Share
array:23 [ "pii" => "S2173574323000606" "issn" => "21735743" "doi" => "10.1016/j.reumae.2023.04.001" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "1665" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Reumatol Clin. 2023;19:235-43" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X22002832" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2022.12.002" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "1665" "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. 2023;19:235-43" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "Enfermedad injerto contra receptor crónica: revisión sistemática de la afectación articular y fascial" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "235" "paginaFinal" => "243" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Chronic graft-versus-recipient disease: systematic review of joint and fascial involvement" ] ] "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" => 1696 "Ancho" => 2508 "Tamanyo" => 310326 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Rango de movilidad articular fotográfico: escala P-ROM.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Hidalgo Calleja, María Dolores Sánchez González, Julio Medina Luezas, Lucía López Corral" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Hidalgo Calleja" ] 1 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Sánchez González" ] 2 => array:2 [ "nombre" => "Julio" "apellidos" => "Medina Luezas" ] 3 => array:2 [ "nombre" => "Lucía" "apellidos" => "López Corral" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574323000606" "doi" => "10.1016/j.reumae.2023.04.001" "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/S2173574323000606?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X22002832?idApp=UINPBA00004M" "url" => "/1699258X/0000001900000005/v1_202304271842/S1699258X22002832/v1_202304271842/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173574323000485" "issn" => "21735743" "doi" => "10.1016/j.reumae.2022.07.002" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "1635" "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. 2023;19:244-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Pro-inflammatory cytokines in patients with low back pain: A comparative study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "244" "paginaFinal" => "248" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Citoquinas proinflamatorias en pacientes con dolor lumbar: un estudio comparativo" ] ] "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" => 1240 "Ancho" => 1245 "Tamanyo" => 54127 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curve (ROC) showing the discriminative value of IL-8 between LBP and pain-free controls.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maroua Slouma, Lobna Kharrat, Aymen Tezegdenti, Leila Metoui, Ezzeddine Ghazouani, Rim Dhahri, Imen Gharsallah, Bassem Louzir" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Maroua" "apellidos" => "Slouma" ] 1 => array:2 [ "nombre" => "Lobna" "apellidos" => "Kharrat" ] 2 => array:2 [ "nombre" => "Aymen" "apellidos" => "Tezegdenti" ] 3 => array:2 [ "nombre" => "Leila" "apellidos" => "Metoui" ] 4 => array:2 [ "nombre" => "Ezzeddine" "apellidos" => "Ghazouani" ] 5 => array:2 [ "nombre" => "Rim" "apellidos" => "Dhahri" ] 6 => array:2 [ "nombre" => "Imen" "apellidos" => "Gharsallah" ] 7 => array:2 [ "nombre" => "Bassem" "apellidos" => "Louzir" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574323000485?idApp=UINPBA00004M" "url" => "/21735743/0000001900000005/v1_202305041257/S2173574323000485/v1_202305041257/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "Chronic graft-versus-recipient disease: Systematic review of joint and fascial involvement" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "235" "paginaFinal" => "243" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cristina Hidalgo Calleja, María Dolores Sánchez González, Julio Medina Luezas, Lucía López Corral" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Cristina" "apellidos" => "Hidalgo Calleja" "email" => array:1 [ 0 => "chidalgoc15@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María Dolores" "apellidos" => "Sánchez González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Julio" "apellidos" => "Medina Luezas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Lucía" "apellidos" => "López Corral" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Hematología, Complejo Asistencial Universitario de Salamanca-IBSAL. Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad injerto contra receptor crónica: revisión sistemática de la afectación articular y fascial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1696 "Ancho" => 2508 "Tamanyo" => 311213 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photographic range of joint motion: P-ROM scale.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Allogeneic haematopoietic stem cell transplantation (allo-HCT) is the treatment of choice and the only curative strategy in multiple malignant and non-malignant haematological pathologies.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It consists of the complete replacement of the patient's haematopoiesis, because it is insufficient or neoplastic, with haematopoietic progenitor cells from a compatible healthy donor, after conditioning the patient with chemotherapy and/or radiotherapy. Its efficacy is based on the beneficial effect of the donor's lymphocytes, responsible for the graft-versus-tumour effect (GvT), in which the donor's T cells act against the host's malignant cells, providing a curative potential in haematopathies in which it is not possible to achieve a cure with the chemotherapy or pharmacological treatment available.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Graft-versus-host disease (GvHD) is one of the major undesirable complications of allo-HCT, correlating with increased mortality, second malignancies and a negative impact on quality of life.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Current mainstream research aims to minimise the risk of GvHD by maintaining GvT. Chronic GvHD (c-GvHD) has a variable incidence depending on risk factors (30%–70%) and is the most frequent late complication.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The median onset of cGvHD is 6 months after allo-HCT and usually occurs within 3 years after transplantation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Clinical manifestations are very diverse; symptoms are characteristic of allo/autoimmune disease with evidence of chronic inflammation and fibrosis of varying intensity. About 50% of patients will have multi-organ involvement.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The skin is the most frequently affected organ, but other tissues (oral, ocular and genital mucosa, liver, lungs, gastrointestinal tract) as well as joints and fascia are commonly involved. Organ involvement may be simultaneous or successive, with a major impact on the patient's quality of life.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Due to sustained immunosuppression, frequent infections occur, compromising patient survival.</p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the biggest challenges in the management of cGvHD is the establishment of a correct, early diagnosis. Recognising these difficulties, the National Institutes of Health (NIH) promoted the formation of an international consensus group on cGvHD that proposed guidelines for correct clinical and pathological diagnosis, unified response criteria and made recommendations for supportive care,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> with two subsequent updates, the latest in 2020.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a> This NIH consensus includes fasciitis and/or joint contractures as definitive diagnostic criteria for cGvHD (not requiring additional tests) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Reduced joint range of motion is usually secondary to sclerodermiform changes and/or fasciitis, as inflammatory joint involvement has rarely been observed. A correct diagnostic approach to cGvHD requires establishing the diagnosis, scoring the severity of each affected organ and classifying cGvHD as mild, moderate or severe.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Different scales have been proposed to assess fascia and joint involvement: the NIH Joint and Fascia Score 0–3 is a composite index that assesses joint stiffness, range of motion (ROM) and activities of daily living (ADL) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The Hopkins fascial scale uses a 0–3-point scale, but only scores stiffness. The photographic range of motion (P-ROM) scale is a series of images that captures ROM separately for shoulders, elbows, wrists/fingers and ankles; lower scores indicate more limited ROM. The total P-ROM score is the sum of the scores at all 4 joints, with a maximum possible score of 25 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The use of the P-ROM scale has been a breakthrough in terms of simplicity and objectivity; it is also useful in detecting longitudinal changes by measuring response to treatment. The NIH scale more accurately captures improvement, while the P-ROM scale better captures worsening.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The skin is the most frequently affected organ, and is often the initial manifestation of cGvHD. Generalised scleroderma can lead to joint contractures and severe functional limitation, frequently affecting the hands, wrists, shoulders, elbows and ankles.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a> Fasciitis due to inflammation of the fascia with an eosinophilic component may manifest as stiffness, oedema, arthralgia, reduced motion and occasionally synovitis.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Because of the multisystemic nature of cGvHD, its monitoring and treatment require a multidisciplinary approach.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Depending on its severity, comorbidities and the risk of relapse of the patient's underlying disease, the first line of treatment in moderate/severe cases is corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Two out of three patients will not respond adequately and sustainably to this treatment and will require rescue therapy.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,22</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objectives</span><p id="par0035" class="elsevierStylePara elsevierViewall">To conduct a systematic review of the literature on musculoskeletal (fascial/articular) involvement as a manifestation of chronic graft-versus-host disease sclerotic phenotype in patients undergoing allogeneic haematopoietic stem cell transplantation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">To describe the clinical features, diagnostic tools and therapeutic possibilities at present, due to the absence of review publications on this topic.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material and methods</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data sources and search strategy</span><p id="par0045" class="elsevierStylePara elsevierViewall">A literature search was conducted in PubMed, Embase and Cochrane, using MeSH terms and keywords to select articles with information on chronic graft-versus-host disease and diagnostic musculoskeletal (fascial, joint) involvement, clinical characterisation, methods of diagnostic evaluation and treatments (see search strategy in Appendix Banexo 1 of the supplementary material).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Selection criteria</span><p id="par0050" class="elsevierStylePara elsevierViewall">As this is a poorly known topic from a rheumatological point of view, a comprehensive search of the existing literature was conducted. Studies from the last 20 years were included. Priority was given to cross-sectional studies to evaluate diagnostic methods and clinical trials for articles on treatment. For clinical manifestations, case series and prospective or retrospective studies were considered. Articles unrelated to the search were excluded (avascular necrosis, bone loss, post-transplant joint infections, Sjögren's syndrome and other systemic autoimmune diseases, osteoporosis, osteonecrosis, osteomyelitis, dermatological involvement only, no allogeneic transplantation), as were exclusively experimental/preclinical studies, in languages other than English or Spanish, those that only included a paediatric population, and those that referred exclusively to acute GvHD (aGvHD). We excluded muscle involvement (myositis) because it is not a diagnostic criterion for cGvHD and because of the existence of a recent systematic review on this condition.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Inclusion criteria were: original studies (clinical trials, systematic reviews, case-controls, prospective or retrospective cohorts, case series, single cases), allo-HCT recipients, and the relationship of musculoskeletal manifestations to cGvHD. Reviewing the references of the most relevant articles, additional publications of interest were identified. Articles were imported into the Zotero reference manager and duplicate articles were removed. All abstracts were read by CHC and MDSG and full articles were obtained for review. Where there were discrepancies they were agreed with the other authors (LLC and JML). <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> details the flowchart for article selection.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data extraction</span><p id="par0060" class="elsevierStylePara elsevierViewall">We classified the articles according to the musculoskeletal involvement to which they referred (fasciitis, arthropathy) and according to the subject of the publication (clinical, diagnosis or treatment). We extracted demographic data, post-transplant time of the clinic, differential characteristics, treatment and other results on the different techniques of interest.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">We identified 6423 studies, of which we reviewed 126 in depth, to finally select 86: 37 on clinical and diagnostic evaluation (28 on fasciitis, of which 23 refer to clinical manifestations clínicas<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,14,17–19,24–42</span></a> and 5 to diagnosis,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,43–46</span></a> and 9 on arthropathy, of which 6 on clinical symptoms<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7,47–51</span></a> and 3 on diagnosis<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,43–46</span></a> and 49 on treatments administered (7 on fasciitis fasciitis,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,12,52–56</span></a> 9 on arthropathies<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16,57–63</span></a> and 33 on therapies administered in sclerodermiform cGvHD with fascial and/or joint involvement<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">64–96</span></a>) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Appendix Banexo 2 (additional material) contains all the articles analysed, with the data extracted. Appendix Banexo 3 (additional material) contains a glossary of terms and the colour code associated with each musculoskeletal manifestation for better understanding.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Most of the articles are of low quality, including only isolated clinical cases or case series with a small and uncontrolled sample size (36 articles, approximately 41%). There are also 14 reviews (≈16% reviews or consensuses), 14 (≈16%) retrospective observational studies, 11 (≈12%) prospective and only 7 (8%) phase II trials. We found only 3 systematic reviews: 3 related to treatments (UVA,<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a> rituximab<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> and extracorporeal photopheresis [ECP])<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a> and a recently published comprehensive narrative review on cGvHD-related eosinophilic fasciitis (EF) by CHC and CLL.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">There is a need to identify early signs, symptoms or other diagnostic determinants of cGvHD which are consistently associated with subsequent progression to highly morbid forms of cGvHD cGvHD.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Early detection of cGvHD requires careful and repeated assessments, including physical examinations by experienced transplant specialists, starting before transplantation and continuing through subsequent follow-up, to allow formal diagnosis and assessment of the disease trajectory.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">97</span></a> Patient education is important for active participation in the detection of early signs and symptoms.</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Fasciitis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Although skin changes are frequent, the detection of fasciitis is not as common and its diagnosis is more difficult, as physical signs and laboratory findings are not always present. Fasciitis is the most relevant musculoskeletal manifestation of cGvHD, with a reported annual incidence of .5%–47%.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,31,41,42</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48,54</span></a> It is important to distinguish fasciitis from sclerodermiform cGvHD, although the two can coexist in up to 80% of patients.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,48</span></a> Oedema is often the first sign of fascial involvement. Fasciitis lesions are usually located in the proximal areas of the extremities and abdomen, sparing the hands and feet.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42,52</span></a> EF-like in the context of cGvHD looks like pseudocellulitis due to subcutaneous septal and fascial fibrosis, often presenting with skin induration, with typical “orange peel” or rippling appearance, arthromyalgia, peripheral eosinophilia and development of joint contractures in the most severe cases (prayer sign).</p><p id="par0085" class="elsevierStylePara elsevierViewall">A careful patient history and systematic physical examination,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> is very important, as advanced fasciitis is hardly distinguishable from cutaneous sclerotic cGvHD,<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> and the gradation of severity should be noted on collection sheets (Appendix Banexo 4, in additional material).<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">When examining the patient, progression from easily compressible mobile skin to “non-mobile” and “stone-like” tightness due to diffuse thickening suggests chronic fibrosis that is difficult to reverse.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> Range of motion should be assessed (ideally with P-ROM) in all patients at baseline and at subsequent check-ups, which will allow us to grade severity and monitor response to treatment.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,12,13</span></a> Elastography measures<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33,80</span></a> are promising, although no large trials have been conducted to validate them. In this regard, most articles emphasize that the diagnosis of fasciitis should be established by histopathological findings - indistinguishable from those of classic EF - in the deep skin biopsy piel<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,25,30,33</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41,42</span></a> and by the alterations in the fascia seen in magnetic resonance imaging,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,33,34,36</span></a> as a non-invasive test,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> that allows us to distinguish between exclusively cutaneous manifestations, fasciitis and myositis, also allowing us to locate the optimal area in which to perform the biopsy.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">On histopathological examination of fasciitis, oedema and fibrosis are limited to the fasciae and subcutaneous septa, with subcutaneous fat trapping and a pericapillary cellular lymphoplasmacytic infiltrate.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The natural history of fasciitis in cGvHD is often progressive, leading to significant impairment of the patient's quality of life and functionality through stiffness, joint contracture and reduced ROM, as well as the development of chronic ulcers and scarring problems, making early diagnosis and therapy with systemic immunosuppression crucial to prevent progression.</p><p id="par0105" class="elsevierStylePara elsevierViewall">CEF, with a 55%–85% response, or PUVA in addition to systemic immunosuppression, can improve fascial involvement and prevent contractures.<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">56,70,75</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Physiotherapy is the mainstay of supportive treatment of fasciitis,<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58,63,98</span></a> especially thermal modalities, stretching, joint mobilisation and lymphatic drainage, and should be initiated as early as possible in order to prevent or resolve joint contractures. Strengthening exercises are controversial, as is surgical therapy of affected joints.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In addition, caution should be exercised with physiotherapy or lymphatic drainage in the acute oedematous stage of fasciitis, as inflammatory processes may be increased by mechanical irritation.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Response to treatment of fasciitis in GvHD is difficult to assess and has often been based on variable and subjective but practical criteria (“complete response”, “partial response”, “no change”, “progression”). Scales of cutaneous or fascial involvement have been prospectively validated.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Arthropathy</span><p id="par0120" class="elsevierStylePara elsevierViewall">Fascia/joint involvement is common in patients with cGvHD, but the incidence of isolated joint involvement is low,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> sometimes unnoticed and under-diagnosed in early stages without a thorough examination of joint motion. In advanced stages, they cause sometimes irreversible joint contractures, causing great disability and loss of quality of life.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The most frequently affected joints are the ankles (93%), followed by the shoulders (19%), wrists and fingers (16%) and elbows (9%). There is a high correlation of fascial/articular sclerosis with skin involvement. High levels of C3<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> have been reported.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Compared to patients with sclerotic skin changes, patients with joint involvement appear to have less functional disability, start earlier after diagnosis of cGvHD and have lower levels of inflammatory markers.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> Further studies are needed to determine whether joint involvement in the absence of skin changes represents deep tissue involvement below the clinical detection limit or a separate clinical process.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Ultrasound<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">99</span></a> and bone scintigraphy<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">100</span></a> have been used to diagnose joint involvement, in addition to MRI and CT.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Synovitis related to cGvHD has also been found in the literature, with the presence of donor cells in the synovial infiltration.<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">98</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Physiotherapy and rehabilitation are essential - it is important that they are started early: massage, heat, ultrasound, paraffin, stretching, hydromassage, strengthening and ADL training.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Pharmacological treatment</span><p id="par0145" class="elsevierStylePara elsevierViewall">In mild cGvHD, topical treatment or systemic corticosteroids are used as monotherapy. If fasciitis is present, NSAIDs should be added. In moderate cGvHD, treatment is with a systemic IS (usually prednisone with or without calcineurin inhibitors) and topical treatment. For severe cGvHD, treatment would be the same as for moderate cGvHD, with the addition of other IS.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">1st line treatment:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0155" class="elsevierStylePara elsevierViewall">Prednisone 1 mg/kg/day for 2–3 weeks, then every other day for 2 weeks and then taper to 1 mg/kg every 2 days for a period of 6–8 weeks if symptoms are stable or improve; maintain this dose for 2–3 months or continue directly to taper by 10%–20% per month.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0160" class="elsevierStylePara elsevierViewall">Depending on severity, it will be associated with calcineurin inhibitors (cyclosporine A and tacrolimus).</p></li></ul></p><p id="par0165" class="elsevierStylePara elsevierViewall">2nd line treatment: There are no established protocols or standard treatment, second-line or salvage treatments are prescribed from the numerous options available and are individually tailored (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">There is a need to identify biomarkers to predict treatment response.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> CD5+ B cells have been described as a biomarker of response to treatment with rituximab and nilotinib.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">72</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">We must also highlight the importance of supportive therapy for long-term patient care, as more and more patients are receiving HCT and hosts are surviving longer,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and the value of multidisciplinary consultations for comprehensive patient care.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0180" class="elsevierStylePara elsevierViewall">Specific studies and reviews on musculoskeletal manifestations in cGvHD are limited and of low quality, as we have reflected in the results.</p><p id="par0185" class="elsevierStylePara elsevierViewall">We have found that there is a need for systematic, objective, reliable and simple assessment of joint and fascial manifestations, as early diagnosis and treatment are decisive in the patient's evolution.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">It is noteworthy that the NIH Consensus Fascia/Joint score does not distinguish contributions to severity of cGvHD from isolated joint involvement compared to joint restriction associated with skin sclerosis.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">It is true that fascia/joint involvement is common in cGvHD and the incidence of isolated joint contracture in the absence of skin sclerosis is low,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> but it is also likely to be under-diagnosed if a full range-of-motion examination is not routinely performed; hence the importance of recording P-ROM at regular patient reviews.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,42</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Further studies are needed to determine whether joint involvement in the absence of sclerotic skin changes represents deep tissue involvement below the limit of clinical detection or whether it is a separate clinical process. Future refinements of the NIH criteria may need to recognise joint restrictions that occur in the absence of sclerotic skin involvement.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">The clinical, genetic and biological factors specifically associated with musculoskeletal and joint involvement in patients with cGvHD are unknown.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">In these patients, it is necessary to perform an analytical evaluation for peripheral eosinophilia as an early serological marker of cGvHD, in particular fasciitis, as well as the determination of muscle enzymes.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,29–31</span></a> The search for serum biomarkers in this fibrosing entity, such as specific autoantibodies (anti-sclerosis) has so far been unsuccessful. In a series of patients with eosinophilic-like fasciitis related to cGvHD, positive antinuclear antibodies were detected in 25% of patients, with the nucleolar pattern being the most frequent.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Patients with clinical manifestations suggestive of EF-like cGvHD should undergo deep biopsy (skin, muscle and fascia) and in some cases MRI to assess the extent of involvement and monitor response to treatment.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,30</span></a> According to the NIH Consensus, fasciitis is a “diagnostic” entity that does not require confirmation with additional tests, but in the event of suggestive symptoms such as arthralgias, muscle cramps, joint stiffness or tendon rubbing, imaging tests (MRI, high-frequency US) 44,80 and even diagnostic biopsy should be considered in certain isolated or doubtful cases.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Assessment of active joint motion as an objective measure with P-ROM is a very good option in routine practice, together with the NIH joint/fascia scale.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The NIH joint/fascia score and the P-ROM total score should be used to assess therapeutic response in joint/fascia c-GvHD. A change from 0 to 1 in the NIH joint/fascia score should not be considered as a worsening.</p><p id="par0225" class="elsevierStylePara elsevierViewall">In terms of treatment, high-dose corticosteroids are still used as first line, with their recognised adverse effects (immunosuppression, osteopenia, avascular necrosis, fractures, muscle and skin atrophy, oedema, delayed healing…) and in the case of cortico-refractoriness or intolerance to the first line, there is no established standard treatment, so the decision is based on the circumstances of each patient, analysed on an individual basis. Physiotherapy and other physical therapies have proven to be effective in improving functionality and preventing disease progression, and should be started as early as possible.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">Musculoskeletal involvement related to c-GvHD is common and can cause significant functional impairment, with great impact on quality of life. Specific studies of fascial and joint complications are scarce and of low quality. One of the major challenges in the management of c-GvHD is the establishment of a correct, early diagnosis, to improve the likelihood of response to treatment and the prevention of irreversible sequelae. New biomarkers are needed to allow more targeted treatment in patients after first-line treatment failure. Physiotherapy is essential to improve functionality and prevent disease progression and should be started early. Because of the multisystemic nature of c-GvHD, its monitoring and treatment require a multidisciplinary approach.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interests</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1893817" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and 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" => "xpalclavsec1638521" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1893816" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y 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" => "xpalclavsec1638522" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objectives" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Data sources and search strategy" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Selection criteria" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Data extraction" ] ] ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Fasciitis" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Arthropathy" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Pharmacological treatment" ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-09-11" "fechaAceptado" => "2022-12-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1638521" "palabras" => array:4 [ 0 => "Graft-versus-host disease" 1 => "Fasciitis" 2 => "Joint contracture" 3 => "Allogeneic transplantation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1638522" "palabras" => array:4 [ 0 => "Enfermedad injerto contra receptor" 1 => "Fascitis" 2 => "Contractura articular" 3 => "Trasplante alogénico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Chronic graft-versus-host disease (cGVRD) is a systemic immune-mediated complication that occurs in approximately half of the patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HCT) and, although it is associated with beneficial graft versus tumour effects and lower relapse rates, it remains the leading cause of late morbidity and mortality in these patients. The aim of this systematic review of the literature is to provide a current overview on the diagnostic musculoskeletal manifestations of cGVRD, its clinical evaluation, and therapeutic possibilities.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">We ran a systematic search in PubMed, Embase, and Cochrane Library. Studies from the last 20 years were included. Priority was given to cross-sectional studies to evaluate diagnostic methods and to clinical trials in the case of articles referring to treatment. The search was limited to humans and articles published in English or Spanish.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">We identified 6423 studies, of which we selected 86 (37 on clinical and diagnostic evaluation and 49 on treatments). Specific studies on fascial and joint complications are scarce and of low quality, including only isolated clinical cases or case series. Fasciitis is the most relevant musculoskeletal manifestation, and isolated joint involvement is low, sometimes unnoticed and underdiagnosed, if a thorough exploration of joint motion is not performed. Early detection of cGVRD with fascial and/or joint involvement requires careful and repeated evaluation.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The search for new biomarkers or advanced imaging techniques that allow early diagnosis is necessary. Physiotherapy is essential to improve functionality and prevent disease progression. Controlled studies are needed to establish recommendations on second lines of treatment. Because of its multisystemic nature, cGVRD requires a multidisciplinary approach.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and 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">Antecedentes y objetivo</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">La enfermedad injerto contra receptor crónica (EICRc) es una complicación inmunomediada sistémica que aparece en aproximadamente la mitad de los pacientes sometidos a trasplante alogénico de progenitores hematopoyéticos (alo-HCT) y, aunque se asocia con efectos beneficiosos de injerto versus tumor y tasas de recaída más bajas, sigue siendo la principal causa de morbimortalidad tardía en estos pacientes. El objetivo de esta revisión sistemática de la literatura es proporcionar una visión actual sobre las manifestaciones musculoesqueléticas diagnósticas de EICRc, su evaluación clínica y sus posibilidades terapéuticas.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Se realizó una búsqueda sistemática en PubMed, Embase y Cochrane Library. Se incluyeron estudios de los últimos 20 años, y se dio prioridad a los estudios transversales para evaluar métodos diagnósticos y a los ensayos clínicos en el caso de artículos referidos a tratamiento. La búsqueda se limitó a humanos y a artículos publicados en inglés o español.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Identificamos 6423 estudios, de los cuales finalmente seleccionamos 86 (37 sobre clínica y evaluación diagnóstica y 49 sobre tratamientos). Los estudios específicos de complicaciones fasciales y articulares son escasos y de baja calidad, al incluir únicamente casos clínicos aislados o series de casos. La detección temprana de la EICRc con afectación fascial y/o articular requiere de evaluaciones cuidadosas y repetitivas, incluidos exámenes físicos por parte de especialistas con experiencia en trasplantes, comenzando antes del trasplante y continuando a través del seguimiento posterior, para permitir el diagnóstico y la evaluación de la trayectoria de la enfermedad.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Es necesaria la búsqueda de nuevos biomarcadores o de técnicas de imagen avanzada que permitan realizar un diagnóstico precoz. La fisioterapia es esencial para mejorar la funcionalidad y prevenir la progresión de la enfermedad. Se precisan estudios controlados para establecer recomendaciones sobre las segundas líneas de tratamiento. Por su carácter multisistémico, la EICRc requiere un abordaje multidisciplinar.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0245" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0075" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1696 "Ancho" => 2508 "Tamanyo" => 311213 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photographic range of joint motion: P-ROM scale.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3043 "Ancho" => 3341 "Tamanyo" => 540135 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of the selection of articles for inclusion and exclusion in the review.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">GvHD: Graft-versus-host disease.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Source: adapted from Andrews et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and Hamilton et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></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=""><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">Organ \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">Diagnosis (sufficient to establish a diagnosis of cGvHD) \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">Distinctive (observed in cGvHD, insufficient alone to establish diagnosis) \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">Other characteristics or entities \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">Muscle, fascia, joint \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">Fascitis, joint contractures secondary to sclerosis \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">Myositis or polymyositis \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">Oedema, muscle cramps, arthralgia or arthritis \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3165756.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagnostic and distinguishing criteria of chronic musculoskeletal GvHD.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">ADL: activities of daily life; NIH: North American National Institutes of Health.</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=""><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">0: Asymptomatic \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">1: Tightness in arms or legs, normal or mildly impaired joint motion not affecting ADLs \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">2: Tightness in arms or legs, joint contractures, erythema due to fasciitis, moderately impaired joint motion with mild to moderate limitation of ADLs \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">3: Contractures with severe impairment of joint motion severely affecting ADLs (unable to tie shoes, dress, etc.) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3165757.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">NIH joint/fascial scale.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Strength of evidence level:</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">• II: >1 well-designed clinical trial without randomisation, cohort or case-control, analytical (preferably > 1 centre) or multiple time series studies, or dramatic results from uncontrolled experiments.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">• III: opinions of respected authorities based on clinical experience, descriptive studies or expert committee reports:</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>◦ III-1: several reports of retrospective evaluations or small uncontrolled clinical trials.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>◦ III-2: a report of a small uncontrolled clinical trial or retrospective evaluations.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>◦ III-3: case reports.</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">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">Evidence \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">References \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">Photopheresis, UVA, UVA 1, UVB \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">II \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"><a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58,61,70,75</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">79,87,90,91</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">94,96</span></a> \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">Calcineurin inhibitors (cyclosporin A and tacrolimus) \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">III-I \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"><a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,70</span></a> \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">mTOR inhibitors (sirolimus, everolimus) \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">III-I \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"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> \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">Tyrosine kinase inhibitors (imatinib, dasatinib, bosutinib, ruxolitinib, nilotinib) \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">III-I \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"><a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,55,71,72</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">77,78,81,82</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">84,86,88,91</span></a> \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">Proteosome inhibitors (ixazomib) \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">II \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"><a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a> \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">IFN I inhibitors \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"> \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"><a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">76</span></a> \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">IL2 \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">III-3 \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"><a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">68,74</span></a> \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">Lidocaine iv \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">III-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"><a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,95</span></a> \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">Rituximab \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">II \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"><a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">72,77,85,89</span></a> \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">Alemtuzumab \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">III-3 \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"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> \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">Alefacept \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">III-3 \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"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> \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">Pentostatin \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">II \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"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> \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">CO<span class="elsevierStyleInf">2</span> Laser \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">III-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"><a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,67</span></a> \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">Anti-TNFα (etanercept, infliximab, adalimumab) \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">III-3 \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"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> \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">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III-I \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"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> \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">Vismodegib \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">III-3 \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"><a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> \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">Mesenchymal stem cells \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">III-3 \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"><a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">66,83,93</span></a> \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">Thoracoabdominal irradiation \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">III-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"><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> \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">Physiotherapy \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">III-I \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"><a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58,63,98</span></a> \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">Topical silicone gel sheeting \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">III-3 \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"><a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">93</span></a> \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">Topical halofuginone \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">III-3 \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"><a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">91</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3165758.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Salvage treatment options in chronic graft-versus-host disease (cGVHD) with fascial/articular involvement.</p>" ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 126667 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:100 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allogeneic stem cell transplantation: a historical and scientific overview" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1158/0008-5472.CAN-16-1311" "Revista" => array:6 [ "tituloSerie" => "Cancer Res." "fecha" => "2016" "volumen" => "76" "paginaInicial" => "6445" "paginaFinal" => "6451" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New ways to separate Graft-versus-Host disease and Graft-versus-Tumour effects after allogeneic haematopoietic stem cell transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.12115" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol." "fecha" => "2013" "volumen" => "160" "paginaInicial" => "133" "paginaFinal" => "145" "link" => array:1 [ …1] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)60237-3" "Revista" => array:6 [ "tituloSerie" => "Lancet." "fecha" => "2009" "volumen" => "373" "paginaInicial" => "1550" "paginaFinal" => "1561" "link" => array:1 [ …1] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing incidence of chronic Graft-versus-Host disease in allogeneic transplantation: a report from the center for International Blood and Marrow Transplant Research" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2014.10.021" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2015" "volumen" => "21" "paginaInicial" => "266" "paginaFinal" => "274" "link" => array:1 [ …1] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How I conduct a comprehensive chronic graft-versus-host disease assessment" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2011-04-314815" "Revista" => array:6 [ "tituloSerie" => "Blood." "fecha" => "2011" "volumen" => "118" "paginaInicial" => "2679" "paginaFinal" => "2687" "link" => array:1 [ …1] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association of performance status and disease severity in patients with chronic Graft-vs-Host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.apmr.2018.04.034" "Revista" => array:6 [ "tituloSerie" => "Arch Phys Med Rehabil." "fecha" => "2019" "volumen" => "100" "paginaInicial" => "606" "paginaFinal" => "612" "link" => array:1 [ …1] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disability associated with chronic Graft-versus-Host disease after allogeneic hematopoietic cell transplantation" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Blood." "fecha" => "2021" "volumen" => "138" "paginaInicial" => "4060" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "German-Austrian-Swiss Consensus Conference on clinical practice in chronic graft-versus-host disease (GVHD): guidance for supportive therapy of chronic cutaneous and musculoskeletal GVHD" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2011.10573.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol." "fecha" => "2011" "volumen" => "165" "paginaInicial" => "18" "paginaFinal" => "29" "link" => array:1 [ …1] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National Institutes of Health Consensus Development Project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2005.09.004" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2005" "volumen" => "11" "paginaInicial" => "945" "paginaFinal" => "956" "link" => array:1 [ …1] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2014.12.001" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2015" "volumen" => "21" "paginaInicial" => "389" "paginaFinal" => "401" "link" => array:1 [ …1] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IIb. The 2020 Preemptive Therapy Working Group Report" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtct.2021.03.029" "Revista" => array:6 [ "tituloSerie" => "Transplant Cell Ther." "fecha" => "2021" "volumen" => "27" "paginaInicial" => "632" "paginaFinal" => "641" "link" => array:1 [ …1] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of joint and fascia manifestations in chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheum." "fecha" => "2014" "volumen" => "66" "paginaInicial" => "1044" "paginaFinal" => "1052" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Strike a pose: the role of photographic range of motion (ROM) images in detection, monitoring, and documentation of fasciitis and sclerosis associated with chronic graft-versus-host disease (cGVHD)" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2018" "volumen" => "24" "paginaInicial" => "S451" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The anatomic distribution of skin involvement in patients with incident chronic graft versus host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2018.09.007" "Revista" => array:2 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2018" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ablative fractional laser resurfacing for treatment of sclerosis and contractures in chronic graft-versus-host disease: a pilot study" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2019.07.084" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2020" "volumen" => "82" "paginaInicial" => "984" "paginaFinal" => "986" "link" => array:1 [ …1] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of refractory joint contractures caused by sclerodermatous graft versus host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bjps.2007.03.036" "Revista" => array:6 [ "tituloSerie" => "J Plast Reconstr Aesthet Surg." "fecha" => "2008" "volumen" => "61" "paginaInicial" => "1235" "paginaFinal" => "1238" "link" => array:1 [ …1] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fasciitis after allogeneic peripheral blood stem cell transplantation in a patient with chronic myelogenous leukemia" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.RHU.0000037772.99917.86" "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol." "fecha" => "2003" "volumen" => "9" "paginaInicial" => "33" "paginaFinal" => "36" "link" => array:1 [ …1] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fasciitis and myositis: an analysis of muscle-related complications caused by chronic GVHD after allo-SCT" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/bmt.2008.297" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant." "fecha" => "2009" "volumen" => "43" "paginaInicial" => "159" "paginaFinal" => "167" "link" => array:1 [ …1] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Joint and fascia manifestations in the course of graft-versus-host disease (GVHD) as a diagnostic trail for doctors of various specialties – case report" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.19271/IRONS-00054-2018-23" "Revista" => array:5 [ "tituloSerie" => "Issue Rehabil Orthop Neurophysiol Sport Promot." "fecha" => "2018" "volumen" => "22" "paginaInicial" => "55" "paginaFinal" => "62" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus conference on clinical practice in chronic graft-versus-host disease (GVHD): first-line and topical treatment of chronic GVHD" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2010.06.015" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2010" "volumen" => "16" "paginaInicial" => "1611" "paginaFinal" => "1628" "link" => array:1 [ …1] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus conference on clinical practice in chronic GVHD: second-line treatment of chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2010.05.011" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2011" "volumen" => "17" "paginaInicial" => "1" "paginaFinal" => "17" "link" => array:1 [ …1] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term outcome and prospective validation of NIH response criteria in 39 patients receiving imatinib for steroid-refractory chronic GVHD" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2013-05-494278" "Revista" => array:6 [ "tituloSerie" => "Blood." "fecha" => "2013" "volumen" => "122" "paginaInicial" => "4111" "paginaFinal" => "4118" "link" => array:1 [ …1] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic graft-versus-host disease presenting as acute polymyositis: a case series and systematic review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.trim.2021.101520" "Revista" => array:3 [ "tituloSerie" => "Transpl Immunol." "fecha" => "2022" "volumen" => "70" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Graft versus host disease-related eosinophilic fasciitis: cohort descripción and literature review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s42358-022-00262-3" "Revista" => array:5 [ "tituloSerie" => "Adv Rheumatol." "fecha" => "2022" "volumen" => "62" "paginaInicial" => "33" "link" => array:1 [ …1] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13256-021-02735-3" "Revista" => array:5 [ "tituloSerie" => "J Med Case Rep." "fecha" => "2021" "volumen" => "15" "paginaInicial" => "135" "link" => array:1 [ …1] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scleroderma mimics – clinical features and management" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Best Pract Res Clin Rheumatol." "fecha" => "2020" "volumen" => "34" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sclerodermalike syndromes: great imitators" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2019.10.010" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol." "fecha" => "2020" "volumen" => "38" "paginaInicial" => "235" "paginaFinal" => "249" "link" => array:1 [ …1] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous manifestations of scleroderma and scleroderma-like disorders: a comprehensive review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12016-017-8625-4" "Revista" => array:6 [ "tituloSerie" => "Clin Rev Allergy Immunol." "fecha" => "2017" "volumen" => "53" "paginaInicial" => "306" "paginaFinal" => "336" "link" => array:1 [ …1] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute myofascitis as a manifestation of chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/mus.24937" "Revista" => array:6 [ "tituloSerie" => "Muscle Nerve." "fecha" => "2016" "volumen" => "53" "paginaInicial" => "327" "paginaFinal" => "329" "link" => array:1 [ …1] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic fasciitis following allogeneic bone marrow transplantation in a patient with acute myeloid leukaemia" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2340/00015555-1669" "Revista" => array:6 [ "tituloSerie" => "Acta Derm Venereol." "fecha" => "2014" "volumen" => "94" "paginaInicial" => "221" "paginaFinal" => "222" "link" => array:1 [ …1] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence, risk factors, and outcomes of sclerosis in patients with chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2012-10-464198" "Revista" => array:6 [ "tituloSerie" => "Blood." "fecha" => "2013" "volumen" => "121" "paginaInicial" => "5098" "paginaFinal" => "5103" "link" => array:1 [ …1] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Graft-versus-host disease of the skin and adjacent mucous membranes" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ddg.12103" "Revista" => array:6 [ "tituloSerie" => "J Dtsch Dermatol Ges." "fecha" => "2013" "volumen" => "11" "paginaInicial" => "477" "paginaFinal" => "495" "link" => array:1 [ …1] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extensive fasciitis as late manifestation of graft-versus-host disease, a purpose of a case" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3324/haematol.2010.035675" "Revista" => array:6 [ "tituloSerie" => "Haematologica." "fecha" => "2011" "volumen" => "96" "paginaInicial" => "590" "paginaFinal" => "591" "link" => array:1 [ …1] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cervical fascial and muscular involvement in chronic GVHD after allo-SCT and radiation therapy" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/bmt.2009.62" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant." "fecha" => "2009" "volumen" => "44" "paginaInicial" => "451" "paginaFinal" => "452" "link" => array:1 [ …1] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin response using NIH consensus criteria vs Hopkins scale in a phase II study for steroid-refractory chronic GVHD" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/bmt.2009.84" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant." "fecha" => "2009" "volumen" => "44" "paginaInicial" => "813" "paginaFinal" => "819" "link" => array:1 [ …1] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rippled skin, fasciitis, and joint contractures" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2008.08.023" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2008" "volumen" => "59" "paginaInicial" => "1070" "paginaFinal" => "1074" "link" => array:1 [ …1] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical and histologic spectrum of chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2006.02.061" "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2006" "volumen" => "55" "paginaInicial" => "729" "link" => array:1 [ …1] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The changing face of graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.sder.2006.09.001" "Revista" => array:6 [ "tituloSerie" => "Semin Cutan Med Surg." "fecha" => "2006" "volumen" => "25" "paginaInicial" => "190" "paginaFinal" => "200" "link" => array:1 [ …1] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic fasciitis associated with autoimmune phenomena after bone marrow transplantation: report of two cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-005-1138-1" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol." "fecha" => "2006" "volumen" => "25" "paginaInicial" => "80" "paginaFinal" => "82" "link" => array:1 [ …1] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Muscle cramps and weakness secondary to graft versus host disease fasciitis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-1331.2004.00964.x" "Revista" => array:6 [ "tituloSerie" => "Eur J Neurol." "fecha" => "2005" "volumen" => "12" "paginaInicial" => "320" "paginaFinal" => "322" "link" => array:1 [ …1] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic fasciitis after allogeneic stem cell transplantation: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/10428190410001683787" "Revista" => array:6 [ "tituloSerie" => "Leuk Lymphoma." "fecha" => "2004" "volumen" => "45" "paginaInicial" => "1707" "paginaFinal" => "1709" "link" => array:1 [ …1] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fasciitis in chronic graft-versus-host disease. A clinicopathologic study of 14 cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-120-12-199406150-00004" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med." "fecha" => "1994" "volumen" => "120" "paginaInicial" => "993" "paginaFinal" => "998" "link" => array:1 [ …1] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. The 2020 Highly morbid forms report" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtct.2021.06.001" "Revista" => array:6 [ "tituloSerie" => "Transplant Cell Ther." "fecha" => "2021" "volumen" => "27" "paginaInicial" => "817" "paginaFinal" => "835" "link" => array:1 [ …1] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Magnetic resonance imaging in sclerotic-type chronic graft-vs-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2009.78" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol." "fecha" => "2009" "volumen" => "145" "paginaInicial" => "918" "paginaFinal" => "922" "link" => array:1 [ …1] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopathologic diagnosis of chronic graft-versus-host disease: National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: II. Pathology working group report" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2005.11.001" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2006" "volumen" => "12" "paginaInicial" => "31" "paginaFinal" => "47" "link" => array:1 [ …1] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute swelling of the limbs: magnetic resonance pictorial review of fascial and muscle signal changes" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0720-048x(98)00119-3" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol." "fecha" => "1999" "volumen" => "30" "paginaInicial" => "11" "paginaFinal" => "21" "link" => array:1 [ …1] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudo-Volkmann contracture as a complication of chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Dermatol Ther." "fecha" => "2021" "volumen" => "34" ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Joint and fascial chronic graft-vs-host disease: correlations with clinical and laboratory parameters" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3325/cmj.2016.57.266" "Revista" => array:6 [ "tituloSerie" => "Croat Med J." "fecha" => "2016" "volumen" => "57" "paginaInicial" => "266" "paginaFinal" => "275" "link" => array:1 [ …1] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of isolated joint involvement in chronic graft-versus-host disease: comment on the article by Inamoto et al." "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheum." "fecha" => "2014" "volumen" => "66" "paginaInicial" => "2646" "paginaFinal" => "2648" ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0250" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The development of inflammatory arthritis and other rheumatic diseases following stem cell transplantation" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2008.03.010" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum." "fecha" => "2009" "volumen" => "39" "paginaInicial" => "55" "paginaFinal" => "60" "link" => array:1 [ …1] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0255" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Late effects of chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.beha.2008.02.016" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Haematol." "fecha" => "2008" "volumen" => "21" "paginaInicial" => "309" "paginaFinal" => "331" "link" => array:1 [ …1] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0260" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Refined National Institutes of Health response algorithm for chronic graft-versus-host disease in joints and fascia" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/bloodadvances.2019000918" "Revista" => array:6 [ "tituloSerie" => "Blood Adv." "fecha" => "2020" "volumen" => "4" "paginaInicial" => "40" "paginaFinal" => "46" "link" => array:1 [ …1] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0265" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rehabilitation in chronic Graft-versus-Host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pmr.2016.08.009" "Revista" => array:6 [ "tituloSerie" => "Phys Med Rehabil Clin N Am." "fecha" => "2017" "volumen" => "28" "paginaInicial" => "143" "paginaFinal" => "151" "link" => array:1 [ …1] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0270" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic graft-versus-host disease presenting as eosinophilic fasciitis: therapeutic challenges and an additional case" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RHU.0000000000000212" "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol." "fecha" => "2015" "volumen" => "21" "paginaInicial" => "86" "paginaFinal" => "94" "link" => array:1 [ …1] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0275" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imatinib is effective for prevention and improvement of fibrotic fasciitis as a manifestation of chronic GVHD" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/bmt.2011.10" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant." "fecha" => "2012" "volumen" => "47" "paginaInicial" => "139" "paginaFinal" => "140" "link" => array:1 [ …1] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0280" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal photochemotherapy for treatment of fasciitis in chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.bmt.1704436" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant." "fecha" => "2004" "volumen" => "33" "paginaInicial" => "869" "paginaFinal" => "870" "link" => array:1 [ …1] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0285" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leflunomide for chronic musculoskeletal graft versus host disease following allogeneic hematopoietic stem cell transplant" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41409-019-0545-x" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant." "fecha" => "2020" "volumen" => "55" "paginaInicial" => "467" "paginaFinal" => "469" "link" => array:1 [ …1] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0290" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of sclerotic cutaneous graft-versus-host disease using extracorporeal photopheresis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JDDG J German Soc Dermatol." "fecha" => "2020" "volumen" => "18" "paginaInicial" => "34" "paginaFinal" => "38" ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0295" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leflunomide: is it the game changer in musculoskeletal chronic graft versus host disease?" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12288-018-0929-x" "Revista" => array:2 [ "tituloSerie" => "Indian J Hematol Blood Transfus." "fecha" => "2018" ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0300" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Musculoskeletal, neurologic, and cardiopulmonary aspects of physical rehabilitation in patients with chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2014.10.019" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2015" "volumen" => "21" "paginaInicial" => "799" "paginaFinal" => "808" "link" => array:1 [ …1] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0305" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Extracorporeal photopheresis in treatment of chronic graft versus host disease]" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lijec Vjesn." "fecha" => "2013" "volumen" => "135" "paginaInicial" => "139" "paginaFinal" => "144" "link" => array:1 [ …1] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0310" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tocilizumab for the treatment of steroid refractory graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2011.07.001" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2011" "volumen" => "17" "paginaInicial" => "1862" "paginaFinal" => "1868" "link" => array:1 [ …1] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0315" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic experience on multiple contractures in sclerodermoid chronic graft versus host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00520-009-0602-x" "Revista" => array:6 [ "tituloSerie" => "Support Care Cancer." "fecha" => "2009" "volumen" => "17" "paginaInicial" => "851" "paginaFinal" => "855" "link" => array:1 [ …1] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0320" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hedgehog blockade in steroid-refractory sclerotic chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.17657" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol." "fecha" => "2021" "volumen" => "195" "paginaInicial" => "e120" "paginaFinal" => "2" "link" => array:1 [ …1] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0325" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rehabilitation interventions in the multidisciplinary management of patients with sclerotic Graft-versus-Host disease of the skin and fascia" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.apmr.2020.10.141" "Revista" => array:6 [ "tituloSerie" => "Arch Phys Med Rehabil." "fecha" => "2021" "volumen" => "102" "paginaInicial" => "776" "paginaFinal" => "788" "link" => array:1 [ …1] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0330" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mesenchymal stem cells for scleroderma-like graft versus host disease: a case series" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cytotherapy." "fecha" => "2021" "volumen" => "23" "paginaInicial" => "24" ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0335" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ixazomib for treatment of refractory chronic Graft-versus-Host disease: a chronic GVHD Consortium Phase II trial" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2020.05.015" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2020" "volumen" => "26" "paginaInicial" => "1612" "paginaFinal" => "1619" "link" => array:1 [ …1] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0340" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complete remission of sclerodermatous cutaneous graft-versus-host disease after low-dose interleukine-2 treatment" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.16524" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol." "fecha" => "2020" "volumen" => "34" "paginaInicial" => "e791" "paginaFinal" => "3" "link" => array:1 [ …1] ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0345" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fractional CO(2) laser for the treatment of sclerodermatous cGVHD" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/14764172.2019.1710537" "Revista" => array:6 [ "tituloSerie" => "J Cosmet Laser Ther." "fecha" => "2020" "volumen" => "22" "paginaInicial" => "49" "paginaFinal" => "51" "link" => array:1 [ …1] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0350" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fototherapy in the resistant chronic cutaneous graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Rev Mex." "fecha" => "2020" "volumen" => "64" "paginaInicial" => "50" "paginaFinal" => "57" ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib0355" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sclerodermatous chronic Graft-versus-Host disease treated with imatinib: a dermatological perspective" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermo-Sifiliogr." "fecha" => "2018" "volumen" => "109" "paginaInicial" => "241" "paginaFinal" => "247" ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib0360" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective evaluation of sequential treatment of sclerotic chronic graft versus host disease with rituximab and nilotinib" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41409-018-0158-9" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant." "fecha" => "2018" "volumen" => "53" "paginaInicial" => "1255" "paginaFinal" => "1262" "link" => array:1 [ …1] ] ] ] ] ] ] 72 => array:3 [ "identificador" => "bib0365" "etiqueta" => "73" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reprint of: emerging therapeutics for the control of chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2017.12.788" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2018" "volumen" => "24" "paginaInicial" => "S7" "paginaFinal" => "14" "link" => array:1 [ …1] ] ] ] ] ] ] 73 => array:3 [ "identificador" => "bib0370" "etiqueta" => "74" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and tolerance of ruxolitinib in refractory sclerodermatous chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.15593" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol." "fecha" => "2017" "volumen" => "177" "paginaInicial" => "e206" "paginaFinal" => "8" "link" => array:1 [ …1] ] ] ] ] ] ] 74 => array:3 [ "identificador" => "bib0375" "etiqueta" => "75" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phototherapy for sclerosing skin conditions" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2016.05.012" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol." "fecha" => "2016" "volumen" => "34" "paginaInicial" => "614" "paginaFinal" => "622" "link" => array:1 [ …1] ] ] ] ] ] ] 75 => array:3 [ "identificador" => "bib0380" "etiqueta" => "76" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type I IFNs regulate inflammation, vasculopathy, and fibrosis in chronic cutaneous Graft-versus-Host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4049/jimmunol.1502190" "Revista" => array:6 [ "tituloSerie" => "J Immunol." "fecha" => "2016" "volumen" => "197" "paginaInicial" => "42" "paginaFinal" => "50" "link" => array:1 [ …1] ] ] ] ] ] ] 76 => array:3 [ "identificador" => "bib0385" "etiqueta" => "77" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized phase II crossover study of imatinib or rituximab for cutaneous sclerosis after hematopoietic cell transplantation" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1158/1078-0432.CCR-15-1443" "Revista" => array:6 [ "tituloSerie" => "Clin Cancer Res." "fecha" => "2016" "volumen" => "22" "paginaInicial" => "319" "paginaFinal" => "327" "link" => array:1 [ …1] ] ] ] ] ] ] 77 => array:3 [ "identificador" => "bib0390" "etiqueta" => "78" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imatinib mesylate for the treatment of steroid-refractory sclerotic-type cutaneous chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2015.03.006" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2015" "volumen" => "21" "paginaInicial" => "1083" "paginaFinal" => "1090" "link" => array:1 [ …1] ] ] ] ] ] ] 78 => array:3 [ "identificador" => "bib0395" "etiqueta" => "79" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal photopheresis for chronic graft-versus-host disease: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5045/br.2014.49.2.100" "Revista" => array:6 [ "tituloSerie" => "Blood Res." "fecha" => "2014" "volumen" => "49" "paginaInicial" => "100" "paginaFinal" => "106" "link" => array:1 [ …1] ] ] ] ] ] ] 79 => array:3 [ "identificador" => "bib0400" "etiqueta" => "80" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "«Assessment of chronic sclerodermoid Graft-versus-Host disease patients, using 20 MHz high-frequency ultrasonography and cutometer methods»" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0846.2012.00659.x" "Revista" => array:6 [ "tituloSerie" => "Skin Res Technol." "fecha" => "2013" "volumen" => "19" "paginaInicial" => "e417" "paginaFinal" => "422" "link" => array:1 [ …1] ] ] ] ] ] ] 80 => array:3 [ "identificador" => "bib0405" "etiqueta" => "81" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of sclerodermatous graft-versus-host disease responsive to imatinib therapy" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1470.2010.01301.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol." "fecha" => "2011" "volumen" => "28" "paginaInicial" => "172" "paginaFinal" => "175" "link" => array:1 [ …1] ] ] ] ] ] ] 81 => array:3 [ "identificador" => "bib0410" "etiqueta" => "82" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are tyrosine kinase inhibitors promising for the treatment of systemic sclerosis and other fibrotic diseases?" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Swiss Med Wkly." "fecha" => "2010" "volumen" => "140" ] ] ] ] ] ] 82 => array:3 [ "identificador" => "bib0415" "etiqueta" => "83" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of bone marrow-derived mesenchymal stem cells in the treatment of sclerodermatous chronic graft-versus-host disease: clinical report" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2009.11.006" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2010" "volumen" => "16" "paginaInicial" => "403" "paginaFinal" => "412" "link" => array:1 [ …1] ] ] ] ] ] ] 83 => array:3 [ "identificador" => "bib0420" "etiqueta" => "84" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tyrosine kinase inhibitors for the treatment of fibrotic diseases such as systemic sclerosis: towards molecular targeted therapies" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2009.120196" "Revista" => array:7 [ "tituloSerie" => "Ann Rheum Dis." "fecha" => "2010" "volumen" => "69" "numero" => "Suppl 1" "paginaInicial" => "i48" "paginaFinal" => "51" "link" => array:1 [ …1] ] ] ] ] ] ] 84 => array:3 [ "identificador" => "bib0425" "etiqueta" => "85" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of rituximab in the setting of Steroid-Refractory Chronic Graft-versus-Host disease: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2009.04.003" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant." "fecha" => "2009" "volumen" => "15" "paginaInicial" => "1005" "paginaFinal" => "1013" "link" => array:1 [ …1] ] ] ] ] ] ] 85 => array:3 [ "identificador" => "bib0430" "etiqueta" => "86" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of imatinib mesylate in the treatment of refractory sclerodermatous chronic GVHD" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/bmt.2008.252" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant." "fecha" => "2008" "volumen" => "42" "paginaInicial" => "757" "paginaFinal" => "760" "link" => array:1 [ …1] ] ] ] ] ] ] 86 => array:3 [ "identificador" => "bib0435" "etiqueta" => "87" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultraviolet A phototherapy for sclerotic skin diseases: a systematic review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2008.07.042" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2008" "volumen" => "59" "paginaInicial" => "1017" "paginaFinal" => "1030" "link" => array:1 [ …1] ] ] ] ] ] ] 87 => array:3 [ "identificador" => "bib0440" "etiqueta" => "88" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imatinib as a potential treatment for sclerodermatous chronic graft-vs-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.144.9.1106" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol." "fecha" => "2008" "volumen" => "144" "paginaInicial" => "1106" "paginaFinal" => "1109" "link" => array:1 [ …1] ] ] ] ] ] ] 88 => array:3 [ "identificador" => "bib0445" "etiqueta" => "89" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rituximab is effective for steroid-refractory sclerodermatous chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.leu.2403996" "Revista" => array:6 [ "tituloSerie" => "Leukemia." "fecha" => "2006" "volumen" => "20" "paginaInicial" => "172" "paginaFinal" => "173" "link" => array:1 [ …1] ] ] ] ] ] ] 89 => array:3 [ "identificador" => "bib0450" "etiqueta" => "90" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medium dose long-wavelength ultraviolet A (UVA1) phototherapy for the treatment of acute and chronic graft-versus-host disease of the skin" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.bmt.1704804" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant." "fecha" => "2005" "volumen" => "35" "paginaInicial" => "515" "paginaFinal" => "519" "link" => array:1 [ …1] ] ] ] ] ] ] 90 => array:3 [ "identificador" => "bib0455" "etiqueta" => "91" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phototherapy and imatibib of sclerosing skin diseases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0781.2005.00154.x" "Revista" => array:6 [ "tituloSerie" => "Photodermatol Photoimmunol Photomed." "fecha" => "2005" "volumen" => "21" "paginaInicial" => "157" "paginaFinal" => "165" "link" => array:1 [ …1] ] ] ] ] ] ] 91 => array:3 [ "identificador" => "bib0460" "etiqueta" => "92" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Silicone gel sheet dressing for sclerodermatous type chronic graft-versus-host-disease (cGVHD)"