Efficacy and Tolerability of Rituximab in Patients With Rhupus

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It is a rare entity, with fewer than 150 cases reported in the literature. An epidemiological study found that the prevalence is about 0.09%.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Although some authors argue that rhupus represents a subset of SLE with predominant joint manifestations and characteristics, clinical and serological evidence support that this is a definite overlap syndrome.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>In most rhupus cases described, the clinical picture starts with a symmetrical and erosive polyarthritis with positive rheumatoid factor and/or citrulline antipeptide antibodies (anti-CCP) and can be classified as RA. It also features other clinical manifestations of SLE and its specific antibodies (anti-dsDNA and/or anti-Sm). In addition to joint disease, the most common manifestations of lupus are mucocutaneous involvement, hematological abnormalities and serositis; renal involvement or central nervous system is uncommon. Arthropathy is usually the predominant manifestation in these patients, with clinical inflammation, deformities and erosions characteristics in RA and even rheumatoid nodules.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3–5</a>In many of the described cases there was no good response to disease-modifying nonbiological drugs (DMARDs) and treatment has been attempted with immunosuppressants (azathioprine, mycophenolate mofetil) and even with biologics (abatacept).<a class="elsevierStyleCrossRefs" href="#bib0010">2,6</a>Despite the undoubted efficacy of anti-TNF drugs in RA patients, previous experience in SLE has shown little efficacy and in some cases even a worsening of symptoms, making them of little use for their use in patients with rhupus.<a class="elsevierStyleCrossRefs" href="#bib0035">7–9</a>Rituximab is a monoclonal antibody directed against the CD20 molecule on B lymphocytes which has been extensively demonstrated to be effective in the treatment of RA.<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> In addition, although recent reports of controlled trials have not yielded the expected results,<a class="elsevierStyleCrossRefs" href="#bib0060">12–14</a> there are many reports in the literature of successful treatment with rituximab in patients with SLE and different types of manifestations, mainly hematological, renal and even central nervous system.<a class="elsevierStyleCrossRefs" href="#bib0075">15–17</a> There are, at this time, no specific reports on the response in joint manifestations, although surely many of these patients presented improvement.The objective of this study was to investigate the efficacy and tolerability of rituximab in a group of patients with rhupus.Patients and MethodsStudy DesignWe performed a prospective, open study to evaluate the efficacy of rituximab in patients with rhupus. The primary endpoint was change in DAS28 at 6 months (improvement defined as a decrease of at least 0.6<a class="elsevierStyleCrossRef" href="#bib0090">18</a>). Secondary endpoints were the change in the MEX-SLEDAI at 6 months follow up to the end of the evaluation, the change in DAS28 at the end of monitoring and assessment and steroid requirements, and the recording of adverse event during the study. We included for analysis only patients who had completed at least 24 months follow-up.We recorded demographic data, clinical features of the disease and the classification criteria for SLE and RA, and data evolution and previous response to different treatments. All patients signed an informed consent for treatment.TreatmentPatients received rituximab 1g by intravenous infusion for 4h, after premedication with hydroxyzine, paracetamol and dexamethasone 8mg intravenously on days 1 and 15 of the study, with subsequent cycles every 9–12 months, depending on the clinical activity evaluated by DAS28.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Nonbiological DMARDs (methotrexate, leflunomide, azulfidine) and immunosuppressants (azathioprine, mycophenolate mofetil, cyclophosphamide) were suspended one month before the start of the study. Concurrent use of low doses of steroids (maximum 15mg of prednisone/day or its equivalent) and hydroxychloroquine, and nonsteroidal anti-inflammatory analgesics and adjuvant therapy (lowering agents, antihypertensives, etc.) was allowed.Study SubjectsThe study population consisted of consecutive patients over 18 years, diagnosed with rhupus according the criteria proposed by Simon et al.,<a class="elsevierStyleCrossRefs" href="#bib0015">3,19</a>: symmetrical erosive polyarthritis, signs and symptoms of SLE and anti-dsDNA antibodies and/or anti-Sm and joint disease with moderate to severe activity, defined as DAS28≥3.2.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> For patients of childbearing age, we used a reliable contraceptive. All patients underwent screening for tuberculosis and viral hepatitis prior to treatment. Exclusion criteria included the presence of pregnancy or lactation, history of hepatitis, need to use other immunosuppressive drugs or concomitant DMARDs (except antimalarials) or active infection at baseline.EvaluationsPatients were evaluated on a quarterly basis throughout the follow up. At each visit patients were questioned on symptoms suggestive of activity; we performed a complete physical examination by a rheumatologist and determined the DAS28 and MEX-SLEDAI scores and also recorded the presence of concomitant medications and adverse events intentionally. We also carried out routine laboratory studies that included CBC with differential and platelet count, blood chemistry, urinalysis, creatinine clearance, 24h urine albumin, acute phase reactants (erythrocyte sedimentation rate, C-reactive protein) and C3 and C4 levels.Statistical AnalysisWe used descriptive statistics, Fisher's exact test for qualitative variables and Student's t test for quantitative variables. The comparison of differences was performed using the Wilcoxon rank test. We used SPSS version 15 in Spanish.ResultsCharacteristics of the study subjects: nine patients were included, all women, with a mean age of 43 years (range 38–57 years) and a duration of illness of 10.03 years (range 18–22 years). In 6 patients the initial diagnosis was RA and preceded SLE manifestations by 2.5 years on average; in only 3 patients the initial diagnosis was SLE. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic, clinical and serological features, and pretreatment of patients included and the criteria by which the diagnosis of rhupus was made. It should be mentioned that in all patients treated we previously employed NSAIDs, steroids in low and medium doses or non-biological DMARD monotherapy or combination therapy without success.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Clinical efficacy: good clinical response was observed, with decrease in the baseline DAS28 score from 5.73 to 4.13 at 3 months and 3.02 at 6 months, a statistically significant change (P<.001). Improvement in DAS28 was maintained during the follow up period, with a DAS 28 score of 3.04 at 12 months and 2.52 at 24 months, as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. At 6 months, 3 patients had remission by DAS28 and 3 had low activity. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the percentage of patients with high, moderate, low activity or remission by DAS28 at baseline and at 6, 12 and 24 months of follow-up.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Regarding the MEX-SLEDAI score, this was reduced from 5 points at baseline to 2.56 at 3 months and 1.22 at 6 months (P<.001) and maintained this improvement at 12 (0.78) and 24 (0.22) months (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). As already mentioned, the decision to apply a second treatment of rituximab depended on clinical activity. Eight patients showed an increase in activity by DAS28 between 9 and 12 months, so they received a second course of rituximab, and only in one patient was this necessary at 15 months. In multivariate analysis, we found a negative correlation between clinical improvement assessed by DAS28 at 12 months and the levels of anti-CCP (r=−0.794, P=.011).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>An indirect measure of clinical efficacy of the treatment is the ability to reduce steroid dose and/or discontinue it during the study. The baseline dose of prednisone in our group of patients was 11.66mg prednisone/day and was progressively decreased to 4.72mg at 6 months and 0.55 and 1.11mg/day 12 and 24 months respectively. The majority of patients did not require<a class="elsevierStyleCrossRef" href="#bib0030">6</a> oral steroids from 12 months of treatment onward (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>Safety aspects: in general, treatment with rituximab was well tolerated during the study. Adverse events were divided as immediate reactions to the infusion, infectious events and serious adverse events. There were three adverse reactions in 2 patients during infusion of rituximab, which consisted of erythema and pruritus, and on all occasions forced us to temporarily stop the infusion and administer steroids and intravenous antihistamines. There were 9 non-serious infectious events in 6 patients, mainly infections of the lower urinary tract (6 cases) and infections of the upper respiratory tract (3 events), in both cases without complications. Only one patient had pneumonia, an event that was considered serious enough to require hospital management, with adequate clinical recovery. There were no deaths, malignancies or opportunistic infections during the follow up period.DiscussionIn our study patients, rituximab treatment was effective in both joint manifestations, with significant reduction in DAS28, as in other manifestations of lupus, with improvement of MEX-SLEDAI. Clinical response was evident after 6 months, however, began to be apparent within the first 3 months of evaluation and was maintained in all patients during the monitoring phase with repeated cycles of treatment at the time clinical reactivation was shown.Usually joint manifestations in SLE patients often respond satisfactorily to DMARDs or low dose steroids; however, in rhupus a large percentage of patients do not have good response, in many cases presenting polyarticular arthropathy with progressive structural damage.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4,6,20,21</a> Among the different biologic therapy options, anti-CD20 blocking antibody rituximab may be a good choice. There are multiple reports and case series that have demonstrated the efficacy of this drug in patients with various manifestations of lupus.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> In a recent meta-analysis published by Ramos-Casals, who performed a systematic review of 188 lupus patients treated with rituximab between 2002 and 2007, therapy was effective in 91% of cases.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Of the few randomized controlled trials that exist to date in the EXPLORER study, which included 257 patients with lupus with moderate to severe activity, there was no significant difference in the percentage of patients achieving major response (1.24 vs 15.9) or partial response (17.2 vs 12.5) in the groups treated with rituximab or placebo, respectively.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> Similar results were observed in the LUNAR study, involving 144 patients with lupus nephritis III or IV, in whom no significant differences could be demonstrated between rituximab and placebo.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> However, it is important to note that in both studies, rituximab response seemed better in minority groups and it also should be noted that in both studies, patients were receiving the standard treatment for lupus, making it difficult to detect differences between groups. We reported in 2010 an open study in lupus patients who received cyclophosphamide or rituximab. The results favored rituximab and although all patients had severe manifestations of the disease as a criterion for inclusion, a significant percentage had joint manifestations, which improved.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>The results of the French registry of lupus patients treated with rituximab have been recently published. The authors found an adequate clinical response in about 80% of patients, specifically, improvement occurred for articular manifestations in 72%.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> Currently, other multicenter controlled clinical studies in patients with different manifestations of lupus, such as the RING study, evaluating the efficacy of rituximab to achieve remission in lupus nephritis are underway and the results will certainly be of great value to define even better the usefulness of this biological agent.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>In patients with rhupus, although manifestations of both lupus and RA coexist, the prevalence is characteristic for the development of joint manifestations, which usually dominate the clinical picture of the disease, sometimes with mucocutaneous manifestations and much less frequently renal manifestations, serious hematological or nervous system involvement.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3–5</a> This was no different in our patients, in which the expression of joint disease was unwieldy, with general or mucocutaneous manifestations associated with low scores explaining MEX-SLEDAI, which, however, improved during the course of the study.We also described the relationship between the severity of joint manifestations in patients with rhupus and positivity for anti-CCP;<a class="elsevierStyleCrossRefs" href="#bib0025">5,24–26</a> hence the negative correlation we found between the titles of these antibodies and clinical response is entirely explicable.While recognizing the limitations of our work, which included a small number of patients with rhupus due to the very low prevalence of this condition<a class="elsevierStyleCrossRef" href="#bib0005">1</a> since it is an open uncontrolled study, we believe that the results obtained are encouraging and, to some extent, expected, and considering past experience, which is extensive, treatment with rituximab in patients with RA and reports of improvement in many manifestations of SLE, place rituximab as a very suitable drug for the management of patients with lupus and even rhupus and prominent joint manifestations.Ethical ResponsibilitiesProtection of People and AnimalsThe authors declare that procedures conformed to the ethical standards of the committee responsible for human experimentation and were in accordance with the World Medical Association Declaration of Helsinki.Data ConfidentialityThe authors declare that they have followed the protocols of their workplace on the publication of data from patients and all patients included in the study have received sufficient information and gave their written informed consent to participate in this study.Right to Privacy and Informed ConsentThe authors have obtained informed consent from patients and/or subjects referred to in the article. This document is in the possession of the corresponding author.Conflict of InterestAndrade-Ortega: speaker for Roche, Bristol, Pfizer, Merck.Irazoque-Palazuelos: Advisory board and/or speaker for Roche, Bristol, Pfizer, Janssen, Merck.Muñoz-López: speaker for Sanofi, Pfizer.Don Pablo Rosales: lecturer for Pfizer." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres222863" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec208319" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres222862" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec208318" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Treatment" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Study Subjects" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Evaluations" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Protection of People and Animals" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Data Confidentiality" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to Privacy and Informed Consent" ] ] ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-08-12" "fechaAceptado" => "2012-10-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec208319" "palabras" => array:3 [ 0 => "Rhupus" 1 => "Treatment" 2 => "Rituximab" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec208318" "palabras" => array:3 [ 0 => "Rhupus" 1 => "Tratamiento" 2 => "Rituximab" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Rhupus in an infrequent disease in which an overlap between lupus eritematosus and rheumatoid arthritis exists. Joint manifestations are prominent and treatment with nonbiological DMARDs is not always satisfactory, so immunosuppressors and biological agents have been tried.A prospective, open clinical study was done to evaluate efficacy and tolerability of rituximab in patients with rhupus. The main objective was a change in DAS28 at 6 months and secondary objectives were a change in MEX-SLEDAI at 6 months, change in DAS28 and MEX-SLEDAI during follow up, steroid requirements and detection of adverse events.We included 9 women with a mean age of 43 years and disease duration of 10 years. A significant reduction in DAS28 was observed (from 5.73 at baseline to 3.02 at 6 months, P<.001). Improvement in DAS28 was maintained during follow up. At 6 months, 3 patients were in remission and 3 had low disease activity. MEX-SLEDAI diminished from 5 points at baseline to 1.22 at 6 months (P<.001). There was a negative correlation between clinical improvement and anti-CCP levels (r=−0.794, P=.011). Mean prednisone dose was reduced from 11.66mg/day at baseline to 0.55 and 1.11mg/day at 12 and 24 months. Treatment was well tolerated.In this study rituximab was effective not only for joint affection but also for other manifestations of the disease. We consider that this biological agent can be a good therapeutic option for patients with rhupus." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El rhupus es una entidad poco común en la que se superponen datos de lupus eritematoso generalizado y artritis reumatoide, predominando con frecuencia las manifestaciones articulares. En muchos casos el tratamiento con fármacos modificadores de la enfermedad no biológicos es insatisfactorio, por lo que se ha intentado el uso de inmunosupresores y fármacos biológicos.Se realizó un estudio prospectivo y abierto para evaluar la eficacia y la tolerabilidad de rituximab en pacientes con rhupus. El objetivo principal fue el cambio en el DAS28 a los 6 meses; fueron objetivos secundarios el cambio en MEX-SLEDAI a los 6 meses, el cambio en DAS28 y MEX-SLEDAI durante el seguimiento, el requerimiento de esteroides y el registro de eventos adversos.Se incluyó a 9 pacientes, todas mujeres, con edad promedio de 43 años y tiempo de evolución de 10 años. Se observó un descenso en la puntuación basal de DAS28 de 5,73 a 3,02 a los 6 meses (p<0,001). La mejoría en el DAS28 se mantuvo durante el periodo de seguimiento. A los 6 meses, 3 pacientes presentaban remisión por DAS28 y 3 actividad baja. La calificación de MEX-SLEDAI disminuyó de 5 puntos a nivel basal a 1,22 a los 6 meses (p<0,001) y mantuvo esta mejoría. Se observó una correlación negativa entre la mejoría clínica y los niveles de anti-CCP (r=−0,794; p=0,011). La dosis de prednisona disminuyó de 11,66mg/día basal a 0,55 y 1,11mg/día a los 12 y 24 meses, respectivamente. En general, el tratamiento con rituximab fue bien tolerado durante el estudio.En los pacientes de nuestro estudio, el tratamiento con rituximab mostró ser eficaz tanto en las manifestaciones articulares, con reducción significativa del DAS28, como en otras manifestaciones de lupus, con mejoría del MEX-SLEDAI. Consideramos que esta puede ser una buena opción terapéutica para pacientes con rhupus." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Andrade-Ortega L, et al. Eficacia y tolerabilidad de rituximab en el tratamiento de pacientes con rhupus. Reumatol Clin. 2013;9:201–5." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1055 "Ancho" => 1316 "Tamanyo" => 81420 ] ] "descripcion" => array:1 [ "en" => "Change in DAS28." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 981 "Ancho" => 1633 "Tamanyo" => 136976 ] ] "descripcion" => array:1 [ "en" => "Activity according to the DAS28 score." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1093 "Ancho" => 1289 "Tamanyo" => 85820 ] ] "descripcion" => array:1 [ "en" => "Change in the MEX-SLEDAI." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1179 "Ancho" => 1703 "Tamanyo" => 101316 ] ] "descripcion" => array:1 [ "en" => "Reduction in the dose of prednisone." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ANA, antinuclear antibodies; anti-dsDNA, anti-dsDNA; anti-CCP, anti-citrullinated peptide antibodies; RA, rheumatoid arthritis; F, female; FR, rheumatoid factor; HD, homogeneous diffuse; SLE, systemic lupus erythematosus; LL, leukolymphopenia; LLT, leukolymphopenia and thrombocytopenia; LP, peripheral; M, male; MG, spotted." "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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">3 \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">4 \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">5 \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">6 \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">7 \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">8 \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">9 \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">Total \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \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">43 (38–57) \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">Sex, F/M \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \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">Years diagnosis \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><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">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" 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><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">1.8 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 \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">10.03 (1.8–22) \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">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \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">Photosensitivity \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (66.6%) \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">Malar erythema \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (88.8%) \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">Oral ulcers \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (77.7%) \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">Discoid lupus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (11.1%) \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">Serositis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (11.1%) \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">Renal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">iii \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ee \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">v \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ii \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (44.4%) \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">Neurological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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">Hematological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LL \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LL \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LLT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LL \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LL \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LL \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 (66.6%) \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">ESR/CRP + \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \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">FR \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">410 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">752 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">681 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">212 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td><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">4560 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (88.8%) \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">Anti-CCP \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">172 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">197 \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="left" 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><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">433 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1260 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">311 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">300 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">224 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (88.8%) \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">AAN \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HD \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mg \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HD \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HD \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HD \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HD \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HD \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HD \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \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">Anti-dsDNA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (55.5%) \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">Erosions Rx \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (88.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="11" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="11" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Criteria</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">RA \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \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">SLE \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="11" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="11" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pretreatment</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">Steroids \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \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">Antimalarial \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (77.7%) \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">Methotrexate \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (88.8%) \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">Sulphasalazine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (77.7%) \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">Azathioprine \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (33.3%) \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">Cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (11.1%) \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">Mycophenolate \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (22.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab337038.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical Characteristics of Patients and Serological Features." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ 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Efficacy and Tolerability of Rituximab in Patients With Rhupus

Eficacia y tolerabilidad de rituximab en el tratamiento de pacientes con rhupus

Lilia Andrade-Ortega

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liliaandrade@prodigy.net.mx

Corresponding author.

, Fedra Irazoque-Palazuelos, Sandra Muñóz-López, Victor Manuel Rosales-Don Pablo

Servicio de Reumatología, Centro Médico Nacional 20 de Noviembre, ISSSTE, México, D.F., Mexico

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rhupus is defined as the superposition of lupus erythematosus &#40;SLE&#41; and rheumatoid arthritis &#40;RA&#41;&#46; It is a rare entity&#44; with fewer than 150 cases reported in the literature&#46; An epidemiological study found that the prevalence is about 0&#46;09&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although some authors argue that rhupus represents a subset of SLE with predominant joint manifestations and characteristics&#44; clinical and serological evidence support that this is a definite overlap syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In most rhupus cases described&#44; the clinical picture starts with a symmetrical and erosive polyarthritis with positive rheumatoid factor and&#47;or citrulline antipeptide antibodies &#40;anti-CCP&#41; and can be classified as RA&#46; It also features other clinical manifestations of SLE and its specific antibodies &#40;anti-dsDNA and&#47;or anti-Sm&#41;&#46; In addition to joint disease&#44; the most common manifestations of lupus are mucocutaneous involvement&#44; hematological abnormalities and serositis&#59; renal involvement or central nervous system is uncommon&#46; Arthropathy is usually the predominant manifestation in these patients&#44; with clinical inflammation&#44; deformities and erosions characteristics in RA and even rheumatoid nodules&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#8211;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In many of the described cases there was no good response to disease-modifying nonbiological drugs &#40;DMARDs&#41; and treatment has been attempted with immunosuppressants &#40;azathioprine&#44; mycophenolate mofetil&#41; and even with biologics &#40;abatacept&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the undoubted efficacy of anti-TNF drugs in RA patients&#44; previous experience in SLE has shown little efficacy and in some cases even a worsening of symptoms&#44; making them of little use for their use in patients with rhupus&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Rituximab is a monoclonal antibody directed against the CD20 molecule on B lymphocytes which has been extensively demonstrated to be effective in the treatment of RA&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> In addition&#44; although recent reports of controlled trials have not yielded the expected results&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a> there are many reports in the literature of successful treatment with rituximab in patients with SLE and different types of manifestations&#44; mainly hematological&#44; renal and even central nervous system&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a> There are&#44; at this time&#44; no specific reports on the response in joint manifestations&#44; although surely many of these patients presented improvement&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The objective of this study was to investigate the efficacy and tolerability of rituximab in a group of patients with rhupus&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patients and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Study Design</span><p id="par0035" class="elsevierStylePara elsevierViewall">We performed a prospective&#44; open study to evaluate the efficacy of rituximab in patients with rhupus&#46; The primary endpoint was change in DAS28 at 6 months &#40;improvement defined as a decrease of at least 0&#46;6<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#41;&#46; Secondary endpoints were the change in the MEX-SLEDAI at 6 months follow up to the end of the evaluation&#44; the change in DAS28 at the end of monitoring and assessment and steroid requirements&#44; and the recording of adverse event during the study&#46; We included for analysis only patients who had completed at least 24 months follow-up&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We recorded demographic data&#44; clinical features of the disease and the classification criteria for SLE and RA&#44; and data evolution and previous response to different treatments&#46; All patients signed an informed consent for treatment&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Treatment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Patients received rituximab 1<span class="elsevierStyleHsp" style=""></span>g by intravenous infusion for 4<span class="elsevierStyleHsp" style=""></span>h&#44; after premedication with hydroxyzine&#44; paracetamol and dexamethasone 8<span class="elsevierStyleHsp" style=""></span>mg intravenously on days 1 and 15 of the study&#44; with subsequent cycles every 9&#8211;12 months&#44; depending on the clinical activity evaluated by DAS28&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Nonbiological DMARDs &#40;methotrexate&#44; leflunomide&#44; azulfidine&#41; and immunosuppressants &#40;azathioprine&#44; mycophenolate mofetil&#44; cyclophosphamide&#41; were suspended one month before the start of the study&#46; Concurrent use of low doses of steroids &#40;maximum 15<span class="elsevierStyleHsp" style=""></span>mg of prednisone&#47;day or its equivalent&#41; and hydroxychloroquine&#44; and nonsteroidal anti-inflammatory analgesics and adjuvant therapy &#40;lowering agents&#44; antihypertensives&#44; etc&#46;&#41; was allowed&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Study Subjects</span><p id="par0050" class="elsevierStylePara elsevierViewall">The study population consisted of consecutive patients over 18 years&#44; diagnosed with rhupus according the criteria proposed by Simon et al&#46;&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;19</span></a>&#58; symmetrical erosive polyarthritis&#44; signs and symptoms of SLE and anti-dsDNA antibodies and&#47;or anti-Sm and joint disease with moderate to severe activity&#44; defined as DAS28&#8805;3&#46;2&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> For patients of childbearing age&#44; we used a reliable contraceptive&#46; All patients underwent screening for tuberculosis and viral hepatitis prior to treatment&#46; Exclusion criteria included the presence of pregnancy or lactation&#44; history of hepatitis&#44; need to use other immunosuppressive drugs or concomitant DMARDs &#40;except antimalarials&#41; or active infection at baseline&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Evaluations</span><p id="par0055" class="elsevierStylePara elsevierViewall">Patients were evaluated on a quarterly basis throughout the follow up&#46; At each visit patients were questioned on symptoms suggestive of activity&#59; we performed a complete physical examination by a rheumatologist and determined the DAS28 and MEX-SLEDAI scores and also recorded the presence of concomitant medications and adverse events intentionally&#46; We also carried out routine laboratory studies that included CBC with differential and platelet count&#44; blood chemistry&#44; urinalysis&#44; creatinine clearance&#44; 24<span class="elsevierStyleHsp" style=""></span>h urine albumin&#44; acute phase reactants &#40;erythrocyte sedimentation rate&#44; C-reactive protein&#41; and C3 and C4 levels&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Statistical Analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">We used descriptive statistics&#44; Fisher&#39;s exact test for qualitative variables and Student&#39;s <span class="elsevierStyleItalic">t</span> test for quantitative variables&#46; The comparison of differences was performed using the Wilcoxon rank test&#46; We used SPSS version 15 in Spanish&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Characteristics of the study subjects&#58; nine patients were included&#44; all women&#44; with a mean age of 43 years &#40;range 38&#8211;57 years&#41; and a duration of illness of 10&#46;03 years &#40;range 18&#8211;22 years&#41;&#46; In 6 patients the initial diagnosis was RA and preceded SLE manifestations by 2&#46;5 years on average&#59; in only 3 patients the initial diagnosis was SLE&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic&#44; clinical and serological features&#44; and pretreatment of patients included and the criteria by which the diagnosis of rhupus was made&#46; It should be mentioned that in all patients treated we previously employed NSAIDs&#44; steroids in low and medium doses or non-biological DMARD monotherapy or combination therapy without success&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Clinical efficacy&#58; good clinical response was observed&#44; with decrease in the baseline DAS28 score from 5&#46;73 to 4&#46;13 at 3 months and 3&#46;02 at 6 months&#44; a statistically significant change &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; Improvement in DAS28 was maintained during the follow up period&#44; with a DAS 28 score of 3&#46;04 at 12 months and 2&#46;52 at 24 months&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; At 6 months&#44; 3 patients had remission by DAS28 and 3 had low activity&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the percentage of patients with high&#44; moderate&#44; low activity or remission by DAS28 at baseline and at 6&#44; 12 and 24 months of follow-up&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding the MEX-SLEDAI score&#44; this was reduced from 5 points at baseline to 2&#46;56 at 3 months and 1&#46;22 at 6 months &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; and maintained this improvement at 12 &#40;0&#46;78&#41; and 24 &#40;0&#46;22&#41; months &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; As already mentioned&#44; the decision to apply a second treatment of rituximab depended on clinical activity&#46; Eight patients showed an increase in activity by DAS28 between 9 and 12 months&#44; so they received a second course of rituximab&#44; and only in one patient was this necessary at 15 months&#46; In multivariate analysis&#44; we found a negative correlation between clinical improvement assessed by DAS28 at 12 months and the levels of anti-CCP &#40;<span class="elsevierStyleItalic">r</span>&#61;&#8722;0&#46;794&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;011&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">An indirect measure of clinical efficacy of the treatment is the ability to reduce steroid dose and&#47;or discontinue it during the study&#46; The baseline dose of prednisone in our group of patients was 11&#46;66<span class="elsevierStyleHsp" style=""></span>mg prednisone&#47;day and was progressively decreased to 4&#46;72<span class="elsevierStyleHsp" style=""></span>mg at 6 months and 0&#46;55 and 1&#46;11<span class="elsevierStyleHsp" style=""></span>mg&#47;day 12 and 24 months respectively&#46; The majority of patients did not require<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> oral steroids from 12 months of treatment onward &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Safety aspects&#58; in general&#44; treatment with rituximab was well tolerated during the study&#46; Adverse events were divided as immediate reactions to the infusion&#44; infectious events and serious adverse events&#46; There were three adverse reactions in 2 patients during infusion of rituximab&#44; which consisted of erythema and pruritus&#44; and on all occasions forced us to temporarily stop the infusion and administer steroids and intravenous antihistamines&#46; There were 9 non-serious infectious events in 6 patients&#44; mainly infections of the lower urinary tract &#40;6 cases&#41; and infections of the upper respiratory tract &#40;3 events&#41;&#44; in both cases without complications&#46; Only one patient had pneumonia&#44; an event that was considered serious enough to require hospital management&#44; with adequate clinical recovery&#46; There were no deaths&#44; malignancies or opportunistic infections during the follow up period&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">In our study patients&#44; rituximab treatment was effective in both joint manifestations&#44; with significant reduction in DAS28&#44; as in other manifestations of lupus&#44; with improvement of MEX-SLEDAI&#46; Clinical response was evident after 6 months&#44; however&#44; began to be apparent within the first 3 months of evaluation and was maintained in all patients during the monitoring phase with repeated cycles of treatment at the time clinical reactivation was shown&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Usually joint manifestations in SLE patients often respond satisfactorily to DMARDs or low dose steroids&#59; however&#44; in rhupus a large percentage of patients do not have good response&#44; in many cases presenting polyarticular arthropathy with progressive structural damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;20&#44;21</span></a> Among the different biologic therapy options&#44; anti-CD20 blocking antibody rituximab may be a good choice&#46; There are multiple reports and case series that have demonstrated the efficacy of this drug in patients with various manifestations of lupus&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> In a recent meta-analysis published by Ramos-Casals&#44; who performed a systematic review of 188 lupus patients treated with rituximab between 2002 and 2007&#44; therapy was effective in 91&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Of the few randomized controlled trials that exist to date in the EXPLORER study&#44; which included 257 patients with lupus with moderate to severe activity&#44; there was no significant difference in the percentage of patients achieving major response &#40;1&#46;24 vs 15&#46;9&#41; or partial response &#40;17&#46;2 vs 12&#46;5&#41; in the groups treated with rituximab or placebo&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> Similar results were observed in the LUNAR study&#44; involving 144 patients with lupus nephritis III or IV&#44; in whom no significant differences could be demonstrated between rituximab and placebo&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However&#44; it is important to note that in both studies&#44; rituximab response seemed better in minority groups and it also should be noted that in both studies&#44; patients were receiving the standard treatment for lupus&#44; making it difficult to detect differences between groups&#46; We reported in 2010 an open study in lupus patients who received cyclophosphamide or rituximab&#46; The results favored rituximab and although all patients had severe manifestations of the disease as a criterion for inclusion&#44; a significant percentage had joint manifestations&#44; which improved&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The results of the French registry of lupus patients treated with rituximab have been recently published&#46; The authors found an adequate clinical response in about 80&#37; of patients&#44; specifically&#44; improvement occurred for articular manifestations in 72&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Currently&#44; other multicenter controlled clinical studies in patients with different manifestations of lupus&#44; such as the RING study&#44; evaluating the efficacy of rituximab to achieve remission in lupus nephritis are underway and the results will certainly be of great value to define even better the usefulness of this biological agent&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In patients with rhupus&#44; although manifestations of both lupus and RA coexist&#44; the prevalence is characteristic for the development of joint manifestations&#44; which usually dominate the clinical picture of the disease&#44; sometimes with mucocutaneous manifestations and much less frequently renal manifestations&#44; serious hematological or nervous system involvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#8211;5</span></a> This was no different in our patients&#44; in which the expression of joint disease was unwieldy&#44; with general or mucocutaneous manifestations associated with low scores explaining MEX-SLEDAI&#44; which&#44; however&#44; improved during the course of the study&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">We also described the relationship between the severity of joint manifestations in patients with rhupus and positivity for anti-CCP&#59;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;24&#8211;26</span></a> hence the negative correlation we found between the titles of these antibodies and clinical response is entirely explicable&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">While recognizing the limitations of our work&#44; which included a small number of patients with rhupus due to the very low prevalence of this condition<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> since it is an open uncontrolled study&#44; we believe that the results obtained are encouraging and&#44; to some extent&#44; expected&#44; and considering past experience&#44; which is extensive&#44; treatment with rituximab in patients with RA and reports of improvement in many manifestations of SLE&#44; place rituximab as a very suitable drug for the management of patients with lupus and even rhupus and prominent joint manifestations&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Ethical Responsibilities</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Protection of People and Animals</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that procedures conformed to the ethical standards of the committee responsible for human experimentation and were in accordance with the World Medical Association Declaration of Helsinki&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data Confidentiality</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of data from patients and all patients included in the study have received sufficient information and gave their written informed consent to participate in this study&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Right to Privacy and Informed Consent</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from patients and&#47;or subjects referred to in the article&#46; This document is in the possession of the corresponding author&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of Interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">Andrade-Ortega&#58; speaker for Roche&#44; Bristol&#44; Pfizer&#44; Merck&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Irazoque-Palazuelos&#58; Advisory board and&#47;or speaker for Roche&#44; Bristol&#44; Pfizer&#44; Janssen&#44; Merck&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Mu&#241;oz-L&#243;pez&#58; speaker for Sanofi&#44; Pfizer&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Don Pablo Rosales&#58; lecturer for Pfizer&#46;</p></span></span>"
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          "identificador" => "xpalclavsec208319"
          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "xres222862"
          "titulo" => "Resumen"
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        3 => array:2 [
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          "titulo" => "Introduction"
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          "titulo" => "Patients and Methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study Design"
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            1 => array:2 [
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              "titulo" => "Treatment"
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              "titulo" => "Protection of People and Animals"
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            1 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Data Confidentiality"
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            2 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Right to Privacy and Informed Consent"
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        9 => array:2 [
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        10 => array:1 [
          "titulo" => "References"
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    "fechaRecibido" => "2012-08-12"
    "fechaAceptado" => "2012-10-15"
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          "clase" => "keyword"
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            2 => "Rituximab"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rhupus in an infrequent disease in which an overlap between lupus eritematosus and rheumatoid arthritis exists&#46; Joint manifestations are prominent and treatment with nonbiological DMARDs is not always satisfactory&#44; so immunosuppressors and biological agents have been tried&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective&#44; open clinical study was done to evaluate efficacy and tolerability of rituximab in patients with rhupus&#46; The main objective was a change in DAS28 at 6 months and secondary objectives were a change in MEX-SLEDAI at 6 months&#44; change in DAS28 and MEX-SLEDAI during follow up&#44; steroid requirements and detection of adverse events&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We included 9 women with a mean age of 43 years and disease duration of 10 years&#46; A significant reduction in DAS28 was observed &#40;from 5&#46;73 at baseline to 3&#46;02 at 6 months&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; Improvement in DAS28 was maintained during follow up&#46; At 6 months&#44; 3 patients were in remission and 3 had low disease activity&#46; MEX-SLEDAI diminished from 5 points at baseline to 1&#46;22 at 6 months &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; There was a negative correlation between clinical improvement and anti-CCP levels &#40;<span class="elsevierStyleItalic">r</span>&#61;&#8722;0&#46;794&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;011&#41;&#46; Mean prednisone dose was reduced from 11&#46;66<span class="elsevierStyleHsp" style=""></span>mg&#47;day at baseline to 0&#46;55 and 1&#46;11<span class="elsevierStyleHsp" style=""></span>mg&#47;day at 12 and 24 months&#46; Treatment was well tolerated&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In this study rituximab was effective not only for joint affection but also for other manifestations of the disease&#46; We consider that this biological agent can be a good therapeutic option for patients with rhupus&#46;</p>"
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        "titulo" => "Resumen"
        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El rhupus es una entidad poco com&#250;n en la que se superponen datos de lupus eritematoso generalizado y artritis reumatoide&#44; predominando con frecuencia las manifestaciones articulares&#46; En muchos casos el tratamiento con f&#225;rmacos modificadores de la enfermedad no biol&#243;gicos es insatisfactorio&#44; por lo que se ha intentado el uso de inmunosupresores y f&#225;rmacos biol&#243;gicos&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio prospectivo y abierto para evaluar la eficacia y la tolerabilidad de rituximab en pacientes con rhupus&#46; El objetivo principal fue el cambio en el DAS28 a los 6 meses&#59; fueron objetivos secundarios el cambio en MEX-SLEDAI a los 6 meses&#44; el cambio en DAS28 y MEX-SLEDAI durante el seguimiento&#44; el requerimiento de esteroides y el registro de eventos adversos&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 9 pacientes&#44; todas mujeres&#44; con edad promedio de 43 a&#241;os y tiempo de evoluci&#243;n de 10 a&#241;os&#46; Se observ&#243; un descenso en la puntuaci&#243;n basal de DAS28 de 5&#44;73 a 3&#44;02 a los 6 meses &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La mejor&#237;a en el DAS28 se mantuvo durante el periodo de seguimiento&#46; A los 6 meses&#44; 3 pacientes presentaban remisi&#243;n por DAS28 y 3 actividad baja&#46; La calificaci&#243;n de MEX-SLEDAI disminuy&#243; de 5 puntos a nivel basal a 1&#44;22 a los 6 meses &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y mantuvo esta mejor&#237;a&#46; Se observ&#243; una correlaci&#243;n negativa entre la mejor&#237;a cl&#237;nica y los niveles de anti-CCP &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;794&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41;&#46; La dosis de prednisona disminuy&#243; de 11&#44;66<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a basal a 0&#44;55 y 1&#44;11<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a a los 12 y 24 meses&#44; respectivamente&#46; En general&#44; el tratamiento con rituximab fue bien tolerado durante el estudio&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En los pacientes de nuestro estudio&#44; el tratamiento con rituximab mostr&#243; ser eficaz tanto en las manifestaciones articulares&#44; con reducci&#243;n significativa del DAS28&#44; como en otras manifestaciones de lupus&#44; con mejor&#237;a del MEX-SLEDAI&#46; Consideramos que esta puede ser una buena opci&#243;n terap&#233;utica para pacientes con rhupus&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Andrade-Ortega L&#44; et al&#46; Eficacia y tolerabilidad de rituximab en el tratamiento de pacientes con rhupus&#46; Reumatol Clin&#46; 2013&#59;9&#58;201&#8211;5&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Reduction in the dose of prednisone&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ANA&#44; antinuclear antibodies&#59; anti-dsDNA&#44; anti-dsDNA&#59; anti-CCP&#44; anti-citrullinated peptide antibodies&#59; RA&#44; rheumatoid arthritis&#59; F&#44; female&#59; FR&#44; rheumatoid factor&#59; HD&#44; homogeneous diffuse&#59; SLE&#44; systemic lupus erythematosus&#59; LL&#44; leukolymphopenia&#59; LLT&#44; leukolymphopenia and thrombocytopenia&#59; LP&#44; peripheral&#59; M&#44; male&#59; MG&#44; spotted&#46;</p>"
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                  \t\t\t\t">5 &#40;55&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Erosions Rx</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;88&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                            0 => "J&#46;A&#46; Simon"
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2013.03.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	10	14	24
2024 October	68	34	102
2024 September	87	30	117
2024 August	86	41	127
2024 July	71	25	96
2024 June	52	24	76
2024 May	55	33	88
2024 April	53	24	77
2024 March	73	19	92
2024 February	31	17	48
2024 January	42	30	72
2023 December	31	23	54
2023 November	29	24	53
2023 October	52	26	78
2023 September	83	44	127
2023 August	49	15	64
2023 July	41	27	68
2023 June	37	28	65
2023 May	64	22	86
2023 April	23	7	30
2023 March	54	23	77
2023 February	46	35	81
2023 January	34	16	50
2022 December	55	29	84
2022 November	34	31	65
2022 October	38	33	71
2022 September	72	33	105
2022 August	66	42	108
2022 July	68	40	108
2022 June	37	26	63
2022 May	55	46	101
2022 April	52	48	100
2022 March	43	53	96
2022 February	31	31	62
2022 January	38	33	71
2021 December	24	35	59
2021 November	44	40	84
2021 October	49	40	89
2021 September	34	35	69
2021 August	46	40	86
2021 July	28	26	54
2021 June	45	35	80
2021 May	51	44	95
2021 April	167	78	245
2021 March	148	28	176
2021 February	152	13	165
2021 January	50	17	67
2020 December	47	15	62
2020 November	42	12	54
2020 October	29	15	44
2020 September	33	22	55
2020 August	24	9	33
2020 July	18	10	28
2020 June	33	30	63
2020 May	30	16	46
2020 April	28	12	40
2020 March	10	8	18
2020 February	1	0	1
2019 April	2	1	3
2019 January	1	0	1
2018 June	0	2	2
2018 May	4	3	7
2018 April	42	14	56
2018 March	48	18	66
2018 February	44	3	47
2018 January	44	7	51
2017 December	51	7	58
2017 November	37	9	46
2017 October	56	14	70
2017 September	41	4	45
2017 August	41	13	54
2017 July	46	20	66
2017 June	52	10	62
2017 May	47	16	63
2017 April	41	5	46
2017 March	52	39	91
2017 February	62	11	73
2017 January	46	5	51
2016 December	95	22	117
2016 November	89	9	98
2016 October	130	17	147
2016 September	172	20	192
2016 August	88	4	92
2016 July	53	7	60
2016 June	0	18	18
2016 May	2	15	17
2016 April	1	0	1
2015 December	3	0	3
2015 November	1	0	1
2015 October	1	15	16
2015 September	3	0	3
2015 July	18	6	24
2015 June	55	5	60
2015 May	66	15	81
2015 April	53	11	64
2015 March	60	8	68
2015 February	91	8	99
2015 January	47	10	57
2014 December	62	13	75
2014 November	54	8	62
2014 October	47	11	58
2014 September	31	9	40
2014 August	30	12	42
2014 July	38	15	53
2014 June	84	17	101
2014 May	49	16	65
2014 April	59	12	71
2014 March	64	21	85
2014 February	48	15	63
2014 January	50	17	67
2013 December	39	9	48
2013 November	37	10	47
2013 October	55	16	71
2013 September	46	31	77
2013 August	74	30	104
2013 July	48	17	65

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