Safety and Efficacy of Methylprednisolone Infiltration in Anserine Syndrome Treatment

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(A) Cystic lesions of subpleural and baseline distribution resembling those seen in usual interstitial pneumonia, associated with areas of ground glass. (B) Ground glass with central distribution, respecting subpleural areas and discrete reticulation, resembling the pattern observed in the nonspecific interstitial pneumonia. 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CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152:726–32." ] ] ] "textoCompleto" => "BackgroundAnserine syndrome (HS), also known as anserine bursitis or tendinobursitis, is a common cause of medial knee pain. There is controversy about the structure affected by the AS. Prevalence in Mexico is 0.34% (95% CI, 0.24–0.45), with foot pain and including regional pain conditions in the lower limb, as reported in a cross-sectional multistage, stratified, randomized study of 3 regions of the country with the methodology used in the COPCORD (Community Oriented Program in the Rheumatic Diseases) program.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Given the lack of evidence of the structure involved in this syndrome and its easy clinical diagnosis, the latter is established on the basis of medial knee pain with inferomedial tenderness. No imaging studies are required. The key point lies in pain on the medial aspect of the tibia, 3–5cm distal to the knee joint line. There are no validated criteria for this disorder and the diagnostic utility of the maneuvers described above has not been evaluated.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Its treatment is based on physiotherapy, oral NSAIDs and correction of predisposing factors (e.g. overweight). In the event that no response is seen then glucocorticoid<a class="elsevierStyleCrossRef" href="#bib0015">3</a> infiltration is merited. In this latter form of treatment, there are no published clinical trials and the methodology<a class="elsevierStyleCrossRef" href="#bib0020">4</a> lacks rigor.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>The aim of this study was to determine the efficacy and safety of the infiltration of methylprednisolone for the treatment of AS and the incidence of adverse events.Materials and MethodsWe performed a randomized, double-blind, placebo-controlled trial at the rheumatology clinic specialty of the Internal Medicine Department of the Hospital Universitario Dr. José Eleuterio González. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the flowchart for recruitment, including monitoring and analysis of the participants. Patients were recruited from both sexes, 18–90 years of age with a prevalent clinical diagnosis of AS. We excluded patients who were carriers of intraarticular pathology reflecting the medial pain in the knee, such as meniscal disease, collateral ligament injury, medial plicature or in addition to glucocorticoids, were allergic to diclofenac or methylprednisolone, or had a coagulopathy that prevented the completion of the procedure. We also excluded, at the discretion of the investigator, patients with uncontrolled disease, including the presence of local or systemic infection. Also removed were patients who failed to comply with monitoring, used some unspecified treatment during the study and those who experienced adverse effects.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The study was previously approved by the ethics committee deputy director of research at the Faculty of Medicine and Hospital Universitario Dr. José Eleuterio González of the Universidad Autonoma de Nuevo Leon and registered in ClinicalTrials.gov. All patients gave written informed consent according to the General Health Law of Mexico.To establish the diagnosis of SA, the principal investigator (VM) first asked the patient: do you have pain when climbing stairs? Is the pain on the medial aspect of the knee? If the answer was yes, palpation was performed at the affected site and the diagnosis established. During the physical examination maneuvers were performed to rule out intra-articular and periarticular pathology manifested with pain on the medial knee (meniscus, collateral ligaments, etc.). After obtaining informed consent, Western Ontario and McMaster Universities Arthritis Index (WOMAC) was filled.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Subsequently, based on a random number table 2 generator,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> groups were assigned; group 1 received a single injection of methylprednisolone 40mg/1ml+2ml of 2% simple lidocaine and group 2 received a single injection of 1ml of distilled water+2ml of 2% simple lidocaine at the site of greatest pain. Both groups received 100mg of diclofenac sodium orally every 24h for 10 days. The injection technique was performed in the most painful spot<a class="elsevierStyleCrossRefs" href="#bib0020">4,8,9</a> using an aseptic technique and blinded (syringes covered) by a certified rheumatologist (NL) different from the evaluator. Participants were seen at 4 weeks to fill a new WOMAC questionnaire, visual analogue scale (VAS) satisfaction of the procedure and adverse event reporting. Complete remission was defined as a WOMAC score equal to 0 at week 4, in addition to quantifying the percentage of improvement from the first measurement.The number of patients enrolled due to sample size calculation for a difference of proportions, where the proportion of patients was based on the complete response to infiltration with methylprednisolone (P1) versus the proportion of patients with complete response to the infiltration of placebo (P2), were compared. P1: 30%, P2: 5% with an alpha of 0.05 and a statistically significant bilateral 95% CI. We determined a beta of 0.20 for a power of 80%, obtaining a sample of 27 participants per group. A P<.05 was statistically significant.We conducted a descriptive statistical analysis of the clinical and epidemiological numerical variables to determine their distribution and to determine their comparative parametric (t-test) or nonparametric analysis (Mann–Whitney). For categorical variables we used the chi-square test and Fisher exact test if required. We evaluated the randomization of participants with statistical tests of difference according to a variable distribution. WOMAC indices were compared at baseline and 4 weeks with the Wilcoxon rank test. To set the primary efficacy objectives of safety and secondary infiltration tests we used the Mann–Whitney and Fisher exact test, respectively.Results58 participants were recruited: 28 were infiltrated with lidocaine and methylprednisolone (group 1) and 30 with lidocaine and distilled water (group 2). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinical and epidemiological characteristics together with the demonstration of homogeneity of each variable by group. The average age was 54.3 and 54.4 years, respectively. Women were 75% and 80% of those included in both groups. The average BMI was 30.9 and 30.6kg/cm2. There was no difference between the occupations of the participants. In most cases the pain was located in the left knee and the median duration of disease was 52 and 50 weeks in each of the groups. The median initial WOMAC in group 1 was 32, while in group 2 it was 25.5, with no statistical difference.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>At 4 weeks, the median WOMAC was 8 and 6.5 points, respectively. The complete remission rate was 21% for group 1 and 30% for group 2. Both groups improved by 62% and 63% (statistically significant compared with intragroup baseline measurement). The median VAS satisfaction score was 87.5 and 70, respectively. <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a> show the rest of the evaluated variables and frequency of adverse events, and neither showed a statistically significant difference.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionWe report the first clinical trial that allows exploration of the efficacy and safety of injection of glucocorticoid in patients with AS. We demonstrate the effectiveness, comparable to placebo infiltration, of methylprednisolone in a group of patients receiving concomitant diclofenac. Improvement was found in 60% of cases and remission at 4 weeks in 30% or so.Among the advantages of this study are as follows: placebo-controlled design, blinding of infiltration and the scales used in the evaluations, which provide greater methodological rigor. The effectiveness evaluation was not reduced to a VAS, as previous<a class="elsevierStyleCrossRef" href="#bib0020">4</a> reports, but rather evaluated in 3 domains of AS involvement in the patient (pain, stiffness and function).Although the use of the WOMAC tool is one of the strengths of the study, it could also be a weakness. This scale was designed for patients with knee osteoarthritis and may have little sensitivity to measure pain, stiffness and function associated with AS alone, as there are items that do not necessarily reflect stress on the structure under study (e.g. functionality standing or morning stiffness). Even so, the individual assessment of pain score as measured by WOMAC showed no difference in both groups.When comparing our results with previous studies, we found that Calvo-Alen et al. reported the results of 44 patients with AS who were assigned to receive 500mg of naproxen sodium 2 times daily or infiltration with glucocorticoids. The main outcome was pain assessed using a verbal scale of intensity with a monthly follow-up. 58% of the naproxen group had a “significant improvement” and in 5% the condition was resolved. In patients with infiltration, 70% had “significant improvement” and the condition was resolved in 30% (P<.05).<a class="elsevierStyleCrossRef" href="#bib0020">4</a> The resolution rate is similar to that found in our trial in both groups infiltrated.Similarly, in a retrospective review of 29 patients with AS, clinical remission was observed in 11 of 12 patients who received infiltration, compared with 7 of 17 of those not receiving it.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Finally, Yoon et al.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> evaluated with ultrasound 26 patients diagnosed with osteoarthritis of the knee and AS. 17 of them received infiltration with triamcinolone acetonide in the bursa. The therapeutic response was evaluated by VAS and WOMAC scales, patient global assessment and the investigator using the Likert scale. Only 2 patients (8.7%) showed the presence of anserine bursitis/tendinitis by ultrasound. The VAS, the pain index and WOMAC functional capacity showed a statistically significant improvement after infiltration. The overall assessment of the patients showed an excellent response in 2 cases, good in 6 and moderate in 1; in 8 cases there was no improvement and none worsened. The initial WOMAC cohort evaluated scored 47 points and after treatment, 37 points. Two patients who reported an excellent response had evidence by ultrasonography of bursitis. Although this study infiltrated a steroid different from ours and made the effort to document the lesion with ultrasound, the procedure was not controlled and there was a satisfaction level similar to that presented by our patients in both groups.Regarding demographics, the average age of participants was 63 years and BMI of 26kg/m2. They presented an average duration of illness of 93 months. By contrast, the present study population included had an average age 10 years lower, most were obese and the median duration of symptoms was 12 months.In our series, we did not conduct ultrasound confirmation of the lesion and, unlike the study by Yoon and Kim, we use as methylprednisolone and triamcinolone acetate, common in our setting for infiltration.Another possible disadvantage is that the application of the results of this study in clinical practice would obey only to patients within the age range established and using oral NSAIDs, which were used in a compassionate and ethical manner for group 2. In patients in whom the use of diclofenac is not possible, infiltration with methylprednisolone is recommended. This clinical scenario was not addressed in our work.Diclofenac treatment was opted for, as it is an effective and safe anti-inflammatory for most of the participants and allowed us to control the use of other drugs by the patient, which was reflected in better control of the conditions of the study. We do not consider that its use modified the inflammatory response observed in the study, but maybe the magnitude of improvement, without changing the resulting difference.When the results of a comparative test like this do not show the difference between the output variables, we must perform a test of statistical power. In our study this was between 90% and 95% and allowed us to establish with more certainty the results obtained in the trial. Still, we should consider that perhaps the sample size was poor and did not allow us to find a difference in the interventions, which was calculated based on the differences found in a blinded clinical trial 4. A future design could be considered with the percentage difference obtained in this trial and would probably find the clinical level expected by the active treatment.As has been suggested in previous reports using a full placebo group, the infiltration of distilled water without Xylocaine corresponds to subtract the effect of lidocaine in the evaluation and thus has a cleaner measurement of the effect of glucocorticoid. However, we consider it unethical. Moreover, it should be pointed out that the absorption of lidocaine is 30min<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and it is unlikely that this causes long-term effect. However, we recognize that the effect of the use of lidocaine could be decisive for the 63% improvement of intra-group in group 2, but not enough to show differences between comparison groups. In a subsequent trial it would be appropriate to evaluate a single infiltration of lidocaine against placebo injection of distilled water.It also suggests that the use of imaging techniques, mainly ultrasound and magnetic resonance imaging helps locate the affected structure in AS and helps infiltrating. This would also rule out, objectively, any intraarticular pathology, which would further reduce the bias in the evaluation of pain.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> However, the prevalence of AS in studies that seek intentionally is not very illustrative, and in addition to that, studies of knee injuries describe alterations in the bursa which are most prevalent and are even present in asymptomatic knees, so that the role of imaging is not yet defined.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a>Similarly, it is important to track the long term to define the recurrence rate of AS group and thus investigate whether there is any superiority in using methylprednisolone.Even taking into account the above considerations, we conclude that the use of an infiltration of methylprednisolone fails, compared to placebo, to achieve improvement at 4 weeks in patients with AS taking diclofenac.Conflict of InterestThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres125731" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec113022" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres125732" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec113023" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-07-18" "fechaAceptado" => "2011-10-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec113022" "palabras" => array:4 [ 0 => "Bursitis" 1 => "Treatment" 2 => "Metilprednisolona" 3 => "Anserine syndrome" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec113023" "palabras" => array:4 [ 0 => "Bursitis" 1 => "Tratamiento" 2 => "Metilprednisolona" 3 => "Síndrome anserino" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectiveThe anserine syndrome is a common cause of knee pain. Infiltration with glucocorticoids has been evaluated in studies with low level of evidence and there are no published clinical trials to determine its usefulness. The objective of this study was to determine the efficacy and safety of the infiltration of methylprednisolone in the treatment of anserin syndrome. MethodsWe conducted a clinical trial in 58 adult patients with anserin syndrome, which presented intra-articular pathology ruled that reflected pain in the medial aspect of the knee. The WOMAC scale was assessed at baseline and patients were randomized to receive an infiltration of lidocaine plus 40mg methylprednisolone acetate (group 1) versus xylocaine plus distilled water (group 2). Both groups received 100mg of diclofenac sodium for 10 days. The WOMAC scale was applied at 4 weeks and adverse events were recorded. ResultsEquivalence was demonstrated in both groups for demographic variables and initial clinical evaluation. There was no statistical difference in the 3 domains of assessment of the baseline WOMAC score. The median baseline WOMAC in group 1 was 32 and in group 2 was 25.5 points. At 4 weeks it was 8 and 6.5 points, which corresponded to an improvement of 61.6% and 62.8%, respectively. ConclusionThe infiltration with methylprednisolone in anserin syndrome is not superior to placebo in patients taking diclofenac measured by the WOMAC scale at 4 weeks. The incidence of adverse events did not show any differences either." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivoEl síndrome anserino es una causa frecuente de dolor de rodilla. La infiltración con glucocorticoides ha sido evaluada en estudios con bajo nivel de evidencia y no se han publicado ensayos clínicos para determinar su utilidad. El objetivo del estudio es determinar la eficacia y la seguridad de la infiltración de metilprednisolona para el tratamiento del síndrome anserino. MétodosEfectuamos un ensayo clínico en 58 pacientes adultos con síndrome anserino, a los que se les descartó patología intraarticular que reflejara dolor en la cara medial de la rodilla. Se evaluó la escala WOMAC basal y se aleatorizaron a recibir una infiltración de xilocaína más 40mg de acetato de metilprednisolona (grupo 1) versus xilocaína más agua destilada (grupo 2). Ambos grupos recibieron 100mg de diclofenaco sódico durante 10 días. Se realizó la escala WOMAC a las 4 semanas y el registro de eventos adversos. ResultadosSe demostró equivalencia en ambos grupos para las variables demográficas y en la evaluación clínica inicial. No hubo diferencias estadísticas en los tres dominios de evaluación de la escala WOMAC basal. La mediana del WOMAC basal en el grupo 1 fue de 32 y en el grupo 2 de 25,5 puntos. A las 4 semanas fue de 8 y 6,5 puntos, que correspondió a una mejoría del 61,6 y 62,8%, respectivamente. ConclusiónLa infiltración con metilprednisolona en el síndrome anserino no es superior al placebo en pacientes que toman diclofenaco medidos por la escala WOMAC a las 4 semanas. La incidencia de eventos adversos tampoco difirió." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Vega-Morales D, et al. Eficacia y seguridad de la infiltración con metilprednisolona en pacientes con síndrome anserino: ensayo clínico aleatorizado. Reumatol Clin. 2012;8(2):63–7." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1562 "Ancho" => 1825 "Tamanyo" => 203298 ] ] "descripcion" => array:1 [ "en" => "CONSORT (Consolidated Standards of Reporting Trials) protocol for the trial: Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152:726–32." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Values expressed as mean and standard deviation.Statistical test: Student's t.BMI, body mass index; WOMAC, Western Ontario and McMaster Universities Arthritis Index." "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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group 1 (n=28) \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group 2 (n=30) \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P \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">Age, years \t\t\t\t\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">53.4 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.4 (10) \t\t\t\t\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">.75 \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">Women, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.65 \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">Weight, kg \t\t\t\t\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">76.6 (14.1) \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">73.3 (11.2) \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="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></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">Height, cm \t\t\t\t\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">158.5 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">158.7 (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">.94 \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">BMI, kg/cm2 \t\t\t\t\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">30.9 (4.1) \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">30.6 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.80 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></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">Occupation, % \t\t\t\t\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="" 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="" 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.26<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \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">Home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (64.3) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (56.7) \t\t\t\t\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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Employee \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (13.3) \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Commerce \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Retired \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></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">Anserine syndrome of the right knee, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (35.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (46.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.39<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \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">Progression in weeks<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 (187) \t\t\t\t\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">.74<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \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">WOMAC initial<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\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 (24.8) \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">25.5 (30.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.40<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \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">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (2.9) \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">7.1 (3.07) \t\t\t\t\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">.89 \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">Stiffness<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (4.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.78<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \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">Function \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.5 (20.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (25.3) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212216.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Median and interquartile range." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Chi squared test." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Mann–Whitney's U." ] ] ] "descripcion" => array:1 [ "en" => "Baseline Clinical Epidemiologic Characteristics." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Values expressed as median and interquartile range.VAS, visual analog scale; WOMAC, Western Ontario and McMaster Universities Arthritis Index." "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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group 1 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group 2 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P \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">WOMAC final \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.5 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.77 \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">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 (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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.78 \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">Stiffness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (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">.21 \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">Function \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (17) \t\t\t\t\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">.74 \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">VAS satisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.5 (50) \t\t\t\t\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">70 (65) \t\t\t\t\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></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">Complete remission, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (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">.45<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a> \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">Percentage of improvement<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\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">61.6 (37) \t\t\t\t\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">62.8 (33) \t\t\t\t\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">.89<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212217.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "Mean and standard deviation. Mann–Whitney's U statistical test." ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "Student's t-test." ] 2 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "c" "nota" => "Chi squared test." ] ] ] "descripcion" => array:1 [ "en" => "Evaluation of Efficacy at 4 Weeks." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Fisher's exact test." "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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group 1 n (%) \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group 2 n (%) \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P \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">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (27) \t\t\t\t\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></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">Echimosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4) \t\t\t\t\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">.40 \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">Bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.50 \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">Paresthesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212215.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Adverse Events." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of rheumatic regional pain syndromes in adults from Mexico: a community survey using COPCORD for screening and syndrome-specific diagnostic criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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Matteson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Musculoskelet Med" "fecha" => "2001" "volumen" => "18" "paginaInicial" => "214" "paginaFinal" => "224" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento de la bursitis anserina: infiltración local con corticoides frente a AINE: estudio prospectivo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Calvo-Alén" 1 => "I. Rua-Figueroa" 2 => "C. Erausquin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Reumatol" "fecha" => "1993" "volumen" => "20" "paginaInicial" => "13" "paginaFinal" => "15" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anserine bursitis in patients with osteoarthritis of the knee" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I. Kang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "South Med J" "fecha" => "2000" "volumen" => "93" "paginaInicial" => "207" "paginaFinal" => "209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10701790" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adaptación transcultural del cuestionario WOMAC específico para artrosis de rodilla y cadera" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Batlle-Gualda" 1 => "J. Esteve-Vives" 2 => "M.C. Piera" 3 => "R. Hargreaves" 4 => "J. Cutts" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Reumatol" "fecha" => "1999" "volumen" => "26" "paginaInicial" => "38" "paginaFinal" => "45" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Urbaniak GC, Plous S. Research randomizer (version 3.0) [Computer software]. Retrieved 22.04.11. Available from: <a class="elsevierStyleInterRef" href="http://www.randomizer.org/">http://www.randomizer.org/</a> [accessed 01.07.09]." ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspiration and injection of joints and periarticular tissues (including intra-articular and intralesional therapy)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.J. Canoso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "Rheumatology" "edicion" => "4th ed." "serieFecha" => "2008" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee ostheoarthritis patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.S. Yoon" 1 => "S.E. Kim" 2 => "Y.R. Suh" 3 => "Y.I. Seo" 4 => "Y.A. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3346/jkms.2005.20.1.109" "Revista" => array:6 [ "tituloSerie" => "J Korean Med Sci" "fecha" => "2005" "volumen" => "20" "paginaInicial" => "109" "paginaFinal" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15716614" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Local anesthetics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.A. Catterall" 1 => "K. Mackie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "Goodman & Gilman's the pharmacological basis of therapeutics" "edicion" => "12th ed." "serieFecha" => "2011" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The contribution of selected non-articular conditions to knee pain severity and associated disability in older adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.R.J. Wood" 1 => "G. Peat" 2 => "E. Thomas" 3 => "R. Duncan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.joca.2007.10.007" "Revista" => array:6 [ "tituloSerie" => "Osteoarthritis Cartilage" "fecha" => "2008" "volumen" => "16" "paginaInicial" => "647" "paginaFinal" => "653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18207435" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and ultrasonographic findings related to knee pain in osteoarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. De Miguel Mendieta" 1 => "C. Ibañez" 2 => "J.U. Jaeger" 3 => "G. Bonilla" 4 => "E. 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Safety and Efficacy of Methylprednisolone Infiltration in Anserine Syndrome Treatment

Eficacia y seguridad de la infiltración con metilprednisolona en pacientes con síndrome anserino: ensayo clínico aleatorizado

David Vega-Morales

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drdavidvega@yahoo.com.mx

Corresponding author.

, Jorge Antonio Esquivel-Valerio, Roberto Negrete-López, Dionicio Ángel Galarza-Delgado, Mario Alberto Garza-Elizondo

Departamento de Medicina Interna, Servicio de Reumatología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anserine syndrome &#40;HS&#41;&#44; also known as anserine bursitis or tendinobursitis&#44; is a common cause of medial knee pain&#46; There is controversy about the structure affected by the AS&#46; Prevalence in Mexico is 0&#46;34&#37; &#40;95&#37; CI&#44; 0&#46;24&#8211;0&#46;45&#41;&#44; with foot pain and including regional pain conditions in the lower limb&#44; as reported in a cross-sectional multistage&#44; stratified&#44; randomized study of 3 regions of the country with the methodology used in the COPCORD &#40;Community Oriented Program in the Rheumatic Diseases&#41; program&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Given the lack of evidence of the structure involved in this syndrome and its easy clinical diagnosis&#44; the latter is established on the basis of medial knee pain with inferomedial tenderness&#46; No imaging studies are required&#46; The key point lies in pain on the medial aspect of the tibia&#44; 3&#8211;5<span class="elsevierStyleHsp" style=""></span>cm distal to the knee joint line&#46; There are no validated criteria for this disorder and the diagnostic utility of the maneuvers described above has not been evaluated&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Its treatment is based on physiotherapy&#44; oral NSAIDs and correction of predisposing factors &#40;e&#46;g&#46; overweight&#41;&#46; In the event that no response is seen then glucocorticoid<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> infiltration is merited&#46; In this latter form of treatment&#44; there are no published clinical trials and the methodology<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> lacks rigor&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to determine the efficacy and safety of the infiltration of methylprednisolone for the treatment of AS and the incidence of adverse events&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a randomized&#44; double-blind&#44; placebo-controlled trial at the rheumatology clinic specialty of the Internal Medicine Department of the Hospital Universitario Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the flowchart for recruitment&#44; including monitoring and analysis of the participants&#46; Patients were recruited from both sexes&#44; 18&#8211;90 years of age with a prevalent clinical diagnosis of AS&#46; We excluded patients who were carriers of intraarticular pathology reflecting the medial pain in the knee&#44; such as meniscal disease&#44; collateral ligament injury&#44; medial plicature or in addition to glucocorticoids&#44; were allergic to diclofenac or methylprednisolone&#44; or had a coagulopathy that prevented the completion of the procedure&#46; We also excluded&#44; at the discretion of the investigator&#44; patients with uncontrolled disease&#44; including the presence of local or systemic infection&#46; Also removed were patients who failed to comply with monitoring&#44; used some unspecified treatment during the study and those who experienced adverse effects&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The study was previously approved by the ethics committee deputy director of research at the Faculty of Medicine and Hospital Universitario Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez of the Universidad Autonoma de Nuevo Leon and registered in ClinicalTrials&#46;gov&#46; All patients gave written informed consent according to the General Health Law of Mexico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">To establish the diagnosis of SA&#44; the principal investigator &#40;VM&#41; first asked the patient&#58; do you have pain when climbing stairs&#63; Is the pain on the medial aspect of the knee&#63; If the answer was yes&#44; palpation was performed at the affected site and the diagnosis established&#46; During the physical examination maneuvers were performed to rule out intra-articular and periarticular pathology manifested with pain on the medial knee &#40;meniscus&#44; collateral ligaments&#44; etc&#46;&#41;&#46; After obtaining informed consent&#44; Western Ontario and McMaster Universities Arthritis Index &#40;WOMAC&#41; was filled&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Subsequently&#44; based on a random number table 2 generator&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> groups were assigned&#59; group 1 received a single injection of methylprednisolone 40<span class="elsevierStyleHsp" style=""></span>mg&#47;1<span class="elsevierStyleHsp" style=""></span>ml&#43;2<span class="elsevierStyleHsp" style=""></span>ml of 2&#37; simple lidocaine and group 2 received a single injection of 1<span class="elsevierStyleHsp" style=""></span>ml of distilled water&#43;2<span class="elsevierStyleHsp" style=""></span>ml of 2&#37; simple lidocaine at the site of greatest pain&#46; Both groups received 100<span class="elsevierStyleHsp" style=""></span>mg of diclofenac sodium orally every 24<span class="elsevierStyleHsp" style=""></span>h for 10 days&#46; The injection technique was performed in the most painful spot<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;8&#44;9</span></a> using an aseptic technique and blinded &#40;syringes covered&#41; by a certified rheumatologist &#40;NL&#41; different from the evaluator&#46; Participants were seen at 4 weeks to fill a new WOMAC questionnaire&#44; visual analogue scale &#40;VAS&#41; satisfaction of the procedure and adverse event reporting&#46; Complete remission was defined as a WOMAC score equal to 0 at week 4&#44; in addition to quantifying the percentage of improvement from the first measurement&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The number of patients enrolled due to sample size calculation for a difference of proportions&#44; where the proportion of patients was based on the complete response to infiltration with methylprednisolone &#40;P1&#41; versus the proportion of patients with complete response to the infiltration of placebo &#40;P2&#41;&#44; were compared&#46; P1&#58; 30&#37;&#44; P2&#58; 5&#37; with an alpha of 0&#46;05 and a statistically significant bilateral 95&#37; CI&#46; We determined a beta of 0&#46;20 for a power of 80&#37;&#44; obtaining a sample of 27 participants per group&#46; A <span class="elsevierStyleItalic">P</span>&#60;&#46;05 was statistically significant&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We conducted a descriptive statistical analysis of the clinical and epidemiological numerical variables to determine their distribution and to determine their comparative parametric &#40;<span class="elsevierStyleItalic">t</span>-test&#41; or nonparametric analysis &#40;Mann&#8211;Whitney&#41;&#46; For categorical variables we used the chi-square test and Fisher exact test if required&#46; We evaluated the randomization of participants with statistical tests of difference according to a variable distribution&#46; WOMAC indices were compared at baseline and 4 weeks with the Wilcoxon rank test&#46; To set the primary efficacy objectives of safety and secondary infiltration tests we used the Mann&#8211;Whitney and Fisher exact test&#44; respectively&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">58 participants were recruited&#58; 28 were infiltrated with lidocaine and methylprednisolone &#40;group 1&#41; and 30 with lidocaine and distilled water &#40;group 2&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinical and epidemiological characteristics together with the demonstration of homogeneity of each variable by group&#46; The average age was 54&#46;3 and 54&#46;4 years&#44; respectively&#46; Women were 75&#37; and 80&#37; of those included in both groups&#46; The average BMI was 30&#46;9 and 30&#46;6<span class="elsevierStyleHsp" style=""></span>kg&#47;cm<span class="elsevierStyleSup">2</span>&#46; There was no difference between the occupations of the participants&#46; In most cases the pain was located in the left knee and the median duration of disease was 52 and 50 weeks in each of the groups&#46; The median initial WOMAC in group 1 was 32&#44; while in group 2 it was 25&#46;5&#44; with no statistical difference&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">At 4 weeks&#44; the median WOMAC was 8 and 6&#46;5 points&#44; respectively&#46; The complete remission rate was 21&#37; for group 1 and 30&#37; for group 2&#46; Both groups improved by 62&#37; and 63&#37; &#40;statistically significant compared with intragroup baseline measurement&#41;&#46; The median VAS satisfaction score was 87&#46;5 and 70&#44; respectively&#46; <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a> show the rest of the evaluated variables and frequency of adverse events&#44; and neither showed a statistically significant difference&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">We report the first clinical trial that allows exploration of the efficacy and safety of injection of glucocorticoid in patients with AS&#46; We demonstrate the effectiveness&#44; comparable to placebo infiltration&#44; of methylprednisolone in a group of patients receiving concomitant diclofenac&#46; Improvement was found in 60&#37; of cases and remission at 4 weeks in 30&#37; or so&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Among the advantages of this study are as follows&#58; placebo-controlled design&#44; blinding of infiltration and the scales used in the evaluations&#44; which provide greater methodological rigor&#46; The effectiveness evaluation was not reduced to a VAS&#44; as previous<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reports&#44; but rather evaluated in 3 domains of AS involvement in the patient &#40;pain&#44; stiffness and function&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Although the use of the WOMAC tool is one of the strengths of the study&#44; it could also be a weakness&#46; This scale was designed for patients with knee osteoarthritis and may have little sensitivity to measure pain&#44; stiffness and function associated with AS alone&#44; as there are items that do not necessarily reflect stress on the structure under study &#40;e&#46;g&#46; functionality standing or morning stiffness&#41;&#46; Even so&#44; the individual assessment of pain score as measured by WOMAC showed no difference in both groups&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">When comparing our results with previous studies&#44; we found that Calvo-Alen et al&#46; reported the results of 44 patients with AS who were assigned to receive 500<span class="elsevierStyleHsp" style=""></span>mg of naproxen sodium 2 times daily or infiltration with glucocorticoids&#46; The main outcome was pain assessed using a verbal scale of intensity with a monthly follow-up&#46; 58&#37; of the naproxen group had a &#8220;significant improvement&#8221; and in 5&#37; the condition was resolved&#46; In patients with infiltration&#44; 70&#37; had &#8220;significant improvement&#8221; and the condition was resolved in 30&#37; &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The resolution rate is similar to that found in our trial in both groups infiltrated&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Similarly&#44; in a retrospective review of 29 patients with AS&#44; clinical remission was observed in 11 of 12 patients who received infiltration&#44; compared with 7 of 17 of those not receiving it&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Finally&#44; Yoon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> evaluated with ultrasound 26 patients diagnosed with osteoarthritis of the knee and AS&#46; 17 of them received infiltration with triamcinolone acetonide in the bursa&#46; The therapeutic response was evaluated by VAS and WOMAC scales&#44; patient global assessment and the investigator using the Likert scale&#46; Only 2 patients &#40;8&#46;7&#37;&#41; showed the presence of anserine bursitis&#47;tendinitis by ultrasound&#46; The VAS&#44; the pain index and WOMAC functional capacity showed a statistically significant improvement after infiltration&#46; The overall assessment of the patients showed an excellent response in 2 cases&#44; good in 6 and moderate in 1&#59; in 8 cases there was no improvement and none worsened&#46; The initial WOMAC cohort evaluated scored 47 points and after treatment&#44; 37 points&#46; Two patients who reported an excellent response had evidence by ultrasonography of bursitis&#46; Although this study infiltrated a steroid different from ours and made the effort to document the lesion with ultrasound&#44; the procedure was not controlled and there was a satisfaction level similar to that presented by our patients in both groups&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Regarding demographics&#44; the average age of participants was 63 years and BMI of 26<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; They presented an average duration of illness of 93 months&#46; By contrast&#44; the present study population included had an average age 10 years lower&#44; most were obese and the median duration of symptoms was 12 months&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In our series&#44; we did not conduct ultrasound confirmation of the lesion and&#44; unlike the study by Yoon and Kim&#44; we use as methylprednisolone and triamcinolone acetate&#44; common in our setting for infiltration&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Another possible disadvantage is that the application of the results of this study in clinical practice would obey only to patients within the age range established and using oral NSAIDs&#44; which were used in a compassionate and ethical manner for group 2&#46; In patients in whom the use of diclofenac is not possible&#44; infiltration with methylprednisolone is recommended&#46; This clinical scenario was not addressed in our work&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Diclofenac treatment was opted for&#44; as it is an effective and safe anti-inflammatory for most of the participants and allowed us to control the use of other drugs by the patient&#44; which was reflected in better control of the conditions of the study&#46; We do not consider that its use modified the inflammatory response observed in the study&#44; but maybe the magnitude of improvement&#44; without changing the resulting difference&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">When the results of a comparative test like this do not show the difference between the output variables&#44; we must perform a test of statistical power&#46; In our study this was between 90&#37; and 95&#37; and allowed us to establish with more certainty the results obtained in the trial&#46; Still&#44; we should consider that perhaps the sample size was poor and did not allow us to find a difference in the interventions&#44; which was calculated based on the differences found in a blinded clinical trial 4&#46; A future design could be considered with the percentage difference obtained in this trial and would probably find the clinical level expected by the active treatment&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As has been suggested in previous reports using a full placebo group&#44; the infiltration of distilled water without Xylocaine corresponds to subtract the effect of lidocaine in the evaluation and thus has a cleaner measurement of the effect of glucocorticoid&#46; However&#44; we consider it unethical&#46; Moreover&#44; it should be pointed out that the absorption of lidocaine is 30<span class="elsevierStyleHsp" style=""></span>min<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and it is unlikely that this causes long-term effect&#46; However&#44; we recognize that the effect of the use of lidocaine could be decisive for the 63&#37; improvement of intra-group in group 2&#44; but not enough to show differences between comparison groups&#46; In a subsequent trial it would be appropriate to evaluate a single infiltration of lidocaine against placebo injection of distilled water&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">It also suggests that the use of imaging techniques&#44; mainly ultrasound and magnetic resonance imaging helps locate the affected structure in AS and helps infiltrating&#46; This would also rule out&#44; objectively&#44; any intraarticular pathology&#44; which would further reduce the bias in the evaluation of pain&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> However&#44; the prevalence of AS in studies that seek intentionally is not very illustrative&#44; and in addition to that&#44; studies of knee injuries describe alterations in the bursa which are most prevalent and are even present in asymptomatic knees&#44; so that the role of imaging is not yet defined&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Similarly&#44; it is important to track the long term to define the recurrence rate of AS group and thus investigate whether there is any superiority in using methylprednisolone&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Even taking into account the above considerations&#44; we conclude that the use of an infiltration of methylprednisolone fails&#44; compared to placebo&#44; to achieve improvement at 4 weeks in patients with AS taking diclofenac&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres125731"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Objective"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusion"
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          "identificador" => "xpalclavsec113022"
          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "xres125732"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Objetivo"
            2 => "M&#233;todos"
            3 => "Resultados"
            4 => "Conclusi&#243;n"
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        3 => array:2 [
          "identificador" => "xpalclavsec113023"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and Methods"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflict of Interest"
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        9 => array:1 [
          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-07-18"
    "fechaAceptado" => "2011-10-29"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec113022"
          "palabras" => array:4 [
            0 => "Bursitis"
            1 => "Treatment"
            2 => "Metilprednisolona"
            3 => "Anserine syndrome"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec113023"
          "palabras" => array:4 [
            0 => "Bursitis"
            1 => "Tratamiento"
            2 => "Metilprednisolona"
            3 => "S&#237;ndrome anserino"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The anserine syndrome is a common cause of knee pain&#46; Infiltration with glucocorticoids has been evaluated in studies with low level of evidence and there are no published clinical trials to determine its usefulness&#46; The objective of this study was to determine the efficacy and safety of the infiltration of methylprednisolone in the treatment of anserin syndrome&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted a clinical trial in 58 adult patients with anserin syndrome&#44; which presented intra-articular pathology ruled that reflected pain in the medial aspect of the knee&#46; The WOMAC scale was assessed at baseline and patients were randomized to receive an infiltration of lidocaine plus 40<span class="elsevierStyleHsp" style=""></span>mg methylprednisolone acetate &#40;group 1&#41; versus xylocaine plus distilled water &#40;group 2&#41;&#46; Both groups received 100<span class="elsevierStyleHsp" style=""></span>mg of diclofenac sodium for 10 days&#46; The WOMAC scale was applied at 4 weeks and adverse events were recorded&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Equivalence was demonstrated in both groups for demographic variables and initial clinical evaluation&#46; There was no statistical difference in the 3 domains of assessment of the baseline WOMAC score&#46; The median baseline WOMAC in group 1 was 32 and in group 2 was 25&#46;5 points&#46; At 4 weeks it was 8 and 6&#46;5 points&#44; which corresponded to an improvement of 61&#46;6&#37; and 62&#46;8&#37;&#44; respectively&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The infiltration with methylprednisolone in anserin syndrome is not superior to placebo in patients taking diclofenac measured by the WOMAC scale at 4 weeks&#46; The incidence of adverse events did not show any differences either&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome anserino es una causa frecuente de dolor de rodilla&#46; La infiltraci&#243;n con glucocorticoides ha sido evaluada en estudios con bajo nivel de evidencia y no se han publicado ensayos cl&#237;nicos para determinar su utilidad&#46; El objetivo del estudio es determinar la eficacia y la seguridad de la infiltraci&#243;n de metilprednisolona para el tratamiento del s&#237;ndrome anserino&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Efectuamos un ensayo cl&#237;nico en 58 pacientes adultos con s&#237;ndrome anserino&#44; a los que se les descart&#243; patolog&#237;a intraarticular que reflejara dolor en la cara medial de la rodilla&#46; Se evalu&#243; la escala WOMAC basal y se aleatorizaron a recibir una infiltraci&#243;n de xiloca&#237;na m&#225;s 40<span class="elsevierStyleHsp" style=""></span>mg de acetato de metilprednisolona &#40;grupo 1&#41; versus xiloca&#237;na m&#225;s agua destilada &#40;grupo 2&#41;&#46; Ambos grupos recibieron 100<span class="elsevierStyleHsp" style=""></span>mg de diclofenaco s&#243;dico durante 10 d&#237;as&#46; Se realiz&#243; la escala WOMAC a las 4 semanas y el registro de eventos adversos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se demostr&#243; equivalencia en ambos grupos para las variables demogr&#225;ficas y en la evaluaci&#243;n cl&#237;nica inicial&#46; No hubo diferencias estad&#237;sticas en los tres dominios de evaluaci&#243;n de la escala WOMAC basal&#46; La mediana del WOMAC basal en el grupo 1 fue de 32 y en el grupo 2 de 25&#44;5 puntos&#46; A las 4 semanas fue de 8 y 6&#44;5 puntos&#44; que correspondi&#243; a una mejor&#237;a del 61&#44;6 y 62&#44;8&#37;&#44; respectivamente&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La infiltraci&#243;n con metilprednisolona en el s&#237;ndrome anserino no es superior al placebo en pacientes que toman diclofenaco medidos por la escala WOMAC a las 4 semanas&#46; La incidencia de eventos adversos tampoco difiri&#243;&#46;</p>"
      ]
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Vega-Morales D&#44; et al&#46; Eficacia y seguridad de la infiltraci&#243;n con metilprednisolona en pacientes con s&#237;ndrome anserino&#58; ensayo cl&#237;nico aleatorizado&#46; Reumatol Clin&#46; 2012&#59;<span class="elsevierStyleBold">8&#40;2&#41;</span>&#58;63&#8211;7&#46;</p>"
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        "etiqueta" => "Fig&#46; 1"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">CONSORT &#40;Consolidated Standards of Reporting Trials&#41; protocol for the trial&#58; Schulz KF&#44; Altman DG&#44; Moher D&#59; CONSORT Group&#46; CONSORT 2010 statement&#58; updated guidelines for reporting parallel group randomized trials&#46; Ann Intern Med&#46; 2010&#59;152&#58;726&#8211;32&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean and standard deviation&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Statistical test&#58; Student&#39;s <span class="elsevierStyleItalic">t</span>&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; WOMAC&#44; Western Ontario and McMaster Universities Arthritis Index&#46;</p>"
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                  \t\t\t\t">53&#46;4 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Women&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;65&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Weight&#44; kg</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">158&#46;7 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Prevalence of rheumatic regional pain syndromes in adults from Mexico&#58; a community survey using COPCORD for screening and syndrome-specific diagnostic criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Alvarez-Nemegyei"
                            1 => "I&#46; Pel&#225;ez-Ballestas"
                            2 => "J&#46; Rodr&#237;guez-Amado"
                            3 => "L&#46;H&#46; Sanin"
                            4 => "C&#46; Garc&#237;a-Garc&#237;a"
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                        "tituloSerie" => "J Rheumatol"
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                        "numero" => "Suppl&#46; 86"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based soft tissue rheumatology iv anserine bursitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Alvarez-Nemegyei"
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                      "doi" => "10.1097/01.rhu.0000135561.41660.b0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Rheumatol"
                        "fecha" => "2004"
                        "volumen" => "10"
                        "paginaInicial" => "205"
                        "paginaFinal" => "206"
                        "link" => array:1 [
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                          ]
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                      "titulo" => "Bursitis&#58; common condition&#44; uncommon challenge"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Arromdee"
                            1 => "E&#46;L&#46; Matteson"
                          ]
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                    0 => array:1 [
                      "Revista" => array:5 [
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                        "paginaInicial" => "214"
                        "paginaFinal" => "224"
                      ]
                    ]
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                      "titulo" => "Tratamiento de la bursitis anserina&#58; infiltraci&#243;n local con corticoides frente a AINE&#58; estudio prospectivo"
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                        0 => array:2 [
                          "etal" => false
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                        ]
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                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Reumatol"
                        "fecha" => "1993"
                        "volumen" => "20"
                        "paginaInicial" => "13"
                        "paginaFinal" => "15"
                      ]
                    ]
                  ]
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                  "contribucion" => array:1 [
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                      "titulo" => "Adaptaci&#243;n transcultural del cuestionario WOMAC espec&#237;fico para artrosis de rodilla y cadera"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Batlle-Gualda"
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                            2 => "M&#46;C&#46; Piera"
                            3 => "R&#46; Hargreaves"
                            4 => "J&#46; Cutts"
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                      "Revista" => array:5 [
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                        "paginaFinal" => "45"
                      ]
                    ]
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                0 => array:1 [
                  "referenciaCompleta" => "Urbaniak GC&#44; Plous S&#46; Research randomizer &#40;version 3&#46;0&#41; &#91;Computer software&#93;&#46; Retrieved 22&#46;04&#46;11&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.randomizer.org/">http&#58;&#47;&#47;www&#46;randomizer&#46;org&#47;</a> &#91;accessed 01&#46;07&#46;09&#93;&#46;"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Aspiration and injection of joints and periarticular tissues &#40;including intra-articular and intralesional therapy&#41;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                      "LibroEditado" => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee ostheoarthritis patient"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            3 => "Y&#46;I&#46; Seo"
                            4 => "Y&#46;A&#46; Kim"
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                      "titulo" => "Local anesthetics"
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                          "autores" => array:2 [
                            0 => "W&#46;A&#46; Catterall"
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                        "titulo" => "Goodman &#38; Gilman&#39;s the pharmacological basis of therapeutics"
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            10 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                          "etal" => false
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2011.10.009

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	12	21	33
2024 October	32	56	88
2024 September	61	49	110
2024 August	75	60	135
2024 July	77	44	121
2024 June	84	53	137
2024 May	69	47	116
2024 April	62	42	104
2024 March	45	54	99
2024 February	34	52	86
2024 January	44	22	66
2023 December	53	35	88
2023 November	65	44	109
2023 October	42	36	78
2023 September	91	40	131
2023 August	53	32	85
2023 July	45	24	69
2023 June	49	28	77
2023 May	40	24	64
2023 April	57	9	66
2023 March	79	34	113
2023 February	55	28	83
2023 January	53	17	70
2022 December	62	39	101
2022 November	56	35	91
2022 October	64	46	110
2022 September	66	52	118
2022 August	66	35	101
2022 July	80	46	126
2022 June	90	37	127
2022 May	82	46	128
2022 April	55	52	107
2022 March	51	59	110
2022 February	57	46	103
2022 January	35	42	77
2021 December	36	34	70
2021 November	57	51	108
2021 October	52	54	106
2021 September	39	44	83
2021 August	33	39	72
2021 July	25	30	55
2021 June	36	53	89
2021 May	40	44	84
2021 April	120	100	220
2021 March	77	37	114
2021 February	44	27	71
2021 January	91	36	127
2020 December	34	20	54
2020 November	86	19	105
2020 October	47	14	61
2020 September	50	30	80
2020 August	42	19	61
2020 July	31	14	45
2020 June	41	29	70
2020 May	40	21	61
2020 April	42	17	59
2020 March	20	4	24
2020 January	4	0	4
2019 September	4	0	4
2019 June	1	0	1
2019 March	1	0	1
2019 January	1	0	1
2018 May	5	1	6
2018 April	35	5	40
2018 March	51	9	60
2018 February	35	2	37
2018 January	35	5	40
2017 December	30	3	33
2017 November	30	7	37
2017 October	23	7	30
2017 September	52	7	59
2017 August	51	6	57
2017 July	47	5	52
2017 June	71	6	77
2017 May	79	8	87
2017 April	60	16	76
2017 March	38	26	64
2017 February	26	5	31
2017 January	31	10	41
2016 December	75	12	87
2016 November	63	9	72
2016 October	87	15	102
2016 September	87	3	90
2016 August	87	8	95
2016 July	52	7	59
2016 June	2	0	2
2016 February	1	0	1
2015 December	2	0	2
2015 October	0	17	17
2015 September	4	0	4
2015 August	4	11	15
2015 July	34	5	39
2015 June	56	7	63
2015 May	77	15	92
2015 April	47	12	59
2015 March	38	6	44
2015 February	79	9	88
2015 January	69	14	83
2014 December	59	10	69
2014 November	40	9	49
2014 October	55	20	75
2014 September	34	15	49
2014 August	36	15	51
2014 July	48	17	65
2014 June	74	14	88
2014 May	53	15	68
2014 April	61	15	76
2014 March	48	21	69
2014 February	53	18	71
2014 January	50	13	63
2013 December	55	14	69
2013 November	49	19	68
2013 October	62	14	76
2013 September	57	19	76
2013 August	51	22	73
2013 July	46	14	60
2013 June	47	17	64
2013 May	62	19	81
2013 April	41	18	59
2013 March	42	27	69
2013 February	50	18	68
2013 January	38	11	49
2012 December	42	5	47
2012 November	29	14	43
2012 October	29	7	36
2012 September	11	5	16
2012 July	3	0	3
2012 June	19	0	19
2012 May	11	0	11
2012 April	14	0	14

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