Case Report
Dermatomiositis y meningioma en el mismo paciente
Dermatomyositis and Meningioma in the Same Patient
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Descripción de 2 casos con buena respuesta a infliximab" ] ] "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" => 820 "Ancho" => 2502 "Tamanyo" => 150246 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Pyoderma gangrenosum: ulcer with purplish edges and geographic contours located on an erythematous nodule (lesion after 24<span class="elsevierStyleHsp" style=""></span>h of administration of bolus methylprednisolone, with obvious improvement). 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array:1 [ 0 => array:2 [ "paginaInicial" => "87" "paginaFinal" => "89" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Raquel Almodóvar, Daniel Paul Lindo, Helena Martín, Ramón Mazzuchelli, Javier Pardo, Francisco Javier Quirós, Pedro Zarco" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Raquel" "apellidos" => "Almodóvar" "email" => array:1 [ 0 => "ralmodovar@fhalcorcon.es" ] "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" => "Daniel Paul" "apellidos" => "Lindo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Helena" "apellidos" => "Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Ramón" "apellidos" => "Mazzuchelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Javier" "apellidos" => "Pardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Quirós" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Pedro" "apellidos" => "Zarco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Rheumathology, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Neurology, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatomyositis and Meningioma in the Same Patient" ] ] "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" => 1623 "Ancho" => 1577 "Tamanyo" => 207660 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Axial cranial T1 magnetic resonance imaging after the administration of intravenous gadolinium that shows the presence of a left frontal mass of 3.5<span class="elsevierStyleHsp" style=""></span>cm×4<span class="elsevierStyleHsp" style=""></span>cm×3<span class="elsevierStyleHsp" style=""></span>cm with heterogeneous peripheral enhancement.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The link between DM and malignancies has been clarified.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The reported rate of malignant diseases in DM has varied from 6% to 60%, with most large population-based cohort studies reporting a rate of 20%–25%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The most common cancers are those of the ovaries, gastrointestinal tract, lung, breast, and non-Hodgkin lymphomas.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> A review of the literature revealed only two cases of meningioma in patients with DM.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 64-year-old woman was admitted to the hospital because of cutaneous rash and muscle weakness. She had been well until three months before; she noted weakness in her legs, while climbing stairs, and in her arms. The physical examination revealed a violaceous periorbital oedema. There were areas of erythema over the proximal and distal interphalangeal joints. Neurological examination revealed bilateral symmetric muscle weakness affecting the shoulders and hip girdle muscles, with strength assessed at 3 of 5 bilaterally. The patient could not stand up from a sitting position. The deep-tendon reflexes were normal and symmetric in arms and legs. The rest of the examination did not reveal abnormalities.</p><p id="par0015" class="elsevierStylePara elsevierViewall">General laboratory investigations are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The results of urinalysis were normal. An antinuclear-antibody test was positive at 1:1560 in a homogeneous pattern; anti-double stranded DNA, anti-ENA, anti Jo-1 antibodies and ANCA were negative. Radiographs of the chest and ultrasonography of the abdomen were normal. A barium study of the oesophagus, stomach, and duodenum only showed decreased motility in the proximal oesophagus. The electromyography showed profuse denervation activity (fibrillations and positive waves) in all the muscles explored, especially in proximal muscles of upper limbs. Polyphasic motor unit, low amplitude and average duration, high-frequency complex potential abnormalities, consistent with myositis. Histological examination of a biopsy from deltoid muscle demonstrated necrosis of types I and II muscle fibres, phagocytosis, regeneration with basophilia, and atrophy in a perifascicular distribution. Treatment with prednisone (60<span class="elsevierStyleHsp" style=""></span>mg/day) was started with subjective improvement in muscle strength and dysphagia. The patient was discharged from hospital, however, with inability to stand up from a sitting position without help. Following clinical improvement, the dosage of prednisone was slowly tapered during the successive months to a daily maintenance dose of 10<span class="elsevierStyleHsp" style=""></span>mg/day; azathioprine was added early to save corticosteroids, however, muscle strength was not totally recovered.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Ten months after the onset of the disease, a flare requiring hospitalisation appeared. The laboratory test results at that point are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The electromyography showed a severe myopathic pattern. All tumoral markers were negative; chest, abdomen and pelvic scanner only showed renal litiasis. Consequently, the dose of prednisone was increased to 60<span class="elsevierStyleHsp" style=""></span>mg/day without any clinical or biochemical improvement. The patient was treated with three bolus of methylprednisolone (1<span class="elsevierStyleHsp" style=""></span>g/day) but her muscle strength did not increase. Three weeks after the admission, the patient developed right facial central paresis, right arm hyperreflexia, and disartria. MRI (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) revealed the presence of a left frontal mass that was removed. The histology showed a fibroblastic type meningioma. After the surgical removal of the tumour, the patient improved dramatically and the muscle enzyme levels returned to normality. The patient continued her treatment with methotrexate (10<span class="elsevierStyleHsp" style=""></span>mg weekly) and prednisone (10<span class="elsevierStyleHsp" style=""></span>mg/day), being asymptomatic so far.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The association between DM and cancer has been recognized for many years; several studies in large populations have shown that patients with DM have a risk of cancer three to six times higher than the general population.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4</span></a> Generalized cancer screening is now recommended for all patients with inflammatory myositis, especially for those who are at increased risk such as older patients, those suffering dermatomyositis rather than polymyositis, cases with evidence of capillary damage detected by muscle biopsy, dermatomyositis complicated with cutaneous necrosis of the trunk, presence of cutaneous leukocytoclastic vasculitis, elevated erythrocyte sedimentation rate, presence of antinuclear antibodies, and in patients with weight loss.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Malignant diseases may occur before the onset of DM, concurrently or after the onset of the symptoms. In addition, the DM might follow the course of the malignant disease (a paraneoplasic course) or may follow its own course independently of the treatment of the tumour. Studies showing benefits of cancer surgery on DM and those showing no link have been reported.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">About 15% of adults with DM have been found to develop a tumour. Meningioma also has a frequency of 13%–26% among the various intracraneal tumours affecting the general population.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, despite the fact of the relatively high incidence of meningioma, the combination of this tumour and DM has been described in two reports.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> There is not even a described association between primary brain tumours and DM.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our report does not prove the association between these two entities, but the patient's improvement after the removal of meningioma and the difficulty to control her disease activity previously suggest that these two entities might be associated in this case.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The association between dermatomyositis (DM) and neoplasms has been widely described, but there is no clear association with central nervous system tumours. In this paper, we show a not previously described case of meningioma in a patient with DM.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres125718" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec113009" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres125717" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec113008" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-02-11" "fechaAceptado" => "2011-06-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec113009" "palabras" => array:3 [ 0 => "Dermatomyositis" 1 => "Meningioma" 2 => "Neoplasms" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec113008" "palabras" => array:3 [ 0 => "Dermatomiositis" 1 => "Meningioma" 2 => "Neoplasma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The association between dermatomyositis (DM) and neoplasm has been widely described, especially in elder patients; this entity can be associated with many different types of tumours, more frequently lung, ovary, and gastric cancers. There is no clear association with central nervous system tumours. We present the case of a 64-year-old woman diagnosed simultaneously of DM with a difficult clinical control and a meningioma, being the course of the two illnesses linked. The activity of the DM was controlled after the meningioma was removed.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La asociación entre la dermatomiositis (DM) y las neoplasias ha sido ampliamente descrita, especialmente en pacientes de edad avanzada; esta entidad puede estar asociada con diferentes tipos de tumores, especialmente con cáncer de pulmón, ovario y estómago. No existe una clara asociación con tumores en el sistema nervioso. Se presenta el caso de una mujer de 64 años a la que se diagnosticó simultáneamente DM de difícil control clínico y un meningioma, estando el curso de ambas enfermedades vinculadas. La actividad de la DM fue controlada tras la extracción del meningioma.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please, cite this article as: Almodóvar R, et al. Dermatomyositis and meningioma in the same patient. Reumatol Clin. 2012;<span class="elsevierStyleBold">8(2)</span>:87–9.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1623 "Ancho" => 1577 "Tamanyo" => 207660 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Axial cranial T1 magnetic resonance imaging after the administration of intravenous gadolinium that shows the presence of a left frontal mass of 3.5<span class="elsevierStyleHsp" style=""></span>cm×4<span class="elsevierStyleHsp" style=""></span>cm×3<span class="elsevierStyleHsp" style=""></span>cm with heterogeneous peripheral enhancement.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">WBC: white blood cells; ALT: alanine-aminotransferase; AST: aspartate-aminotransferase; CK: creatine-kinase; ESR: erythrocyte sedimentation rate.</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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">First Admission \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Two months After Discharge \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Second Admission \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">After Surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">WBC (per mm<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6560 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11460 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9910 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8630 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin (g/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Platelets (per mm<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">377000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">332000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">344000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">307000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CK (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11713 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6779 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3801 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">181 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALT (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">213 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">209 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AST (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">447 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">365 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">194 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aldolase (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2086 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">688 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1747 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">559 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR (mm/h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212205.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Laboratory Tests.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatomyositis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.P. Callen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(99)05157-0" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2000" "volumen" => "355" "paginaInicial" => "53" "paginaFinal" => "57" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10615903" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation between dermatomyositis and polymyositis and cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.P. Callen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(00)03535-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2001" "volumen" => "357" "paginaInicial" => "85" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11197441" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyositis and dermatomyositis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. Dalakas" 1 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 16 | 28 |
| 2024 October | 32 | 27 | 59 |
| 2024 September | 50 | 17 | 67 |
| 2024 August | 48 | 38 | 86 |
| 2024 July | 42 | 29 | 71 |
| 2024 June | 51 | 35 | 86 |
| 2024 May | 57 | 30 | 87 |
| 2024 April | 45 | 34 | 79 |
| 2024 March | 77 | 37 | 114 |
| 2024 February | 84 | 36 | 120 |
| 2024 January | 77 | 23 | 100 |
| 2023 December | 64 | 28 | 92 |
| 2023 November | 58 | 41 | 99 |
| 2023 October | 40 | 27 | 67 |
| 2023 September | 66 | 38 | 104 |
| 2023 August | 67 | 22 | 89 |
| 2023 July | 28 | 28 | 56 |
| 2023 June | 25 | 22 | 47 |
| 2023 May | 38 | 24 | 62 |
| 2023 April | 25 | 12 | 37 |
| 2023 March | 42 | 27 | 69 |
| 2023 February | 37 | 32 | 69 |
| 2023 January | 29 | 10 | 39 |
| 2022 December | 45 | 46 | 91 |
| 2022 November | 49 | 36 | 85 |
| 2022 October | 53 | 45 | 98 |
| 2022 September | 26 | 48 | 74 |
| 2022 August | 26 | 47 | 73 |
| 2022 July | 34 | 47 | 81 |
| 2022 June | 40 | 44 | 84 |
| 2022 May | 25 | 48 | 73 |
| 2022 April | 28 | 46 | 74 |
| 2022 March | 44 | 60 | 104 |
| 2022 February | 37 | 48 | 85 |
| 2022 January | 37 | 50 | 87 |
| 2021 December | 24 | 41 | 65 |
| 2021 November | 23 | 43 | 66 |
| 2021 October | 59 | 63 | 122 |
| 2021 September | 27 | 47 | 74 |
| 2021 August | 28 | 44 | 72 |
| 2021 July | 26 | 39 | 65 |
| 2021 June | 20 | 49 | 69 |
| 2021 May | 38 | 46 | 84 |
| 2021 April | 67 | 83 | 150 |
| 2021 March | 53 | 39 | 92 |
| 2021 February | 49 | 37 | 86 |
| 2021 January | 21 | 31 | 52 |
| 2020 December | 26 | 35 | 61 |
| 2020 November | 28 | 34 | 62 |
| 2020 October | 33 | 18 | 51 |
| 2020 September | 31 | 30 | 61 |
| 2020 August | 21 | 22 | 43 |
| 2020 July | 16 | 20 | 36 |
| 2020 June | 26 | 30 | 56 |
| 2020 May | 24 | 16 | 40 |
| 2020 April | 18 | 19 | 37 |
| 2020 March | 18 | 10 | 28 |
| 2020 February | 2 | 0 | 2 |
| 2020 January | 4 | 0 | 4 |
| 2019 September | 6 | 0 | 6 |
| 2019 June | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 6 | 1 | 7 |
| 2018 April | 41 | 4 | 45 |
| 2018 March | 43 | 9 | 52 |
| 2018 February | 29 | 3 | 32 |
| 2018 January | 26 | 3 | 29 |
| 2017 December | 37 | 6 | 43 |
| 2017 November | 29 | 6 | 35 |
| 2017 October | 25 | 6 | 31 |
| 2017 September | 31 | 6 | 37 |
| 2017 August | 56 | 11 | 67 |
| 2017 July | 54 | 9 | 63 |
| 2017 June | 54 | 8 | 62 |
| 2017 May | 39 | 9 | 48 |
| 2017 April | 31 | 42 | 73 |
| 2017 March | 33 | 17 | 50 |
| 2017 February | 29 | 11 | 40 |
| 2017 January | 23 | 7 | 30 |
| 2016 December | 64 | 16 | 80 |
| 2016 November | 47 | 10 | 57 |
| 2016 October | 79 | 20 | 99 |
| 2016 September | 75 | 4 | 79 |
| 2016 August | 54 | 6 | 60 |
| 2016 July | 36 | 8 | 44 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 0 | 10 | 10 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 3 | 0 | 3 |
| 2015 July | 24 | 8 | 32 |
| 2015 June | 24 | 4 | 28 |
| 2015 May | 41 | 6 | 47 |
| 2015 April | 33 | 8 | 41 |
| 2015 March | 22 | 5 | 27 |
| 2015 February | 22 | 5 | 27 |
| 2015 January | 24 | 10 | 34 |
| 2014 December | 29 | 6 | 35 |
| 2014 November | 16 | 7 | 23 |
| 2014 October | 22 | 7 | 29 |
| 2014 September | 15 | 9 | 24 |
| 2014 August | 17 | 11 | 28 |
| 2014 July | 29 | 13 | 42 |
| 2014 June | 46 | 6 | 52 |
| 2014 May | 32 | 11 | 43 |
| 2014 April | 26 | 12 | 38 |
| 2014 March | 33 | 15 | 48 |
| 2014 February | 20 | 3 | 23 |
| 2014 January | 38 | 6 | 44 |
| 2013 December | 28 | 3 | 31 |
| 2013 November | 23 | 10 | 33 |
| 2013 October | 37 | 8 | 45 |
| 2013 September | 31 | 11 | 42 |
| 2013 August | 35 | 11 | 46 |
| 2013 July | 48 | 13 | 61 |
| 2013 June | 31 | 6 | 37 |
| 2013 May | 31 | 9 | 40 |
| 2013 April | 29 | 12 | 41 |
| 2013 March | 27 | 11 | 38 |
| 2013 February | 27 | 9 | 36 |
| 2013 January | 34 | 7 | 41 |
| 2012 December | 28 | 10 | 38 |
| 2012 November | 16 | 18 | 34 |
| 2012 October | 19 | 9 | 28 |
| 2012 September | 11 | 2 | 13 |
| 2012 July | 7 | 0 | 7 |
| 2012 June | 10 | 0 | 10 |
| 2012 May | 9 | 0 | 9 |
| 2012 April | 10 | 0 | 10 |
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