Case Report
Hypertrophic Osteoarthropathy With Acro-osteolysis in a Patient With Primary Pulmonary Hypertension
Osteoartropatía hipertrófica con acro-osteolisis y neoformación ósea en un paciente con hipertensión pulmonar primaria
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"documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2012;8:208-11" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8961 "formatos" => array:3 [ "EPUB" => 153 "HTML" => 7650 "PDF" => 1158 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Osteoartropatía hipertrófica con acro-osteolisis y neoformación ósea en un paciente con hipertensión pulmonar primaria" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "208" "paginaFinal" => "211" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Hypertrophic osteoarthropathy with acro-osteolysis in a patient with primary pulmonary hypertension" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1561 "Ancho" => 1250 "Tamanyo" => 143483 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Radiografía de manos (A) en la que se observa reacción perióstica en radio. Ensanchamiento distal con cambios hipertróficos en los penachos y áreas de osteolisis en los mismos, de las que es un buen ejemplo el cuarto dedo de la mano derecha. Desmineralización yuxtaarticular. Radiografía de pies (B) en la que se observan marcados cambios destructivos en falanges distales, algunas con morfología aplanada y penachos distales hipertróficos con proliferación ósea. Marcada deformidad de los dedos en palillo de tambor.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Walter Alberto Sifuentes Giraldo, María Ahijón Lana, Ignacio Gallego Rivera, Francisco Javier Bachiller Corral, María Luz Gámir Gámir" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Walter Alberto" "apellidos" => "Sifuentes Giraldo" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Ahijón Lana" ] 2 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Gallego Rivera" ] 3 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Bachiller Corral" ] 4 => array:2 [ "nombre" => "María Luz" "apellidos" => "Gámir Gámir" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357431200086X" "doi" => "10.1016/j.reumae.2012.06.012" "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/S217357431200086X?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X11003160?idApp=UINPBA00004M" "url" => "/1699258X/0000000800000004/v1_201305061922/S1699258X11003160/v1_201305061922/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574312000834" "issn" => "21735743" "doi" => "10.1016/j.reumae.2012.06.009" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "383" "copyright" => "Elsevier España, S.L." 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Evolution of cavitated nodules. (a) and (b) Case 2: cavitated rheumatoid nodules that increase in size. The case was complicated and open pneumothorax produced a cavitated nodule on the pleura (pneumothorax image not shown). (c) and (d) Case 3: rounded subpleural nodules, in a patient with signs of interstitial lung disease. 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The anti-CD19 spectrum extends from pro B to plasmablasts and some plasma cells.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Walter A. Sifuentes Giraldo, María J. García Villanueva, Alina L. Boteanu, Ana Lois Iglesias, Antonio C. Zea Mendoza" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Walter A." "apellidos" => "Sifuentes Giraldo" ] 1 => array:2 [ "nombre" => "María J." "apellidos" => "García Villanueva" ] 2 => array:2 [ "nombre" => "Alina L." "apellidos" => "Boteanu" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Lois Iglesias" ] 4 => array:2 [ "nombre" => "Antonio C." 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There are two distinct radiological patterns of HOA, one characterized by hypertrophia or bone neoformation, predominant in patients with lung disease (pneumic HOA) and which has its onset after puberty; and another with acroosteolysis, associated frequently with cyanotic congenital heart disease and which has its onset during childhood. Two variants have been seen in this last pattern, one in which the reabsorption of the distal phalanges makes them adopt a pyramidal form and another in which its massive destruction leads to the formation of flat surfaces.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> We present the case of a patient with primary pulmonary hypertension who developed HOA with a mixed radiological pattern.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Presentation</span><p id="par0010" class="elsevierStylePara elsevierViewall">The case is a 30-year-old male patient with a history of primary pulmonary hypertension without a shunt and followed by pediatric cardiology ever since. He had no other history of importance, including rheumatic disease or psoriasis. At age 29 he started presenting episodes of symmetric, additive polyarthritis which affected knees, ankles, shoulders, wrists and metacarpophalangeal joints, with important functional limitation. Physical examination found, in addition to generalized cyanosis and acropachy, no skin or nail lesions suggestive of psoriasis. Laboratory analysis found normal acute phase reactants, negative rheumatoid factor and positive low titer anti-CCP antibodies in a single determination. X-rays showed acroosteolysis of the distal phalanges of the hands and feet, severest in the latter, in which some of the phalanges adopted the form of a pyramid or had a flattened end, with important bone neoformation in both locations, especially the hands (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Both wrists observed, in addition to radiocarpal and intercarpal joint impingement, especially of the left side, no erosions. Long bones (tibia, peroneal, radial) had a cottony cortex and periosteal separation compatible with periostitis. A bone scyntigraphy showed moderate uptake in the distal phalanges of both hands, as well as right wrist and radium with a theoretical zone in the left semilunar.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was diagnosed with pneumic HOA and treated with low dose steroid (deflazacort 6<span class="elsevierStyleHsp" style=""></span>mg/day), zoledronate (single 5<span class="elsevierStyleHsp" style=""></span>mg dose) and calcium and vitamin D supplements. He responded rapidly to treatment with remission of arthritis and steroids were suspended after a few months; he only presented a single relapse which responded after 2 weeks of treatment with no further relapses.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">This case involved a patient with underlying lung pathology of pediatric onset, who developed a late polyarthritis that led to the diagnosis of pneumic HOA. However, changes such as acro-osteolysis, new bone formation and periostitis probably had a longer evolution, but because these events often have a more insidious course and patients are often asymptomatic, it is usually detected in an incidental radiological study.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Previous studies have reported that foot affection is more frequent and more severe than that of the hand,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> as in our patient. Solid and continuous periosteal reaction in the long bones is also a common finding,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> such as the one our patient presented on the tibial and radial bones.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The mixed pattern combining acroosteolysis and bone neoformation in the same patient was what called our attention, however, some studies suggest that these patterns are not mutually exclusive and constitute a continuum in which initial stages have a predominance of proliferative changes with osteolysis in late stages.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Another characteristic is that generally, areas of hypertrophy/osteolysis correspond with greater uptake in scyntigraphy,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> as seen in this case.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient had positive low titer anti-CCP antibodies in a single determination with no other criteria for rheumatoid arthritis nor with any compatible radiological lesions, nor did he require treatment with methotrexate or any other disease modifying drug. We have not found, in the reviewed literature, any relationship between HOA and anti-CCP positivity, thus considering a false positive case. The patient did not have any skin lesions or axial or enthesitic affection suggesting psoriatic arthritis; however, because it was a rapid onset case of polyarthritis with osteolytic and proliferative changes, psoriatic arthritis must be considered in the differential diagnosis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The mechanism that leads to bone lesions in HOA is unknown. From the histological standpoint it is characterized by an excessive deposition of collagen, endothelial hyperplasia, edema and osteoblast proliferation in the distal parts of long bones, leading to subperiostic bone neoformation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Among the factors that intervene in these changes are endothelial vascular growth factor (VEGF),<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reflex vagal hyperstimulation,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> interleukin 11,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> paraneoplasic growth factors,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> hormonal alterations,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> circulating immune complexes,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> antiphopholipid antibodies,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> alterations in platelet function<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and endothelial activation.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Treatment of secondary HOA corresponds to that of the underlying condition (for example, correction of the heart defect, treatment of cancer or infection, etc.). Symptomatic management of HOA includes non steroidal antiinlammatory drugs and steroids for joint pain,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and bisphosphonates such as pamidronate<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and zoledronate<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> which control pain due to periostitis, with antiosteoclastic activity that inhibits the expression of VEGF.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Another drug employed is octeotride which has also shown activity on VEGF.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects.</span> The authors declare that no experiments were performed on humans or animals for this investigation.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data.</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.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent.</span> The authors have obtained the informed consent of the patients and /or subjects mentioned in the article. The author for correspondence is in possession of this document.<span class="elsevierStyleVsp" style="height:0.5px"></span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres125838" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec113133" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres125837" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec113132" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Presentation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-05-19" "fechaAceptado" => "2011-10-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec113133" "palabras" => array:4 [ 0 => "Hypertrophic osteoarthropathy" 1 => "Acro-osteolysis" 2 => "New bone formation" 3 => "Primary pulmonary hypertension" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec113132" "palabras" => array:4 [ 0 => "Osteoartropatía hipertrófica" 1 => "Acro-osteolisis" 2 => "Neoformación ósea" 3 => "Hipertensión pulmonar primaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypertrophic osteoarthropathy is an entity characterized by a triad of periostitis of long bones, clubbing and arthritis. Radiologically there are two patterns, one characterized by new bone formation which predominates in patients with pulmonary disease, and another by acro-osteolysis that is most frequently associated with congenital heart disease. We report the case of a 30-year-old man diagnosed with primary pulmonary hypertension for two years, developing hypertrophic osteoarthropathy with a mixed radiological pattern.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La osteoartropatía hipertrófica es una entidad caracterizada por la tríada de periostitis de huesos largos, acropaquias y artritis. Radiológicamente se distinguen 2 patrones; uno caracterizado por neoformación ósea que predomina en pacientes con patología pulmonar, y otro por acro-osteolisis que se asocia más frecuentemente con cardiopatías congénitas. Presentamos el caso de un varón de 30 años diagnosticado de hipertensión arterial pulmonar primaria desde los 2 años, que desarrolló una osteoartropatía hipertrófica con un patrón radiológico mixto.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Sifuentes Giraldo WA, et al. Osteoartropatía hipertrófica con acro-osteolisis y neoformación ósea en un paciente con hipertensión pulmonar primaria. Reumatol Clin. 2012;8:208–11.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2602 "Ancho" => 2077 "Tamanyo" => 306543 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hand X-ray (A) in which there is a periosteal reaction on the radius. There is distal widening with hypertrophic changes and areas of osteolysis, with a good example on the right fourth finger. Juxtaarticular demineralization. Feet X-ray (B) observing marked destruction of the distal phalanges, some with flattened morphology and distal hypertrophy with bone proliferation. There is marked deformity of the fingers.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1377 "Ancho" => 2070 "Tamanyo" => 100952 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Comparative image of the distal phalange of the hand (A) and foot (B); the first has proliferative changes and the second destructive changes with flattened morphology.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acro-osteolysis associated with hypertrophic pulmonary osteoarthropathy and pachydermoperiostosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. 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| 2022 May | 65 | 50 | 115 |
| 2022 April | 55 | 50 | 105 |
| 2022 March | 44 | 63 | 107 |
| 2022 February | 72 | 39 | 111 |
| 2022 January | 80 | 55 | 135 |
| 2021 December | 50 | 36 | 86 |
| 2021 November | 47 | 40 | 87 |
| 2021 October | 62 | 63 | 125 |
| 2021 September | 56 | 46 | 102 |
| 2021 August | 71 | 47 | 118 |
| 2021 July | 72 | 43 | 115 |
| 2021 June | 49 | 46 | 95 |
| 2021 May | 49 | 58 | 107 |
| 2021 April | 234 | 118 | 352 |
| 2021 March | 193 | 45 | 238 |
| 2021 February | 147 | 30 | 177 |
| 2021 January | 91 | 31 | 122 |
| 2020 December | 71 | 30 | 101 |
| 2020 November | 63 | 20 | 83 |
| 2020 October | 59 | 17 | 76 |
| 2020 September | 55 | 38 | 93 |
| 2020 August | 48 | 28 | 76 |
| 2020 July | 51 | 31 | 82 |
| 2020 June | 64 | 39 | 103 |
| 2020 May | 57 | 19 | 76 |
| 2020 April | 50 | 31 | 81 |
| 2020 March | 28 | 7 | 35 |
| 2020 February | 2 | 0 | 2 |
| 2020 January | 5 | 0 | 5 |
| 2019 October | 2 | 0 | 2 |
| 2019 September | 6 | 0 | 6 |
| 2019 June | 2 | 0 | 2 |
| 2019 May | 2 | 0 | 2 |
| 2019 March | 3 | 0 | 3 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 9 | 1 | 10 |
| 2018 April | 71 | 17 | 88 |
| 2018 March | 136 | 19 | 155 |
| 2018 February | 59 | 2 | 61 |
| 2018 January | 118 | 5 | 123 |
| 2017 December | 44 | 8 | 52 |
| 2017 November | 49 | 5 | 54 |
| 2017 October | 47 | 11 | 58 |
| 2017 September | 59 | 8 | 67 |
| 2017 August | 79 | 20 | 99 |
| 2017 July | 46 | 20 | 66 |
| 2017 June | 90 | 21 | 111 |
| 2017 May | 92 | 24 | 116 |
| 2017 April | 85 | 14 | 99 |
| 2017 March | 78 | 11 | 89 |
| 2017 February | 65 | 15 | 80 |
| 2017 January | 50 | 21 | 71 |
| 2016 December | 99 | 26 | 125 |
| 2016 November | 90 | 10 | 100 |
| 2016 October | 145 | 17 | 162 |
| 2016 September | 206 | 6 | 212 |
| 2016 August | 142 | 15 | 157 |
| 2016 July | 70 | 9 | 79 |
| 2015 December | 2 | 0 | 2 |
| 2015 November | 3 | 0 | 3 |
| 2015 October | 2 | 0 | 2 |
| 2015 September | 7 | 0 | 7 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 59 | 9 | 68 |
| 2015 June | 62 | 21 | 83 |
| 2015 May | 103 | 32 | 135 |
| 2015 April | 74 | 18 | 92 |
| 2015 March | 67 | 10 | 77 |
| 2015 February | 81 | 13 | 94 |
| 2015 January | 85 | 14 | 99 |
| 2014 December | 89 | 10 | 99 |
| 2014 November | 98 | 9 | 107 |
| 2014 October | 85 | 10 | 95 |
| 2014 September | 79 | 7 | 86 |
| 2014 August | 60 | 15 | 75 |
| 2014 July | 85 | 14 | 99 |
| 2014 June | 102 | 10 | 112 |
| 2014 May | 83 | 14 | 97 |
| 2014 April | 102 | 7 | 109 |
| 2014 March | 104 | 20 | 124 |
| 2014 February | 94 | 11 | 105 |
| 2014 January | 85 | 19 | 104 |
| 2013 December | 81 | 11 | 92 |
| 2013 November | 86 | 20 | 106 |
| 2013 October | 91 | 19 | 110 |
| 2013 September | 94 | 10 | 104 |
| 2013 August | 90 | 17 | 107 |
| 2013 July | 86 | 13 | 99 |
| 2013 June | 83 | 21 | 104 |
| 2013 May | 80 | 13 | 93 |
| 2013 April | 86 | 15 | 101 |
| 2013 March | 84 | 19 | 103 |
| 2013 February | 56 | 18 | 74 |
| 2013 January | 57 | 9 | 66 |
| 2012 December | 74 | 23 | 97 |
| 2012 November | 66 | 23 | 89 |
| 2012 October | 64 | 15 | 79 |
| 2012 September | 27 | 9 | 36 |
Show all
