Letter to the Editor
Humeral Artery Thrombosis Simulating an Elbow Monoarthritis in a Woman With Primary Antiphospholipid Syndrome (Hughes Syndrome)
Trombosis de la arteria humeral simulando una monoartritis de codo en una paciente con síndrome antifosfolipídico primario (síndrome de Hughes)
Read
6072
Timeswas read the article
2381
Total PDF
3691
Total HTML
Share statistics
array:24 [ "pii" => "S2173574313001433" "issn" => "21735743" "doi" => "10.1016/j.reumae.2013.12.012" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "556" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2014;10:135-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2270 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 1405 "PDF" => 813 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X13000831" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2013.03.003" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "556" "copyright" => "Elsevier España, S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2014;10:135-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6730 "formatos" => array:3 [ "EPUB" => 148 "HTML" => 5163 "PDF" => 1419 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Trombosis de la arteria humeral simulando una monoartritis de codo en una paciente con síndrome antifosfolipídico primario (síndrome de Hughes)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "135" "paginaFinal" => "136" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Humeral artery thrombosis simulating an elbow monoarthritis in a woman with primary antiphospholipid syndrome (Hughes syndrome)" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1308 "Ancho" => 1500 "Tamanyo" => 139121 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagen de trombosis arteria humeral.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Manuel Feced Olmos, Juan José Alegre Sancho, José Ivorra Cortés, José Miguel Zaragozá García" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Carlos Manuel" "apellidos" => "Feced Olmos" ] 1 => array:2 [ "nombre" => "Juan José" "apellidos" => "Alegre Sancho" ] 2 => array:2 [ "nombre" => "José" "apellidos" => "Ivorra Cortés" ] 3 => array:2 [ "nombre" => "José Miguel" "apellidos" => "Zaragozá García" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574313001433" "doi" => "10.1016/j.reumae.2013.12.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313001433?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X13000831?idApp=UINPBA00004M" "url" => "/1699258X/0000001000000002/v2_201404030117/S1699258X13000831/v2_201404030117/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574311000499" "issn" => "21735743" "doi" => "10.1016/j.reumae.2011.05.006" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "333" "copyright" => "Elsevier España, S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "err" "cita" => "Reumatol Clin. 2014;10:137" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1741 "formatos" => array:3 [ "EPUB" => 58 "HTML" => 1302 "PDF" => 381 ] ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Erratum</span>" "titulo" => "Erratum for “Sensitivity, Specificity and Positive and Negative Predictive Values of the Indication Criteria for Bone Densitometry of the Medical Technology and Research Evaluation Agency of Cataluña”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "137" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniel Roig Vilaseca, Carles Valero García, Maria Pilar Boncompte Vilanova, Juli Munoz López, Carme Contreras García, Montserrat Romera Baurés" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Daniel" "apellidos" => "Roig Vilaseca" ] 1 => array:2 [ "nombre" => "Carles" "apellidos" => "Valero García" ] 2 => array:2 [ "nombre" => "Maria Pilar" "apellidos" => "Boncompte Vilanova" ] 3 => array:2 [ "nombre" => "Juli" "apellidos" => "Munoz López" ] 4 => array:2 [ "nombre" => "Carme" "apellidos" => "Contreras García" ] 5 => array:2 [ "nombre" => "Montserrat" "apellidos" => "Romera Baurés" ] 6 => array:1 [ "colaborador" => "in representation of the Referral to densitometry study group" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X11001458" "doi" => "10.1016/j.reuma.2011.05.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X11001458?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574311000499?idApp=UINPBA00004M" "url" => "/21735743/0000001000000002/v2_201403290120/S2173574311000499/v2_201403290120/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574313001457" "issn" => "21735743" "doi" => "10.1016/j.reumae.2013.12.014" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "564" "copyright" => "Elsevier España, S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2014;10:134-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2240 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 1770 "PDF" => 425 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Absence of Radiographic Progression at Two Years in a Cohort of Patients With Non-radiographic Axial Spondyloarthritis Treated With TNF-<span class="elsevierStyleBold">α</span> Blockers" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "134" "paginaFinal" => "135" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ausencia de progresión radiológica a los 2 años en una cohorte de pacientes con espondiloartritis axial no radiológica tratados con terapia anti-TNF-<span class="elsevierStyleBold">α</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miriam Almirall, Josue Guillermo López-Velandia, Joan Maymó" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Miriam" "apellidos" => "Almirall" ] 1 => array:2 [ "nombre" => "Josue Guillermo" "apellidos" => "López-Velandia" ] 2 => array:2 [ "nombre" => "Joan" "apellidos" => "Maymó" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X1300096X" "doi" => "10.1016/j.reuma.2013.04.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1300096X?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313001457?idApp=UINPBA00004M" "url" => "/21735743/0000001000000002/v2_201403290120/S2173574313001457/v2_201403290120/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Humeral Artery Thrombosis Simulating an Elbow Monoarthritis in a Woman With Primary Antiphospholipid Syndrome (Hughes Syndrome)" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "135" "paginaFinal" => "136" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Manuel Feced Olmos, Juan José Alegre Sancho, José Ivorra Cortés, José Miguel Zaragozá García" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Carlos Manuel" "apellidos" => "Feced Olmos" "email" => array:1 [ 0 => "carlosfeced@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan José" "apellidos" => "Alegre Sancho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "José" "apellidos" => "Ivorra Cortés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "José Miguel" "apellidos" => "Zaragozá García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Reumatología, Hospital Universitario Dr. Peset, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Vascular, Hospital Universitario Dr. Peset, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trombosis de la arteria humeral simulando una monoartritis de codo en una paciente con síndrome antifosfolipídico primario (síndrome de Hughes)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 785 "Ancho" => 900 "Tamanyo" => 80797 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of humeral artery thrombosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Antiphospholipid syndrome is defined as a hypercoagulability state with episodic arterial or venous thrombosis and recurrent fetal loss in the presence of antiphospholipid antibodies.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Arterial thrombosis is less common than venous thrombosis and peripheral arteries are only affected in 25% of events.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Among the peripheral arterial thrombosis, upper limbs are only affected in 2.7% of cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a patient with left humeral artery thrombosis and antiphospholipid syndrome, who presented with atypical symptoms. The patient, a 66-year-old woman with a history of smoking (30 packs/year) and with mild hypertriglyceridemia, came to the clinic due to urgent pain, swelling and functional impairment of the left elbow which began acutely seven days prior, associated with a decrease in the hand on the same side, with no fever or other clinical manifestations. Upon examination we found a swollen and functionally limited elbow (flexion 40°) with erythema and increased local temperature. The fingers felt cold and there was a reduction in the radial pulse compared to the contralateral side, but with good capillary flow. Laboratory analysis showed: CRP 115<span class="elsevierStyleHsp" style=""></span>mg/dl; D dimer 469<span class="elsevierStyleHsp" style=""></span>ng/ml; fibrinogen 550<span class="elsevierStyleHsp" style=""></span>mg/dl; leucocytes 13.4×10<span class="elsevierStyleSup">9</span>/l (10.8×10<span class="elsevierStyleSup">9</span>/l). An echographic study was performed ruling out joint affection but showing the existence of a hypoechoic, heterogeneous thickening of the extensor-supinator muscles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A Doppler study showed an occlusion of the humeral artery at the elbow flexure. Vascular surgeons, who began treatment with cilostazole, low molecular weight heparin and aspirin, confirmed these findings. When searching for the underlying cause we found the presence of positive lupus anticoagulant in two separate determinations 3 months apart, with negative anticardiolipin and anti-b2-glucoprotein 1 antibodies. With the diagnosis of thrombosis of the humeral artery in the context of antiphospholipid syndrome we recommended oral anticoagulation with acenocoumarin, with a good progression.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Acute arterial thrombosis is the sudden interruption of blood supply due to the obstruction of the artery that irrigates a specific territory, due to prior stenosis or the existence of an aneurysm at that level, generally having a precipitating factor (hypercoagulability, low cardiac output, etc.). It is clinically manifested as intense pain, pallor, coldness and loss of distal strength, with abolished distal pulse. In our patient, in addition to the poor frequency with which humeral artery occurs, most of the typical signs of acute arterial thrombosis were absent and rather simulated an acute elbow arthritis. When reviewing the literature we have only found descriptions of pain and impairment of the elbow when humeral artery thrombosis is associated to suprachondileal fractures,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> as opposed to our case.</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: Feced Olmos CM, Alegre Sancho JJ, Ivorra Cortés J, Zaragozá García JM. Trombosis de la arteria humeral simulando una monoartritis de codo en una paciente con síndrome antifosfolipídico primario (síndrome de Hughes). Reumatol Clin. 2014;10:135–136.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 785 "Ancho" => 900 "Tamanyo" => 80797 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of humeral artery thrombosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "APhL antibody ELISA as an alternative to anticardiolipin test for the diagnosis of antiphospholipid syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.B. Suh-Lailam" 1 => "A. Cromar" 2 => "K.W. Davis" 3 => "A.E. Tebo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Clin Exp Pathol" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "210" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22558475" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Cervera" 1 => "J.C. Piette" 2 => "J. Font" 3 => "M.A. Khamashta" 4 => "Y. Shoenfeld" 5 => "M.T. Camps" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2002" "volumen" => "46" "paginaInicial" => "1019" "paginaFinal" => "1027" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11953980" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiphospholipid syndrome: an overview" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.G. Hanly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Can Med Assoc J" "fecha" => "2003" "volumen" => "168" "paginaInicial" => "1675" "paginaFinal" => "1682" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiphospholipid syndrome and vascular ischemic (occlusive) diseases: an overview" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.A. Atanassova" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3349/ymj.2007.48.6.901" "Revista" => array:6 [ "tituloSerie" => "Yonsei Med J" "fecha" => "2007" "volumen" => "48" "paginaInicial" => "901" "paginaFinal" => "926" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18159581" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Supracondylar fractures of the humerus and disorders of circulation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Babala" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rozhl Chir" "fecha" => "2001" "volumen" => "80" "paginaInicial" => "545" "paginaFinal" => "548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11787209" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of supracondylar fracture with brachial artery thrombosis in a child: case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.S. Broudy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "1979" "volumen" => "19" "paginaInicial" => "540" "paginaFinal" => "543" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/458898" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001000000002/v2_201403290120/S2173574313001433/v2_201403290120/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001000000002/v2_201403290120/S2173574313001433/v2_201403290120/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313001433?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 11 | 20 |
| 2024 October | 26 | 39 | 65 |
| 2024 September | 43 | 17 | 60 |
| 2024 August | 51 | 30 | 81 |
| 2024 July | 48 | 26 | 74 |
| 2024 June | 57 | 38 | 95 |
| 2024 May | 64 | 39 | 103 |
| 2024 April | 46 | 16 | 62 |
| 2024 March | 37 | 31 | 68 |
| 2024 February | 37 | 35 | 72 |
| 2024 January | 25 | 17 | 42 |
| 2023 December | 28 | 19 | 47 |
| 2023 November | 35 | 28 | 63 |
| 2023 October | 32 | 25 | 57 |
| 2023 September | 59 | 31 | 90 |
| 2023 August | 37 | 23 | 60 |
| 2023 July | 28 | 18 | 46 |
| 2023 June | 28 | 21 | 49 |
| 2023 May | 38 | 23 | 61 |
| 2023 April | 28 | 10 | 38 |
| 2023 March | 34 | 21 | 55 |
| 2023 February | 37 | 36 | 73 |
| 2023 January | 26 | 24 | 50 |
| 2022 December | 41 | 33 | 74 |
| 2022 November | 44 | 25 | 69 |
| 2022 October | 33 | 40 | 73 |
| 2022 September | 31 | 35 | 66 |
| 2022 August | 34 | 54 | 88 |
| 2022 July | 32 | 30 | 62 |
| 2022 June | 37 | 30 | 67 |
| 2022 May | 35 | 38 | 73 |
| 2022 April | 56 | 34 | 90 |
| 2022 March | 43 | 50 | 93 |
| 2022 February | 35 | 17 | 52 |
| 2022 January | 34 | 35 | 69 |
| 2021 December | 31 | 36 | 67 |
| 2021 November | 35 | 47 | 82 |
| 2021 October | 64 | 38 | 102 |
| 2021 September | 31 | 37 | 68 |
| 2021 August | 34 | 36 | 70 |
| 2021 July | 26 | 26 | 52 |
| 2021 June | 35 | 44 | 79 |
| 2021 May | 46 | 30 | 76 |
| 2021 April | 137 | 61 | 198 |
| 2021 March | 73 | 15 | 88 |
| 2021 February | 31 | 17 | 48 |
| 2021 January | 37 | 17 | 54 |
| 2020 December | 38 | 22 | 60 |
| 2020 November | 29 | 17 | 46 |
| 2020 October | 36 | 8 | 44 |
| 2020 September | 72 | 27 | 99 |
| 2020 August | 76 | 16 | 92 |
| 2020 July | 50 | 16 | 66 |
| 2020 June | 33 | 21 | 54 |
| 2020 May | 25 | 8 | 33 |
| 2020 April | 23 | 17 | 40 |
| 2020 March | 16 | 13 | 29 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 34 | 16 | 50 |
| 2018 March | 59 | 21 | 80 |
| 2018 February | 18 | 9 | 27 |
| 2018 January | 19 | 10 | 29 |
| 2017 December | 16 | 9 | 25 |
| 2017 November | 20 | 13 | 33 |
| 2017 October | 19 | 3 | 22 |
| 2017 September | 16 | 4 | 20 |
| 2017 August | 17 | 8 | 25 |
| 2017 July | 22 | 14 | 36 |
| 2017 June | 39 | 10 | 49 |
| 2017 May | 55 | 13 | 68 |
| 2017 April | 37 | 7 | 44 |
| 2017 March | 30 | 23 | 53 |
| 2017 February | 12 | 7 | 19 |
| 2017 January | 29 | 7 | 36 |
| 2016 December | 58 | 28 | 86 |
| 2016 November | 38 | 17 | 55 |
| 2016 October | 49 | 22 | 71 |
| 2016 September | 73 | 25 | 98 |
| 2016 August | 81 | 37 | 118 |
| 2016 July | 38 | 23 | 61 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 18 | 4 | 22 |
| 2015 June | 20 | 20 | 40 |
| 2015 May | 44 | 59 | 103 |
| 2015 April | 24 | 37 | 61 |
| 2015 March | 27 | 19 | 46 |
| 2015 February | 28 | 33 | 61 |
| 2015 January | 64 | 37 | 101 |
| 2014 December | 39 | 27 | 66 |
| 2014 November | 28 | 30 | 58 |
| 2014 October | 29 | 43 | 72 |
| 2014 September | 21 | 39 | 60 |
| 2014 August | 25 | 27 | 52 |
| 2014 July | 40 | 34 | 74 |
| 2014 June | 58 | 16 | 74 |
| 2014 May | 37 | 19 | 56 |
| 2014 April | 75 | 25 | 100 |
| 2014 March | 38 | 18 | 56 |
Show all
