Editorial
Neuropsychiatric Manifestations in Systemic Lupus Erythematosus: Physiopathogenic and Therapeutic Basis
Manifestaciones neuropsiquiátricas en lupus eritematoso generalizado: bases fisiopatogénicas y terapéuticas
Georgina Aguilera-Pickens, Carlos Abud-Mendoza
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Unidad Regional de Reumatología y Osteoporosis, Hospital Central «Dr. Ignacio Morones Prieto», Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
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its neuropsychiatric expression has been compiled by the ACR into 19 syndrome that range from vascular headache and behavioral alterations to cognitive abnormalities and other severe, disabling manifestations such as transverse myelitis, which have a well defined physiopathogenic basis, leading to a targeted treatment, but represent both a diagnostic as well as therapeutic challenge.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of neuropsychiatric lupus (NP-SLE) varies from 37% to 95%,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> depending upon the definition, heterogeneous designs (prospective or retrospective), the population studied (adult or pediatric), ethnicity, time since onset, severity and follow-up.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The most prevalent manifestations include cognitive alterations (55%–80%), headache (24%–72%), mood disorders (14%–57%), stroke (5%–18%), convulsions (6%–51%), polyneuropathy (3%–28%), anxiety (7%–24%) and psychosis (8%). The rest of the syndromes have a prevalence of ≤1%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Cognitive alterations are not related to the time since onset of the disease, activity or treatment, and the most common are a reduced attention, memory (particularly visospatial) and executive dysfunction.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It may be variably associated to dementia in 25% and most often improve with treatment.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Of the psychiatric alterations, depression, auditory hallucinations and anxiety disorders predominatel.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Transverse myelitis (TM) is rare but severe; its onset usually occurs in the first five years of disease. 50% of patients present it at disease onset and it recurs in 21%–55%; A fifth (21%) do not improve or worsen.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Convulsions frequently accompany other SLE manifestations, but may occur as an isolated event, most commonly in younger patients and are associated to antiphospholipid antibodies (APL).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis is clinical and is additionally supported by laboratory and imaging testing, as well as neuropsychiatric evaluations. It represents a therapeutic challenge because none of the syndromes are exclusive to SLE and up to 41% is attributable to other causes; it is specifically necessary to rule out central nervous system infection, uremia, thrombotic thrombocytopenic purpura, reversible encephalopathy, steroid induced psychosis and hypertension.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Magnetic resonance (MR) is the test of choice<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>; it detects focal lesions in the subcortical and/or periventricular white matter (15%–60%), hyperintensity in the gray matter (24%–30%), atrophy, ventricular dilation and infarctions, although 30%–40% of NP-SLE has a normal MR.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Positron emission tomography and single or unique photon emission computed tomography detect hypoperfused or hypermetabolic areas and have a better sensitivity than MR.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In spite of advances, imaging studies do not allow the differentiation of active from inactive disease, and findings are not specific.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In spite of the effort to understand the physiopathology of SLE and of specific therapeutic proposals,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> because of the varied nature of the physiopathogenic mechanisms underlying NP-SLE, which frequently participate in diffuse (psychosis, depression or cognitive alterations) o focal processes (TM or stroke), we classify them as vasculopathy (generally with small caliber vessel affection), mediated by autoantibodies and inflammatory components.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Vasculitis rarely explains NP-SLE, which is commonly related to vasculopathy, which is characterized by a perivascular mononuclear infiltrate; small subsequent infarctions may be observed due to luminal occlusion with fibrin, platelets and intimal hyperplasia, and consequently an increase in the blood–brain barrier (BBB) and in the extravasation of antibodies.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">APL are related to convulsions, stroke, transient ischemic attacks and transverse myelitis; elevated IgG anticardiolipin titers (IgG aCL) lead to a sensitivity of 58% and a specificity of 81% for the diagnosis of ischemic NP-SLE manifestations.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> The accelerated atherosclerosis characteristically associated to SLE increases the risk (5–10 times) of coronary disease and stroke.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the MR, hyperintensities are translated as vasculopathy; they are attributed to demyelination, gliosis and interstitial edema due to ischemia and lacunar infarctions; extensive and confluent hyperintensities in the white matter indicate chronic hypoperfusion.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Antiphospholipid antibodies occur in 60% of patients with SLE, of which 30% have the antiphospholipid antibody syndrome; they are related to focal dysfunction and cognitive deficit, in particular when lupus anticoagulant is present. There is an association of aCL with psychomotor, learning, verbal memory and execution reduction. LA and aCL inhibit the proliferation of astrocytes and increase the synaptoneurosomal depolarization.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">TM is classically considered as an inflammation-mediated syndrome, but its relationship with aCL also indicates a concurrent ischemic contribution, with a very probable thrombosis of the thoracic spinal vessels, and with anticoagulation associated with a better prognosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,16</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Humoral immunity is extensive against neuronal antigens, ribosomes and phospholipids; it has been implicated in the pathogenesis of NP-SLE, with autoantibodies in the CSF and, to a lesser extent, in cerebral tissue (in autopsy).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Antineuronal antibodies are seen in the CSF of NP-SLE cases with diffuse manifestations (65%); there is experimental evidence of direct toxicity; thus, in NZM88 mice, predisposed to lupus nephritis and behavioral alterations, IgG vs cerebral antigens might be found. These antibodies against diamin-1 (a molecule involved in the endocytosis of synaptic vesicles), when injected into healthy models, reproduce the behavioral alterations.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Gangliosides, components of the neuronal membrane, are involved in signal transduction, memory, synaptic transmission and the muscle union; anti-ganglioside IgG antibodies are associated to migraine, dementia and peripheral neuropathy, and IgM to depression.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> They are common in juvenile NP-SL (83%) and associate to cognitive dysfunction.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">There are reports of anti-protein 2 antibodies directed against microtubules, glial fibrillar acidic protein and neurofilaments, important in communication, cell structure and integrity of the BBB.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Those directed against alphatubulin occur in 36% of NP-SLE cases, in 4% of SLE and in no controls (multiple sclerosis, epilepsy, healthy); they are associated to psychomotor alterations, obsessive–compulsive neurosis, temporal epilepsy, memory and concentration deficits, depression and migraine.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We know that antibodies against the N methyl D aspartate receptor (NMDAR) occur in 40%–50% of patients with SLE and cross-react with dsDNA. NMDAR is composed of two units NR1, which presents a binding site for glycine (coagonist), and NR2 (with 4 subtypes A–D) A and B, present mainly in the hippocampus (learning and memory) and the amygdala (fear). They function as voltage regulated calcium channels. After electrical stimulation, glutamate and glycine bind to NR2 and NR1 and allow the passage of calcium into the cell.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Anti-NMDAR antibodies are not limited to NP-SLE; they may occur without underlying disease or be associated o other diseases such as neoplasia. The experimental administration of anti-NMDAR (R4A) with lipopolysaccharide and epinephrine induce BBB dysfunction. R4A binds to the DWEYS pentapeptide in NR2A and NR2B, permitting an increase in cytosolic calcium, especially mitochondrial, and conditions the depolarization of the membrane potential, a reduction in respiration and an increase in oxygen reactive species, with the consequential increase in permeability and apoptosis.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Anti-NMDAR in CSF and the brain correlates with convulsions, delirium, psychosis, headache and stroke.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Anti-endothelium antibodies generate endothelial dysfunction, increase inflammatory markers, adhesion molecules, apoptosis, BBB permeability and the flow of autoantibodies; the activation of endothelial cells is carried out through NF-κB by anti NR2 antibodies.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,22</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">There are other antibodies associated to psychiatric manifestations, such as those against Nedd 5 (27% of NP-SLE) and septin (which belongs to the cytoskeleton GTPase family that intervenes in cytokinesis).<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Triosaphosphate isomeraze (TPI) intervene in glucolysis and the production of erythrocyte and neuronal energy; IgM vs TPI favor anemia and neurological abnormalitied<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>; a-TPI IgG with high specificity in NP-SLE (94.5%) favor the activation of complement and low serum levels of C3d, but increased in the CSF, indicating intratechal production.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Ribosomal P antibodies (P0, P1 and P2) are associated LEG-NP (45%–88% psychosis), lupus nephritis, and hepatitis, and determine the alteration of protein synthesis, dysfunction and neuronal apoptosis, impaired memory, cognition, emotion, depression and olfactory dysfunction.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,25</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Particular attention has been paid to IL-6 in the inflammation associated convulsion and IFN-α has been associated to psychosis; MMP-9, macrophage, T lymphocytes and endothelial cells and smooth muscle cell gelatinase are implicated in the plaque rupture and loss of the BBB, promoting the migration of inflammatory cells. They are associated to cognitive alterations and hyperintense lesions in MR T1 and T2; some periventricular lesions resemble leukoaraiosis, which is translated as a loss of the BBB. There may be thalamic, hippocampal, corpus callosum, cortical atrophy, among others.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9,15</span></a> In the NZM88 mice model, elevated hypothalamic concentrations of IL-6, IL-10, IL-12, IL-16, IFN-γ and tumor necrosis factor alpha are found, in addition to microglial activation which, along with autoantibodies, increases the proinflammatory cytokines even more.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,26</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Therefore, its evident that, in the same patient, different physiopathogenic mechanisms converge in NP-SLE, making it necessary to use a combination of drugs for its management, including “symptomatics” (anticonvulsives, antipsychotics, antiplatelet, anticoagulants), high dose steroids (pulse methylprednisolone) and immunomodulators (antimalarials, statins, cyclophosphamide, azathioprine, methotrexate, mycophenolic acid). Plasmapheresis may be useful, in addition to IV immunoglobulin and rituximab, particularly due to the diversity of potentially pathogenic autoantibodies.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Long term remission is plausible although symptoms persist in 3%–20%; most require steroids and the recurrence rate is 21%–47%.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,26–28</span></a> Mortality can be high (≥18%).<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Aguilera-Pickens G, Abud-Mendoza C. Manifestaciones neuropsiquiátricas en lupus eritematoso generalizado: bases fisiopatogénicas y terapéuticas. Reumatol Clin. 2013;9:331–333.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changes in regional brain morphology in neuropsychiatric systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.C. Cagnoli" 1 => "P.C. Sundgren" 2 => "A. Kairys" 3 => "C.C. Graft" 4 => "D.J. Clauw" 5 => "S. Gebarski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Rheumatol" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "5" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuropsychiatric features of systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.T. Borchers" 1 => "C.A. Aokia" 2 => "S.M. Naguwa" 3 => "C.L. Keen" 4 => "Y. Shoenfeld" 5 => "M.E. Gershwin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2005.01.008" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2005" "volumen" => "4" "paginaInicial" => "329" "paginaFinal" => "344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16081024" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuropsychiatric syndromes in systemic lupus erythematosus: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Unterman" 1 => "J.E. Nolte" 2 => "M. Boaz" 3 => "M. Abady" 4 => "Y. Shoenfeld" 5 => "G. Zandman-Goddard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2010.08.001" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2011" "volumen" => "41" "paginaInicial" => "1" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20965549" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuropsychiatric lupus: the prevalence and autoantibody associations depend on the definition: results from the 1000 faces of lupus cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. Borowoy" 1 => "J.E. Pope" 2 => "E. Silverman" 3 => "P.R. Forin" 4 => "C. Pineau" 5 => "C.D. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2012.03.011" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2012" "volumen" => "42" "paginaInicial" => "179" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22595642" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and pattern of cognitive impairment in systemic lupus erythematosus patients with and without overt neuropsychiatric manifestations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Monastero" 1 => "P. Bettini" 2 => "E. Del Zotto" 3 => "E. Cottini" 4 => "A. Tincani" 5 => "G. Balestrieri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neurol Sci" "fecha" => "2001" "volumen" => "184" "paginaInicial" => "33" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11231030" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of patients with NPSLE" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Hermosillo-Romo" 1 => "L.R. Brey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/berh.2001.0223" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Rheumatol" "fecha" => "2002" "volumen" => "16" "paginaInicial" => "229" "paginaFinal" => "244" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12041951" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initial presentation of acute transverse myelitis in systemic lupus erythematosus: demographics, diagnosis, management and comparison to idiopathic cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.W. Schulz" 1 => "M. Shenin" 2 => "A. Mehta" 3 => "A. Kebede" 4 => "M. Fluerant" 5 => "C.T. Derk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00296-011-2053-1" "Revista" => array:6 [ "tituloSerie" => "Rheumatol Int" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "2623" "paginaFinal" => "2627" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21833518" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seizure disorders in systemic lupus erythematosus results from an international, prospective, inception cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.G. Hanly" 1 => "M.B. Urowitz" 2 => "L. Su" 3 => "C. Gordon" 4 => "S.C. Bae" 5 => "J. Sanchez-Guerrero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2011-201089" "Revista" => array:7 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2012" "volumen" => "71" "paginaInicial" => "1502" "paginaFinal" => "1509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22492779" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673600049540" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of neuropsychiatric lupus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.G. Hanly" 1 => "M.J. Harrison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.berh.2005.04.003" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Rheumatol" "fecha" => "2005" "volumen" => "19" "paginaInicial" => "799" "paginaFinal" => "821" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16150404" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Magnetic resonance imaging and brain histopathology in neuropsychiatric systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W.L. Sibbitt" 1 => "W.M. Brooks" 2 => "M. Kornfeld" 3 => "B.L. Hart" 4 => "A.D. Bankhurst" 5 => "C.A. Roldan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2009.08.005" "Revista" => array:7 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2010" "volumen" => "40" "paginaInicial" => "32" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19880162" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673608607266" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuropsychiatric systemic lupus erythematosus correlation of brain MR imaging, CT, and SPECT" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.R. Abreu" 1 => "A. Jakosky" 2 => "M. Folgerini" 3 => "R.M. Xavier" 4 => "J.T. Brenol" 5 => "F. Kapczinsky" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Imaging" "fecha" => "2005" "volumen" => "29" "paginaInicial" => "215" "paginaFinal" => "221" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy of brain 18F-fluorodeoxyglucose positron emission tomography in neuropsychiatric lupus patients with normal brain magnetic resonance imaging findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.W. Lee" 1 => "M.C. Park" 2 => "S.K. Lee" 3 => "Y.B. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0961203312459104" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2012" "volumen" => "21" "paginaInicial" => "1531" "paginaFinal" => "1537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22941565" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoantibodies involved in neuropsychiatric manifestations associated with systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Colasanti" 1 => "F. Delunardo" 2 => "P. Margutti" 3 => "D. Vacirca" 4 => "E. Piro" 5 => "A. Siracusano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jneuroim.2009.05.003" "Revista" => array:7 [ "tituloSerie" => "J Neuroimmunol" "fecha" => "2009" "volumen" => "212" "paginaInicial" => "3" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19500858" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0190962211001319" "estado" => "S300" "issn" => "01909622" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective study of clinical phenotypes in neuropsychiatric systemic lupus erythematosus; multidisciplinary approach to diagnosis and therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E.J. Zirkzee" 1 => "G.M. Steup-Beekman" 2 => "R.C. van der Mast" 3 => "E.L. Bollen" 4 => "N.J. van der Wee" 5 => "E. Baptist" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.120545" "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "2118" "paginaFinal" => "2126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22984275" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuropsychiatric systemic lupus erythematosus; lessons learned from magnetic resonance imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Luyendijk" 1 => "S.C. Steens" 2 => "W.J. Ouwendijk" 3 => "G.M. Steup-Beekman" 4 => "E.L. Bollen" 5 => "J. van der Grond" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.30157" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2011" "volumen" => "63" "paginaInicial" => "722" "paginaFinal" => "732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21360502" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mielitis transversa en lupus eritematoso sistémico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.L. Velloso" 1 => "F. García" 2 => "C. Ocaña" 3 => "R. González" 4 => "R. Garrido" 5 => "J. Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1699-258X(07)73605-7" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2007" "volumen" => "3" "paginaInicial" => "73" "paginaFinal" => "77" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21794402" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibody induction of lupus-like neuropsychiatric manifestations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.A. Lawrence" 1 => "J.V. Bolivar" 2 => "C.A. Hudson" 3 => "T.K. Mondal" 4 => "N.G. Pabello" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jneuroim.2006.10.017" "Revista" => array:6 [ "tituloSerie" => "J Neuroimmunol" "fecha" => "2007" "volumen" => "182" "paginaInicial" => "185" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17156859" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of measurement of serum autoantibodies in prediction of pediatric neuropsychiatric systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.A. Mostafa" 1 => "D.H. Ibrahim" 2 => "A.A. Shehab" 3 => "A.K. Mohammed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jneuroim.2010.07.014" "Revista" => array:6 [ "tituloSerie" => "J Neuroimmunol" "fecha" => "2010" "volumen" => "227" "paginaInicial" => "195" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20724007" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of a-tubulin as an autoantigen recognized by sera from patients with neuropsychiatric systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Ndhlovu" 1 => "B.E. Preuß" 2 => "J. Dengiel" 3 => "S. Stevanovic" 4 => "S.M. Weiner" 5 => "R. Klein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbi.2010.09.019" "Revista" => array:6 [ "tituloSerie" => "Brain Behav Immun" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "279" "paginaFinal" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20884345" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glutamate receptor biology and its clinical significance in neuropsychiatric systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Aranow" 1 => "B. Diamond" 2 => "M. Mackay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheum Dis Clin N Am" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "187" "paginaFinal" => "201" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurotoxic lupus autoantibodies alter brain function through two distinct mechanisms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.W. Faust" 1 => "E.H. Changa" 2 => "C. Kowal" 3 => "R. Berlin" 4 => "I.G. Gazaryana" 5 => "E. Bertini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1073/pnas.1006980107" "Revista" => array:6 [ "tituloSerie" => "Proc Natl Acad Sci U S A" "fecha" => "2010" "volumen" => "107" "paginaInicial" => "18569" "paginaFinal" => "18574" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20921396" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IgG anti-NR2 glutamato receptor autoantibodies from patients with systemic lupus erythematosus activate endothelial cells" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Yoshio" 1 => "H. Okamoto" 2 => "S. Hirohata" 3 => "S. Minota" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.37745" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2013" "volumen" => "65" "paginaInicial" => "457" "paginaFinal" => "463" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23055186" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening of an endothelial cDNA library identifies the C-terminal region of Nedd5 as a novel autoantigen in systemic lupus erythematosus with psychiatric manifestations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Margutti" 1 => "M. Sorice" 2 => "F. Conti" 3 => "F. Delunardo" 4 => "M. Racaniello" 5 => "C. Alessandri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/ar1759" "Revista" => array:6 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2005" "volumen" => "7" "paginaInicial" => "R896" "paginaFinal" => "R903" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15987492" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-triosephosphate isomerase antibodies in cerebrospinal fluid are associated with neuropsychiatric lupus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Sasajima" 1 => "H. Watanabe" 2 => "S. Sato" 3 => "Y. Sato" 4 => "H. Ohira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jneuroim.2006.09.003" "Revista" => array:6 [ "tituloSerie" => "J Neuroimmunol" "fecha" => "2006" "volumen" => "181" "paginaInicial" => "150" "paginaFinal" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17064784" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiribosomal-P autoantibodies from psychiatric lupus target a novel neuronal surface protein causing calcium influx and apoptosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Matus" 1 => "P.V. Burgos" 2 => "M. Bravo-Zehnder" 3 => "R. Kraft" 4 => "O.H. Porras" 5 => "L.F. Barros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jneuroim.2009.05.003" "Revista" => array:6 [ "tituloSerie" => "J Neuroimmunol" "fecha" => "2009" "volumen" => "212" "paginaInicial" => "3" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19500858" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoantibody-mediated neuroinflammation: pathogenesis of neuropsychiatric systemic lupus erythematosus in the NZM88 murine model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Mondal" 1 => "S.K. Saha" 2 => "V.M. Miller" 3 => "R.F. Seegal" 4 => "D.A. Lawrence" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbi.2008.01.013" "Revista" => array:6 [ "tituloSerie" => "Brain Behav Immun" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "949" "paginaFinal" => "959" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18411022" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuropsychiatric systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Popescu" 1 => "A.H. Kao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2174/157015911796557984" "Revista" => array:6 [ "tituloSerie" => "Curr Neuropharmacol" "fecha" => "2011" "volumen" => "9" "paginaInicial" => "449" "paginaFinal" => "457" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22379459" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Central nervous system involvement in systemic lupus erythematosus: overview on classification criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Sciascia" 1 => "M.L. Berolaccini" 2 => "S. Baldovino" 3 => "D. Roccatello" 4 => "M.A. Khamashta" 5 => "G. Sanna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2012.08.014" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2013" "volumen" => "12" "paginaInicial" => "426" "paginaFinal" => "429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22944298" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and predictive factors in neuro-psychiatric lupus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Chiewthanakul" 1 => "K. Sawanyawisuth" 2 => "C. Foocharoen" 3 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 19 | 31 |
| 2024 October | 78 | 32 | 110 |
| 2024 September | 79 | 23 | 102 |
| 2024 August | 83 | 34 | 117 |
| 2024 July | 76 | 43 | 119 |
| 2024 June | 102 | 38 | 140 |
| 2024 May | 96 | 56 | 152 |
| 2024 April | 82 | 33 | 115 |
| 2024 March | 64 | 39 | 103 |
| 2024 February | 55 | 24 | 79 |
| 2024 January | 89 | 28 | 117 |
| 2023 December | 59 | 33 | 92 |
| 2023 November | 65 | 31 | 96 |
| 2023 October | 65 | 38 | 103 |
| 2023 September | 144 | 48 | 192 |
| 2023 August | 63 | 20 | 83 |
| 2023 July | 76 | 27 | 103 |
| 2023 June | 68 | 31 | 99 |
| 2023 May | 82 | 27 | 109 |
| 2023 April | 52 | 18 | 70 |
| 2023 March | 119 | 45 | 164 |
| 2023 February | 91 | 28 | 119 |
| 2023 January | 90 | 28 | 118 |
| 2022 December | 77 | 36 | 113 |
| 2022 November | 96 | 25 | 121 |
| 2022 October | 76 | 30 | 106 |
| 2022 September | 154 | 40 | 194 |
| 2022 August | 121 | 45 | 166 |
| 2022 July | 113 | 46 | 159 |
| 2022 June | 72 | 38 | 110 |
| 2022 May | 77 | 57 | 134 |
| 2022 April | 101 | 40 | 141 |
| 2022 March | 109 | 48 | 157 |
| 2022 February | 88 | 47 | 135 |
| 2022 January | 100 | 43 | 143 |
| 2021 December | 55 | 35 | 90 |
| 2021 November | 78 | 55 | 133 |
| 2021 October | 75 | 67 | 142 |
| 2021 September | 72 | 55 | 127 |
| 2021 August | 104 | 66 | 170 |
| 2021 July | 93 | 46 | 139 |
| 2021 June | 110 | 42 | 152 |
| 2021 May | 95 | 39 | 134 |
| 2021 April | 271 | 82 | 353 |
| 2021 March | 157 | 39 | 196 |
| 2021 February | 126 | 26 | 152 |
| 2021 January | 73 | 35 | 108 |
| 2020 December | 93 | 38 | 131 |
| 2020 November | 75 | 26 | 101 |
| 2020 October | 42 | 13 | 55 |
| 2020 September | 57 | 23 | 80 |
| 2020 August | 24 | 19 | 43 |
| 2020 July | 32 | 19 | 51 |
| 2020 June | 31 | 24 | 55 |
| 2020 May | 42 | 14 | 56 |
| 2020 April | 32 | 24 | 56 |
| 2020 March | 6 | 5 | 11 |
| 2020 February | 2 | 0 | 2 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 111 | 8 | 119 |
| 2018 March | 98 | 8 | 106 |
| 2018 February | 37 | 4 | 41 |
| 2018 January | 42 | 9 | 51 |
| 2017 December | 52 | 8 | 60 |
| 2017 November | 60 | 9 | 69 |
| 2017 October | 48 | 5 | 53 |
| 2017 September | 58 | 7 | 65 |
| 2017 August | 83 | 11 | 94 |
| 2017 July | 54 | 8 | 62 |
| 2017 June | 84 | 14 | 98 |
| 2017 May | 114 | 16 | 130 |
| 2017 April | 92 | 8 | 100 |
| 2017 March | 86 | 13 | 99 |
| 2017 February | 53 | 11 | 64 |
| 2017 January | 61 | 7 | 68 |
| 2016 December | 95 | 21 | 116 |
| 2016 November | 86 | 16 | 102 |
| 2016 October | 92 | 23 | 115 |
| 2016 September | 122 | 10 | 132 |
| 2016 August | 80 | 8 | 88 |
| 2016 July | 67 | 13 | 80 |
| 2016 April | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 2 | 21 | 23 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 32 | 11 | 43 |
| 2015 June | 70 | 9 | 79 |
| 2015 May | 71 | 27 | 98 |
| 2015 April | 59 | 20 | 79 |
| 2015 March | 63 | 11 | 74 |
| 2015 February | 54 | 13 | 67 |
| 2015 January | 44 | 13 | 57 |
| 2014 December | 65 | 13 | 78 |
| 2014 November | 39 | 12 | 51 |
| 2014 October | 46 | 13 | 59 |
| 2014 September | 38 | 13 | 51 |
| 2014 August | 39 | 16 | 55 |
| 2014 July | 49 | 21 | 70 |
| 2014 June | 65 | 17 | 82 |
| 2014 May | 68 | 17 | 85 |
| 2014 April | 59 | 18 | 77 |
| 2014 March | 81 | 21 | 102 |
| 2014 February | 74 | 32 | 106 |
| 2014 January | 62 | 24 | 86 |
| 2013 December | 69 | 30 | 99 |
| 2013 November | 21 | 7 | 28 |
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