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However, for clinical-therapeutic purposes it is important to reach a diagnosis as soon as possible to establish an effective treatment for preventing the development of functional limitation or structural<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> damage.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In Spain the average delay between onset of symptoms and diagnosis of SpA is more than 6 years.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> This may be due in part to the fact that classification criteria contemplate late appearing signs, such as radiological damage. For this reason, new classification criteria have recently been proposed,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> which allow us to identify such patients early. Another reason that could explain the delay in diagnosis is that primary care physicians (PCP) are not familiar with the symptoms of the disease in its early stages, when it is also called a prerradiologic phase of the disease. It is a proven fact that the early identification of the initial symptoms and referral to a rheumatologist contributes to early diagnosis of SpA.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> That is why the Spanish Society of Rheumatology (SER) developed in collaboration with PCP the Esperanza<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Program,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> in which referral criteria for patients suspected of SpA from primary care to rheumatology were established.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study is to assess the degree of agreement between PCPs and rheumatologists in the evaluation of the criteria for referral of patients with suspected early SpA. This will optimize, if necessary, the training for PCP in SpA, which can translate into a decrease in delayed diagnosis and optimization of available resources.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">The Esperanza Program is a collaborative program between the SER care and PC with national coverage, which aims to reduce variability in care received by patients with SpA, facilitate diagnosis and dissemination of knowledge of aspects of care in this group of diseases, and to promote rational use of health resources.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient Selection and Data Acquisition</span><p id="par0030" class="elsevierStylePara elsevierViewall">25 SpA units (UESP) were created in Spanish hospitals, each with a rheumatologist responsible, who kept a close collaboration with the PC from the area of reference attached to the program. Additionally, we designed a training course in Spain for PCP (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The course was taught in training sessions by the rheumatologist, and was also available for consultation and follow-up on an electronic platform designed specifically for this program.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Referral criteria were established based on what UESP the PCP should direct patients with suspected early SpA. They could refer patients aged between 18 and 45 years with symptoms lasting 3–24 months and at least one of the three following symptoms: inflammatory back pain, asymmetric arthritis or a number of variables related to SpA (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Each PCP registered patients through the electronic platform where the referral criteria considered for each patient was filled out.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Rheumatologists at the reference UESP assessed whether patients had early SpA using the same criteria as the PCP. The presence of radiographic sacroiliitis was based on the anteroposterior radiograph of the sacroiliac joints, and involvement was defined as grade 2 or higher, if the lesion was bilateral, and grade 3 or higher if only unilateral.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The data (baseline and follow-up) was gathered for all patients who met the criteria for early SpA (according to the rheumatologist) and the patients who signed informed consent were entered into the electronic platform. The rheumatologist was responsible for data management at each visit following routine clinical practice.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Variables</span><p id="par0045" class="elsevierStylePara elsevierViewall">The Esperanza Program collected data on: (a) sociodemographic variables (age, sex, race, disability), (b) clinical variables (comorbidity, variables related to the activity and severity of the disease, treatments prescribed), and (c) data related to the management of the UESP.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical Analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">The data for this analysis was gathered from the baseline visit of the patients included in the Esperanza Program from April 1, 2008 to May 31, 2011. Since the program allowed the inclusion of patients referred from other specialties (Orthopaedics, Ophthalmology, etc.), and the fact that some patients, despite being derived by the PCP finally did not meet criteria for early SpA and did not stay in the program, the analysis was performed only on patients with available information needed by both the PCP by the rheumatologist responsible for the UESP.</p><p id="par0055" class="elsevierStylePara elsevierViewall">This study matched the criteria for referral between PCP and rheumatologists using kappa analysis and 95% confidence intervals. The agreement, ie the degree of agreement between PCP and rheumatologists, was established based on the kappa score as follows: “poor agreement” was considered if the kappa index was less than 0.20, ‘weak’ between 0.21 and 0.40, “moderate” between 0.41 and 0.60; “good” between 0.61 and 0.80, and “very good” above 0.81.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The Esperanza Program involved 1844 PCP that led filled data into the electronic platform used for this purpose, with a total of 1179 patients entered (both good/poor referrals and those with a final diagnosis of SpA), with most patients being male (54%), white (96%), with a mean age of 33 years (SD 7 years), with 12% in a situation of temporary work disability and 2% in a situation of permanent disability.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally, for the purposes of this study we have analyzed data from 802 patients (about 70% of the total sample); we excluded poor referrals not meeting inclusion criteria or without enough data were available. Only in 98 cases (8.31%) we considered that the patient was a poor referral. Furthermore, the average time between referral from primary care and review by the UESP was 11 days (SD 28 days).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Kappa (<span class="elsevierStyleItalic">k</span>) scores obtained are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, along with the number of patients for which the estimate was made. Regarding the referral criteria with more weight at the time of diagnosis of SpA, inflammatory back pain showed a poor level of agreement (<span class="elsevierStyleItalic">k</span>=0.162, 95% CI 0.09–0.23), as did radiological sacroiliitis (<span class="elsevierStyleItalic">k</span>=0.319, 95% CI 0.21–0.43), and joint or back pain (<span class="elsevierStyleItalic">k</span>=0.216, 95% CI 0.14–0.29). However, the criterion of asymmetric arthritis showed a moderate degree of agreement (<span class="elsevierStyleItalic">k</span>=0.513, 95% CI 0.43–0.59), as well as family history of SpA, psoriasis, IBD or AU (<span class="elsevierStyleItalic">k</span>=0.509, 95% CI 0.41–0.60) and the presence of positive HLA B27 (<span class="elsevierStyleItalic">k</span>=0.597, 95% CI 0.52–0.67).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">In relation to the degree of agreement with other criteria related to the diagnosis of SpA, but with less weight, there was a degree of good or very good agreement on the following criteria: AU (<span class="elsevierStyleItalic">k</span>=0.81, 95% CI 0.68–0.93), IBD (<span class="elsevierStyleItalic">k</span>=0.877, 95% CI 0.79–0.96), and psoriasis (<span class="elsevierStyleItalic">k</span>=0.735, 95% CI 0.65–0.81).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The Esperanza Program was built to improve the management of patients with SpA.</p><p id="par0085" class="elsevierStylePara elsevierViewall">It has allowed both rheumatologists and PCP to be aware of the need for early and accurate diagnosis of patients with these diseases. For this reason, among others, criteria for referral to Rheumatology were generated to serve in establishing a definitive and/or early diagnosis of SpA. The results of this analysis indicate a degree of agreement between PCP and rheumatologists regarding the evaluation of established referral criteria.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Moreover, the objective was to analyze the correlation between PCP and rheumatologists regarding patients with early SpA, not the early clinical suspicion (in general). We have not analyzed all patients referred by PCP, but inclusion of patients occurred in a random, common, daily practice, so we think that selection bias is very low and there is no overestimating the effect.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Regarding the design of the study, the observations were not independent, which in theory may overestimate the degree of agreement. However, we think this effect is in turn offset by the second evaluation and reclassification on patients once they reach the UESP, by a rheumatologist and, whose judgment was not considered to be influenced by the PCP.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Furthermore, it should be noted that radiological sacroiliitis and the presence of HLA B27 should be interpreted with caution since these results could not be analyzed in all patients.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The degree of agreement was good or very good for some of the referral criteria, in particular for the presence of UA, psoriasis and IBD. This may be because they are, a priori, clinical entities easily identified by both PCP and rheumatologists.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The degree of agreement was moderate for the presence of HLA B27, asymmetric arthritis and family history. In the case of HLA B27, not a laboratory test requested very often by primary care unlike Rheumatology, there are a few centers where this can be obtained. A very similar explanation can be given in relation to the presence of asymmetric arthritis. The rheumatologist constantly turned towards the anamnesis, symptoms and signs suggestive of inflammation, and detected very early and mildly intense arthritis, something that often is only possible after having reached a high degree of specialization, and having the necessary time to evaluate the joints of patients. In this context, we believe that the PCP can acquire the skills and knowledge needed to detect incipient arthritis cases with adequate training and education. Finally, note that a correct history in the case of family history is relevant because it is a very specific variable in this group of diseases. Increased knowledge in SpA could help include this variable in the history performed by the PCP in selected patients with suspected disease.</p><p id="par0115" class="elsevierStylePara elsevierViewall">We should note that the results showing the lowest level of agreement was that regarding the most important referral criteria to establish the diagnosis of SpA, inflammatory back pain and radiological sacroiliitis. Diagnostic difficulty regarding inflammatory back pain in primary care has been observed,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and possibly because low back pain is a common, but vague and poorly reported symptom, and that a large percentage of those with LBP are referred first to the orthopedic specialist instead of the rheumatologist, without delving deeper into pain characteristics. Given the large volume of patients seen by PCP and requiring clinical diagnoses, to improve these results, in the most prevalent groups with this disease, i.e. young adults, a differential diagnosis between mechanical and inflammatory back pain should be done before referring to a specialist. Probably more and specific training for PCP in this regard would be very satisfactory and sufficient.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Furthermore, in the case of the evaluation of sacroilitis, we advance the same arguments and provide ways to improve them. If there is a clinical suspicion of inflammatory back pain of possible sacroiliac origin it is easy to ask for an X-ray of these joints. And again, the training and ability of PCP reading sacroiliac radiography should not delay over 30<span class="elsevierStyleHsp" style=""></span>s, and allow a high percentage of patients to have a more precise<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> diagnostic orientation. Additionally, due to the lack of good agreement regarding X-rays, training activities for standardizing the reading thereof could arise as a means to optimize the results of future diagnoses of SpA.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In conclusion, based on the importance of early diagnosis and the need for optimal treatment in patients with SpA, and PCP as the first contact with the health system, targeted training in this regard could help achieve these objectives, in young patients with inflammatory LBP features, requesting a sacroiliac X-ray and performing anamnesis directed toward these pathologies.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0135" 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.<span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0140" 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.<span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0145" 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.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres90917" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec78141" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres90916" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec78140" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient Selection and Data Acquisition" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Variables" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Ethical disclosures" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-03-11" "fechaAceptado" => "2012-06-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec78141" "palabras" => array:7 [ 0 => "Primary health care" 1 => "Spondyloarthritis" 2 => "Referral" 3 => "Referral criteria" 4 => "Early diagnosis" 5 => "Agreement" 6 => "Esperanza Program" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec78140" "palabras" => array:7 [ 0 => "Atención primaria de salud" 1 => "Espondiloartritis" 2 => "Referencia" 3 => "Criterios de derivación" 4 => "Diagnóstico precoz" 5 => "Concordancias" 6 => "Programa Esperanza" ] ] ] ] "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 degree of agreement between primary care physicians and rheumatologists when evaluating the referral criteria in patients with suspected early spondyloarthropathy (Spa).</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients with suspected early Spa (according to predefined clinical referral criteria) were sent by primary care physicians to early Spa units (where a rheumatologist evaluated the same criteria and confirmed the diagnosis) through an on-line platform. We assessed the agreement between primary care physicians and rheumatologists regarding the predefined clinical refererral criteria among patients with definitive Spa using the kappa index (<span class="elsevierStyleItalic">k</span>).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Eight hundred and two patients were analysed, 8.31% of whom were incorrectly referred to the rheumatologist. The degree of agreement regarding the predefined clinical referral criteria was poor for inflammatory back pain (<span class="elsevierStyleItalic">k</span>=0.16; 95% confidence interval [95% CI] 0.09–0.23), radiographic sacroiliitis (<span class="elsevierStyleItalic">k</span>=0.31; 95% 0.211–0.428), back or joint pain (<span class="elsevierStyleItalic">k</span>=0.21; 95% CI 0.14–0.29); mild for asymmetric arthritis (<span class="elsevierStyleItalic">k</span>=0.51; 95% CI 0.43–0.59), positive HLA B27 (<span class="elsevierStyleItalic">k</span>=0.59; 95% CI 0.52–0.67) and family history (<span class="elsevierStyleItalic">k</span>=0.50; 95% CI 0.415–0.604); and it was good or very good for anterior uveitis (<span class="elsevierStyleItalic">k</span>=0.81; 95% CI 0.68–0.93), inflammatory bowel disease (<span class="elsevierStyleItalic">k</span>=0.87; 95% CI 0.79–0.96) and psoriasis (<span class="elsevierStyleItalic">k</span>=0.73; 95% CI 0.65–0.81).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The degree of agreement between primary care physicians and rheumatologists regarding the predefined clinical referral criteria was variable. Agreement was very poor for variables like inflammatory back pain, which are crucial for the diagnosis of Spa. Training programs for primary care physicians are important in order for them to correctly identify early Spa patients.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar el grado de acuerdo entre los médicos de atención primaria (MAP) y los reumatólogos en la valoración de los criterios de derivación en pacientes con sospecha de espondiloartritis (EspA) precoz.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se derivaron los pacientes con sospecha de EspA precoz, a través de la plataforma electrónica, por MAP siguiendo unos criterios de derivación predeterminados a Unidades de EspA precoz, donde fueron de nuevo evaluados por reumatólogos y confirmados los diagnósticos. Se ha analizado la concordancia de los criterios de derivación predeterminados entre MAP y reumatólogos mediante el índice kappa (<span class="elsevierStyleItalic">k</span>) en aquellos pacientes con diagnóstico de EspA precoz.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizamos 802 pacientes, de los que el 8,31% fueron mal derivados. El grado de acuerdo en relación con criterios de derivación predeterminados fue pobre para la lumbalgia inflamatoria (k = 0,16; intervalo de confianza del 95% [95% CI] 0,09–0,23), sacroilitis radiológica (k = 0,31; 95% CI 0,211–0,428), raquialgia o artralgia (k = 0,21; 95% CI 0,14–0,29); moderado para el criterio de artritis asimétrica (k = 0,51; 95% CI 0,43–0,59), HLA B27 positivo (k = 0,59; 95% CI 0,52–0,67) e historia familiar (k = 0,50; 95% CI 0,415–0,604). Los grados de acuerdo fueron buenos o muy buenos para la presencia de uveítis anterior (k = 0,81; 95% CI 0,68–0,93), enfermedad inflamatoria intestinal (k = 0,87; 95% CI 0,79–0,96) y psoriasis (k = 0,73; 95% CI 0,65–0,81).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El grado de acuerdo entre MAP y reumatólogos respecto a la valoración de los criterios preestablecidos para derivación de EspA precoz es variable. La concordancia es baja para criterios de derivación clave para el diagnóstico de pacientes con EspA. Facilitar programas de formación y entrenamiento para MAP resulta fundamental para identificar a pacientes con EspA precoz.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please, cite this article as: López-González R, et al. ¿Se derivan adecuadamente las espondiloartropatías desde primaria a especializada? Reumatol Clin. 2012. <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2012.06.013">http://dx.doi.org/10.1016/j.reuma.2012.06.013</span></p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">NSAID: non steroidal anti-inflammatory drugs; SpA: spondyloarthritis; DMARD: disease modifying anti-rheumatic drugs; MR: magnetic resonance; SER: Spanish Society of Rheumatology; CT: computerized tomography; EULAR: European League Against Rheumatism.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><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"><span class="elsevierStyleItalic">Module 1: Generalities and benefits in the collaboration between primary care and Rheumatology for the attention of patients with SpA</span> \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"><span class="elsevierStyleHsp" style=""></span>Concept of SpA \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"><span class="elsevierStyleHsp" style=""></span>Classification \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"><span class="elsevierStyleHsp" style=""></span>Forms of presentation \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"><span class="elsevierStyleHsp" style=""></span>Criteria for referral to Rheumatology \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"><span class="elsevierStyleHsp" style=""></span>Reasons for early diagnosis and treatment of SpA \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"><span class="elsevierStyleHsp" style=""></span>Esperanza Program and program referral criteria \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"><span class="elsevierStyleVsp" style="height:0.5px"></span> \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"><span class="elsevierStyleItalic">Module 2: What do we know on the ethiopathogenesis and epidemiology of SpA? Key to early diagnosis: clinical history</span> \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"><span class="elsevierStyleHsp" style=""></span>Ethiopathogenesis of SpA \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"><span class="elsevierStyleHsp" style=""></span>Epidemiology of SpA \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"><span class="elsevierStyleHsp" style=""></span>Anamnesis and physical examination of patients with SpA in primary care \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"><span class="elsevierStyleVsp" style="height:0.5px"></span> \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"><span class="elsevierStyleItalic">Module 3: Diagnosis and evaluation of the patient</span> \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"><span class="elsevierStyleHsp" style=""></span>Laboratory and its diagnostic usefulness \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"><span class="elsevierStyleHsp" style=""></span>Conventional imaging and its usefulness for diagnosis \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"><span class="elsevierStyleHsp" style=""></span>Other diagnostic techniques: MR, echography, bone scan, CT \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"><span class="elsevierStyleHsp" style=""></span>Evaluation of inflammatory activity and functional capacity of the patient: methods and interpretation \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"><span class="elsevierStyleVsp" style="height:0.5px"></span> \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"><span class="elsevierStyleItalic">Module 4: Treatment of SpA. What can we expect?</span> \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"><span class="elsevierStyleHsp" style=""></span>Physiotherapy and rehabilitation: What can we expect? \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"><span class="elsevierStyleHsp" style=""></span>NSAID: real importance and how to avoid gastropathy \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"><span class="elsevierStyleHsp" style=""></span>DMARD (sulfasalazine, methotrexate, etc.): to give or not to give \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"><span class="elsevierStyleHsp" style=""></span>Inhibitor of tumor necrosis factor alpha: indications, efficacy and safety. What can we expect? \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"><span class="elsevierStyleHsp" style=""></span>EULAR and SER Recommendations for the treatment of SpA \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"><span class="elsevierStyleHsp" style=""></span>Identification of poor prognostic factors \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab176521.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Contents of the Course for Primary Care Physicians.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IBD: inflammatory bowel disease; SpA: spondyloarthritis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><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"><span class="elsevierStyleBold">Patients between 18 and 45 years of age with disease lasting 3–24 months and at least one of the following:</span> \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1. Inflammatory back pain: back pain that has 2 of the following 3 characteristics:</span> \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>a) Progressive onset \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>b) Morning spinal stiffness lasting over 30 minutes \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>c) Improvement in physical activity that does not remit with rest \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2. Asymmetric lower limb arthritis</span> \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">3. Other criteria that include non specific axial pain or joint pain with at least one of the following:</span> \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>a) Psoriasis \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>b) Inflammatory bowel disease \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>c) Anterior uveitis \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>d) Family history of SpA, psoriasis, IBD or anterior uveitis \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>e) X-ray sacroilitis \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>f) HLA B27 positive \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab176519.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Referral Criteria to the Early Spondyloarthritis Units.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patient number on which estimation was based is shown.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">AS: Ankylosing spondylitis; IBD: inflammatory bowel disease; CI: confidence interval; AU: anterior uveitis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Criterion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Kappa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \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">Inflammatory back pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.162 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.09–0.23 \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">802 \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">Asymmetric arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.513 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.43–0.59 \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">802 \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">Back or joint pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.216 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.14–0.29 \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">802 \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">Psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.735 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.65–0.81 \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">802 \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">Inflammatory bowel disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.877 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.79–0.96 \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">802 \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">Anterior uveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.810 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.68–0.93 \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">802 \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">Family history of AS, psoriasis, IBDI, AU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.509 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.415–0.604 \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">802 \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">X-ray sacroilitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.319 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.211–0.428 \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">529 \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">HLA B27 positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.597 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52–0.67 \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">507 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab176520.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Agreement Between Primary Care Physicians and Rheumatologists in the Early Spondyloarthritis Units.</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" => "Update on spondyloarthropathies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.A. Khan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 10 | 11 | 21 |
2024 October | 44 | 20 | 64 |
2024 September | 67 | 16 | 83 |
2024 August | 64 | 27 | 91 |
2024 July | 63 | 25 | 88 |
2024 June | 60 | 21 | 81 |
2024 May | 65 | 40 | 105 |
2024 April | 53 | 28 | 81 |
2024 March | 56 | 22 | 78 |
2024 February | 42 | 23 | 65 |
2024 January | 50 | 21 | 71 |
2023 December | 34 | 24 | 58 |
2023 November | 41 | 32 | 73 |
2023 October | 32 | 26 | 58 |
2023 September | 73 | 37 | 110 |
2023 August | 25 | 6 | 31 |
2023 July | 29 | 23 | 52 |
2023 June | 26 | 17 | 43 |
2023 May | 17 | 9 | 26 |
2023 April | 14 | 6 | 20 |
2023 March | 57 | 25 | 82 |
2023 February | 33 | 34 | 67 |
2023 January | 28 | 17 | 45 |
2022 December | 44 | 35 | 79 |
2022 November | 60 | 34 | 94 |
2022 October | 29 | 35 | 64 |
2022 September | 33 | 28 | 61 |
2022 August | 39 | 38 | 77 |
2022 July | 30 | 39 | 69 |
2022 June | 38 | 35 | 73 |
2022 May | 27 | 29 | 56 |
2022 April | 39 | 45 | 84 |
2022 March | 50 | 59 | 109 |
2022 February | 33 | 36 | 69 |
2022 January | 25 | 32 | 57 |
2021 December | 28 | 38 | 66 |
2021 November | 30 | 43 | 73 |
2021 October | 47 | 50 | 97 |
2021 September | 38 | 44 | 82 |
2021 August | 33 | 36 | 69 |
2021 July | 23 | 35 | 58 |
2021 June | 24 | 36 | 60 |
2021 May | 70 | 32 | 102 |
2021 April | 157 | 71 | 228 |
2021 March | 77 | 27 | 104 |
2021 February | 34 | 18 | 52 |
2021 January | 18 | 17 | 35 |
2020 December | 35 | 19 | 54 |
2020 November | 18 | 16 | 34 |
2020 October | 21 | 18 | 39 |
2020 September | 35 | 15 | 50 |
2020 August | 23 | 18 | 41 |
2020 July | 25 | 13 | 38 |
2020 June | 39 | 23 | 62 |
2020 May | 44 | 13 | 57 |
2020 April | 60 | 14 | 74 |
2020 March | 16 | 13 | 29 |
2020 February | 1 | 0 | 1 |
2019 January | 3 | 0 | 3 |
2018 May | 5 | 0 | 5 |
2018 April | 35 | 6 | 41 |
2018 March | 51 | 9 | 60 |
2018 February | 28 | 1 | 29 |
2018 January | 26 | 7 | 33 |
2017 December | 30 | 4 | 34 |
2017 November | 23 | 5 | 28 |
2017 October | 27 | 3 | 30 |
2017 September | 39 | 2 | 41 |
2017 August | 35 | 6 | 41 |
2017 July | 42 | 6 | 48 |
2017 June | 58 | 10 | 68 |
2017 May | 58 | 7 | 65 |
2017 April | 34 | 5 | 39 |
2017 March | 31 | 10 | 41 |
2017 February | 16 | 1 | 17 |
2017 January | 30 | 4 | 34 |
2016 December | 97 | 18 | 115 |
2016 November | 66 | 6 | 72 |
2016 October | 93 | 11 | 104 |
2016 September | 80 | 11 | 91 |
2016 August | 55 | 5 | 60 |
2016 July | 26 | 2 | 28 |
2016 June | 0 | 10 | 10 |
2016 May | 0 | 9 | 9 |
2016 April | 0 | 6 | 6 |
2016 March | 2 | 10 | 12 |
2016 February | 0 | 19 | 19 |
2016 January | 3 | 18 | 21 |
2015 December | 2 | 13 | 15 |
2015 November | 1 | 12 | 13 |
2015 October | 4 | 11 | 15 |
2015 September | 1 | 12 | 13 |
2015 August | 3 | 0 | 3 |
2015 July | 22 | 5 | 27 |
2015 June | 41 | 12 | 53 |
2015 May | 67 | 16 | 83 |
2015 April | 38 | 9 | 47 |
2015 March | 27 | 6 | 33 |
2015 February | 26 | 4 | 30 |
2015 January | 16 | 10 | 26 |
2014 December | 38 | 8 | 46 |
2014 November | 23 | 9 | 32 |
2014 October | 43 | 10 | 53 |
2014 September | 17 | 6 | 23 |
2014 August | 25 | 7 | 32 |
2014 July | 30 | 9 | 39 |
2014 June | 61 | 8 | 69 |
2014 May | 38 | 20 | 58 |
2014 April | 41 | 9 | 50 |
2014 March | 44 | 16 | 60 |
2014 February | 34 | 13 | 47 |
2014 January | 34 | 13 | 47 |
2013 December | 33 | 11 | 44 |
2013 November | 31 | 3 | 34 |
2013 October | 47 | 14 | 61 |
2013 September | 42 | 10 | 52 |
2013 August | 53 | 14 | 67 |
2013 July | 36 | 7 | 43 |
2013 June | 50 | 14 | 64 |
2013 May | 56 | 34 | 90 |
2013 April | 19 | 13 | 32 |