Original Article
A Survey on the Current Evaluation and Treatment of Gout in Buenos Aires, Argentina
Una encuesta sobre la evaluación y el tratamiento actual de la gota en Buenos Aires, Argentina
Nauan Faraa, Janitzia Vázquez Melladob, Gabriel Sequeiraa,
, Eduardo Kerzberga,c
Corresponding author
a Servicio de Reumatología, Hospital J.M. Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
b Servicio de Reumatología, Hospital General de México, Facultad de Medicina, UNAM, Ciudad de México, Mexico
c Centro de Osteoporosis y Enfermedades Osteoarticulares, Centro de Farmacología Clínica e Investigaciones Clínico-Farmacológicas, Facultad de Medicina, Universidad de Buenos Aires. Ciudad Autónoma de Buenos Aires, Argentina
Read
6927
Timeswas read the article
2247
Total PDF
4680
Total HTML
Share statistics
array:24 [ "pii" => "S2173574312001529" "issn" => "21735743" "doi" => "10.1016/j.reumae.2012.05.004" "estado" => "S300" "fechaPublicacion" => "2012-11-01" "aid" => "470" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2012;8:306-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2888 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 2339 "PDF" => 499 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X1200160X" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2012.05.008" "estado" => "S300" "fechaPublicacion" => "2012-11-01" "aid" => "470" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2012;8:306-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7200 "formatos" => array:3 [ "EPUB" => 159 "HTML" => 5079 "PDF" => 1962 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Una encuesta sobre la evaluación y el tratamiento actual de la gota en Buenos Aires, Argentina" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "306" "paginaFinal" => "309" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "A survey on the current evaluation and treatment of gout in Buenos Aires, Argentina" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nauan Fara, Janitzia Vázquez Mellado, Gabriel Sequeira, Eduardo Kerzberg" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Nauan" "apellidos" => "Fara" ] 1 => array:2 [ "nombre" => "Janitzia" "apellidos" => "Vázquez Mellado" ] 2 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Sequeira" ] 3 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Kerzberg" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574312001529" "doi" => "10.1016/j.reumae.2012.05.004" "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/S2173574312001529?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1200160X?idApp=UINPBA00004M" "url" => "/1699258X/0000000800000006/v1_201305061930/S1699258X1200160X/v1_201305061930/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574312001621" "issn" => "21735743" "doi" => "10.1016/j.reumae.2012.10.005" "estado" => "S300" "fechaPublicacion" => "2012-11-01" "aid" => "438" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2012;8:310-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2900 "formatos" => array:3 [ "EPUB" => 57 "HTML" => 2387 "PDF" => 456 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Situation of Spanish Echography in Spanish Rheumatology 2012" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "310" "paginaFinal" => "314" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Situación de la ecografía en la reumatología española 2012" ] ] "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" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 724 "Ancho" => 1405 "Tamanyo" => 63324 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Area of echography examination (%).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eugenio de Miguel, Jose Luis Andreu, Esperanza Naredo, Ingrid Möller" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Eugenio" "apellidos" => "de Miguel" ] 1 => array:2 [ "nombre" => "Jose Luis" "apellidos" => "Andreu" ] 2 => array:2 [ "nombre" => "Esperanza" "apellidos" => "Naredo" ] 3 => array:2 [ "nombre" => "Ingrid" "apellidos" => "Möller" ] 4 => array:1 [ "colaborador" => "Grupo de Trabajo de Ecografía de la Sociedad Española de Reumatología (ECOSER)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X12000848" "doi" => "10.1016/j.reuma.2012.03.004" "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/S1699258X12000848?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312001621?idApp=UINPBA00004M" "url" => "/21735743/0000000800000006/v1_201305061648/S2173574312001621/v1_201305061648/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S217357431200161X" "issn" => "21735743" "doi" => "10.1016/j.reumae.2012.04.013" "estado" => "S300" "fechaPublicacion" => "2012-11-01" "aid" => "456" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2012;8:304-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4140 "formatos" => array:3 [ "EPUB" => 51 "HTML" => 3291 "PDF" => 798 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Musculoskeletal Ultrasound in Mexico 10 Years After its Inception" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "304" "paginaFinal" => "305" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La ecografía musculoesquelética en México a 10 años de su inicio" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mario Chávez-López, Carlos Pineda" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Mario" "apellidos" => "Chávez-López" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Pineda" ] 2 => array:1 [ "colaborador" => "on behalf of the Escuela de Ultrasonido del Colegio Mexicano de Reumatología (ECOMER [Cristina Hernández-Díaz, Lucio Ventura, and Carlos Moya])" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X12001295" "doi" => "10.1016/j.reuma.2012.04.003" "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/S1699258X12001295?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431200161X?idApp=UINPBA00004M" "url" => "/21735743/0000000800000006/v1_201305061648/S217357431200161X/v1_201305061648/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "A Survey on the Current Evaluation and Treatment of Gout in Buenos Aires, Argentina" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "306" "paginaFinal" => "309" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nauan Fara, Janitzia Vázquez Mellado, Gabriel Sequeira, Eduardo Kerzberg" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Nauan" "apellidos" => "Fara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Janitzia" "apellidos" => "Vázquez Mellado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Gabriel" "apellidos" => "Sequeira" "email" => array:1 [ 0 => "gabriel.sequeira@live.com.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Kerzberg" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital J.M. Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital General de México, Facultad de Medicina, UNAM, Ciudad de México, Mexico" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Osteoporosis y Enfermedades Osteoarticulares, Centro de Farmacología Clínica e Investigaciones Clínico-Farmacológicas, Facultad de Medicina, Universidad de Buenos Aires. Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Una encuesta sobre la evaluación y el tratamiento actual de la gota en Buenos Aires, Argentina" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Although gout has been described since antiquity and its treatment includes drugs used for millenia,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> it remains an under-diagnosed disease or is diagnosed at later stages and, even when correctly diagnosed, treatment is usually suboptimal.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Unlike rheumatoid arthritis or systemic lupus erythematosus, gout seems to be regarded by rheumatologists as a minor illness and its diagnosis and management usually falls to general practitioners.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this study was to assess the current management of gout by general practitioners and specialists in the city of Buenos Aires and its surrounding areas.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">An anonymous, closed, multiple-choice survey was applied to doctors from the city of Buenos Aires and surrounding areas, between May 2010 and May 2011.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The initial development of the survey was conducted by 2 authors (NF and GS) on the basis of: (a) changes made to a survey used in a previously published study by other authors<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> (JVM) and (b) other publications.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The survey was modified and finally accepted by the consensus of all authors: the survey tried to find out what professionals do in their daily practice. It consisted of 18 questions and included a first part with professional data, frequency of patients evaluated for gout (too often, usually infrequently and rarely) and number of patients seen per month (between 1 and 5, between 6 and 10, between 11 and 20, over 20).</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the second part, we asked about the manner in which gout patients are commonly attended and how the diagnosis of gout was made, with special emphasis on the detection and identification of monosodium urate crystals (MUC) in synovial fluid or tophi. The third part assessed the treatment of acute and chronic gout. We also evaluated the indications for lifestyle modifications and changes and, finally, asked about 5 measures for evaluation of the metabolic syndrome.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Rheumatologists (REU), internal medicine specialists (EMI) and physicians without specialty, or other physicians who worked mostly in emergency services (Other) were surveyed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Surveys were completed personally by professionals assisting to different scientific events related to rheumatology, held in the City of Buenos Aires in that period. We also visited several emergency rooms and medical clinics in Buenos Aires, where other professionals completed the survey.</p><p id="par0045" class="elsevierStylePara elsevierViewall">While there was strict control of the percentage of professionals contacted who agreed to answer the survey, it is estimated that the percentage of participation did not exceed 20% of professionals who were contacted personally. We also sent 75 emails, with a copy of the survey from a closed contact at the Rheumatology department of the Hospital JM Ramos Mejia, and 19 professionals answered (6 REU, 6 and 7 Others EMI).</p><p id="par0050" class="elsevierStylePara elsevierViewall">For the analysis we used descriptive statistics and <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> test (significant <span class="elsevierStyleItalic">P</span><.05) and SPSS for Windows version 17.0 software.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">One hundred seventy-one physicians responded to the questionnaire: REU 19.3%, EMI 30.4% and 50.3% Other. The other group had fewer years of professional experience: only 18.6% of the Other group had more than 10 years vs 36.4% of the REU and 38.5% of the EMI (<span class="elsevierStyleItalic">P</span><.021).</p><p id="par0060" class="elsevierStylePara elsevierViewall">Patients most commonly assessed by REU and EMI were those with hyperuricemia with or without a diagnosis of gout (48.5 and 46.2%, respectively), while for the other 39.5%, acute monoarthritis was the most frequent form of presentation.</p><p id="par0065" class="elsevierStylePara elsevierViewall">REU cared for gout patients very frequently or habitually in 51.5% of cases vs EMI 11.5% and 8.1% Other (<span class="elsevierStyleItalic">P</span><.001). The REU examined between 1 and 5 gout patients per month in 81.82% of cases, EMI in 96.15% and Others in 96.51%, while 18.18% of the REU, 85% of EMI and 3.49% of Others saw more than 5 patients with gout per month (<span class="elsevierStyleItalic">P</span>=.009).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Physicians were asked if they based their diagnosis on clinical gout, hyperuricemia, the presence of tophi, identifying MUC or a combination of the above.</p><p id="par0075" class="elsevierStylePara elsevierViewall">To diagnose gout, clinical data (alone or combined with other criteria), were used by 93.9% of the REU, 92.3% of EMI vs 72.1% Other (<span class="elsevierStyleItalic">P</span><.01). The study and identification of MUC were used for diagnosis (alone or combined) by 51.5% of REU vs 28.8% of EMI and 26.7% Others (<span class="elsevierStyleItalic">P</span>=.010). The presence of tophi (alone or combined) was reported by 60.6% of REU vs 30.8% EMI and 30.2% of Others (<span class="elsevierStyleItalic">P</span>=.005). Hyperuricemia was used by 42.4% of REU, 44.2% of EMI and 43% Others (<span class="elsevierStyleItalic">P</span>=.98, NS).</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the ideal case of a patient with acute monoarthritis and a history of gout, 75.8% of REU would perform articular puncture vs 44.2% of EMI and 30.2% Others (<span class="elsevierStyleItalic">P</span><.001).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Over 80% of respondents would use nonsteroidal antiinflammatory drugs (NSAIDs) alone or in combination for acute gout.</p><p id="par0090" class="elsevierStylePara elsevierViewall">REU and EMI indicate colchicine more alone or combined frequently: 75.8% and 80.8%, respectively, vs 47.7% Other (<span class="elsevierStyleItalic">P</span><.001). 32.6% of the Others included allopurinol in the treatment of acute gout vs 19.2% of the EMI and 6.1% of the REU (<span class="elsevierStyleItalic">P</span>=.007).</p><p id="par0095" class="elsevierStylePara elsevierViewall">With respect to the use of allopurinol, we found that REU used it later (after the second attack) in 60.6% vs 15.4% of EMI and Others 14% (<span class="elsevierStyleItalic">P</span><.001). 84% of the REU recognized that concomitant treatment for the prevention of acute gout (NSAID or colchicine) is indicated when starting treatment with allopurinol vs 46.2% of EMI and 37.2% Others (<span class="elsevierStyleItalic">P</span><.001).</p><p id="par0100" class="elsevierStylePara elsevierViewall">Ideally, in cases of renal failure, liver and tolerability of the drug, 42.4% of REU, 44.2% EMI and 44.2% Other (<span class="elsevierStyleItalic">P</span>=.98, NS) would use higher doses of 300<span class="elsevierStyleHsp" style=""></span>mg of allopurinol/day.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The goal of treatment with allopurinol is to lower uric acid to less than 6<span class="elsevierStyleHsp" style=""></span>mg/dl according to 72.7% of REU, 57.7% of EMI and 48% of Others (<span class="elsevierStyleItalic">P</span>=.06, NS).</p><p id="par0110" class="elsevierStylePara elsevierViewall">Allopurinol was maintained indefinitely by 90.9% of REU vs 61.5% of EMI and 57.0% of Others (<span class="elsevierStyleItalic">P</span>=.002).</p><p id="par0115" class="elsevierStylePara elsevierViewall">On a list of 10 preventive measures, doctors’ responses differed only in (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>):<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0120" class="elsevierStylePara elsevierViewall">Avoid the use of diuretics: 100%. Of REU vs 82.7% EMI and 75.6% Other (<span class="elsevierStyleItalic">P</span>=.007).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0125" class="elsevierStylePara elsevierViewall">Suggest the use of losartan in cases of hypertension by 84.8% REU vs 65.4% of EMI and Others 54.7% (<span class="elsevierStyleItalic">P</span>=.009).</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0130" class="elsevierStylePara elsevierViewall">Suggest the use of fibrates in case of hypertriglyceridemia: 90.9% of REU vs 75.0% of EMI and 62.8% Others (<span class="elsevierStyleItalic">P</span>=.008).</p></li></ul></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Regarding the five measures for the evaluation of the metabolic syndrome (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), REU measure blood pressure, blood glucose and lipid profile in the same proportion as the EMI, but they measured height/weigh of the patient only sometimes: 66.7% vs 92.3% of EMI (<span class="elsevierStyleItalic">P</span>=.006). REU also measure waist circumference less often than EMI (45.5% vs 75%, <span class="elsevierStyleItalic">P</span>=.01).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Professionals were asked whether they referred the patient to the REU and the answers were: (a) never: 3.85% of EMI and 9.30% Others; (b) after the first attack: 46% and 40.70% of EMI and Others, respectively; (c) after the second attack: 15.38 and 22.09% of EMI and Others, respectively; (d) patients with polyarticular disease with tophi or no response to treatment: 42.31% and 27.91% of the EMI and Other, respectively.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Although there are guidelines for the diagnosis and treatment of gout, there is evidence that patients with gout are not treated correctly.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> From our data it appears that about 40% of EMI and other physicians never refer patients to the rheumatologist or only do so in the presence of a case of polyarticular tophi, complications or treatment failure. Thus, rheumatologists see patients late in the clinical course of the disease, since referring doctors rely on the presence of tophi for diagnosis in 60% of cases. The search and identification of MUC and articular puncture (necessary to confirm the diagnosis) are used in a significantly higher manner by REU, who are probably better-trained in these techniques.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Colchicine is still an option for the treatment of acute gout for a major portion of REU and EMI.</p><p id="par0155" class="elsevierStylePara elsevierViewall">REU tend to maintain allopurinol longer and use it more frequently with concomitant medication at the onset of therapy.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Rheumatologists surveyed considered metabolic syndrome and evaluated it in a similar way than clinicians, but should weigh patients and take other measurements more frequently.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Different surveys were published in the last 10 years on the diagnosis and treatment of gout.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,9–11</span></a> The participation of professionals in these surveys, overall, was low.</p><p id="par0170" class="elsevierStylePara elsevierViewall">While in some surveys<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,9</span></a> more than 80% of rheumatologists reported finding and identifying MUC, our results were similar to those reported in Mexico in 2003, where 51% of rheumatologists and 30% of internists used this as a diagnostic<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> method.</p><p id="par0175" class="elsevierStylePara elsevierViewall">In this survey, the use of colchicine by the REU was higher than reported in the U.S. in 2006.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">It is possible that physicians in the polls express their opinions or their academic knowledge and not necessarily what they really do in clinical practice, which is evident when performing audit work on patient files.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Among the strengths of our study we can note that, in addition to REU, we included general practitioners (who worked mostly in emergency rooms) and EMI.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Hyperuricemia and gout are closely linked to the metabolic syndrome<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> or cardiovascular<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> risk. This entails taking a broader view of gout, where joint involvement is only part of the problem. This survey included a section on the evaluation and management of metabolic syndrome.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Under the constraints of a survey and the low turnout, this data cannot be directly extrapolated to all doctors in Buenos Aires.</p><p id="par0200" class="elsevierStylePara elsevierViewall">However, the data is disappointing and, in the absence of similar studies, it is a starting point to estimate adherence to treatment guidelines and quality of care received by patients with gout in the Autonomous City of Buenos Aires.</p><p id="par0205" class="elsevierStylePara elsevierViewall">In conclusion, patients with gout should be referred earlier to REU in order to confirm the diagnosis and improve care.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0215" 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="par0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data</span>. The authors declare that no patient data appears in this article.</p><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent</span>. The authors declare that no patient data appears in this article.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres125991" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec113286" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres125992" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec113287" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethical disclosures" ] 9 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-04-03" "fechaAceptado" => "2012-05-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec113286" "palabras" => array:5 [ 0 => "Survey" 1 => "Gout" 2 => "Colchicine" 3 => "Allopurinol" 4 => "Metabolic syndrome" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec113287" "palabras" => array:5 [ 0 => "Encuesta" 1 => "Gota" 2 => "Colchicina" 3 => "Alopurinol" 4 => "Síndrome metabólico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the current management of gout in general practitioners and specialists in Buenos Aires city.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple choice, anonymous, survey, performed on 33 rheumatologists (REU), 52 Internal Medicine specialists (EMI) and 86 general practitioners (Otros).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Gout is a very common or usual disease for 51.5% of REU vs 11.5% EMI and 8.1% Otros. At diagnosis, uric acid crystals are identified by 51.5% REU vs 28.8% EMI and 26.7% Otros and tophi observed by 60.6% REU vs 30.8% EMI and 30.2% Otros. REU and EMI should indicate colchicine for acute gout in 75.8% and 80.8% respectively vs 7.7% of Otros. REU measure patient's height/weight and waist circumference less frequently than EMI (66.7% vs 92.3% and 45.5% vs 75% respectively).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">REU usually examine patients with gout but in a chronic stage. The identification of crystals in synovial fluid is low. The use of colchicine is still high. REU should improve the evaluation of the metabolic syndrome.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la gestión actual de la gota en los médicos generales y especialistas en Buenos Aires.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Preguntas de selección múltiple, encuesta anónima, realizada a 33 reumatólogos (REU), 52 especialistas en medicina interna (EMI) y 86 médicos generales (Otros).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los REU atienden a pacientes con gota muy frecuentemente o habitualmente en un 51,5% de los casos vs. un 11,5% de EMI y un 8,1% de Otros. Al momento del diagnóstico, los cristales de ácido úrico fueron identificados por un 51,5% de REU vs. un 28,8% de EMI y Otros 26,7%; los tofos fueron identificados por un 60,6% de REU % vs. un 30,8% de EMI y un 30,2% Otros. Los REU y los EMI usan colchicina para la gota aguda en el 75,8 y el 80,8%, respectivamente, frente al 7,7% de Otros. La medida de altura/peso y la circunferencia de la cintura del paciente fue realizada con menos frecuencia por REU que por EMI (el 66,7 vs. el 92,3% y el 45,5 vs. el 75%, respectivamente).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los REU suelen examinar a los pacientes con gota, pero en una etapa crónica. La identificación de los cristales en el líquido sinovial es baja. El uso de colchicina sigue siendo alto. Los REU deben mejorar la evaluación del síndrome metabólico.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Fara N, et al. Una encuesta sobre la evaluación y el tratamiento actual de la gota en Buenos Aires, Argentina. Reumatol Clin. 2012;8:306–9.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara">This work was presented as a poster at the <span class="elsevierStyleItalic">44.° Congreso Argentino de Reumatología</span>, held from 12 to 15 October 2011 in the city of Rosario, Argentina.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">REU (n=33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">EMI (n=52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Others (n=86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physical activity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoidance of diuretics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoidance of alcohol and spirits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoidance of beer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoidance of cola flavored drinks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diet based on fruits and vegetables \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Limiting red meat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lowering weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of losartan for hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of fibrates for hypertriglyceridemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212505.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frequency With Which Those Surveyed Indicated 10 Diet and Lifestyle Recommendations (%).</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">REU (n=33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">EMI (n=52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Others (n=86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Measures and weighs the patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Measures blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Requests a lipid profile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Measures waist circumference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Requests blood glucose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212504.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Frequency of Evaluation of Parameters of Metabolic Syndrome by Those Surveyed (%).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trastornos del metabolismo de las purinas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Smith Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Cecil-Loeb. Tratado de medicina interna" "paginaInicial" => "1951" "paginaFinal" => "1966" "edicion" => "14th ed." "serieFecha" => "1977" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EULAR evidence based recommendations for gout. Part I. Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "EULAR Standing Committee for International Clinical Studies Including Therapeutics" "etal" => true "autores" => array:6 [ 0 => "W. Zhang" 1 => "M. Doherty" 2 => "E. Pascual" 3 => "T. Bardin" 4 => "V. Barskova" 5 => "P. Conaghan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2006.055251" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2006" "volumen" => "65" "paginaInicial" => "1301" "paginaFinal" => "1311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16707533" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why is gout so poorly managed?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Pascual" 1 => "F. Sivera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2007.078469" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "1269" "paginaFinal" => "1270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17881662" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of gout in Mexico City. Results from a physician survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Vazquez-Mellado" 1 => "J. Espinoza" 2 => "A. Hernandez-Garduno" 3 => "L. Lino" 4 => "R. Burgos-Vargas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Invest Clin" "fecha" => "2003" "volumen" => "55" "paginaInicial" => "621" "paginaFinal" => "628" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15011730" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A survey of current evaluation and treatment of gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Schlesinger" 1 => "D.F. Moore" 2 => "J.D. Sun" 3 => "H.R. Schumacher Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2006" "volumen" => "33" "paginaInicial" => "2050" "paginaFinal" => "2052" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17014020" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EULAR Evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "EULAR Standing Committee for International Clinical Studies Including Therapeutics" "etal" => true "autores" => array:6 [ 0 => "W. Zhang" 1 => "M. Doherty" 2 => "T. Bardin" 3 => "E. Pascual" 4 => "V. Barskova" 5 => "P. Conaghan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2006.055269" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2006" "volumen" => "65" "paginaInicial" => "1312" "paginaFinal" => "1324" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16707532" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quality of care for gout in the US needs improvement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.A. Singh" 1 => "J.S. Hodges" 2 => "J.P. Toscano" 3 => "S.M. Asch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheum (Arthritis Care Res)" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "822" "paginaFinal" => "829" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Concordance of the management of chronic gout in a UK primary care population with the EULAR gout recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Roddy" 1 => "W. Zhang" 2 => "M. Doherty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2007.070755" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "1311" "paginaFinal" => "1315" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17504843" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International survey on the diagnosis and management of gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Doherty" 1 => "T. Bardin" 2 => "E. Pascual" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2007.071530" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "1685" "paginaFinal" => "1686" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17998219" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survey on management of gout among Dutch rheumatologists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.K. Reinders" 1 => "T.L. Jansen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2007.085902" "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2008" "volumen" => "67" "paginaInicial" => "1049" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18556447" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The management of gout at an academic healthcare center in Beijing: a physician survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Fang" 1 => "X. Zeng" 2 => "M. Li" 3 => "L.X. Chen" 4 => "H.R. Schumacher Jr." 5 => "F. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2006" "volumen" => "33" "paginaInicial" => "2041" "paginaFinal" => "2049" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17014019" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An audit of the variability of diagnosis and management of gout in the rheumatology setting: the gout evaluation and management study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "GEMA Study Group, Sociedad Española de Reumatología" "etal" => true "autores" => array:6 [ 0 => "F. Pérez-Ruiz" 1 => "L. Carmona" 2 => "M.J. Yébenes" 3 => "E. Pascual" 4 => "E. de Miguel" 5 => "I. Ureña" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RHU.0b013e3182314d40" "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "349" "paginaFinal" => "355" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21946457" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of the metabolic syndrome in individuals with hyperuricemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.K. Choi" 1 => "E.S. Ford" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2006.06.040" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2007" "volumen" => "120" "paginaInicial" => "442" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17466656" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.K. Choi" 1 => "E.S. Ford" 2 => "C. Li" 3 => "G. Curhan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheum (Arthritis Care Res)" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "109" "paginaFinal" => "115" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum uric acid and cardiovascular mortality. The NHANES I epidemiologic follow-up study, 1971–1992" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Fang" 1 => "M.H. Alderman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2000" "volumen" => "283" "paginaInicial" => "2404" "paginaFinal" => "2410" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10815083" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000800000006/v1_201305061648/S2173574312001529/v1_201305061648/en/main.assets" "Apartado" => array:4 [ "identificador" => "17338" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000800000006/v1_201305061648/S2173574312001529/v1_201305061648/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312001529?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 15 | 26 |
| 2024 October | 39 | 40 | 79 |
| 2024 September | 44 | 32 | 76 |
| 2024 August | 51 | 43 | 94 |
| 2024 July | 45 | 38 | 83 |
| 2024 June | 48 | 36 | 84 |
| 2024 May | 51 | 35 | 86 |
| 2024 April | 43 | 24 | 67 |
| 2024 March | 40 | 31 | 71 |
| 2024 February | 42 | 29 | 71 |
| 2024 January | 40 | 25 | 65 |
| 2023 December | 35 | 29 | 64 |
| 2023 November | 52 | 35 | 87 |
| 2023 October | 38 | 34 | 72 |
| 2023 September | 78 | 34 | 112 |
| 2023 August | 41 | 14 | 55 |
| 2023 July | 35 | 25 | 60 |
| 2023 June | 37 | 24 | 61 |
| 2023 May | 29 | 14 | 43 |
| 2023 April | 26 | 7 | 33 |
| 2023 March | 77 | 30 | 107 |
| 2023 February | 51 | 30 | 81 |
| 2023 January | 29 | 27 | 56 |
| 2022 December | 75 | 38 | 113 |
| 2022 November | 42 | 30 | 72 |
| 2022 October | 65 | 44 | 109 |
| 2022 September | 47 | 35 | 82 |
| 2022 August | 33 | 37 | 70 |
| 2022 July | 37 | 36 | 73 |
| 2022 June | 41 | 34 | 75 |
| 2022 May | 39 | 46 | 85 |
| 2022 April | 63 | 43 | 106 |
| 2022 March | 54 | 45 | 99 |
| 2022 February | 35 | 33 | 68 |
| 2022 January | 41 | 42 | 83 |
| 2021 December | 21 | 36 | 57 |
| 2021 November | 38 | 42 | 80 |
| 2021 October | 39 | 51 | 90 |
| 2021 September | 39 | 36 | 75 |
| 2021 August | 46 | 53 | 99 |
| 2021 July | 30 | 29 | 59 |
| 2021 June | 42 | 44 | 86 |
| 2021 May | 35 | 46 | 81 |
| 2021 April | 53 | 70 | 123 |
| 2021 March | 46 | 24 | 70 |
| 2021 February | 40 | 15 | 55 |
| 2021 January | 37 | 17 | 54 |
| 2020 December | 40 | 13 | 53 |
| 2020 November | 32 | 16 | 48 |
| 2020 October | 19 | 18 | 37 |
| 2020 September | 32 | 16 | 48 |
| 2020 August | 36 | 15 | 51 |
| 2020 July | 25 | 23 | 48 |
| 2020 June | 49 | 22 | 71 |
| 2020 May | 52 | 17 | 69 |
| 2020 April | 26 | 17 | 43 |
| 2020 March | 9 | 14 | 23 |
| 2020 February | 1 | 0 | 1 |
| 2019 January | 1 | 0 | 1 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 40 | 5 | 45 |
| 2018 March | 53 | 8 | 61 |
| 2018 February | 38 | 4 | 42 |
| 2018 January | 32 | 8 | 40 |
| 2017 December | 22 | 4 | 26 |
| 2017 November | 33 | 7 | 40 |
| 2017 October | 38 | 16 | 54 |
| 2017 September | 41 | 4 | 45 |
| 2017 August | 60 | 5 | 65 |
| 2017 July | 54 | 11 | 65 |
| 2017 June | 66 | 7 | 73 |
| 2017 May | 66 | 16 | 82 |
| 2017 April | 45 | 3 | 48 |
| 2017 March | 52 | 6 | 58 |
| 2017 February | 36 | 5 | 41 |
| 2017 January | 30 | 8 | 38 |
| 2016 December | 75 | 10 | 85 |
| 2016 November | 61 | 3 | 64 |
| 2016 October | 65 | 9 | 74 |
| 2016 September | 75 | 10 | 85 |
| 2016 August | 58 | 5 | 63 |
| 2016 July | 34 | 2 | 36 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 4 | 0 | 4 |
| 2015 October | 1 | 16 | 17 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 17 | 5 | 22 |
| 2015 June | 54 | 11 | 65 |
| 2015 May | 59 | 20 | 79 |
| 2015 April | 58 | 13 | 71 |
| 2015 March | 37 | 4 | 41 |
| 2015 February | 39 | 5 | 44 |
| 2015 January | 42 | 10 | 52 |
| 2014 December | 41 | 8 | 49 |
| 2014 November | 30 | 6 | 36 |
| 2014 October | 44 | 7 | 51 |
| 2014 September | 21 | 7 | 28 |
| 2014 August | 28 | 12 | 40 |
| 2014 July | 23 | 9 | 32 |
| 2014 June | 39 | 6 | 45 |
| 2014 May | 43 | 14 | 57 |
| 2014 April | 56 | 5 | 61 |
| 2014 March | 52 | 14 | 66 |
| 2014 February | 33 | 7 | 40 |
| 2014 January | 29 | 10 | 39 |
| 2013 December | 25 | 6 | 31 |
| 2013 November | 27 | 8 | 35 |
| 2013 October | 41 | 10 | 51 |
| 2013 September | 38 | 14 | 52 |
| 2013 August | 34 | 9 | 43 |
| 2013 July | 56 | 9 | 65 |
| 2013 June | 36 | 6 | 42 |
| 2013 May | 37 | 18 | 55 |
| 2013 April | 35 | 10 | 45 |
| 2013 March | 39 | 12 | 51 |
| 2013 February | 33 | 10 | 43 |
| 2013 January | 41 | 18 | 59 |
| 2012 December | 51 | 20 | 71 |
| 2012 November | 10 | 4 | 14 |
Show all
