array:24 [
  "pii" => "S2173574312000573"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2012.04.006"
  "estado" => "S300"
  "fechaPublicacion" => "2012-09-01"
  "aid" => "429"
  "copyright" => "Elsevier España, S.L.. All rights reserved"
  "copyrightAnyo" => "2011"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "sco"
  "cita" => "Reumatol Clin. 2012;8:280-3"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 4329
    "formatos" => array:3 [
      "EPUB" => 59
      "HTML" => 3570
      "PDF" => 700
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X12000617"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2011.12.012"
      "estado" => "S300"
      "fechaPublicacion" => "2012-09-01"
      "aid" => "429"
      "copyright" => "Elsevier España, S.L."
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "sco"
      "cita" => "Reumatol Clin. 2012;8:280-3"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 12940
        "formatos" => array:3 [
          "EPUB" => 161
          "HTML" => 9956
          "PDF" => 2823
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
        "titulo" => "Maculopat&#237;a en paciente con lupus eritematoso sist&#233;mico tratado con hidroxicloroquina"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "280"
            "paginaFinal" => "283"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Maculopathy in patient with systemic lupus erythematosus treated with hydroxychloroquine"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 2340
                "Ancho" => 3148
                "Tamanyo" => 676692
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Electrorretinograma multifocal central de la paciente con 100 hex&#225;gonos&#46; Se aprecia una disminuci&#243;n moderada de la densidad el&#233;ctrica de la regi&#243;n foveolar del ojo derecho &#40;ausencia de blancos&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Francisco Jorge Rodr&#237;guez-Hurtado, Jos&#233; Antonio S&#225;ez-Moreno, Jos&#233; Manuel Rodr&#237;guez-Ferrer"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Francisco Jorge"
                "apellidos" => "Rodr&#237;guez-Hurtado"
              ]
              1 => array:2 [
                "nombre" => "Jos&#233; Antonio"
                "apellidos" => "S&#225;ez-Moreno"
              ]
              2 => array:2 [
                "nombre" => "Jos&#233; Manuel"
                "apellidos" => "Rodr&#237;guez-Ferrer"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574312000573"
          "doi" => "10.1016/j.reumae.2012.04.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312000573?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X12000617?idApp=UINPBA00004M"
      "url" => "/1699258X/0000000800000005/v1_201305061926/S1699258X12000617/v1_201305061926/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574312000354"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2011.11.007"
    "estado" => "S300"
    "fechaPublicacion" => "2012-09-01"
    "aid" => "408"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2012;8:284-6"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 11044
      "formatos" => array:3 [
        "EPUB" => 61
        "HTML" => 10107
        "PDF" => 876
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Reactive Arthritis After the Intravesical Instillation of BCG"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "284"
          "paginaFinal" => "286"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Artritis reactiva secundaria a la instilaci&#243;n intravesical de bacilo de Calmette-Gu&#233;rin"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 741
              "Ancho" => 940
              "Tamanyo" => 78551
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diffuse swelling of the second right toe &#40;dactylitis&#41; and arthritis of the left ankle&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cristina Mac&#237;a Villa, Walter Sifuentes Giraldo, Alina Boteanu, Mariano Gonz&#225;lez Lanza, Javier Bachiller Corral"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Mac&#237;a Villa"
            ]
            1 => array:2 [
              "nombre" => "Walter"
              "apellidos" => "Sifuentes Giraldo"
            ]
            2 => array:2 [
              "nombre" => "Alina"
              "apellidos" => "Boteanu"
            ]
            3 => array:2 [
              "nombre" => "Mariano"
              "apellidos" => "Gonz&#225;lez Lanza"
            ]
            4 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Bachiller Corral"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X12000216"
        "doi" => "10.1016/j.reuma.2011.11.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X12000216?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312000354?idApp=UINPBA00004M"
    "url" => "/21735743/0000000800000005/v1_201305061645/S2173574312000354/v1_201305061645/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173574312000743"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2011.11.010"
    "estado" => "S300"
    "fechaPublicacion" => "2012-09-01"
    "aid" => "401"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2012;8:278-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 6510
      "formatos" => array:3 [
        "EPUB" => 54
        "HTML" => 5639
        "PDF" => 817
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Cushings Disease as a Cause of Severe Osteoporosis&#58; A Clinical Challenge"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "278"
          "paginaFinal" => "279"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad de Cushing como causa de osteoporosis grave&#46; Un reto cl&#237;nico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1320
              "Ancho" => 2167
              "Tamanyo" => 176158
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Severe stage 3 dorsal vertebral fractures &#40;arrows&#41;&#44; moderate stage 1&#8211;2 dorsal fracture&#46; &#40;B&#41; Fracture of the upper sternal body&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Nadia Abdel-Kader, Mario H&#46; Cardiel, Victoria Navarro Compan, Juan Piedra Priego, Ana Gonz&#225;lez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Nadia"
              "apellidos" => "Abdel-Kader"
            ]
            1 => array:2 [
              "nombre" => "Mario H&#46;"
              "apellidos" => "Cardiel"
            ]
            2 => array:2 [
              "nombre" => "Victoria"
              "apellidos" => "Navarro Compan"
            ]
            3 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Piedra Priego"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Gonz&#225;lez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X11003718"
        "doi" => "10.1016/j.reuma.2011.11.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X11003718?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312000743?idApp=UINPBA00004M"
    "url" => "/21735743/0000000800000005/v1_201305061645/S2173574312000743/v1_201305061645/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Maculopathy in Patient With Systemic Lupus Erythematosus Treated With Hydroxychloroquine"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "280"
        "paginaFinal" => "283"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Francisco Jorge Rodr&#237;guez-Hurtado, Jos&#233; Antonio S&#225;ez-Moreno, Jos&#233; Manuel Rodr&#237;guez-Ferrer"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Francisco Jorge"
            "apellidos" => "Rodr&#237;guez-Hurtado"
            "email" => array:1 [
              0 => "frhurtado&#64;telefonica&#46;net"
            ]
            "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" => "Jos&#233; Antonio"
            "apellidos" => "S&#225;ez-Moreno"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Jos&#233; Manuel"
            "apellidos" => "Rodr&#237;guez-Ferrer"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Oftalmolog&#237;a&#44; Hospital Virgen de las Nieves&#44; Granada&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Laboratorio de Neurociencia Visual y Cognitiva&#44; Universidad de Granada&#44; Granada&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Neurofisiolog&#237;a Cl&#237;nica&#44; Hospital Universitario San Cecilio&#44; Granada&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Maculopat&#237;a en paciente con lupus eritematoso sist&#233;mico tratado con hidroxicloroquina"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1248
            "Ancho" => 1493
            "Tamanyo" => 174326
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Angiography of the right eye&#46; Microaneurysms are seen in inferior temporal region and a small temporal macula area &#40;arrows&#41;&#46; Hypo-and hyperfluorescent images of the fovea &#40;asterisk&#41; are not modified during the angiogram&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Synthetic antimalarials in the treatment of systemic lupus erythematosus &#40;SLE&#41; have been a major therapeutic advance and serve as immunomodulators and inhibitors of thrombosis&#44; with few side effects&#44; prolonging the quality of life of patients&#46; Their withdrawal leaves the patient with SLE at the mercy of the side effects of corticosteroids and immunosuppressants&#44; and increases the risk of flares&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Hydroxychloroquine can cause severe retinal toxicity&#44; requiring discontinuation of therapy&#44; although there are few cases of cloroquine retinopathy&#44; always related to very high cumulative drug dose&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Synthetic antimalarial toxicity is detected by ophthalmic screening protocols focused on development of macular pathology&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> One must not forget that the patient with SLE is predisposed to retinal ischemia that may be confused with macular damage due to cloroquine&#46; We present a case in which the ocular findings represented a challenge in the therapeutic decision&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 50-year-old woman with SLE was treated with a umulative dose of 365<span class="elsevierStyleHsp" style=""></span>g of hydroxychloroquine for 13 years&#44; with mild lupus nephritis and hypertension controlled 5 years prior&#59; during her screening for ocular toxicity she presented moderate loss of vision&#44; presenting a corrected visual acuity of 0&#46;7 in the right eye and 1 in the left eye&#46; In the right fundus we observed irregular areas of hyperpigmentation and depigmentation in the macula&#44; without apparent serous uprising&#44; and some arcades microhemorrhages&#46; The left fundus appeared normal&#46; 10-2 the visual field was normal in both eyes&#46; Optical coherence tomography &#40;OCT&#41; of the right eye showed hyperreflective foveal thickening and hyporreflective cavities in deep layers &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The OCT of the left eye was normal&#46; Fluorescein angiography &#40;FA&#41; showed no bull&#39;s-eye pattern&#44; but microaneurysms in both eyes &#40;not detected on fundoscopy&#41;&#44; sectoral distribution and hyper-and hypofluorescence late macular leakage &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In the multifocal electroretinogram &#40;mfERG&#41; there were low amplitude responses in both peripheral retinas&#44; low power density in the foveal region of the right eye and normal foveolar activity in the left eye &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The alteration of the N95 wave of the electroretinogram pattern reflected a dysfunction of the ganglion cells of both retinas&#44; probably causing the disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The neurophysiological findings&#44; the OCT and FA suggested a vascular origin rather than a toxic effect&#44; so it toxicity was ruled out and hydroxychloroquine retinopathy was diagnosed as lupus&#44; recommending the maintenance of the antimalarial but with close monitoring of the patient to prevent maculopathy as a risk factor&#46; In subsequent visits the patient maintained her visual acuity and had improved lupus symptoms with hydroxychloroquine maintenance treatment&#44; which confirmed the suspected end diagnosis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">In the early alterations of the visual field as a sign of cloroquine maculopathy 10-2&#44; central mfERG&#44; OCT and autofluorescence have recently been added as diagnostic tests&#44; with their use recommended for routine screening&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Central mfERG shows very early alterations&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> but its availability is scarce&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The field of view of our patient was normal in both eyes&#44; which ruled cloroquine maculopathy&#46; The mfERG showed macular dysfunction only in the right eye and asymmetry is rare in drug toxicity&#46; The results of the AGF and the rest of neurophysiological studies suggested an episode of retinal ischemia&#46; The OCT image was reminiscent of a rare form of central serous chorioretinopathy&#44; lupus<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> choroidopathy&#44; while microaneurysms in cuneiform distributions were more typical of hypertensive episodes&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Faced with a maculopathy in a patient with SLE treated with hydroxychloroquine&#44; we must not forget that they are patients exposed to thrombotic events that can generate retinal confusion&#44; so that additional tests may be necessary to make an adequate differential diagnosis&#44; because without maculopathy there is no need for drug withdrawal&#44; even to assess an increase in dosage&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects&#46;</span> The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data&#46;</span> The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent&#46;</span> The authors have obtained the informed consent of the patients and &#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no disclosures to make&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:2 [
          "identificador" => "xres125902"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec113196"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres125901"
          "titulo" => "Resumen"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec113197"
          "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" => "sec0025"
          "titulo" => "Ethical disclosures"
        ]
        8 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conflict of Interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-09-09"
    "fechaAceptado" => "2011-12-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec113196"
          "palabras" => array:4 [
            0 => "Lupus erythematosus"
            1 => "Hydroxychloroquine"
            2 => "Central serous chorioretinopathy"
            3 => "Multifocal electroretinography"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec113197"
          "palabras" => array:4 [
            0 => "Lupus eritematoso"
            1 => "Hidroxicloroquina"
            2 => "Coriorretinopat&#237;a central serosa"
            3 => "Electrorretinograf&#237;a multifocal"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 50-year-old woman with systemic lupus erythematosus treated for 13 years with hydroxychloroquine developed nephropathy and high blood pressure 5 years ago as well as moderate loss of vision in her right eye&#46; Fundoscopy showed alterations of macular pigmentation only in the right eye&#46; Visual fields 10-2 were normal in both eyes&#46; Optical coherence tomography showed hyperreflective foveal thickening with a hyporreflective cavity underlying in the right macula&#44; and was normal in left macula&#46; Fluorescein angiography showed no bulls-eye pattern&#44; but did show microaneurysms in vascular arcades&#46; Multifocal central electroretinogram was diminished in right eye and the electroretinogram pattern was diminished in both eyes&#46; We concluded that the alterations of the right eye were suggestive of ischemic maculopathy&#44; not chloroquine toxicity&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Una mujer de 50 a&#241;os con lupus eritematoso sist&#233;mico&#44; tratada 13 a&#241;os con hidroxicloroquina y desde hace 5 a&#241;os con nefropat&#237;a e hipertensi&#243;n arterial&#44; refiri&#243; en la revisi&#243;n peri&#243;dica p&#233;rdida moderada de visi&#243;n en el ojo derecho&#46; La fundoscopia mostr&#243; solo alteraciones de la pigmentaci&#243;n macular en el ojo derecho&#46; El campo visual 10-2 fue normal en ambos ojos&#46; La tomograf&#237;a de coherencia &#243;ptica mostr&#243; en la m&#225;cula derecha un engrosamiento foveal hiperreflectivo&#44; con cavidad hiporreflectiva subyacente&#44; y fue normal en la m&#225;cula izquierda&#46; La angiograf&#237;a fluoresce&#237;nica no mostr&#243; patr&#243;n en ojo de buey&#44; sino microaneurismas en arcadas vasculares&#46; El electrorretinograma multifocal central estaba disminuido en el ojo derecho y el electrorretinograma patr&#243;n moderadamente disminuido en ambos ojos&#46; En conclusi&#243;n&#44; las alteraciones del ojo derecho fueron indicativas de maculopat&#237;a isqu&#233;mica&#44; pero no de toxicidad cloroqu&#237;nica&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Rodr&#237;guez-Hurtado FJ&#44; et al&#46; Maculopat&#237;a en paciente con lupus eritematoso sist&#233;mico tratado con hidroxicloroquina&#46; Reumatol Clin&#46; 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2011.12.012">doi&#58;10&#46;1016&#47;j&#46;reuma&#46;2011&#46;12&#46;012</span></p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3493
            "Ancho" => 3167
            "Tamanyo" => 1151768
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography of the right eye of the patient showing discrete thickening of the fovea&#44; with a hyporeflective space in the outer layers of the retina &#40;arrows&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2361
            "Ancho" => 3153
            "Tamanyo" => 688538
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Central multifocal electroretinogram with 100 hexagons&#46; We observe a moderate decrease in the rpower density of the foveal region of the right eye &#40;no white areas&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1248
            "Ancho" => 1493
            "Tamanyo" => 174326
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Angiography of the right eye&#46; Microaneurysms are seen in inferior temporal region and a small temporal macula area &#40;arrows&#41;&#46; Hypo-and hyperfluorescent images of the fovea &#40;asterisk&#41; are not modified during the angiogram&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A long-term study of hydroxychloroquine withdrawal on exacerbations in systemic lupus erythematosus&#46; The Canadian Hydroxychloroquine Study Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Tsakonas"
                            1 => "L&#46; Joseph"
                            2 => "J&#46;M&#46; Esdaile"
                            3 => "D&#46; Choquette"
                            4 => "J&#46;L&#46; Sen&#233;cal"
                            5 => "A&#46; Cividino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "1998"
                        "volumen" => "7"
                        "paginaInicial" => "80"
                        "paginaFinal" => "85"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9541091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ocular safety of hydroxychloroquine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;N&#46; Bernstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Annals of Ophthalmology"
                        "fecha" => "1991"
                        "volumen" => "23"
                        "paginaInicial" => "292"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1952638"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "American Academy of Ophthalmology"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;F&#46; Marmor"
                            1 => "U&#46; Kellner"
                            2 => "T&#46;Y&#46; Lai"
                            3 => "J&#46;S&#46; Lyons"
                            4 => "W&#46;F&#46; Mieler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ophtha.2010.11.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology"
                        "fecha" => "2011"
                        "volumen" => "118"
                        "paginaInicial" => "415"
                        "paginaFinal" => "422"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21292109"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection of early hydroxychloroquine retinal toxicity enhanced by ring ratio analysis of multifocal electroretinography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;S&#46; Lyons"
                            1 => "M&#46;L&#46; Severns"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajo.2006.12.042"
                      "Revista" => array:6 [
                        "tituloSerie" => "American Journal of Ophthalmology"
                        "fecha" => "2007"
                        "volumen" => "143"
                        "paginaInicial" => "801"
                        "paginaFinal" => "809"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17336914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central serous chorioretinopathy in patients with systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;T&#46; Cunningham Jr&#46;"
                            1 => "P&#46;R&#46; Alfred"
                            2 => "A&#46;R&#46; Irvine"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Opthalmology"
                        "fecha" => "1996"
                        "volumen" => "103"
                        "paginaInicial" => "2081"
                        "paginaFinal" => "2090"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000000800000005/v1_201305061645/S2173574312000573/v1_201305061645/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "17376"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Case Report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000800000005/v1_201305061645/S2173574312000573/v1_201305061645/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312000573?idApp=UINPBA00004M"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Case report
Maculopathy in Patient With Systemic Lupus Erythematosus Treated With Hydroxychloroquine
Maculopatía en paciente con lupus eritematoso sistémico tratado con hidroxicloroquina
Francisco Jorge Rodríguez-Hurtadoa,
Corresponding author
frhurtado@telefonica.net

Corresponding author.
, José Antonio Sáez-Morenob,c, José Manuel Rodríguez-Ferrerb
a Servicio de Oftalmología, Hospital Virgen de las Nieves, Granada, Spain
b Laboratorio de Neurociencia Visual y Cognitiva, Universidad de Granada, Granada, Spain
c Servicio de Neurofisiología Clínica, Hospital Universitario San Cecilio, Granada, Spain
Read
10115
Times
was read the article
2658
Total PDF
7457
Total HTML
Share statistics
 array:24 [
  "pii" => "S2173574312000573"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2012.04.006"
  "estado" => "S300"
  "fechaPublicacion" => "2012-09-01"
  "aid" => "429"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;. All rights reserved"
  "copyrightAnyo" => "2011"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "sco"
  "cita" => "Reumatol Clin. 2012;8:280-3"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 4329
    "formatos" => array:3 [
      "EPUB" => 59
      "HTML" => 3570
      "PDF" => 700
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X12000617"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2011.12.012"
      "estado" => "S300"
      "fechaPublicacion" => "2012-09-01"
      "aid" => "429"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "sco"
      "cita" => "Reumatol Clin. 2012;8:280-3"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 12940
        "formatos" => array:3 [
          "EPUB" => 161
          "HTML" => 9956
          "PDF" => 2823
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
        "titulo" => "Maculopat&#237;a en paciente con lupus eritematoso sist&#233;mico tratado con hidroxicloroquina"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "280"
            "paginaFinal" => "283"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Maculopathy in patient with systemic lupus erythematosus treated with hydroxychloroquine"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 2340
                "Ancho" => 3148
                "Tamanyo" => 676692
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Electrorretinograma multifocal central de la paciente con 100 hex&#225;gonos&#46; Se aprecia una disminuci&#243;n moderada de la densidad el&#233;ctrica de la regi&#243;n foveolar del ojo derecho &#40;ausencia de blancos&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Francisco Jorge Rodr&#237;guez-Hurtado, Jos&#233; Antonio S&#225;ez-Moreno, Jos&#233; Manuel Rodr&#237;guez-Ferrer"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Francisco Jorge"
                "apellidos" => "Rodr&#237;guez-Hurtado"
              ]
              1 => array:2 [
                "nombre" => "Jos&#233; Antonio"
                "apellidos" => "S&#225;ez-Moreno"
              ]
              2 => array:2 [
                "nombre" => "Jos&#233; Manuel"
                "apellidos" => "Rodr&#237;guez-Ferrer"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574312000573"
          "doi" => "10.1016/j.reumae.2012.04.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312000573?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X12000617?idApp=UINPBA00004M"
      "url" => "/1699258X/0000000800000005/v1_201305061926/S1699258X12000617/v1_201305061926/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574312000354"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2011.11.007"
    "estado" => "S300"
    "fechaPublicacion" => "2012-09-01"
    "aid" => "408"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2012;8:284-6"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 11044
      "formatos" => array:3 [
        "EPUB" => 61
        "HTML" => 10107
        "PDF" => 876
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Reactive Arthritis After the Intravesical Instillation of BCG"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "284"
          "paginaFinal" => "286"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Artritis reactiva secundaria a la instilaci&#243;n intravesical de bacilo de Calmette-Gu&#233;rin"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 741
              "Ancho" => 940
              "Tamanyo" => 78551
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diffuse swelling of the second right toe &#40;dactylitis&#41; and arthritis of the left ankle&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cristina Mac&#237;a Villa, Walter Sifuentes Giraldo, Alina Boteanu, Mariano Gonz&#225;lez Lanza, Javier Bachiller Corral"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Mac&#237;a Villa"
            ]
            1 => array:2 [
              "nombre" => "Walter"
              "apellidos" => "Sifuentes Giraldo"
            ]
            2 => array:2 [
              "nombre" => "Alina"
              "apellidos" => "Boteanu"
            ]
            3 => array:2 [
              "nombre" => "Mariano"
              "apellidos" => "Gonz&#225;lez Lanza"
            ]
            4 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Bachiller Corral"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X12000216"
        "doi" => "10.1016/j.reuma.2011.11.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X12000216?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312000354?idApp=UINPBA00004M"
    "url" => "/21735743/0000000800000005/v1_201305061645/S2173574312000354/v1_201305061645/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173574312000743"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2011.11.010"
    "estado" => "S300"
    "fechaPublicacion" => "2012-09-01"
    "aid" => "401"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2012;8:278-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 6510
      "formatos" => array:3 [
        "EPUB" => 54
        "HTML" => 5639
        "PDF" => 817
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Cushings Disease as a Cause of Severe Osteoporosis&#58; A Clinical Challenge"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "278"
          "paginaFinal" => "279"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad de Cushing como causa de osteoporosis grave&#46; Un reto cl&#237;nico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1320
              "Ancho" => 2167
              "Tamanyo" => 176158
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Severe stage 3 dorsal vertebral fractures &#40;arrows&#41;&#44; moderate stage 1&#8211;2 dorsal fracture&#46; &#40;B&#41; Fracture of the upper sternal body&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Nadia Abdel-Kader, Mario H&#46; Cardiel, Victoria Navarro Compan, Juan Piedra Priego, Ana Gonz&#225;lez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Nadia"
              "apellidos" => "Abdel-Kader"
            ]
            1 => array:2 [
              "nombre" => "Mario H&#46;"
              "apellidos" => "Cardiel"
            ]
            2 => array:2 [
              "nombre" => "Victoria"
              "apellidos" => "Navarro Compan"
            ]
            3 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Piedra Priego"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Gonz&#225;lez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X11003718"
        "doi" => "10.1016/j.reuma.2011.11.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X11003718?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312000743?idApp=UINPBA00004M"
    "url" => "/21735743/0000000800000005/v1_201305061645/S2173574312000743/v1_201305061645/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Maculopathy in Patient With Systemic Lupus Erythematosus Treated With Hydroxychloroquine"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "280"
        "paginaFinal" => "283"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Francisco Jorge Rodr&#237;guez-Hurtado, Jos&#233; Antonio S&#225;ez-Moreno, Jos&#233; Manuel Rodr&#237;guez-Ferrer"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Francisco Jorge"
            "apellidos" => "Rodr&#237;guez-Hurtado"
            "email" => array:1 [
              0 => "frhurtado&#64;telefonica&#46;net"
            ]
            "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" => "Jos&#233; Antonio"
            "apellidos" => "S&#225;ez-Moreno"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Jos&#233; Manuel"
            "apellidos" => "Rodr&#237;guez-Ferrer"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Oftalmolog&#237;a&#44; Hospital Virgen de las Nieves&#44; Granada&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Laboratorio de Neurociencia Visual y Cognitiva&#44; Universidad de Granada&#44; Granada&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Neurofisiolog&#237;a Cl&#237;nica&#44; Hospital Universitario San Cecilio&#44; Granada&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Maculopat&#237;a en paciente con lupus eritematoso sist&#233;mico tratado con hidroxicloroquina"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1248
            "Ancho" => 1493
            "Tamanyo" => 174326
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Angiography of the right eye&#46; Microaneurysms are seen in inferior temporal region and a small temporal macula area &#40;arrows&#41;&#46; Hypo-and hyperfluorescent images of the fovea &#40;asterisk&#41; are not modified during the angiogram&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Synthetic antimalarials in the treatment of systemic lupus erythematosus &#40;SLE&#41; have been a major therapeutic advance and serve as immunomodulators and inhibitors of thrombosis&#44; with few side effects&#44; prolonging the quality of life of patients&#46; Their withdrawal leaves the patient with SLE at the mercy of the side effects of corticosteroids and immunosuppressants&#44; and increases the risk of flares&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Hydroxychloroquine can cause severe retinal toxicity&#44; requiring discontinuation of therapy&#44; although there are few cases of cloroquine retinopathy&#44; always related to very high cumulative drug dose&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Synthetic antimalarial toxicity is detected by ophthalmic screening protocols focused on development of macular pathology&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> One must not forget that the patient with SLE is predisposed to retinal ischemia that may be confused with macular damage due to cloroquine&#46; We present a case in which the ocular findings represented a challenge in the therapeutic decision&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 50-year-old woman with SLE was treated with a umulative dose of 365<span class="elsevierStyleHsp" style=""></span>g of hydroxychloroquine for 13 years&#44; with mild lupus nephritis and hypertension controlled 5 years prior&#59; during her screening for ocular toxicity she presented moderate loss of vision&#44; presenting a corrected visual acuity of 0&#46;7 in the right eye and 1 in the left eye&#46; In the right fundus we observed irregular areas of hyperpigmentation and depigmentation in the macula&#44; without apparent serous uprising&#44; and some arcades microhemorrhages&#46; The left fundus appeared normal&#46; 10-2 the visual field was normal in both eyes&#46; Optical coherence tomography &#40;OCT&#41; of the right eye showed hyperreflective foveal thickening and hyporreflective cavities in deep layers &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The OCT of the left eye was normal&#46; Fluorescein angiography &#40;FA&#41; showed no bull&#39;s-eye pattern&#44; but microaneurysms in both eyes &#40;not detected on fundoscopy&#41;&#44; sectoral distribution and hyper-and hypofluorescence late macular leakage &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In the multifocal electroretinogram &#40;mfERG&#41; there were low amplitude responses in both peripheral retinas&#44; low power density in the foveal region of the right eye and normal foveolar activity in the left eye &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The alteration of the N95 wave of the electroretinogram pattern reflected a dysfunction of the ganglion cells of both retinas&#44; probably causing the disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The neurophysiological findings&#44; the OCT and FA suggested a vascular origin rather than a toxic effect&#44; so it toxicity was ruled out and hydroxychloroquine retinopathy was diagnosed as lupus&#44; recommending the maintenance of the antimalarial but with close monitoring of the patient to prevent maculopathy as a risk factor&#46; In subsequent visits the patient maintained her visual acuity and had improved lupus symptoms with hydroxychloroquine maintenance treatment&#44; which confirmed the suspected end diagnosis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">In the early alterations of the visual field as a sign of cloroquine maculopathy 10-2&#44; central mfERG&#44; OCT and autofluorescence have recently been added as diagnostic tests&#44; with their use recommended for routine screening&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Central mfERG shows very early alterations&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> but its availability is scarce&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The field of view of our patient was normal in both eyes&#44; which ruled cloroquine maculopathy&#46; The mfERG showed macular dysfunction only in the right eye and asymmetry is rare in drug toxicity&#46; The results of the AGF and the rest of neurophysiological studies suggested an episode of retinal ischemia&#46; The OCT image was reminiscent of a rare form of central serous chorioretinopathy&#44; lupus<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> choroidopathy&#44; while microaneurysms in cuneiform distributions were more typical of hypertensive episodes&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Faced with a maculopathy in a patient with SLE treated with hydroxychloroquine&#44; we must not forget that they are patients exposed to thrombotic events that can generate retinal confusion&#44; so that additional tests may be necessary to make an adequate differential diagnosis&#44; because without maculopathy there is no need for drug withdrawal&#44; even to assess an increase in dosage&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects&#46;</span> The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data&#46;</span> The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent&#46;</span> The authors have obtained the informed consent of the patients and &#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no disclosures to make&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:2 [
          "identificador" => "xres125902"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec113196"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres125901"
          "titulo" => "Resumen"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec113197"
          "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" => "sec0025"
          "titulo" => "Ethical disclosures"
        ]
        8 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conflict of Interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-09-09"
    "fechaAceptado" => "2011-12-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec113196"
          "palabras" => array:4 [
            0 => "Lupus erythematosus"
            1 => "Hydroxychloroquine"
            2 => "Central serous chorioretinopathy"
            3 => "Multifocal electroretinography"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec113197"
          "palabras" => array:4 [
            0 => "Lupus eritematoso"
            1 => "Hidroxicloroquina"
            2 => "Coriorretinopat&#237;a central serosa"
            3 => "Electrorretinograf&#237;a multifocal"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 50-year-old woman with systemic lupus erythematosus treated for 13 years with hydroxychloroquine developed nephropathy and high blood pressure 5 years ago as well as moderate loss of vision in her right eye&#46; Fundoscopy showed alterations of macular pigmentation only in the right eye&#46; Visual fields 10-2 were normal in both eyes&#46; Optical coherence tomography showed hyperreflective foveal thickening with a hyporreflective cavity underlying in the right macula&#44; and was normal in left macula&#46; Fluorescein angiography showed no bulls-eye pattern&#44; but did show microaneurysms in vascular arcades&#46; Multifocal central electroretinogram was diminished in right eye and the electroretinogram pattern was diminished in both eyes&#46; We concluded that the alterations of the right eye were suggestive of ischemic maculopathy&#44; not chloroquine toxicity&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Una mujer de 50 a&#241;os con lupus eritematoso sist&#233;mico&#44; tratada 13 a&#241;os con hidroxicloroquina y desde hace 5 a&#241;os con nefropat&#237;a e hipertensi&#243;n arterial&#44; refiri&#243; en la revisi&#243;n peri&#243;dica p&#233;rdida moderada de visi&#243;n en el ojo derecho&#46; La fundoscopia mostr&#243; solo alteraciones de la pigmentaci&#243;n macular en el ojo derecho&#46; El campo visual 10-2 fue normal en ambos ojos&#46; La tomograf&#237;a de coherencia &#243;ptica mostr&#243; en la m&#225;cula derecha un engrosamiento foveal hiperreflectivo&#44; con cavidad hiporreflectiva subyacente&#44; y fue normal en la m&#225;cula izquierda&#46; La angiograf&#237;a fluoresce&#237;nica no mostr&#243; patr&#243;n en ojo de buey&#44; sino microaneurismas en arcadas vasculares&#46; El electrorretinograma multifocal central estaba disminuido en el ojo derecho y el electrorretinograma patr&#243;n moderadamente disminuido en ambos ojos&#46; En conclusi&#243;n&#44; las alteraciones del ojo derecho fueron indicativas de maculopat&#237;a isqu&#233;mica&#44; pero no de toxicidad cloroqu&#237;nica&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Rodr&#237;guez-Hurtado FJ&#44; et al&#46; Maculopat&#237;a en paciente con lupus eritematoso sist&#233;mico tratado con hidroxicloroquina&#46; Reumatol Clin&#46; 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2011.12.012">doi&#58;10&#46;1016&#47;j&#46;reuma&#46;2011&#46;12&#46;012</span></p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3493
            "Ancho" => 3167
            "Tamanyo" => 1151768
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography of the right eye of the patient showing discrete thickening of the fovea&#44; with a hyporeflective space in the outer layers of the retina &#40;arrows&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2361
            "Ancho" => 3153
            "Tamanyo" => 688538
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Central multifocal electroretinogram with 100 hexagons&#46; We observe a moderate decrease in the rpower density of the foveal region of the right eye &#40;no white areas&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1248
            "Ancho" => 1493
            "Tamanyo" => 174326
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Angiography of the right eye&#46; Microaneurysms are seen in inferior temporal region and a small temporal macula area &#40;arrows&#41;&#46; Hypo-and hyperfluorescent images of the fovea &#40;asterisk&#41; are not modified during the angiogram&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A long-term study of hydroxychloroquine withdrawal on exacerbations in systemic lupus erythematosus&#46; The Canadian Hydroxychloroquine Study Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Tsakonas"
                            1 => "L&#46; Joseph"
                            2 => "J&#46;M&#46; Esdaile"
                            3 => "D&#46; Choquette"
                            4 => "J&#46;L&#46; Sen&#233;cal"
                            5 => "A&#46; Cividino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "1998"
                        "volumen" => "7"
                        "paginaInicial" => "80"
                        "paginaFinal" => "85"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9541091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ocular safety of hydroxychloroquine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;N&#46; Bernstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Annals of Ophthalmology"
                        "fecha" => "1991"
                        "volumen" => "23"
                        "paginaInicial" => "292"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1952638"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "American Academy of Ophthalmology"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;F&#46; Marmor"
                            1 => "U&#46; Kellner"
                            2 => "T&#46;Y&#46; Lai"
                            3 => "J&#46;S&#46; Lyons"
                            4 => "W&#46;F&#46; Mieler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ophtha.2010.11.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology"
                        "fecha" => "2011"
                        "volumen" => "118"
                        "paginaInicial" => "415"
                        "paginaFinal" => "422"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21292109"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection of early hydroxychloroquine retinal toxicity enhanced by ring ratio analysis of multifocal electroretinography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;S&#46; Lyons"
                            1 => "M&#46;L&#46; Severns"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajo.2006.12.042"
                      "Revista" => array:6 [
                        "tituloSerie" => "American Journal of Ophthalmology"
                        "fecha" => "2007"
                        "volumen" => "143"
                        "paginaInicial" => "801"
                        "paginaFinal" => "809"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17336914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central serous chorioretinopathy in patients with systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;T&#46; Cunningham Jr&#46;"
                            1 => "P&#46;R&#46; Alfred"
                            2 => "A&#46;R&#46; Irvine"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Opthalmology"
                        "fecha" => "1996"
                        "volumen" => "103"
                        "paginaInicial" => "2081"
                        "paginaFinal" => "2090"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000000800000005/v1_201305061645/S2173574312000573/v1_201305061645/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "17376"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Case Report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000800000005/v1_201305061645/S2173574312000573/v1_201305061645/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312000573?idApp=UINPBA00004M"
]
Article information
ISSN: 21735743
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 15 16 31
2024 October 59 42 101
2024 September 61 22 83
2024 August 67 45 112
2024 July 58 30 88
2024 June 70 43 113
2024 May 61 44 105
2024 April 51 22 73
2024 March 64 27 91
2024 February 55 24 79
2024 January 52 22 74
2023 December 53 32 85
2023 November 60 46 106
2023 October 49 49 98
2023 September 111 43 154
2023 August 121 20 141
2023 July 70 20 90
2023 June 81 37 118
2023 May 69 25 94
2023 April 67 6 73
2023 March 59 33 92
2023 February 81 30 111
2023 January 48 34 82
2022 December 71 41 112
2022 November 117 37 154
2022 October 92 47 139
2022 September 127 41 168
2022 August 107 34 141
2022 July 44 45 89
2022 June 89 35 124
2022 May 60 49 109
2022 April 85 48 133
2022 March 74 57 131
2022 February 81 41 122
2022 January 60 38 98
2021 December 50 41 91
2021 November 65 48 113
2021 October 81 56 137
2021 September 73 40 113
2021 August 83 37 120
2021 July 63 25 88
2021 June 84 32 116
2021 May 78 46 124
2021 April 128 70 198
2021 March 122 34 156
2021 February 80 27 107
2021 January 53 19 72
2020 December 55 27 82
2020 November 45 27 72
2020 October 38 13 51
2020 September 57 35 92
2020 August 28 33 61
2020 July 37 42 79
2020 June 44 27 71
2020 May 41 18 59
2020 April 61 20 81
2020 March 32 16 48
2020 February 1 0 1
2020 January 4 0 4
2019 September 4 0 4
2019 June 1 0 1
2019 May 1 0 1
2019 March 1 0 1
2019 January 1 0 1
2018 December 2 0 2
2018 May 5 1 6
2018 April 90 8 98
2018 March 62 6 68
2018 February 46 3 49
2018 January 37 5 42
2017 December 45 7 52
2017 November 52 5 57
2017 October 31 10 41
2017 September 51 7 58
2017 August 66 13 79
2017 July 68 12 80
2017 June 97 11 108
2017 May 89 13 102
2017 April 78 12 90
2017 March 62 16 78
2017 February 55 8 63
2017 January 55 14 69
2016 December 87 19 106
2016 November 82 9 91
2016 October 118 11 129
2016 September 164 10 174
2016 August 80 8 88
2016 July 49 13 62
2016 May 1 0 1
2016 February 1 0 1
2016 January 3 0 3
2015 December 2 0 2
2015 November 1 0 1
2015 October 1 0 1
2015 September 1 21 22
2015 August 1 0 1
2015 July 28 5 33
2015 June 74 6 80
2015 May 71 17 88
2015 April 58 7 65
2015 March 65 7 72
2015 February 58 5 63
2015 January 57 10 67
2014 December 64 15 79
2014 November 75 8 83
2014 October 68 12 80
2014 September 68 14 82
2014 August 56 14 70
2014 July 62 21 83
2014 June 72 10 82
2014 May 59 18 77
2014 April 68 17 85
2014 March 88 21 109
2014 February 60 18 78
2014 January 65 23 88
2013 December 64 10 74
2013 November 68 10 78
2013 October 62 15 77
2013 September 53 11 64
2013 August 56 14 70
2013 July 45 10 55
2013 June 59 10 69
2013 May 48 14 62
2013 April 53 12 65
2013 March 42 22 64
2013 February 42 10 52
2013 January 55 20 75
2012 December 47 15 62
2012 November 47 19 66
2012 October 18 18 36
Show all

Follow this link to access the full text of the article

Idiomas
Reumatología Clínica (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?