics, Juan Carlos Pozos Immunology Division Medical Manager and José Luis Cañadas, Medical Director and Regulatory Affairs, all in AbbVie for their valuable help." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/1699258X/0000001500000005/v1_201910230648/S1699258X1730270X/v1_201910230648/en/main.assets" "Apartado" => array:4 [ "identificador" => "17499" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001500000005/v1_201910230648/S1699258X1730270X/v1_201910230648/en/main.pdf?idApp=UINPBA00004M&text.app=https://www.reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1730270X?idApp=UINPBA00004M"]

Estadísticas

Original Article

Subclinical synovitis and tenosynovitis by ultrasonography (US) 7 score in patients with rheumatoid arthritis treated with synthetic drugs, in clinical remission by DAS28

Sinovitis y tenosinovitis subclínica evaluada por índice ultrasonográfico 7 en pacientes con artritis reumatoide tratados con fármacos sintéticos en remisión clínica por DAS-28

Lucio Ventura-Ríosa,

Autor para correspondencia

venturarioslucio@gmail.com

Corresponding author.

, Guadalupe Sánchez Bringasb, Cristina Hernández-Díaza, Esteban Cruz-Arenasc, Rubén Burgos-Vargasd

a Laboratorio de ultrasonido musculoesquelético y articular, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México City, Mexico

b Jefa de Departamento de Embriología, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico

c Unidad de Vigilancia Epidemiológica Hospitalaria-Investigación Sociomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México City, Mexico

d Director de Investigación, Hospital General de México “Eduardo Liceaga”, México City, Mexico

Leído

6480

Veces
se ha leído el artículo

2455

Total PDF

4025

Total HTML

Compartir estadísticas

 array:23 [
  "pii" => "S1699258X1730270X"
  "issn" => "1699258X"
  "doi" => "10.1016/j.reuma.2017.10.011"
  "estado" => "S300"
  "fechaPublicacion" => "2019-09-01"
  "aid" => "1147"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Reumatol Clin. 2019;15:e5-e9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 764
    "formatos" => array:3 [
      "EPUB" => 43
      "HTML" => 277
      "PDF" => 444
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1699258X17302784"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2017.11.004"
    "estado" => "S300"
    "fechaPublicacion" => "2019-09-01"
    "aid" => "1155"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2019;15:e10-e13"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 663
      "formatos" => array:3 [
        "EPUB" => 67
        "HTML" => 317
        "PDF" => 279
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>"
      "titulo" => "Reumatolog&#237;a privada ambulatoria&#44; estudio descriptivo en la Comunidad de Madrid"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e10"
          "paginaFinal" => "e13"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Private Rheumatology in the Community of Madrid&#44; Spain&#58; Descriptive Study"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1072
              "Ancho" => 1512
              "Tamanyo" => 65871
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Relaci&#243;n de pacientes atendidos en la consulta ambulatoria privada seg&#250;n la compa&#241;&#237;a de seguro&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Juan Carlos Nieto Gonz&#225;lez"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Juan Carlos"
              "apellidos" => "Nieto Gonz&#225;lez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173574318301771"
        "doi" => "10.1016/j.reumae.2018.12.007"
        "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/S2173574318301771?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302784?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001500000005/v1_201910230648/S1699258X17302784/v1_201910230648/es/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1699258X17302723"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2017.10.013"
    "estado" => "S300"
    "fechaPublicacion" => "2019-09-01"
    "aid" => "1149"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2019;15:e1-e4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 609
      "formatos" => array:3 [
        "EPUB" => 36
        "HTML" => 199
        "PDF" => 374
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Validation of fragility fractures in primary care electronic medical records&#58; A population-based study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e1"
          "paginaFinal" => "e4"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Validaci&#243;n de las fracturas por fragilidad en la historia cl&#237;nica informatizada de atenci&#243;n primaria&#58; un estudio poblacional"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1203
              "Ancho" => 1500
              "Tamanyo" => 89630
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Population flow-chart&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Daniel Martinez-Laguna, Alberto Soria-Castro, Cristina Carbonell-Abella, Pilar Orozco-L&#243;pez, Pilar Estrada-Laza, Xavier Nogues, Adolfo D&#237;ez-Perez, Daniel Prieto-Alhambra"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Daniel"
              "apellidos" => "Martinez-Laguna"
            ]
            1 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Soria-Castro"
            ]
            2 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Carbonell-Abella"
            ]
            3 => array:2 [
              "nombre" => "Pilar"
              "apellidos" => "Orozco-L&#243;pez"
            ]
            4 => array:2 [
              "nombre" => "Pilar"
              "apellidos" => "Estrada-Laza"
            ]
            5 => array:2 [
              "nombre" => "Xavier"
              "apellidos" => "Nogues"
            ]
            6 => array:2 [
              "nombre" => "Adolfo"
              "apellidos" => "D&#237;ez-Perez"
            ]
            7 => array:2 [
              "nombre" => "Daniel"
              "apellidos" => "Prieto-Alhambra"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302723?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001500000005/v1_201910230648/S1699258X17302723/v1_201910230648/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Subclinical synovitis and tenosynovitis by ultrasonography &#40;US&#41; 7 score in patients with rheumatoid arthritis treated with synthetic drugs&#44; in clinical remission by DAS28"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "e5"
        "paginaFinal" => "e9"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Lucio Ventura-R&#237;os, Guadalupe S&#225;nchez Bringas, Cristina Hern&#225;ndez-D&#237;az, Esteban Cruz-Arenas, Rub&#233;n Burgos-Vargas"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Lucio"
            "apellidos" => "Ventura-R&#237;os"
            "email" => array:1 [
              0 => "venturarioslucio@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Guadalupe"
            "apellidos" => "S&#225;nchez Bringas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Cristina"
            "apellidos" => "Hern&#225;ndez-D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Esteban"
            "apellidos" => "Cruz-Arenas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Rub&#233;n"
            "apellidos" => "Burgos-Vargas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Laboratorio de ultrasonido musculoesquel&#233;tico y articular&#44; Instituto Nacional de Rehabilitaci&#243;n Luis Guillermo Ibarra Ibarra&#44; M&#233;xico City&#44; Mexico"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Jefa de Departamento de Embriolog&#237;a&#44; Facultad de Medicina&#44; Universidad Nacional Aut&#243;noma de M&#233;xico&#44; M&#233;xico City&#44; Mexico"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Unidad de Vigilancia Epidemiol&#243;gica Hospitalaria-Investigaci&#243;n Sociom&#233;dica&#44; Instituto Nacional de Rehabilitaci&#243;n Luis Guillermo Ibarra Ibarra&#44; M&#233;xico City&#44; Mexico"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Director de Investigaci&#243;n&#44; Hospital General de M&#233;xico &#8220;Eduardo Liceaga&#8221;&#44; M&#233;xico City&#44; Mexico"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Sinovitis y tenosinovitis subcl&#237;nica evaluada por &#237;ndice ultrasonogr&#225;fico 7 en pacientes con artritis reumatoide tratados con f&#225;rmacos sint&#233;ticos en remisi&#243;n cl&#237;nica por DAS-28"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The aim of treatment in rheumatoid arthritis &#40;RA&#41; is to suppress the disease activity and induce remission as quickly and for as long as possible&#44; to prevent joint damage and loss of function&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> The assessment of disease activity relies on composite indexes that include clinical findings&#46; However&#44; several reports have shown that a high percentage of patients categorized on remission by clinical methods may develop radiographic progression &#40;irreversible structural damage&#41; throughout follow up because of subclinical synovitis that is not detectable with simple X-ray&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> Magnetic Resonance Imaging &#40;MRI&#41; is perhaps the best tool to assess subclinical synovitis and early loss of the articular cartilage and erosions development&#44; but its high cost and sometimes the need for enhancing medium to evaluate synovitis among others limit its accessibility&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this context&#44; US is a highly useful technique low cost&#44; multiplanar&#44; and non-invasive technique that does no produce any radiation&#44; does not require contrast medium&#44; and can be repeated as many times as necessary&#46; Grayscale &#40;GS&#41; and power Doppler &#40;PD&#41; may show subclinical synovitis in patients with RA in remission achieved by the use of synthetic or biologic disease-modifying antirheumatic drugs &#40;DMARDs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> GS synovitis suggest the development or worsening of bone erosions<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> and the presence of PD signal increases at least &#62;1 the probability of flare up in clinical remission&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">US is superior to clinical examination in detecting joint inflammation in undifferentiated arthritis&#44; and in established RA&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Joint exploration by US has been used to reclassify patients who clinically have fewer inflamed joints by showing synovitis in those which are apparently normal&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Also&#44; it has validity comparable to MRI with contrast medium and arthroscopy to detect synovitis&#44; and is superior to simple X-ray to detect erosions&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> There are different scales to evaluate joint inflammation&#46; Today&#44; it has been shown that the US 7 scale is equally sensitive as the 78-joint scale to evaluate changes in grayscale and PD&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The importance of proper monitoring of the disease is that timely modifications of treatment can be made&#44; which may really change the course of the disease&#44; by preventing structural damage and permanent disability&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> It is therefore that the objective of this investigation was to evaluate the presence of inflammatory activity&#44; by means of the US 7 scale&#44; in patients with RA treated with synthetic DMARDs who were clinically in remission according to the DAS28 score&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a prospective&#44; cross-sectional&#44; observational phase IV study between March&#44; 2013&#44; and June&#44; 2014 in three centers in M&#233;xico City&#46; Ninety-four patients over 18 years of age with RA<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> receiving treatment with synthetic DMARDs &#40;methotrexate&#44; hydroxychloroquine&#44; chloroquine&#44; leflunomide&#44; sulfasalazine&#41; &#40;either as monotherapy or combined therapy&#41;&#44; without corticosteroid and treatment without modifications in clinical remission by DAS28 score &#40;&#60;2&#46;6&#41; at least for 6 months before they were included in the study&#46; Only subjects whose treatment remained stable for 6 months before entering the study were included&#46; We excluded patients who had received glucocorticoid infiltration during 6 months prior to inclusion in the study&#46; All patients agreed to participate in the study and signed an informed consent form&#46; Patients currently or past treated with anti-TNFs such as infliximab&#44; adalimumab&#44; certolizumab pegol and golimumab&#44; or with circulating receptor fusion proteins like etanercept&#44; were not included in the study&#46; The National Bioethics Committee for clinical research approved the protocol&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The sample included 100 patients of whom 94 patients completed the two visits planned for the study&#46; At visit 1 &#40;days &#8722;10 to 0&#41;&#44; informed consent was presented to patients and signed by those who accepted their participation&#59; then&#44; inclusion and exclusion criteria were checked&#59; and data on clinical evaluation and therapeutic history was collected&#46; One experimented rheumatologist conducted clinical evaluation&#46; At visit 2 &#40;days 1&#8211;7&#41;&#44; patients were sent to only one of the centers to underwent the US 7 scale &#40;grayscale and PD&#41; joint evaluation<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> performed by a rheumatologist&#44; who was blinded to clinical findings&#46; The average time for each evaluation was 15<span class="elsevierStyleHsp" style=""></span>min&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">US studies were carried out with a Esaote MyLab 25&#174; US equipment &#40;Biomedica&#44; Genoa&#44; Italy&#41; equipped with a 10&#8211;18<span class="elsevierStyleHsp" style=""></span>MHz linear transducer&#59; PD was adjusted according to the following parameters&#58; frequency&#44; 8&#46;0&#44; PRF&#44; 0&#46;500&#44; wall filter&#44; 3&#44; gain between 50 and 70&#46; PD gain was set to a level below its appearance from cortical bone&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a> The US 7 scale included the wrist&#44; 2nd&#44; and 3rd metacarpophalangeal &#40;MCP&#41; joints&#44; 2nd and 3rd proximal interphalangeal &#40;PIP&#41; joints&#44; and 2nd and 5th metatarsophalangeal &#40;MTP&#41; joints on the clinically dominant side&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> according to EULAR US guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">OMERACT definitions were used to describe synovitis&#44; tenosynovitis&#44; and erosions&#46; Synovitis is seen as effusion defined as abnormal&#44; hypoechoic or anechoic&#44; compressible&#44; displaceable intraarticular material&#44; without PD signal&#44; and synovial hypertrophy as abnormal hypoechoic&#44; poorly compressible intra-articular tissue that may exhibit PD signal&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Tenosynovitis&#58; abnormal&#44; hypoechoic or anechoic &#40;relative to tendon fibers&#41; tendon sheath widening which can be related both to the presence of abnormal tenosynovial fluid and&#47;or hypertrophy<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> thickened&#44; hypoechoic or anechoic tissue with or without fluid in the tendon sheath&#46; Erosion&#58; an intraarticular discontinuity of the bone surface visible in 2 perpendicular planes&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> Also&#44; the presence of paratenonitis&#44; was evaluated&#44; and defined as a hypoechoic halo around the tendon with or without the presence of PD&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> Tenosynovitis or paratenonitis&#44; and erosions were reported as present or absent &#40;1 or 0&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Grayscale synovitis was evaluated semi-quantitatively&#58; 0 absent&#44; 1 mild&#44; 2 moderate&#44; and 3 severe&#46; Grade 1 describes a hypoechoic or anechoic area which does not extend beyond the joint capsule interline&#59; in grade 2&#44; the joint capsule is raised parallel to the articular area&#59; and grade 3 shows notable widening of the joint capsule&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> The presence of PD was graduated as follows&#58; grade 0 without intra-articular signal&#59; grade 1&#44; up to 3 signals in the joint area&#59; grade 2&#44; more than 3 signals in less than 50&#37; of the intraarticular area&#59; grade 3&#44; more than 50&#37; of the intraarticular area&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> US evaluation was performed only by one ultrasonographer&#46; Intra and inter-reading exercise were done by 2 ultrasonographers&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Median&#44; standard deviation &#40;SD&#41;&#44; and percentages were used to describe patients&#8217; clinical characteristics and US findings&#46; Intra and Inter-reader reliability were calculated by the Cohen&#39;s kappa coefficient&#46; Kappa values were assigned the following designations&#58; below 0&#46;20 as poor&#44; 0&#46;21&#8211;0&#46;40 as fair&#44; 0&#46;41&#8211;0&#46;60 as moderate&#44; 0&#46;61&#8211;0&#46;80 as good&#44; and 0&#46;81&#8211;1 as excellent&#46; The analyses were performed using the SPSS ver&#46; 21&#46;0 statistical computer software &#40;SPSS&#44; Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Clinical and demographic data are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Ninety-four patients were included&#59; six were excluded for failing to meet the criterion of DAS28 below 2&#46;6&#46; As expected&#44; most patients were women&#46; Disease duration was 27&#46;5<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>31&#46;8 months and DAS28 was 1&#46;9<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;66&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the prevalence of elementary lesions in all joints evaluated&#46; In grayscale we observed a high prevalence of synovitis in 94&#37; &#40;88 patients&#41;&#44; although in almost 90&#37; changes were mild and moderate in only 12&#46;5&#37;&#59; there were no severe lesions found in the study&#46; Only 12 &#40;13&#37;&#41; of the 94 patients had PD signal and in all it was mild&#46; Tenosynovitis was observed in 9 &#40;9&#46;6&#37;&#41; in grayscale and with PD only 2 &#40;2&#46;1&#37;&#41;&#46; Paratenonitis was not observed in any case&#46; Erosions were found in 34 &#40;36&#37;&#41; patients&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the frequency of elementary lesions by US grayscale in most affected regions&#46; The prevalence was high in metatarsal joints&#44; followed by MCP and carpal joints &#40;88&#46;6&#37;&#44; 60&#46;8&#37;&#44; and 51&#46;5&#37; respectively&#41;&#46; On the other hand&#44; tenosynovitis was more common in hand flexors in MCP joints than in the carpus &#40;8&#46;2&#37; vs&#46; 1&#37;&#41;&#46; Erosions were more common in metatarsal heads than in metacarpal joints &#40;29&#46;9&#37; vs&#46; 16&#46;5&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> presents the distribution of elementary lesions with PD signal&#46; The highest prevalence was in MCP joints&#44; then in wrists&#44; and the lowest in MTP joints &#40;8&#46;2&#37;&#44; 5&#46;1&#37;&#44; and 1&#46;0&#37; respectively&#41;&#46; In only 1&#37; of patients&#44; PD was observed in tenosynovitis of finger flexors at the metacarpal level and 1&#37; in carpus&#46; None of the erosions showed PD signal&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The intra and inter-reading kappa value were respectively 0&#46;77&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;003 &#40;CI 95&#37;&#44; 0&#46;34&#8211;0&#46;81&#41; and 0&#46;81&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 &#40;CI 95&#37;&#44; 0&#46;27&#8211;0&#46;83&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this study the prevalence of subclinical synovitis&#44; in grayscale was high and low by PD&#44; similar as shown by a systematic review of the literature&#44; where percentages ranging from 73&#37; to 95&#37; and from 8&#46;5&#37; to 62&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Thus&#44; in turn&#44; corroborates the discrepancy between the criterion of clinical remission used and US findings&#46; Some studies have reported that&#44; regardless of the specific criteria of remission used&#44; when evaluated by US&#44; synovitis active is detected in 60&#8211;80&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> The use of US to monitor patients in clinical remission can help to predict those likely to suffer flare-up or structural damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;18</span></a> Because some studies have demonstrated high percentage of synovial hypertrophy on US in patients considered to be in remission&#44; this state should be defined only in the absence of synovitis by this technique&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The sites of greatest prevalence of synovitis are the carpal and the MCP joints&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> However&#44; in our study&#44; we observed more synovitis in the metatarsal joints&#44; which correlates with reports indicating that the feet are affected in around 90&#37; of patients during the course of the disease&#44; 91&#37; in women and 85&#37; in men&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> Additionally&#44; this is the region that conditions the highest rates of disability&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> which underscores the importance of including such joints in scanning for synovitis&#46; In relation to PD&#44; multiple studies have reported that a signal was present in around 50&#37; of patients in clinical remission in MCP and carpal joints of the dominant hand&#46; Our findings are some similar&#44; since we detected a lower percentage of activity&#44; perhaps of the longer remission time in our group&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#44;22</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The prevalence of tenosynovitis in long term RA ranges from 5&#37; to 55&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> We found tenosynovitis in less than 10&#37; of patients&#44; predominantly in the third flexor of the dominant hand&#46; This finding may be related to biomechanical factors due to the high range of movement of that tendon compared with others&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Tenosynovitis may be very important for monitoring RA&#44; because could conditioned tendon damage and consequently disability&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> Lillegraven et al&#46; have demonstrated that tenosynovitis assessed by US predicts the development of erosive joint damage in a cohort of early RA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> Two studies have shown that tenosynovitis is not present in true remission&#44; suggesting the high value of its assessment by US&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">26&#44;27</span></a> Furthermore&#44; damaged tendon as assessed by US correlates very well with bone structural damage assessed by X-ray&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> Today&#44; however&#44; there is neither established scale nor which tendons should be included in US evaluation for monitoring&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Bone erosions including in this score pertain to the realm of structural damage&#46; In this study&#44; around 30&#37; had erosions in the MTP joints and 16&#37; in the MCP joints&#46; For patients with established diagnosis of RA&#44; perhaps bone erosions have not great value&#44; and may be more useful in patients with suspected early-stage RA&#46; However&#44; some data suggest that bone erosions may sensitive to change&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this is the first study that applied US 7 scale to detect any residual inflammatory activity in clinical remission&#44; in joint and tendon level with vantage of consuming less time than more extended count joint and had been used to evaluate response to treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">We considered another method&#44; such as magnetic resonance imaging &#40;MRI&#41; was needed to compare the findings&#44; but MRI is not a feasible technique to evaluate multiple joints at the same time&#46; Additionally&#44; control group was absence&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">The prevalence of synovitis and tenosynovitis assessed by US 7 score is low in patients with rheumatoid arthritis in clinical remission by DAS28 during long time of disease remission&#46; The US 7 score <span class="elsevierStyleUnderline">i</span>s useful because add additional value to detect tenosynovitis that appear other instruments to measure real remission state&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">The present work was supported by unrestricted <span class="elsevierStyleGrantSponsor" id="gs1">AbbVie</span> grants&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare have not conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:15 [
        0 => array:3 [
          "identificador" => "xres1257083"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1164563"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1257084"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1164562"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Statistical analysis"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Results"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Limitations"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conclusions"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Funding"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflicts of interest"
        ]
        13 => array:2 [
          "identificador" => "xack430964"
          "titulo" => "Acknowledgements"
        ]
        14 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-06-27"
    "fechaAceptado" => "2017-10-24"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1164563"
          "palabras" => array:4 [
            0 => "Rheumatoid arthritis"
            1 => "Remission"
            2 => "Ultrasonography"
            3 => "Disease-modifying antirheumatic drugs"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1164562"
          "palabras" => array:4 [
            0 => "Artritis reumatoide"
            1 => "Remisi&#243;n"
            2 => "Ultrasonograf&#237;a"
            3 => "F&#225;rmacos antirreum&#225;ticos modificadores de la enfermedad sint&#233;tica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To identify synovitis and tenosynovitis active by using the Ultrasound 7 &#40;US 7&#41; scoring system in patients with rheumatoid arthritis &#40;RA&#41; in clinical remission induced by synthetic disease-modifying antirheumatic drugs &#40;DMARDs&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is a multicentric&#44; cross-sectional&#44; observational study including 94 RA patients &#62;18 years old who were in remission as defined by the 28-joints disease activity score &#40;DAS28&#41; &#60;2&#46;6 induced by synthetic DMARD during at least 6 months&#46; Patients with a previous or current history of biologic DMARD treatment were not included in the study&#46; Demographic and clinical data were collected by the local rheumatologist&#59; the US evaluation was performed by a calibrated rheumatologist&#44; who intended to detect grayscale synovitis and power Doppler &#40;PD&#41; using the 7-joint scale&#46; Intra and inter-reader exercises of images between 2 ultrasonographers were realized&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients&#8217; mean age was 49&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;7 years&#59; 83&#37; were women&#46; The mean disease duration was 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7 years and remission lasted for 27&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;8 months&#46; The mean DAS28 score was 1&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;66&#46; Grayscale synovitis was present in 94&#37; of cases&#59; it was mild in 87&#46;5&#37; and moderate in 12&#46;5&#37;&#46; Only 12&#46;8&#37; of the patients had PD&#46; The metatarsophalangeal&#44; metacarpophalangeal&#44; and carpal joints of the dominant hand were the joints more frequently affected by synovitis&#46; Tenosynovitis by grayscale was observed in 9 patients &#40;9&#46;6&#37;&#41;&#46; The intra and inter-reading kappa value were 0&#46;77&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;003 &#40;CI 95&#37;&#44; 0&#46;34&#8211;0&#46;81&#41; and 0&#46;81&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 &#40;CI 95&#37;&#44; 0&#46;27&#8211;0&#46;83&#41; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Low percentage of synovitis and tenosynovitis active were founded according to PD US by 7 score in RA patients under synthetic DMARDs during long remission&#46; This score has benefit because evaluate tenosynovitis&#44; another element of subclinical disease activity&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Identificar la sinovitis y tenosinovitis activa mediante el uso de ultrasonido en un &#237;ndice de 7 articulaciones &#40;US7&#41; en pacientes con artritis reumatoide &#40;AR&#41; en remisi&#243;n cl&#237;nica inducida por f&#225;rmacos antirreum&#225;ticos modificadores de la enfermedad sint&#233;tica &#40;DMARD&#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">Se trata de un estudio observacional multic&#233;ntrico&#44; transversal&#44; que incluy&#243; a 94 pacientes con AR mayores de 18 a&#241;os que estaban en &#171;remisi&#243;n de acuerdo a DAS-28<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#44;6 inducida por DMARD sint&#233;tico durante al menos 6 meses&#187;&#46; Los pacientes con antecedentes previos o actuales de tratamiento biol&#243;gico no fueron incluidos en el estudio&#46; Los datos demogr&#225;ficos y cl&#237;nicos fueron recogidos por el reumat&#243;logo tratante&#59; la evaluaci&#243;n de US fue realizada por un reumat&#243;logo experimentado&#44; para detectar sinovitis en escala de grises y power Doppler &#40;PD&#41; utilizando la escala de 7 articulaciones&#46; Se realizaron ejercicios intra e inter-lector de im&#225;genes entre 2 ultrasonografistas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media de los pacientes fue de 49&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;7 a&#241;os&#59; el 83&#37; eran mujeres&#46; La duraci&#243;n media de la enfermedad fue de 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7 a&#241;os y la remisi&#243;n dur&#243; 27&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#44;8 meses&#46; La media de DAS-28 fue de 1&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;66&#46; La sinovitis en escala de grises estuvo presente en el 94&#37; de los casos&#59; fue leve en el 87&#44;5&#37; y moderada en el 12&#44;5&#37;&#46; Solo el 12&#44;8&#37; de los pacientes ten&#237;an PD&#46; Las articulaciones metatarsofal&#225;ngicas&#44; metacarpofal&#225;ngicas y carpales de la mano dominante fueron las articulaciones m&#225;s frecuentemente afectadas por la sinovitis&#46; La tenosinovitis en escala de grises se observ&#243; en 9 pacientes &#40;9&#44;6&#37;&#41;&#46; El valor de kappa intra e inter-lector fue 0&#44;77&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;003 &#40;CI 95&#37;&#58; 0&#44;34-0&#44;81&#41; y 0&#44;81&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001 &#40;CI 95&#37;&#58; 0&#44;27-0&#44;83&#41;&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se observ&#243; un bajo porcentaje de sinovitis y tenosinovitis activa de acuerdo a PD por US7 en pacientes con AR tratados con DMARD sint&#233;ticos&#46; Esta escala tiene ventaja porque eval&#250;a tenosinovitis&#44; otro elemento de la actividad inflamatoria subcl&#237;nica&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&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">Value&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">Mean age&#44; years &#40;&#177;SD&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#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">Sex female&#47;male&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;88&#41;&#47;11 &#40;12&#41;&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">AR seropositive&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;80&#46;8&#37;&#41;&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">AR erosive&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;47&#46;8&#41;&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">Mean disease duration&#44; years &#40;&#177;SD&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>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">Mean duration of disease remission by DAS28 in months &#40;&#177;SD&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#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">Mean DAS28 score &#40;&#177;SD&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;66&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">Mean CPR&#44; mg&#47;dL &#40;&#177;SD&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;76&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">Mean ESR&#44; mm &#40;&#177;SD&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#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">Mean Pain Visual Analogue Scale &#40;&#177;SD&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;7<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>13&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2149835.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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">Treatment&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">No&#46; &#40;&#37;&#41; of patients&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">Methotrexate&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">87 &#40;92&#46;5&#41;&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">Sulfasalazine&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 &#40;28&#46;7&#41;&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">Leflunomide&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">14 &#40;14&#46;9&#41;&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">Hydroxychloroquine&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">14 &#40;14&#46;9&#41;&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">Patients with methotrexate plus another DMARD&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">42 &#40;44&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2149832.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical and demographic data for patients&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">NA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>not applicable&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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  " colspan="6" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage of patients with elementary lesions observed by ultrasound</th></tr><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Disease activity&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  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grayscale &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Power Doppler &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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">Synovitis<span class="elsevierStyleItalic">n</span> &#40;&#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">Tenosynovitis<span class="elsevierStyleItalic">n</span> &#40;&#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">Erosion<span class="elsevierStyleItalic">n</span> &#40;&#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">Synovitis<span class="elsevierStyleItalic">n</span> &#40;&#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">Tenosynovitis<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&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="elsevierStyleItalic">Present</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">88 &#40;94&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;9&#46;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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;36&#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">12 &#40;13&#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">2 &#40;2&#46;1&#41;&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="6" 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  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grade</span></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="elsevierStyleHsp" style=""></span>Mild&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 &#40;88&#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  " rowspan="3" align="left" valign="middle">NA</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">NA</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">12 &#40;100&#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">2 &#40;100&#41;&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="elsevierStyleHsp" style=""></span>Moderate&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 &#40;12&#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">0 &#40;0&#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 &#40;0&#41;&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="elsevierStyleHsp" style=""></span>Severe&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&#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 &#40;0&#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 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2149833.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prevalence of elementary lesions in all joints evaluated by US 7 score&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">NA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>not applicable&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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">Anatomical region&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">Synovitis&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">Tenosynovitis&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">Erosions&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">Carpal&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">50 &#40;51&#46;5&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;0&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&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">Metacarpophalangeal&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">59 &#40;60&#46;8&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;8&#46;2&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;16&#46;5&#37;&#41;&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">Metatarsophalangeal&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">86 &#40;88&#46;6&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;29&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2149834.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Frequency of elementary lesions by US grayscale in most affected regions&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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">Anatomical regions&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">Synovitis&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">Tenosynovitis&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">Erosions&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">Carpal&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;5&#46;1&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#37;&#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 &#40;0&#37;&#41;&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">Metacarpophalangeal&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 &#40;8&#46;2&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#37;&#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 &#40;0&#37;&#41;&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">Metatarsophalangeal&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 &#40;1&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&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&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2149831.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Frequency of elementary lesions with PD signal in most affected regions&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive treatment with methotrexate in early rheumatoid arthritis&#58; aiming for remission&#46; Computer Assisted Management in Early Rheumatoid Arthritis &#40;CAMERA&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Verstappen"
                            1 => "J&#46;W&#46; Jacobs"
                            2 => "M&#46;J&#46; Van der Veen"
                            3 => "A&#46;H&#46;M&#46; Heurkens"
                            4 => "Y&#46; Schenk"
                            5 => "E&#46;J&#46; Borg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2007.071092"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2007"
                        "volumen" => "66"
                        "paginaInicial" => "1443"
                        "paginaFinal" => "1449"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17519278"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MRI in early rheumatoid arthritis&#58; synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; B&#248;yesen"
                            1 => "E&#46;A&#46; Haavardsholm"
                            2 => "M&#46; &#216;stergaard"
                            3 => "D&#46; Van der Heijde"
                            4 => "S&#46; Sesseng"
                            5 => "T&#46;K&#46; Kvien"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2009.123950"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "428"
                        "paginaFinal" => "433"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20810395"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MRI and musculoskeletal ultrasonography as diagnostic tools in early arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Keen"
                            1 => "A&#46; Brown"
                            2 => "R&#46; Wakefield"
                            3 => "P&#46; Conhagan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheum Dis Clin N Am"
                        "fecha" => "2005"
                        "volumen" => "31"
                        "paginaInicial" => "699"
                        "paginaFinal" => "714"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disease remission state in patients treated with the combination of tumor necrosis factor blockade and methotrexate or with disease-modifying antirheumatic drugs&#58; a clinical and imaging comparative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Saleem"
                            1 => "A&#46;K&#46; Brown"
                            2 => "H&#46; Keen"
                            3 => "S&#46; Nizam"
                            4 => "J&#46; Freeston"
                            5 => "Z&#46; Karim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.24596"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2009"
                        "volumen" => "60"
                        "paginaInicial" => "1915"
                        "paginaFinal" => "1922"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19565512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Can flare be predicted in DMARD treated RA patients in remission&#44; and is it important&#63; A cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Saleem"
                            1 => "A&#46;K&#46; Brown"
                            2 => "M&#46; Quinn"
                            3 => "Z&#46; Karim"
                            4 => "E&#46;M&#46; Hensor"
                            5 => "P&#46; Conaghan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2011-200548"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2012"
                        "volumen" => "71"
                        "paginaInicial" => "1316"
                        "paginaFinal" => "1321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22294638"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Power Doppler ultrasound&#44; but not low-field magnetic resonance imaging&#44; predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Foltz"
                            1 => "F&#46; Gandjbakhch"
                            2 => "F&#46; Etchepare"
                            3 => "C&#46; Rosenberg"
                            4 => "M&#46;L&#46; Tanguy"
                            5 => "S&#46; Rozenberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.33312"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2012"
                        "volumen" => "64"
                        "paginaInicial" => "67"
                        "paginaFinal" => "76"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21904998"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis &#8211; a systematic review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;F&#46; Ten Cate"
                            1 => "J&#46;J&#46; Luime"
                            2 => "N&#46; Swen"
                            3 => "A&#46;H&#46; Gerards"
                            4 => "M&#46;H&#46; De Jager"
                            5 => "N&#46;M&#46; Basoski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/ar4132"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2013"
                        "volumen" => "15"
                        "paginaInicial" => "R4"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23298444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;K&#46; Brown"
                            1 => "M&#46;A&#46; Quinn"
                            2 => "Z&#46; Karim"
                            3 => "P&#46;G&#46; Conaghan"
                            4 => "C&#46;G&#46; Peterfy"
                            5 => "E&#46; Hensor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.22190"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2006"
                        "volumen" => "54"
                        "paginaInicial" => "3761"
                        "paginaFinal" => "3773"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17133543"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice&#58; a pilot project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Backhaus"
                            1 => "S&#46; Ohrndorf"
                            2 => "H&#46; Kellner"
                            3 => "J&#46; Strunk"
                            4 => "M&#46; Backhaus"
                            5 => "W&#46; Hartung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2009"
                        "volumen" => "61"
                        "paginaInicial" => "1194"
                        "paginaFinal" => "1201"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparisons of 7- to 78-joint ultrasonography scores&#58; all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;B&#46; Hammer"
                            1 => "T&#46;K&#46; Kvien"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2011"
                        "volumen" => "27"
                        "paginaInicial" => "R78"
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204507702450"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disease flare in rheumatoid arthritis are associated with joint damage progression and disability&#58; 10-year results from the BeSt study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46;M&#46; Markusse"
                            1 => "L&#46; Dirven"
                            2 => "A&#46;H&#46; Gerards"
                            3 => "J&#46;H&#46; van Groenendael"
                            4 => "H&#46;K&#46; Ronday"
                            5 => "P&#46;J&#46; Kerstens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13075-015-0730-2"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2015"
                        "volumen" => "17"
                        "paginaInicial" => "232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26321751"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Value of a short four-joint ultrasound test for gout diagnosis&#58; a pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Peiteado"
                            1 => "E&#46; de Miguel"
                            2 => "A&#46; Villalba"
                            3 => "M&#46;C&#46; Ordonez"
                            4 => "C&#46; Castillo"
                            5 => "E&#46; Martin Mola"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Rheumatol"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "830"
                        "paginaFinal" => "837"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23020889"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for musculoskeletal ultrasound in rheumatology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Backhaus"
                            1 => "G&#46;R&#46; Burmester"
                            2 => "T&#46; Gerber"
                            3 => "W&#46; Grassi"
                            4 => "K&#46;P&#46; Machold"
                            5 => "W&#46;A&#46; Swen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.60.7.641"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2001"
                        "volumen" => "60"
                        "paginaInicial" => "641"
                        "paginaFinal" => "649"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11406516"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Musculoskeletal ultrasound including definitions for ultrasonographic pathology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Wakefield"
                            1 => "P&#46; Balint"
                            2 => "M&#46; Skudlarek"
                            3 => "E&#46; Filippuci"
                            4 => "M&#46; Backhaus"
                            5 => "M&#46;A&#46; D&#8217;Agostino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheum"
                        "fecha" => "2005"
                        "volumen" => "32"
                        "paginaInicial" => "2485"
                        "paginaFinal" => "2487"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16331793"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Naredo"
                            1 => "M&#46;A&#46; DAgostino"
                            2 => "R&#46;J&#46; Wakefield"
                            3 => "I&#46; M&#246;ller"
                            4 => "P&#46;V&#46; Balint"
                            5 => "E&#46; Filippucci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2012-202092"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2013"
                        "volumen" => "72"
                        "paginaInicial" => "1328"
                        "paginaFinal" => "1334"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22984169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contrast-enhanced power Doppler ultrasonography of the metacarpophalangeal joints in rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Szkudlarek"
                            1 => "M&#46; Court-Payen"
                            2 => "C&#46; Strandberg"
                            3 => "M&#46; Klarlund"
                            4 => "T&#46; Klausen"
                            5 => "M&#46; Ostergaard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00330-002-1459-2"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Radiol"
                        "fecha" => "2003"
                        "volumen" => "13"
                        "paginaInicial" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12541125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonographic predictors for the development of joint damage in rheumatoid arthritis patients&#58; a single joint prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Macchioni"
                            1 => "M&#46; Magnani"
                            2 => "R&#46; Mul&#233;"
                            3 => "S&#46; Galletti"
                            4 => "M&#46; Catanoso"
                            5 => "E&#46; Pignotti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Exp Rheum"
                        "fecha" => "2013"
                        "volumen" => "31"
                        "paginaInicial" => "8"
                        "paginaFinal" => "17"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;C&#46; Arnett"
                            1 => "S&#46;M&#46; Edworthy"
                            2 => "D&#46;A&#46; Bloch"
                            3 => "D&#46;J&#46; McShane"
                            4 => "J&#46;F&#46; Fries"
                            5 => "N&#46;S&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "1998"
                        "volumen" => "31"
                        "paginaInicial" => "315"
                        "paginaFinal" => "324"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis&#58; from diagnosis to remission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; D&#8217;Agostino"
                            1 => "L&#46; Terslev"
                            2 => "R&#46; Wakefield"
                            3 => "M&#46; Ostergaard"
                            4 => "P&#46; Balint"
                            5 => "E&#46; Naredo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2016"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should imaging be a component of rheumatoid arthritis remission criteria&#63; A comparison between traditional and modified composite remission scores and imaging assessments"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Saleem"
                            1 => "A&#46;K&#46; Brown"
                            2 => "H&#46; Keen"
                            3 => "S&#46; Nizam"
                            4 => "J&#46; Freeston"
                            5 => "R&#46; Wakefield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2010.134445"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "792"
                        "paginaFinal" => "798"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21242236"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The foot&#58; still the most important reason for walking incapacity in rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Grondal"
                            1 => "B&#46; Tengstrand"
                            2 => "B&#46; Nordmark"
                            3 => "P&#46; Wretenburg"
                            4 => "A&#46; Stark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/17453670710015067"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Orthop"
                        "fecha" => "2008"
                        "volumen" => "79"
                        "paginaInicial" => "257"
                        "paginaFinal" => "261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18484253"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of US to show subclinical joint abnormalities in asymptomatic feet of RA patients compared to healthy controls"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Sant&#8217;Ana Petterle"
                            1 => "J&#46; Natour"
                            2 => "K&#46; Rodriguez da Luz"
                            3 => "F&#46; Soares Machado"
                            4 => "M&#46;F&#46; dos Santos"
                            5 => "A&#46; da Rocha Correa Fernandes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Exp Rheum"
                        "fecha" => "2013"
                        "volumen" => "31"
                        "paginaInicial" => "904"
                        "paginaFinal" => "912"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis&#58; power Doppler subclinical synovitis is associated with bone erosion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Kawashiri"
                            1 => "T&#46; Suzuki"
                            2 => "Y&#46; Nakashima"
                            3 => "Y&#46; Horai"
                            4 => "A&#46; Okada"
                            5 => "N&#46; Iwamoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/ket405"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2014"
                        "volumen" => "53"
                        "paginaInicial" => "562"
                        "paginaFinal" => "569"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24319104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Hamamouchi"
                            1 => "R&#46; Bahiri"
                            2 => "N&#46; Srifi"
                            3 => "S&#46; Aktaou"
                            4 => "Abouqal"
                            5 => "N&#46; Hajjaj-Hassouni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Musculoskelet Dis"
                        "fecha" => "2011"
                        "volumen" => "12"
                        "paginaInicial" => "91"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Lillegraven"
                            1 => "P&#46; B&#248;yesen"
                            2 => "H&#46;B&#46; Hammer"
                            3 => "M&#46; &#216;stergaard"
                            4 => "T&#46; Uhlig"
                            5 => "S&#46; Sesseng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2011.151316"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "2049"
                        "paginaFinal" => "2050"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21515919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Vlad"
                            1 => "F&#46; Berghea"
                            2 => "M&#46; Micu"
                            3 => "L&#46; Varzaru"
                            4 => "M&#46; Bojinca"
                            5 => "M&#46; Milicescu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.11152/mu.2013.2066.173.viv"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Ultrason"
                        "fecha" => "2015"
                        "volumen" => "17"
                        "paginaInicial" => "352"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26343085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Structural damage in rheumatoid arthritis&#58; comparison between tendon damage evaluated by ultrasound and radiographic damage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Janta"
                            1 => "D&#46; Stanciu"
                            2 => "M&#46; Hinojosa"
                            3 => "J&#46;C&#46; Nieto-Gonz&#225;lez"
                            4 => "L&#46; Valor"
                            5 => "N&#46; Bello"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/kew020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2016"
                        "volumen" => "55"
                        "paginaInicial" => "1042"
                        "paginaFinal" => "1046"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26945055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound joint inflammation in rheumatoid arthritis in clinical remission&#58; how many and which joints should be assessed&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Naredo"
                            1 => "L&#46; Valor"
                            2 => "I&#46; De la Torre"
                            3 => "L&#46; Mart&#237;nez-Estupi&#241;&#225;n"
                            4 => "J&#46;C&#46; Nieto"
                            5 => "J&#46;G&#46; Ovalles-Bonilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2013"
                        "volumen" => "65"
                        "paginaInicial" => "512"
                        "paginaFinal" => "517"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound 7 versus ultrasound 12 in monitoring the response to infliximab in patients with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "X&#46; Leng"
                            1 => "W&#46; Xiao"
                            2 => "Z&#46; Xu"
                            3 => "X&#46; Zhu"
                            4 => "Y&#46; Liu"
                            5 => "D&#46; Zhao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Rheum"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "587"
                        "paginaFinal" => "594"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack430964"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0125" class="elsevierStylePara elsevierViewall">The authors thank Angel Mario Coll Mu&#241;oz&#44; Senior Operations Manager Clinics&#44; Juan Carlos Pozos Immunology Division Medical Manager and Jos&#233; Luis Ca&#241;adas&#44; Medical Director and Regulatory Affairs&#44; all in AbbVie for their valuable help&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/1699258X/0000001500000005/v1_201910230648/S1699258X1730270X/v1_201910230648/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "17499"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001500000005/v1_201910230648/S1699258X1730270X/v1_201910230648/en/main.pdf?idApp=UINPBA00004M&text.app=https://www.reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1730270X?idApp=UINPBA00004M"
]

Información del artículo

ISSN: 1699258X
Idioma original: Inglés

DOI:10.1016/j.reuma.2017.10.011

Datos actualizados diariamente

año/Mes	Html	Pdf	Total

2024 Octubre	30	30	60
2024 Septiembre	88	35	123
2024 Agosto	84	58	142
2024 Julio	75	32	107
2024 Junio	87	40	127
2024 Mayo	66	33	99
2024 Abril	65	38	103
2024 Marzo	42	26	68
2024 Febrero	48	31	79
2024 Enero	31	31	62
2023 Diciembre	52	26	78
2023 Noviembre	50	41	91
2023 Octubre	63	26	89
2023 Septiembre	127	33	160
2023 Agosto	32	18	50
2023 Julio	45	28	73
2023 Junio	38	22	60
2023 Mayo	48	29	77
2023 Abril	52	16	68
2023 Marzo	88	35	123
2023 Febrero	63	32	95
2023 Enero	56	20	76
2022 Diciembre	85	51	136
2022 Noviembre	73	26	99
2022 Octubre	62	46	108
2022 Septiembre	69	42	111
2022 Agosto	78	41	119
2022 Julio	88	38	126
2022 Junio	49	57	106
2022 Mayo	49	34	83
2022 Abril	43	53	96
2022 Marzo	48	54	102
2022 Febrero	52	46	98
2022 Enero	59	41	100
2021 Diciembre	58	41	99
2021 Noviembre	57	52	109
2021 Octubre	98	58	156
2021 Septiembre	49	32	81
2021 Agosto	30	48	78
2021 Julio	24	41	65
2021 Junio	32	37	69
2021 Mayo	56	61	117
2021 Abril	135	99	234
2021 Marzo	82	38	120
2021 Febrero	65	27	92
2021 Enero	66	19	85
2020 Diciembre	65	19	84
2020 Noviembre	45	29	74
2020 Octubre	102	19	121
2020 Septiembre	121	38	159
2020 Agosto	138	24	162
2020 Julio	109	22	131
2020 Junio	57	15	72
2020 Mayo	82	38	120
2020 Abril	104	16	120
2020 Marzo	83	29	112
2020 Febrero	5	0	5
2019 Diciembre	3	2	5
2019 Noviembre	1	0	1
2019 Octubre	2	0	2
2019 Junio	0	1	1
2019 Mayo	70	34	104
2019 Abril	42	35	77
2019 Marzo	44	32	76
2019 Febrero	17	20	37
2019 Enero	57	31	88
2018 Diciembre	41	45	86
2018 Noviembre	0	19	19
2018 Octubre	0	16	16
2018 Septiembre	0	8	8
2018 Agosto	0	15	15
2018 Julio	0	11	11
2018 Marzo	0	22	22
2018 Febrero	0	69	69
2018 Enero	0	31	31
2017 Diciembre	0	53	53

Mostrar todo

Indexada en:

Síguenos:

Suscribirse:

Estadísticas

Indexada en:

Síguenos:

Suscribirse:

Estadísticas

Suscríbase a la newsletter