Symptomatic and Asymptomatic Interphalangeal Osteoarthritis: An Ultrasonographic Study

array:24 ["pii" => "S217357431400080X" "issn" => "21735743" "doi" => "10.1016/j.reumae.2014.01.008" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "aid" => "651" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2014;10:278-82" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2585 "formatos" => array:3 [ "EPUB" => 51 "HTML" => 2216 "PDF" => 318 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X14000333" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2014.01.008" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "aid" => "651" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2014;10:278-82" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 35721 "formatos" => array:3 [ "EPUB" => 190 "HTML" => 33644 "PDF" => 1887 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Artrosis interfalángica sintomática y asintomática: un estudio ecográfico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "278" "paginaFinal" => "282" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Symptomatic and asymptomatic interphalageal osteoarthritis: An ultrasonographic study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "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" => 787 "Ancho" => 2257 "Tamanyo" => 256711 ] ] "descripcion" => array:1 [ "es" => "Atrosis IFD: imagen de las manos (A), radiografía (B), zoom de la articulación (C) y estudio ecográfico correspondiente desde dorsal (D), medial (E), lateral (C) y palmar (D)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jacqueline Usón, Cruz Fernández-Espartero, Virginia Villaverde, Emilia Condés, Javier Godo, Maria Jesus Martínez-Blasco, Roberto Miguélez" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Jacqueline" "apellidos" => "Usón" ] 1 => array:2 [ "nombre" => "Cruz" "apellidos" => "Fernández-Espartero" ] 2 => array:2 [ "nombre" => "Virginia" "apellidos" => "Villaverde" ] 3 => array:2 [ "nombre" => "Emilia" "apellidos" => "Condés" ] 4 => array:2 [ "nombre" => "Javier" "apellidos" => "Godo" ] 5 => array:2 [ "nombre" => "Maria Jesus" "apellidos" => "Martínez-Blasco" ] 6 => array:2 [ "nombre" => "Roberto" "apellidos" => "Miguélez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357431400080X" "doi" => "10.1016/j.reumae.2014.01.008" "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/S217357431400080X?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14000333?idApp=UINPBA00004M" "url" => "/1699258X/0000001000000005/v1_201408240347/S1699258X14000333/v1_201408240347/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S217357431400063X" "issn" => "21735743" "doi" => "10.1016/j.reumae.2014.03.013" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "aid" => "644" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2014;10:283-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2307 "formatos" => array:3 [ "EPUB" => 58 "HTML" => 1850 "PDF" => 399 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Nutritional Support in Patients With Systemic Sclerosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "283" "paginaFinal" => "287" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Soporte nutricional a pacientes con esclerosis sistémica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vera Ortiz-Santamaria, Celia Puig, Cristina Soldevilla, Anna Barata, Jordi Cuquet, Asunción Recasens" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Vera" "apellidos" => "Ortiz-Santamaria" ] 1 => array:2 [ "nombre" => "Celia" "apellidos" => "Puig" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Soldevilla" ] 3 => array:2 [ "nombre" => "Anna" "apellidos" => "Barata" ] 4 => array:2 [ "nombre" => "Jordi" "apellidos" => "Cuquet" ] 5 => array:2 [ "nombre" => "Asunción" "apellidos" => "Recasens" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X14000096" "doi" => "10.1016/j.reuma.2013.12.011" "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/S1699258X14000096?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431400063X?idApp=UINPBA00004M" "url" => "/21735743/0000001000000005/v1_201409070108/S217357431400063X/v1_201409070108/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S217357431400135X" "issn" => "21735743" "doi" => "10.1016/j.reumae.2014.07.002" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "aid" => "706" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2014;10:275-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2576 "formatos" => array:3 [ "EPUB" => 58 "HTML" => 2048 "PDF" => 470 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial" "titulo" => "Triple therapy in rheumatoid arthritis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "275" "paginaFinal" => "277" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Triple terapia en la artritis reumatoide" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lydia Abásolo Alcázar" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Lydia" "apellidos" => "Abásolo Alcázar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X14001569" "doi" => "10.1016/j.reuma.2014.07.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14001569?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431400135X?idApp=UINPBA00004M" "url" => "/21735743/0000001000000005/v1_201409070108/S217357431400135X/v1_201409070108/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Symptomatic and Asymptomatic Interphalangeal Osteoarthritis: An Ultrasonographic Study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "278" "paginaFinal" => "282" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jacqueline Usón, Cruz Fernández-Espartero, Virginia Villaverde, Emilia Condés, Javier Godo, Maria Jesus Martínez-Blasco, Roberto Miguélez" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Jacqueline" "apellidos" => "Usón" "email" => array:1 [ 0 => "juson62@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Cruz" "apellidos" => "Fernández-Espartero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Virginia" "apellidos" => "Villaverde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Emilia" "apellidos" => "Condés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Javier" "apellidos" => "Godo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Maria Jesus" "apellidos" => "Martínez-Blasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Roberto" "apellidos" => "Miguélez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Reumatología, Hospital Universitario Móstoles, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento Ciencias de la Salud, Universidad Europea de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Reumatología, Hospital Universitario Jiménez Díaz, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artrosis interfalángica sintomática y asintomática: un estudio ecográfico" ] ] "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" => 676 "Ancho" => 1936 "Tamanyo" => 208684 ] ] "descripcion" => array:1 [ "en" => "DIP osteoarthritis: image of hand (A), X (B) zoom of the joint (C) and corresponding ultrasound study from dorsal (D), medial (E), lateral (F) and palmar perspectives (G)." ] ] ] "textoCompleto" => "IntroductionOsteoarthritis of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints is the most common cause of hand pain and disability in the developed world. At present, both its diagnosis and its follow-up are based on clinical and radiological parameters. However, as is well known, there is no correlation between symptoms and radiographic changes. We may find patients with joint pain and little or no radiological changes and patients with significant radiological structural lesions without pain. There are numerous alterations, inflammatory, morphological and structural, on the joint and extra-articularly that can cause joint pain, effusion, synovitis, mucinous cysts, cartilage lesions, erosions and osteophytes. Ultrasound has innate characteristics that no other imaging techniques have, such as excellent spatial resolution, the ability to obtain multiplanar and dynamic images in real time, and is safe, accessible and performable by the clinician. All the above make this imaging modality widely researched and developed for osteoarthritis.Helen Keen's group in Leeds, UK, has demonstrated construct validity for ultrasonography versus radiology and the ability of this technique in detecting osteophytes, joint impingement and synovitis in osteoarthritis of the fingers.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> These same authors have shown that ultrasound detected more osteophytes than conventional radiology and, in symptomatic osteoarthritis of the fingers, more synovitis, osteophytes and articular impingement are detected in the joints of<a class="elsevierStyleCrossRef" href="#bib0010">2</a> healthy controls. However, to date no one has explored whether there are detectable morphological differences found by ultrasound between painless and painful PIP or DIP joints in the same patient with osteoarthritis of the fingers.The objective of this study was to describe and compare the clinical, radiographic and ultrasonographic findings in patients with osteoarthritis of the PIP and/or DIP joints with and without pain. Moreover, morphological alterations related to painful joints were identified.Patients and MethodsThis descriptive, prospective, cross-sectional study was approved by the local ethics committee and conducted at the University Hospital of Móstoles, Madrid. Patients recruited from the hospital's rheumatology outpatient clinic gave their written consent and had been diagnosed with PIP and/or PIP osteoarthritis according to the criteria of the “American College of Rheumatology”.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> No patient had inflammatory arthropathy, microcrystalline arthritis or fibromyalgia. Intra-articular injection was not allowed at least 6 months before the study. In each patient, the clinician identified 2 or 3 symptomatic and asymptomatic PIP and/or DIP joints with deformity upon inspection, to form osteoarthritis pain (PG) and without pain (PFG) groups. PG joints exhibited pain intensity greater than or equal to 3 on the numeric scale as well as tenderness and joint deformity on inspection, while PFG joints exhibited only articular deformity. All patients underwent clinical, radiological and ultrasound tests as detailed below.Clinical StudySex, age, duration of disease from diagnosis, dominant hand, profession/occupation and current treatment were recorded. The clinical rheumatologist asked each patient which PIP and/or DIP joint was most painful and the numerical global pain intensity scale (ENID 0-10) score of the finger joints was calculated. The clinician palpated each joint and determined the presence or absence of pain, deformity and effusion. In addition, the clinician chose and recorded the joints of each patient for each cohort. In a diagram of the joints of the hand, the clinician marked with an X those he intended to explore using joint ultrasound.Radiological StudyOne posteroanterior conventional radiography of both hands in the same week as the clinical study was performed. The reading was performed by the same rheumatologist (CFE), blinded to the clinical and ultrasound testing. The following structural lesions were interpreted, as recommended by the OARSI atlas,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> as absent or present: medial and lateral osteophytes in the proximal and distal phalanges of the proximal and distal interphalangeal joints, and joint impingement. Erosions were defined as a cessation of the intrajoint cortex. The intraobserver reliability was tested each month with radiographs of the last 5 of the included patients (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>UltrasonographyAn ultrasound expert rheumatologist (JU) performed the test blinded to clinical and radiological information, a maximum 48h after the clinical examination. A General Electric Logic 9 ultrasound machine with an M12 linear probe (GE Medical Systems Ultrasound and Primary Care Diagnostics, LLC, Wauwatosa, USA) was employed. In their longitudinal and transverse axis, the dorsal, palmar, lateral and medial aspects of each PIP and DIP joint, with the hand outstretched on the table, were explored. Ultrasound semiology of the lesions<a class="elsevierStyleCrossRef" href="#bib0025">5</a> is described below. Each lesion was recorded as absent or present.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">Osteophytes: hyperechoic cortical protrusions visualized in 2 planes in the dorsal aspects, palmar, lateral, medial proximal and distal phalanges of the PIP and DIP joints.</li><li class="elsevierStyleListItem" id="lsti0010">Joint impingement: decrease in the space between the cortical margins.</li><li class="elsevierStyleListItem" id="lsti0015">Mucinous cysts: extraarticular anechogenic collection communicating with the joint.</li><li class="elsevierStyleListItem" id="lsti0020">Ultrasonographic synovitis (effusion and/or synovial hypertrophy): distension of the joint capsule ≥1.5mm in its anteroposterior diameter with compressible and/or movable material measured in the dorsal or palmar face.</li><li class="elsevierStyleListItem" id="lsti0025">Signal power Doppler intraarticular Doppler signal (Doppler frequency from 6.3 to 7.5MHz PRF 600Hz, gain set to remove noise).</li><li class="elsevierStyleListItem" id="lsti0030">Erosion by ultrasound: intraarticular cortical defect visualized in 3 planes and in extension and flexion.</li><li class="elsevierStyleListItem" id="lsti0035">Cartilage phalanx head on maximum longitudinal flexion and with the probe on the head of the proximal phalanx, the display or non-display of an anechoic band over the head of the phalanx was assessed.</li></ul>Once a month, the intraobserver reliability was assessed with video clips of the joints of the last 5 of the patients included.Statistical AnalysisStatistical analysis was performed using SPSS version 15.0. Quantitative variables were calculated as the average and 95% confidence interval. Qualitative variables were calculated as the percentages. A radiological osteophyte index was calculated as the sum of proximal and distal osteophytes of a medial and lateral location divided by 4, and the ultrasonographic osteophyte index was calculated as the sum of proximal and distal osteophytes of dorsal, palmar, medial and lateral location divided by 8. To study the statistical contrasts, the McNamara and Fisher's tests for related dichotomous independent variables and Student's t-test for independent or related variables were employed. The percentage of radiographic and ultrasonographic intraobserver agreement was calculated.ResultsA total of 50 joints were studied in the PG and 50 in the PFG in 20 right-handed women, 61.85 (46–73) years of age, diagnosed with osteoarthritis of the PIP and/or DIP for a mean 6.80 years (1–17). Seven women worked as maids, 6 as housewives, 3 as laboratory technicians, 3 as seamstresses and one was a manipulative graphic artist. Seventeen of the 20 patients were taking pain medications, NSAIDs being the most common (60%). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the distribution of the joints of the PG and PFG. In all, 70% of painful joints were located in the right hand and their corresponding non-painful joints on the left hand; 40% of PG joints were located on the second right DIP, right third DIP and left second DIP.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the radiographic and ultrasonographic findings in the PG and PFG. The PG had significantly greater radiographic and ultrasonographic osteophyte index scores, with no sonographic visualization of synovitis and cartilage. Sonography detected more osteophytes than radiology. The ultrasound osteophyte index was higher in PG and PFG than radiologically (P<.001 and P<.006, respectively). Ultrasound detected synovitis in 15 and 6 joints of the PG and PFG, respectively, while clinical palpation led to the suspicion of arthritis in 14 and 0 joints of the PG and PFG, respectively.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The radiological intraobserver agreement was 100% for joint impingement and erosion, and 98% for the osteophyte index. The ultrasound intraobserver agreement was 100% for joint impingement, erosion, synovitis and absence of articular cartilage, and 98% for the osteophyte index.The analysis of all radiological and ultrasonographic variables grouping the PIP and DIP showed no statistical significance. While the analysis of radiological and ultrasound variables in the 2 cohorts according to age showed that patients aged 60 years or less tended to have a higher rate of ultrasound osteophyte, erosion and synovitis, patients older than 61 years tended to present a greater radiographic osteophyte index and no ultrasound visualization of articular cartilage.DiscussionThis study, which was conducted in PIP and DIP of 20 women who were skilled manual workers, demonstrated that symptomatic joints (PG) are found mostly (70%) in the dominant hand and exhibit a higher radiological-ultrasound structural damage and inflammation-through-ultrasound than asymptomatic joints (PFG). This clinical–morphological finding indicates that mechanical stress on the dominant hand plays a pathogenic role in osteoarthritis of the fingers and supports some of the few epidemiological studies designed to demonstrate the association between manual activity and osteoarthritis of fingers.<a class="elsevierStyleCrossRefs" href="#bib0030">6–9</a>Patients with osteoarthritis of the hands have more ultrasonographic synovitis than healthy controls.<a class="elsevierStyleCrossRefs" href="#bib0005">1,10</a> and ultrasonographic synovitis in painful osteoarthritic hands than in painless ones.<a class="elsevierStyleCrossRefs" href="#bib0010">2,11,12</a> Keen et al.,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> and Kortekaas et al. studied<a class="elsevierStyleCrossRef" href="#bib0055">11</a> 30 hand joints, finding synovitis in approximately 80% of joints in patients with osteoarthritis of the hands, while Arrestier et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> studied the interphalangeal joints of the hands, finding synovitis in about 25% of the joints; however, they did not distinguish the asymptomatic from the symptomatic. We found synovitis in 21% of the studied joints, and was significantly higher in the painful joints than in the non-painful (15 vs 6, P=.02). As for intraarticular Doppler signal, this was lower in our study compared with that in the studies by Keen et al.,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> and Kortekaas et al.,<a class="elsevierStyleCrossRef" href="#bib0055">11</a> but similar to the values found in other studies such as Arrestier et al.,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> and Mancarella et al.,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Unlike previous studies,<a class="elsevierStyleCrossRefs" href="#bib0010">2,11,12</a> in our study 98% of the patients were taking NSAIDs, which decreases the detection of synovitis in gray scale and Doppler modes.<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a>The higher spatial resolution of ultrasound versus radiology allows for the detection of osteophytes on the palm and back of fingers not visible using radiology. Like other studies,<a class="elsevierStyleCrossRefs" href="#bib0005">1,2,15</a> and especially in the study of Mathiessen et al.,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> which is the largest cohort to date, with 127 patients with osteoarthritis of the hand, ultrasound clearly detected more osteophytes than plain radiography of the hands. Curiously, given that MRI detects few osteophytes in the palm of the hand,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Mathiessen et al.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> did not include palmar ultrasound examination, while we did include it.It has been shown that radiographic erosive hand osteoarthritis exhibits more ultrasound B mode and Doppler synovitis than nonerosive cases.<a class="elsevierStyleCrossRefs" href="#bib0055">11,17,18</a> We did not differentiate these phenotypes in the inclusion criteria or study it. We found that patients aged 60 years or less tended to have more erosions and synovitis than those aged more than 60 years, which indicates the possibility of differences in the phenotype of the patients.To date, this pilot study is the first to compare morphological causes of pain in the same patient with osteoarthritis of the fingers. When compared with the same patient, the bias of the patient's personality decreases in the pain assessment. Also, the fact that the clinician seeks the most similar non-painful joint in appearance for comparison reduces bias at the articular level. Kortekaas published 2 different studies; the first demonstrates that synovitis is associated with pain in patients with osteoarthritis of the hand<a class="elsevierStyleCrossRef" href="#bib0055">11</a> and the second shows that both osteophytes and joint space narrowing are independently associated with pain.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> We jointly studied the inflammation and structural damage, observing that painful joints have more synovitis and structural damage on ultrasound with regard to the presence of radiographic osteophytes, as well as the absence of ultrasonographic cartilage, with a trend toward significance in radiological and ultrasound joint erosion, as other authors have indicated.<a class="elsevierStyleCrossRefs" href="#bib0050">10,19</a> Although ultrasound articular impingement is a non-standardized qualitative variable, our results suggest that it is not related to pain.Our study has some drawbacks. On the market there is a shorter, narrower “hockey stick” high frequency B transducer which is easier to use in small joints on Doppler mode. However, a small linear 2.5cm long probe and a high-end ultrasound were employed, as well as a very experienced rheumatologist sonographer. The total number of patients included in the study is small and we believe it is mandatory that our results are confirmed with a larger population.In conclusion, this work demonstrates that patients with joint pain have major structural damage and ultrasonographic synovitis than those without pain in osteoarthritis of the PIP and DIP. It confirms that ultrasound detected more osteophytes than conventional radiology of the hands. We hope that longitudinal studies of the diagnostic–therapeutic clinical importance are performed to elucidate whether synovitis predicts structural damage in patients with osteoarthritis of the hands or vice versa.Ethical ResponsibilitiesProtection of persons and animalsThe authors declare that the performed 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 privacyThe 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 written informed consent to participate in the 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.FinancingThe authors declare that this study did not have funding.Conflict of InterestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres368282" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec347454" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres368283" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec347455" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical Study" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Radiological Study" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Ultrasonography" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical Analysis" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 9 => array:3 [ "identificador" => "sec0045" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of persons and animals" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Data privacy" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Financing" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of Interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-08-27" "fechaAceptado" => "2014-01-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec347454" "palabras" => array:3 [ 0 => "Finger osteoarthritis" 1 => "Ultrasonography" 2 => "Pain" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec347455" "palabras" => array:3 [ 0 => "Artrosis de dedos" 1 => "Ecografía" 2 => "Dolor" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo date few studies have examined whether ultrasonography can depict morphologic differences in painful and painless osteoarthritis (OA). This study describes and compares the clinical, radiographic and ultrasonographic findings of patients with both painful and painless proximal interphalangeal (PIP) and/or distal interphalangeal (DIP) OA. MethodsPatients with PIP and/or DIP OA (ACR criteria) were prospectively recruited. The clinical rheumatologist chose up to 3 painful joints and up to 3 painless symmetric joints in each patient to define 2 cohorts of OA: symptomatic (SG) and asymptomatic (ASG). A conventional postero-anterior hand X-ray was performed and read by one rheumatologist following the OARSI atlas, blinded to clinical and sonographic data. Ultrasound (US) was performed by an experienced rheumatologist, blinded to both clinical and radiographic data in joints previously selected by the clinical rheumatologist. US-pathology was assessed as present or absent as defined in previous reports: osteophytes, joint space narrowing, synovitis, intra-articular power Doppler signal, intra-articular bony erosion, and visualization of cartilage. Radiographic and ultrasonographic intrareader reliability test was performed. ResultsA total of 50 joints in the SG and ASG were included from 20 right-handed women aged 61.85 (46–73) years with PIP and DIP OA diagnosed 6.8 (1–17) years ago. In all, 70% SG and ASG joints were right and left sided respectively. The SG showed significantly more osteophytes, synovitis and non-visualization of joint cartilage. Intrareader radiographic and ultrasonographic agreement was excellent. ConclusionThis study demonstrates that painful PIP and/or DIP OA has more ultrasonographic structural changes and synovitis." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivoPocos estudios han examinado si existen diferencias morfológicas detectables con ecografía entre las articulaciones sintomáticas y las que no lo son en pacientes con artrosis. Este estudio describe y compara los hallazgos clínicos, radiológicos y ecográficos de los pacientes con artrosis interfalángica proximal (IFP) y/o distal (IFD) que tienen articulaciones con y sin dolor. MétodosProspectivamente, se incluyó a pacientes con artrosis IFP y/o IFD según los criterios ACR. El reumatólogo clínico eligió hasta un máximo de 3 articulaciones dolorosas y 3 articulaciones no dolorosas de localización simétrica en cada paciente para formar 2 cohortes de artrosis: grupo con dolor (GD) y grupo sin dolor (GSD). La radiografía simple postero-anterior de las manos fue leída por un reumatólogo según las recomendaciones del atlas OARSI, ciego a toda información clínica y ecográfica. El estudio ecográfico fue realizado por un reumatólogo en las articulaciones previamente seleccionadas por el clínico ciego a los datos clínicos y radiológicos. Se registraron como ausente o presente: osteofitos, pinzamiento articular, sinovitis, señal Doppler intraarticular, erosiones y visualización del cartílago. Se realizó un estudio de fiabilidad intralector para la radiología y para la ecografía. ResultadosSe estudió un total de 50 articulaciones en cada cohorte de 20 mujeres diestras de 61,85 años de edad (46–73) con artrosis IFP y IFD diagnosticada hace 6,8 años (1–17 años). El 70% de las articulaciones del GD y GSD se localizaron en la mano derecha e izquierda, respectivamente. El GD tenía significativamente más osteofitos, sinovitis y ausencia de cartílago que el GSD. La fiabilidad interlector radiológico y ecográfico fue excelente. ConclusiónLa ecografía detecta más daño estructural y sinovitis en las IFP y/o IFD artrósicas que presentan dolor." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Usón J, Fernández-Espartero C, Villaverde V, Condés E, Godo J, Martínez-Blasco MJ, et al. Artrosis interfalángica sintomática y asintomática: un estudio ecográfico. Reumatol Clin. 2014;10:278–282." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 676 "Ancho" => 1936 "Tamanyo" => 208684 ] ] "descripcion" => array:1 [ "en" => "DIP osteoarthritis: image of hand (A), X (B) zoom of the joint (C) and corresponding ultrasound study from dorsal (D), medial (E), lateral (F) and palmar perspectives (G)." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n=100 \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">PG \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">PFG \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-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">50 \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">50 \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">Right \t\t\t\t\t\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">34 \t\t\t\t\t\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">18 \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">PIP \t\t\t\t\t\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">16 \t\t\t\t\t\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 \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">DIP \t\t\t\t\t\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">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="char" 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></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" 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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left \t\t\t\t\t\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">16 \t\t\t\t\t\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">32 \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">PIP \t\t\t\t\t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DIP \t\t\t\t\t\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 \t\t\t\t\t\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">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab553706.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of the Joints of PG and PFG." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "AC: absence of cartilage; E: erosion; IO: osteophyte index; O: osteophytes; PA: joint impingement; PDS: power Doppler synovitis; QM: mucinous cyst; S: synovitis." "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">PG \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">PFG \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">P \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">PA-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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 (98) \t\t\t\t\t\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></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" 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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IO-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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.76 \t\t\t\t\t\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">0.44 \t\t\t\t\t\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">.028 \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">O proximal-lateral \t\t\t\t\t\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">13 (26%) \t\t\t\t\t\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 (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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.039 \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">O proximal-medial \t\t\t\t\t\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">21 (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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (26%) \t\t\t\t\t\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></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">O distal-lateral \t\t\t\t\t\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">30 (60%) \t\t\t\t\t\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">15 (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O distal-medial \t\t\t\t\t\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">41 (82%) \t\t\t\t\t\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">31 (26%) \t\t\t\t\t\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">.021 \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="4" 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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">E-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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (28%) \t\t\t\t\t\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 (14%) \t\t\t\t\t\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">* \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">PA-ECO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (90%) \t\t\t\t\t\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">44 (88%) \t\t\t\t\t\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></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" 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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IO-ECO \t\t\t\t\t\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">0.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O proximal-lateral \t\t\t\t\t\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">35 (70%) \t\t\t\t\t\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">31 (61%) \t\t\t\t\t\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></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">O proximal-medial \t\t\t\t\t\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">38 (76%) \t\t\t\t\t\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">32 (64%) \t\t\t\t\t\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></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">O proximal-dorsal \t\t\t\t\t\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">24 (48%) \t\t\t\t\t\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">17 (34%) \t\t\t\t\t\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">.065 \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">O proximal-palmar \t\t\t\t\t\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">21 (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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (32%) \t\t\t\t\t\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></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">O distal-lateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (90%) \t\t\t\t\t\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">44 (88%) \t\t\t\t\t\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></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">O distal-medial \t\t\t\t\t\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">44 (88%) \t\t\t\t\t\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">42 (84%) \t\t\t\t\t\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></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">O distal-dorsal \t\t\t\t\t\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">34 (68%) \t\t\t\t\t\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">30 (60%) \t\t\t\t\t\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></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">O distal-palmar \t\t\t\t\t\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">25 (50%) \t\t\t\t\t\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">26 (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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="4" 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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">E-ECO \t\t\t\t\t\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 (20%) \t\t\t\t\t\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 (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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \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">S-ECO \t\t\t\t\t\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">15 (30%) \t\t\t\t\t\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 (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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.022 \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">PDS-ECO \t\t\t\t\t\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 (2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\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></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">AC-ECO \t\t\t\t\t\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">15 (30%) \t\t\t\t\t\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 (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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.022 \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">QM-ECO \t\t\t\t\t\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 (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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab553707.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Trend toward significance." ] ] ] "descripcion" => array:1 [ "en" => "Radiographic and Ultrasound Findings in PG and PFG." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can ultrasonography improve radiographic assessment in osteoarthritis of the hands? A comparison between radiographic and ultrasonographic detected pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.I. Keen" 1 => "R.J. Wakefield" 2 => "A.J. Grainger" 3 => "E.M.A. Hensor" 4 => "P. Emery" 5 => "P.G. Conaghan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "67" "paginaInicial" => "116" "paginaFinal" => "120" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An ultrasonographic study of osteoarthritis of the hand: synovitis and its relationship to structural pathology and symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.I. Keen" 1 => "R.J. Wakefield" 2 => "A.J. Grainger" 3 => "E.M.A. Hensor" 4 => "P. Emery" 5 => "P.G. Conaghan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.24312" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2008" "volumen" => "59" "paginaInicial" => "1756" "paginaFinal" => "1763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19035429" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Altman" 1 => "G. Alarcón" 2 => "D. Appelrouth" 3 => "D. Bloch" 4 => "D. Borenstein" 5 => "K. Brandt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1990" "volumen" => "33" "paginaInicial" => "1601" "paginaFinal" => "1610" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2242058" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atlas of individual radiographic features in osteoarthritis, revised" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.D. Altman" 1 => "G.E. Gold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.joca.2006.06.017" "Revista" => array:6 [ "tituloSerie" => "Osteoarthr Cartil" "fecha" => "2007" "volumen" => "15" "paginaInicial" => "1" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16891130" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Musculoskeletal ultrasound including definitions for ultrasonographic pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J. Wakefield" 1 => "P.V. Balint" 2 => "M. Szhudlarek" 3 => "E. Filippucci" 4 => "M. Backhaus" 5 => "M.A. DÁgostino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "2485" "paginaFinal" => "2487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16331793" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Distribution of radiographic osteoarthritis between the right and left hands, hips and knees" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Neame" 1 => "W. Zhang" 2 => "C. Deighton" 3 => "M. Doherty" 4 => "S. Doherty" 5 => "P. Lanyon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.20145" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2004" "volumen" => "50" "paginaInicial" => "1495" "paginaFinal" => "1500" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15146419" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Artropatía de las manos de origen profesional: mano del ordenador" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Ferreiro" 1 => "R. Gomez" 2 => "R. Ibañez" 3 => "R. Formigo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "1997" "volumen" => "109" "paginaInicial" => "661" "paginaFinal" => "663" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hand use and patterns of joint involvement in osteoarthritis. A comparison of female dentists and teachers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Solovieva" 1 => "T. Vehmas" 2 => "H. Riihimaki" 3 => "K. Luoma" 4 => "P. Leino-Arjas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/keh534" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2005" "volumen" => "44" "paginaInicial" => "521" "paginaFinal" => "528" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15728421" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chopstick arthropathy: the Beijing Osteoarthritis Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. Hunter" 1 => "Y. Zhang" 2 => "M.C. Nevitt" 3 => "L. Xu" 4 => "J. Niu" 5 => "L.Y. Lui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.20145" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2004" "volumen" => "50" "paginaInicial" => "1495" "paginaFinal" => "1500" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15146419" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-detected synovitis with power Doppler signal is associated with severe radiographic damage and reduced cartilage thickness in hand osteoarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Mancarella" 1 => "M. Magnani" 2 => "O. Addimanda" 3 => "E. Pignotti" 4 => "S. Galletti" 5 => "R. Meliconi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.joca.2010.06.006" "Revista" => array:6 [ "tituloSerie" => "Osteoarthr Cartil" "fecha" => "2010" "volumen" => "18" "paginaInicial" => "1263" "paginaFinal" => "1268" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20656045" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In erosive hand osteoarthritis more inflammatory signs on ultrasound are found than in the rest of hand osteoarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.C. Kortekaas" 1 => "W.Y. Kwok" 2 => "M. Reijnierse" 3 => "T.W.J. Huizinga" 4 => "M. Kloppenburg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2009.124875" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2010" "volumen" => "69" "paginaInicial" => "1367" "paginaFinal" => "1369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20472595" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound features of nonstructural lesions of the proximal and distal interphalangeal joints of the hands in patients with finger osteoarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Arrestier" 1 => "C. Rosenberg" 2 => "F. Etchepare" 3 => "S. Rozenberg" 4 => "V. Foltz" 5 => "B. Fautrel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jbspin.2010.05.006" "Revista" => array:6 [ "tituloSerie" => "Joint Bone Spine" "fecha" => "2011" "volumen" => "78" "paginaInicial" => "65" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20599415" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and ultrasonographic changes in patients with symptomatic knee osteoarthritis treated with celecoxib" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Uson" 1 => "R. Miguelez-Sanchez" 2 => "M.C. Fernandez-Espartero" 3 => "R. Gonzalez-Crespo" 4 => "V. Villaverde-García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Ann Reum Dis" "fecha" => "2006" "volumen" => "65" "paginaInicial" => "61" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do non-steroidal anti-inflammatory drugs have a significant effect on detection and grading of ultrasound-detected synovitis in patients with rheumatoid arthritis? Results from a randomised study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.S. Zayat" 1 => "P.G. Conaghan" 2 => "M. Sharif" 3 => "J.E. Freeston" 4 => "C. Wenham" 5 => "E.M. Hensor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2011-200017" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "1746" "paginaFinal" => "1751" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21803749" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonographic assessment of osteophytes in 127 patients with hand osteoarthritis: exploring reliability and associations with MRI, radiographs and clinical joint findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Mathiessen" 1 => "I.K. Haugen" 2 => "B. Slatkowsky-Christensen" 3 => "P. Bøyesen" 4 => "T.K. Kvien" 5 => "H.B. Hammer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2011-201195" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2013" "volumen" => "72" "paginaInicial" => "51" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22523427" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "A.L. Tan" 1 => "A.J. Grainger" 2 => "S.F. Tanner" 3 => "D.M. Shelley" 4 => "C. Pease" 5 => "P. Emery" 6 => "D. McGonagle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.21210" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2005" "volumen" => "52" "paginaInicial" => "2355" "paginaFinal" => "2365" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16052535" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Structural and inflammatory sonographic findings in erosive and non-erosive osteoarthritis of the interphalangeal finger joints" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Wittoek" 1 => "P. Carron" 2 => "G. Verbruggen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2010.128504" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2010" "volumen" => "69" "paginaInicial" => "2173" "paginaFinal" => "2176" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20693271" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Vlychou" 1 => "A. Koutroumpas" 2 => "K. Malizos" 3 => "L.I. Sakkas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Osteoarthr Cartilage" "fecha" => "2009" "volumen" => "17" "paginaInicial" => "1283" "paginaFinal" => "1287" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteophytes and joint space narrowing are independently associated with pain in finger joints in hand osteoarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.C. Kortekaas" 1 => "W.-Y. Kwok" 2 => "M. Reijnierse" 3 => "T.W.J. Huizinga" 4 => "M. Kloppenburg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2010.147553" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "1835" "paginaFinal" => "1837" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21742640" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001000000005/v1_201409070108/S217357431400080X/v1_201409070108/en/main.assets" "Apartado" => array:4 [ "identificador" => "17338" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001000000005/v1_201409070108/S217357431400080X/v1_201409070108/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431400080X?idApp=UINPBA00004M"]

Statistics

Original Article

Symptomatic and Asymptomatic Interphalangeal Osteoarthritis: An Ultrasonographic Study

Artrosis interfalángica sintomática y asintomática: un estudio ecográfico

Jacqueline Usóna,

Corresponding author

juson62@hotmail.com

Corresponding author.

, Cruz Fernández-Esparteroa, Virginia Villaverdea, Emilia Condésb, Javier Godoc, Maria Jesus Martínez-Blascoa, Roberto Miguéleza

a Sección de Reumatología, Hospital Universitario Móstoles, Madrid, Spain

b Departamento Ciencias de la Salud, Universidad Europea de Madrid, Madrid, Spain

c Sección de Reumatología, Hospital Universitario Jiménez Díaz, Madrid, Spain

Read

7690

Times
was read the article

2125

Total PDF

5565

Total HTML

Share statistics

 array:24 [
  "pii" => "S217357431400080X"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2014.01.008"
  "estado" => "S300"
  "fechaPublicacion" => "2014-09-01"
  "aid" => "651"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;. All rights reserved"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Reumatol Clin. 2014;10:278-82"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2585
    "formatos" => array:3 [
      "EPUB" => 51
      "HTML" => 2216
      "PDF" => 318
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X14000333"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2014.01.008"
      "estado" => "S300"
      "fechaPublicacion" => "2014-09-01"
      "aid" => "651"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "fla"
      "cita" => "Reumatol Clin. 2014;10:278-82"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 35721
        "formatos" => array:3 [
          "EPUB" => 190
          "HTML" => 33644
          "PDF" => 1887
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Artrosis interfal&#225;ngica sintom&#225;tica y asintom&#225;tica&#58; un estudio ecogr&#225;fico"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "278"
            "paginaFinal" => "282"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Symptomatic and asymptomatic interphalageal osteoarthritis&#58; An ultrasonographic study"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "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" => 787
                "Ancho" => 2257
                "Tamanyo" => 256711
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Atrosis IFD&#58; imagen de las manos &#40;A&#41;&#44; radiograf&#237;a &#40;B&#41;&#44; zoom de la articulaci&#243;n &#40;C&#41; y estudio ecogr&#225;fico correspondiente desde dorsal &#40;D&#41;&#44; medial &#40;E&#41;&#44; lateral &#40;C&#41; y palmar &#40;D&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Jacqueline Us&#243;n, Cruz Fern&#225;ndez-Espartero, Virginia Villaverde, Emilia Cond&#233;s, Javier Godo, Maria Jesus Mart&#237;nez-Blasco, Roberto Migu&#233;lez"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "Jacqueline"
                "apellidos" => "Us&#243;n"
              ]
              1 => array:2 [
                "nombre" => "Cruz"
                "apellidos" => "Fern&#225;ndez-Espartero"
              ]
              2 => array:2 [
                "nombre" => "Virginia"
                "apellidos" => "Villaverde"
              ]
              3 => array:2 [
                "nombre" => "Emilia"
                "apellidos" => "Cond&#233;s"
              ]
              4 => array:2 [
                "nombre" => "Javier"
                "apellidos" => "Godo"
              ]
              5 => array:2 [
                "nombre" => "Maria Jesus"
                "apellidos" => "Mart&#237;nez-Blasco"
              ]
              6 => array:2 [
                "nombre" => "Roberto"
                "apellidos" => "Migu&#233;lez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S217357431400080X"
          "doi" => "10.1016/j.reumae.2014.01.008"
          "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/S217357431400080X?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14000333?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001000000005/v1_201408240347/S1699258X14000333/v1_201408240347/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S217357431400063X"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2014.03.013"
    "estado" => "S300"
    "fechaPublicacion" => "2014-09-01"
    "aid" => "644"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2014;10:283-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2307
      "formatos" => array:3 [
        "EPUB" => 58
        "HTML" => 1850
        "PDF" => 399
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Nutritional Support in Patients With Systemic Sclerosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "283"
          "paginaFinal" => "287"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Soporte nutricional a pacientes con esclerosis sist&#233;mica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Vera Ortiz-Santamaria, Celia Puig, Cristina Soldevilla, Anna Barata, Jordi Cuquet, Asunci&#243;n Recasens"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Vera"
              "apellidos" => "Ortiz-Santamaria"
            ]
            1 => array:2 [
              "nombre" => "Celia"
              "apellidos" => "Puig"
            ]
            2 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Soldevilla"
            ]
            3 => array:2 [
              "nombre" => "Anna"
              "apellidos" => "Barata"
            ]
            4 => array:2 [
              "nombre" => "Jordi"
              "apellidos" => "Cuquet"
            ]
            5 => array:2 [
              "nombre" => "Asunci&#243;n"
              "apellidos" => "Recasens"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X14000096"
        "doi" => "10.1016/j.reuma.2013.12.011"
        "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/S1699258X14000096?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431400063X?idApp=UINPBA00004M"
    "url" => "/21735743/0000001000000005/v1_201409070108/S217357431400063X/v1_201409070108/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S217357431400135X"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2014.07.002"
    "estado" => "S300"
    "fechaPublicacion" => "2014-09-01"
    "aid" => "706"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2014;10:275-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2576
      "formatos" => array:3 [
        "EPUB" => 58
        "HTML" => 2048
        "PDF" => 470
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Triple therapy in rheumatoid arthritis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "275"
          "paginaFinal" => "277"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Triple terapia en la artritis reumatoide"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lydia Ab&#225;solo Alc&#225;zar"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Lydia"
              "apellidos" => "Ab&#225;solo Alc&#225;zar"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X14001569"
        "doi" => "10.1016/j.reuma.2014.07.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14001569?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431400135X?idApp=UINPBA00004M"
    "url" => "/21735743/0000001000000005/v1_201409070108/S217357431400135X/v1_201409070108/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Symptomatic and Asymptomatic Interphalangeal Osteoarthritis&#58; An Ultrasonographic Study"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "278"
        "paginaFinal" => "282"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Jacqueline Us&#243;n, Cruz Fern&#225;ndez-Espartero, Virginia Villaverde, Emilia Cond&#233;s, Javier Godo, Maria Jesus Mart&#237;nez-Blasco, Roberto Migu&#233;lez"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "Jacqueline"
            "apellidos" => "Us&#243;n"
            "email" => array:1 [
              0 => "juson62&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Cruz"
            "apellidos" => "Fern&#225;ndez-Espartero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Virginia"
            "apellidos" => "Villaverde"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Emilia"
            "apellidos" => "Cond&#233;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Javier"
            "apellidos" => "Godo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Maria Jesus"
            "apellidos" => "Mart&#237;nez-Blasco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Roberto"
            "apellidos" => "Migu&#233;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Secci&#243;n de Reumatolog&#237;a&#44; Hospital Universitario M&#243;stoles&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departamento Ciencias de la Salud&#44; Universidad Europea de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Secci&#243;n de Reumatolog&#237;a&#44; Hospital Universitario Jim&#233;nez D&#237;az&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Artrosis interfal&#225;ngica sintom&#225;tica y asintom&#225;tica&#58; un estudio ecogr&#225;fico"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 676
            "Ancho" => 1936
            "Tamanyo" => 208684
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">DIP osteoarthritis&#58; image of hand &#40;A&#41;&#44; X &#40;B&#41; zoom of the joint &#40;C&#41; and corresponding ultrasound study from dorsal &#40;D&#41;&#44; medial &#40;E&#41;&#44; lateral &#40;F&#41; and palmar perspectives &#40;G&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Osteoarthritis of the proximal interphalangeal &#40;PIP&#41; and distal interphalangeal &#40;DIP&#41; joints is the most common cause of hand pain and disability in the developed world&#46; At present&#44; both its diagnosis and its follow-up are based on clinical and radiological parameters&#46; However&#44; as is well known&#44; there is no correlation between symptoms and radiographic changes&#46; We may find patients with joint pain and little or no radiological changes and patients with significant radiological structural lesions without pain&#46; There are numerous alterations&#44; inflammatory&#44; morphological and structural&#44; on the joint and extra-articularly that can cause joint pain&#44; effusion&#44; synovitis&#44; mucinous cysts&#44; cartilage lesions&#44; erosions and osteophytes&#46; Ultrasound has innate characteristics that no other imaging techniques have&#44; such as excellent spatial resolution&#44; the ability to obtain multiplanar and dynamic images in real time&#44; and is safe&#44; accessible and performable by the clinician&#46; All the above make this imaging modality widely researched and developed for osteoarthritis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Helen Keen&#39;s group in Leeds&#44; UK&#44; has demonstrated construct validity for ultrasonography versus radiology and the ability of this technique in detecting osteophytes&#44; joint impingement and synovitis in osteoarthritis of the fingers&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These same authors have shown that ultrasound detected more osteophytes than conventional radiology and&#44; in symptomatic osteoarthritis of the fingers&#44; more synovitis&#44; osteophytes and articular impingement are detected in the joints of<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> healthy controls&#46; However&#44; to date no one has explored whether there are detectable morphological differences found by ultrasound between painless and painful PIP or DIP joints in the same patient with osteoarthritis of the fingers&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of this study was to describe and compare the clinical&#44; radiographic and ultrasonographic findings in patients with osteoarthritis of the PIP and&#47;or DIP joints with and without pain&#46; Moreover&#44; morphological alterations related to painful joints were identified&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This descriptive&#44; prospective&#44; cross-sectional study was approved by the local ethics committee and conducted at the University Hospital of M&#243;stoles&#44; Madrid&#46; Patients recruited from the hospital&#39;s rheumatology outpatient clinic gave their written consent and had been diagnosed with PIP and&#47;or PIP osteoarthritis according to the criteria of the &#8220;American College of Rheumatology&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> No patient had inflammatory arthropathy&#44; microcrystalline arthritis or fibromyalgia&#46; Intra-articular injection was not allowed at least 6 months before the study&#46; In each patient&#44; the clinician identified 2 or 3 symptomatic and asymptomatic PIP and&#47;or DIP joints with deformity upon inspection&#44; to form osteoarthritis pain &#40;PG&#41; and without pain &#40;PFG&#41; groups&#46; PG joints exhibited pain intensity greater than or equal to 3 on the numeric scale as well as tenderness and joint deformity on inspection&#44; while PFG joints exhibited only articular deformity&#46; All patients underwent clinical&#44; radiological and ultrasound tests as detailed below&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Clinical Study</span><p id="par0025" class="elsevierStylePara elsevierViewall">Sex&#44; age&#44; duration of disease from diagnosis&#44; dominant hand&#44; profession&#47;occupation and current treatment were recorded&#46; The clinical rheumatologist asked each patient which PIP and&#47;or DIP joint was most painful and the numerical global pain intensity scale &#40;ENID 0-10&#41; score of the finger joints was calculated&#46; The clinician palpated each joint and determined the presence or absence of pain&#44; deformity and effusion&#46; In addition&#44; the clinician chose and recorded the joints of each patient for each cohort&#46; In a diagram of the joints of the hand&#44; the clinician marked with an X those he intended to explore using joint ultrasound&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Radiological Study</span><p id="par0030" class="elsevierStylePara elsevierViewall">One posteroanterior conventional radiography of both hands in the same week as the clinical study was performed&#46; The reading was performed by the same rheumatologist &#40;CFE&#41;&#44; blinded to the clinical and ultrasound testing&#46; The following structural lesions were interpreted&#44; as recommended by the OARSI atlas&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> as absent or present&#58; medial and lateral osteophytes in the proximal and distal phalanges of the proximal and distal interphalangeal joints&#44; and joint impingement&#46; Erosions were defined as a cessation of the intrajoint cortex&#46; The intraobserver reliability was tested each month with radiographs of the last 5 of the included patients &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ultrasonography</span><p id="par0035" class="elsevierStylePara elsevierViewall">An ultrasound expert rheumatologist &#40;JU&#41; performed the test blinded to clinical and radiological information&#44; a maximum 48<span class="elsevierStyleHsp" style=""></span>h after the clinical examination&#46; A General Electric Logic 9 ultrasound machine with an M12 linear probe &#40;GE Medical Systems Ultrasound and Primary Care Diagnostics&#44; LLC&#44; Wauwatosa&#44; USA&#41; was employed&#46; In their longitudinal and transverse axis&#44; the dorsal&#44; palmar&#44; lateral and medial aspects of each PIP and DIP joint&#44; with the hand outstretched on the table&#44; were explored&#46; Ultrasound semiology of the lesions<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> is described below&#46; Each lesion was recorded as absent or present&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Osteophytes&#58;</span> hyperechoic cortical protrusions visualized in 2 planes in the dorsal aspects&#44; palmar&#44; lateral&#44; medial proximal and distal phalanges of the PIP and DIP joints&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Joint impingement</span>&#58; decrease in the space between the cortical margins&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Mucinous cysts</span>&#58; extraarticular anechogenic collection communicating with the joint&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ultrasonographic synovitis</span> &#40;effusion and&#47;or synovial hypertrophy&#41;&#58; distension of the joint capsule &#8805;1&#46;5<span class="elsevierStyleHsp" style=""></span>mm in its anteroposterior diameter with compressible and&#47;or movable material measured in the dorsal or palmar face&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Signal power Doppler</span> intraarticular Doppler signal &#40;Doppler frequency from 6&#46;3 to 7&#46;5<span class="elsevierStyleHsp" style=""></span>MHz PRF 600<span class="elsevierStyleHsp" style=""></span>Hz&#44; gain set to remove noise&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Erosion by ultrasound</span>&#58; intraarticular cortical defect visualized in 3 planes and in extension and flexion&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cartilage phalanx head</span> on maximum longitudinal flexion and with the probe on the head of the proximal phalanx&#44; the display or non-display of an anechoic band over the head of the phalanx was assessed&#46;</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">Once a month&#44; the intraobserver reliability was assessed with video clips of the joints of the last 5 of the patients included&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical Analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS version 15&#46;0&#46; Quantitative variables were calculated as the average and 95&#37; confidence interval&#46; Qualitative variables were calculated as the percentages&#46; A radiological osteophyte index was calculated as the sum of proximal and distal osteophytes of a medial and lateral location divided by 4&#44; and the ultrasonographic osteophyte index was calculated as the sum of proximal and distal osteophytes of dorsal&#44; palmar&#44; medial and lateral location divided by 8&#46; To study the statistical contrasts&#44; the McNamara and Fisher&#39;s tests for related dichotomous independent variables and Student&#39;s <span class="elsevierStyleItalic">t</span>-test for independent or related variables were employed&#46; The percentage of radiographic and ultrasonographic intraobserver agreement was calculated&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 50 joints were studied in the PG and 50 in the PFG in 20 right-handed women&#44; 61&#46;85 &#40;46&#8211;73&#41; years of age&#44; diagnosed with osteoarthritis of the PIP and&#47;or DIP for a mean 6&#46;80 years &#40;1&#8211;17&#41;&#46; Seven women worked as maids&#44; 6 as housewives&#44; 3 as laboratory technicians&#44; 3 as seamstresses and one was a manipulative graphic artist&#46; Seventeen of the 20 patients were taking pain medications&#44; NSAIDs being the most common &#40;60&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the distribution of the joints of the PG and PFG&#46; In all&#44; 70&#37; of painful joints were located in the right hand and their corresponding non-painful joints on the left hand&#59; 40&#37; of PG joints were located on the second right DIP&#44; right third DIP and left second DIP&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the radiographic and ultrasonographic findings in the PG and PFG&#46; The PG had significantly greater radiographic and ultrasonographic osteophyte index scores&#44; with no sonographic visualization of synovitis and cartilage&#46; Sonography detected more osteophytes than radiology&#46; The ultrasound osteophyte index was higher in PG and PFG than radiologically &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001 and <span class="elsevierStyleItalic">P</span>&#60;&#46;006&#44; respectively&#41;&#46; Ultrasound detected synovitis in 15 and 6 joints of the PG and PFG&#44; respectively&#44; while clinical palpation led to the suspicion of arthritis in 14 and 0 joints of the PG and PFG&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The radiological intraobserver agreement was 100&#37; for joint impingement and erosion&#44; and 98&#37; for the osteophyte index&#46; The ultrasound intraobserver agreement was 100&#37; for joint impingement&#44; erosion&#44; synovitis and absence of articular cartilage&#44; and 98&#37; for the osteophyte index&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The analysis of all radiological and ultrasonographic variables grouping the PIP and DIP showed no statistical significance&#46; While the analysis of radiological and ultrasound variables in the 2 cohorts according to age showed that patients aged 60 years or less tended to have a higher rate of ultrasound osteophyte&#44; erosion and synovitis&#44; patients older than 61 years tended to present a greater radiographic osteophyte index and no ultrasound visualization of articular cartilage&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study&#44; which was conducted in PIP and DIP of 20 women who were skilled manual workers&#44; demonstrated that symptomatic joints &#40;PG&#41; are found mostly &#40;70&#37;&#41; in the dominant hand and exhibit a higher radiological-ultrasound structural damage and inflammation-through-ultrasound than asymptomatic joints &#40;PFG&#41;&#46; This clinical&#8211;morphological finding indicates that mechanical stress on the dominant hand plays a pathogenic role in osteoarthritis of the fingers and supports some of the few epidemiological studies designed to demonstrate the association between manual activity and osteoarthritis of fingers&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;9</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Patients with osteoarthritis of the hands have more ultrasonographic synovitis than healthy controls&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;10</span></a> and ultrasonographic synovitis in painful osteoarthritic hands than in painless ones&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;11&#44;12</span></a> Keen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Kortekaas et al&#46; studied<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> 30 hand joints&#44; finding synovitis in approximately 80&#37; of joints in patients with osteoarthritis of the hands&#44; while Arrestier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> studied the interphalangeal joints of the hands&#44; finding synovitis in about 25&#37; of the joints&#59; however&#44; they did not distinguish the asymptomatic from the symptomatic&#46; We found synovitis in 21&#37; of the studied joints&#44; and was significantly higher in the painful joints than in the non-painful &#40;15 vs 6&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41;&#46; As for intraarticular Doppler signal&#44; this was lower in our study compared with that in the studies by Keen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Kortekaas et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> but similar to the values found in other studies such as Arrestier et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and Mancarella et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Unlike previous studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;11&#44;12</span></a> in our study 98&#37; of the patients were taking NSAIDs&#44; which decreases the detection of synovitis in gray scale and Doppler modes&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The higher spatial resolution of ultrasound versus radiology allows for the detection of osteophytes on the palm and back of fingers not visible using radiology&#46; Like other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;15</span></a> and especially in the study of Mathiessen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> which is the largest cohort to date&#44; with 127 patients with osteoarthritis of the hand&#44; ultrasound clearly detected more osteophytes than plain radiography of the hands&#46; Curiously&#44; given that MRI detects few osteophytes in the palm of the hand&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Mathiessen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> did not include palmar ultrasound examination&#44; while we did include it&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">It has been shown that radiographic erosive hand osteoarthritis exhibits more ultrasound B mode and Doppler synovitis than nonerosive cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;17&#44;18</span></a> We did not differentiate these phenotypes in the inclusion criteria or study it&#46; We found that patients aged 60 years or less tended to have more erosions and synovitis than those aged more than 60 years&#44; which indicates the possibility of differences in the phenotype of the patients&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">To date&#44; this pilot study is the first to compare morphological causes of pain in the same patient with osteoarthritis of the fingers&#46; When compared with the same patient&#44; the bias of the patient&#39;s personality decreases in the pain assessment&#46; Also&#44; the fact that the clinician seeks the most similar non-painful joint in appearance for comparison reduces bias at the articular level&#46; Kortekaas published 2 different studies&#59; the first demonstrates that synovitis is associated with pain in patients with osteoarthritis of the hand<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and the second shows that both osteophytes and joint space narrowing are independently associated with pain&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> We jointly studied the inflammation and structural damage&#44; observing that painful joints have more synovitis and structural damage on ultrasound with regard to the presence of radiographic osteophytes&#44; as well as the absence of ultrasonographic cartilage&#44; with a trend toward significance in radiological and ultrasound joint erosion&#44; as other authors have indicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;19</span></a> Although ultrasound articular impingement is a non-standardized qualitative variable&#44; our results suggest that it is not related to pain&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our study has some drawbacks&#46; On the market there is a shorter&#44; narrower &#8220;hockey stick&#8221; high frequency B transducer which is easier to use in small joints on Doppler mode&#46; However&#44; a small linear 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm long probe and a high-end ultrasound were employed&#44; as well as a very experienced rheumatologist sonographer&#46; The total number of patients included in the study is small and we believe it is mandatory that our results are confirmed with a larger population&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; this work demonstrates that patients with joint pain have major structural damage and ultrasonographic synovitis than those without pain in osteoarthritis of the PIP and DIP&#46; It confirms that ultrasound detected more osteophytes than conventional radiology of the hands&#46; We hope that longitudinal studies of the diagnostic&#8211;therapeutic clinical importance are performed to elucidate whether synovitis predicts structural damage in patients with osteoarthritis of the hands or vice versa&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical Responsibilities</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of persons and animals</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that the performed 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="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Data privacy</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of data from patients&#44; and all patients included in the study have received sufficient information and gave written informed consent to participate in the study&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0150" 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="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financing</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that this study did not have funding&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of Interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:2 [
          "identificador" => "xres368282"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Objective"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusion"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec347454"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres368283"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Objetivo"
            2 => "M&#233;todos"
            3 => "Resultados"
            4 => "Conclusi&#243;n"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec347455"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Patients and Methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Clinical Study"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Radiological Study"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Ultrasonography"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Statistical Analysis"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Results"
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Discussion"
        ]
        9 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "Ethical Responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Protection of persons and animals"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Data privacy"
            ]
            2 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Financing"
        ]
        11 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflict of Interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-08-27"
    "fechaAceptado" => "2014-01-24"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec347454"
          "palabras" => array:3 [
            0 => "Finger osteoarthritis"
            1 => "Ultrasonography"
            2 => "Pain"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec347455"
          "palabras" => array:3 [
            0 => "Artrosis de dedos"
            1 => "Ecograf&#237;a"
            2 => "Dolor"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To date few studies have examined whether ultrasonography can depict morphologic differences in painful and painless osteoarthritis &#40;OA&#41;&#46; This study describes and compares the clinical&#44; radiographic and ultrasonographic findings of patients with both painful and painless proximal interphalangeal &#40;PIP&#41; and&#47;or distal interphalangeal &#40;DIP&#41; OA&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients with PIP and&#47;or DIP OA &#40;ACR criteria&#41; were prospectively recruited&#46; The clinical rheumatologist chose up to 3 painful joints and up to 3 painless symmetric joints in each patient to define 2 cohorts of OA&#58; symptomatic &#40;SG&#41; and asymptomatic &#40;ASG&#41;&#46; A conventional postero-anterior hand X-ray was performed and read by one rheumatologist following the OARSI atlas&#44; blinded to clinical and sonographic data&#46; Ultrasound &#40;US&#41; was performed by an experienced rheumatologist&#44; blinded to both clinical and radiographic data in joints previously selected by the clinical rheumatologist&#46; US-pathology was assessed as present or absent as defined in previous reports&#58; osteophytes&#44; joint space narrowing&#44; synovitis&#44; intra-articular power Doppler signal&#44; intra-articular bony erosion&#44; and visualization of cartilage&#46; Radiographic and ultrasonographic intrareader reliability test was performed&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 50 joints in the SG and ASG were included from 20 right-handed women aged 61&#46;85 &#40;46&#8211;73&#41; years with PIP and DIP OA diagnosed 6&#46;8 &#40;1&#8211;17&#41; years ago&#46; In all&#44; 70&#37; SG and ASG joints were right and left sided respectively&#46; The SG showed significantly more osteophytes&#44; synovitis and non-visualization of joint cartilage&#46; Intrareader radiographic and ultrasonographic agreement was excellent&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study demonstrates that painful PIP and&#47;or DIP OA has more ultrasonographic structural changes and synovitis&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pocos estudios han examinado si existen diferencias morfol&#243;gicas detectables con ecograf&#237;a entre las articulaciones sintom&#225;ticas y las que no lo son en pacientes con artrosis&#46; Este estudio describe y compara los hallazgos cl&#237;nicos&#44; radiol&#243;gicos y ecogr&#225;ficos de los pacientes con artrosis interfal&#225;ngica proximal &#40;IFP&#41; y&#47;o distal &#40;IFD&#41; que tienen articulaciones con y sin dolor&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Prospectivamente&#44; se incluy&#243; a pacientes con artrosis IFP y&#47;o IFD seg&#250;n los criterios ACR&#46; El reumat&#243;logo cl&#237;nico eligi&#243; hasta un m&#225;ximo de 3 articulaciones dolorosas y 3 articulaciones no dolorosas de localizaci&#243;n sim&#233;trica en cada paciente para formar 2 cohortes de artrosis&#58; grupo con dolor &#40;GD&#41; y grupo sin dolor &#40;GSD&#41;&#46; La radiograf&#237;a simple postero-anterior de las manos fue le&#237;da por un reumat&#243;logo seg&#250;n las recomendaciones del atlas OARSI&#44; ciego a toda informaci&#243;n cl&#237;nica y ecogr&#225;fica&#46; El estudio ecogr&#225;fico fue realizado por un reumat&#243;logo en las articulaciones previamente seleccionadas por el cl&#237;nico ciego a los datos cl&#237;nicos y radiol&#243;gicos&#46; Se registraron como ausente o presente&#58; osteofitos&#44; pinzamiento articular&#44; sinovitis&#44; se&#241;al Doppler intraarticular&#44; erosiones y visualizaci&#243;n del cart&#237;lago&#46; Se realiz&#243; un estudio de fiabilidad intralector para la radiolog&#237;a y para la ecograf&#237;a&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; un total de 50 articulaciones en cada cohorte de 20 mujeres diestras de 61&#44;85 a&#241;os de edad &#40;46&#8211;73&#41; con artrosis IFP y IFD diagnosticada hace 6&#44;8 a&#241;os &#40;1&#8211;17 a&#241;os&#41;&#46; El 70&#37; de las articulaciones del GD y GSD se localizaron en la mano derecha e izquierda&#44; respectivamente&#46; El GD ten&#237;a significativamente m&#225;s osteofitos&#44; sinovitis y ausencia de cart&#237;lago que el GSD&#46; La fiabilidad interlector radiol&#243;gico y ecogr&#225;fico fue excelente&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a detecta m&#225;s da&#241;o estructural y sinovitis en las IFP y&#47;o IFD artr&#243;sicas que presentan dolor&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Us&#243;n J&#44; Fern&#225;ndez-Espartero C&#44; Villaverde V&#44; Cond&#233;s E&#44; Godo J&#44; Mart&#237;nez-Blasco MJ&#44; et al&#46; Artrosis interfal&#225;ngica sintom&#225;tica y asintom&#225;tica&#58; un estudio ecogr&#225;fico&#46; Reumatol Clin&#46; 2014&#59;10&#58;278&#8211;282&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 676
            "Ancho" => 1936
            "Tamanyo" => 208684
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">DIP osteoarthritis&#58; image of hand &#40;A&#41;&#44; X &#40;B&#41; zoom of the joint &#40;C&#41; and corresponding ultrasound study from dorsal &#40;D&#41;&#44; medial &#40;E&#41;&#44; lateral &#40;F&#41; and palmar perspectives &#40;G&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#61;100&nbsp;\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">PG&nbsp;\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">PFG&nbsp;\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-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">&nbsp;\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">50&nbsp;\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">50&nbsp;\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"><span class="elsevierStyleItalic">Right</span>&nbsp;\t\t\t\t\t\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">34&nbsp;\t\t\t\t\t\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">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PIP&nbsp;\t\t\t\t\t\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">16&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DIP&nbsp;\t\t\t\t\t\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">18&nbsp;\t\t\t\t\t\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">13&nbsp;\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="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Left</span>&nbsp;\t\t\t\t\t\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">16&nbsp;\t\t\t\t\t\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">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PIP&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DIP&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab553706.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of the Joints of PG and PFG&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AC&#58; absence of cartilage&#59; E&#58; erosion&#59; IO&#58; osteophyte index&#59; O&#58; osteophytes&#59; PA&#58; joint impingement&#59; PDS&#58; power Doppler synovitis&#59; QM&#58; mucinous cyst&#59; S&#58; synovitis&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\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">PG&nbsp;\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">PFG&nbsp;\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"><span class="elsevierStyleItalic">P</span>&nbsp;\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"><span class="elsevierStyleItalic">PA-RX</span>&nbsp;\t\t\t\t\t\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">50 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\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">49 &#40;98&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\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="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IO-RX</span>&nbsp;\t\t\t\t\t\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&#46;76&nbsp;\t\t\t\t\t\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&#46;44&nbsp;\t\t\t\t\t\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">&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O proximal-lateral&nbsp;\t\t\t\t\t\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">13 &#40;26&#37;&#41;&nbsp;\t\t\t\t\t\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 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\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">&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O proximal-medial&nbsp;\t\t\t\t\t\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">21 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\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">13 &#40;26&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O distal-lateral&nbsp;\t\t\t\t\t\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">30 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\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">15 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\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">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O distal-medial&nbsp;\t\t\t\t\t\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">41 &#40;82&#37;&#41;&nbsp;\t\t\t\t\t\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">31 &#40;26&#37;&#41;&nbsp;\t\t\t\t\t\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">&#46;021&nbsp;\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="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">E-RX</span>&nbsp;\t\t\t\t\t\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">14 &#40;28&#37;&#41;&nbsp;\t\t\t\t\t\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 &#40;14&#37;&#41;&nbsp;\t\t\t\t\t\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">&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PA-ECO</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;90&#37;&#41;&nbsp;\t\t\t\t\t\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">44 &#40;88&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\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="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IO-ECO</span>&nbsp;\t\t\t\t\t\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&#46;83&nbsp;\t\t\t\t\t\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&#46;79&nbsp;\t\t\t\t\t\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">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O proximal-lateral&nbsp;\t\t\t\t\t\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">35 &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\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">31 &#40;61&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O proximal-medial&nbsp;\t\t\t\t\t\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">38 &#40;76&#37;&#41;&nbsp;\t\t\t\t\t\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">32 &#40;64&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O proximal-dorsal&nbsp;\t\t\t\t\t\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">24 &#40;48&#37;&#41;&nbsp;\t\t\t\t\t\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">17 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\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">&#46;065&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O proximal-palmar&nbsp;\t\t\t\t\t\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">21 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\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">16 &#40;32&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O distal-lateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;90&#37;&#41;&nbsp;\t\t\t\t\t\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">44 &#40;88&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O distal-medial&nbsp;\t\t\t\t\t\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">44 &#40;88&#37;&#41;&nbsp;\t\t\t\t\t\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">42 &#40;84&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O distal-dorsal&nbsp;\t\t\t\t\t\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">34 &#40;68&#37;&#41;&nbsp;\t\t\t\t\t\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">30 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>O distal-palmar&nbsp;\t\t\t\t\t\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">25 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\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">26 &#40;52&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\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="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">E-ECO</span>&nbsp;\t\t\t\t\t\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 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\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 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\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"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S-ECO</span>&nbsp;\t\t\t\t\t\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">15 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\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 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\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">&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PDS-ECO</span>&nbsp;\t\t\t\t\t\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 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\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 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">AC-ECO</span>&nbsp;\t\t\t\t\t\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">15 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\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 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\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">&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">QM-ECO</span>&nbsp;\t\t\t\t\t\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 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\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 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab553707.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Trend toward significance&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Radiographic and Ultrasound Findings in PG and PFG&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Can ultrasonography improve radiographic assessment in osteoarthritis of the hands&#63; A comparison between radiographic and ultrasonographic detected pathology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;I&#46; Keen"
                            1 => "R&#46;J&#46; Wakefield"
                            2 => "A&#46;J&#46; Grainger"
                            3 => "E&#46;M&#46;A&#46; Hensor"
                            4 => "P&#46; Emery"
                            5 => "P&#46;G&#46; Conaghan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2007"
                        "volumen" => "67"
                        "paginaInicial" => "116"
                        "paginaFinal" => "120"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An ultrasonographic study of osteoarthritis of the hand&#58; synovitis and its relationship to structural pathology and symptoms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;I&#46; Keen"
                            1 => "R&#46;J&#46; Wakefield"
                            2 => "A&#46;J&#46; Grainger"
                            3 => "E&#46;M&#46;A&#46; Hensor"
                            4 => "P&#46; Emery"
                            5 => "P&#46;G&#46; Conaghan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.24312"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2008"
                        "volumen" => "59"
                        "paginaInicial" => "1756"
                        "paginaFinal" => "1763"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19035429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Altman"
                            1 => "G&#46; Alarc&#243;n"
                            2 => "D&#46; Appelrouth"
                            3 => "D&#46; Bloch"
                            4 => "D&#46; Borenstein"
                            5 => "K&#46; Brandt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "1990"
                        "volumen" => "33"
                        "paginaInicial" => "1601"
                        "paginaFinal" => "1610"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2242058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atlas of individual radiographic features in osteoarthritis&#44; revised"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;D&#46; Altman"
                            1 => "G&#46;E&#46; Gold"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.joca.2006.06.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoarthr Cartil"
                        "fecha" => "2007"
                        "volumen" => "15"
                        "paginaInicial" => "1"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16891130"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Musculoskeletal ultrasound including definitions for ultrasonographic pathology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;J&#46; Wakefield"
                            1 => "P&#46;V&#46; Balint"
                            2 => "M&#46; Szhudlarek"
                            3 => "E&#46; Filippucci"
                            4 => "M&#46; Backhaus"
                            5 => "M&#46;A&#46; D&#193;gostino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2005"
                        "volumen" => "32"
                        "paginaInicial" => "2485"
                        "paginaFinal" => "2487"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16331793"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Distribution of radiographic osteoarthritis between the right and left hands&#44; hips and knees"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Neame"
                            1 => "W&#46; Zhang"
                            2 => "C&#46; Deighton"
                            3 => "M&#46; Doherty"
                            4 => "S&#46; Doherty"
                            5 => "P&#46; Lanyon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.20145"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2004"
                        "volumen" => "50"
                        "paginaInicial" => "1495"
                        "paginaFinal" => "1500"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15146419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Artropat&#237;a de las manos de origen profesional&#58; mano del ordenador"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Ferreiro"
                            1 => "R&#46; Gomez"
                            2 => "R&#46; Iba&#241;ez"
                            3 => "R&#46; Formigo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin"
                        "fecha" => "1997"
                        "volumen" => "109"
                        "paginaInicial" => "661"
                        "paginaFinal" => "663"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hand use and patterns of joint involvement in osteoarthritis&#46; A comparison of female dentists and teachers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Solovieva"
                            1 => "T&#46; Vehmas"
                            2 => "H&#46; Riihimaki"
                            3 => "K&#46; Luoma"
                            4 => "P&#46; Leino-Arjas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/keh534"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2005"
                        "volumen" => "44"
                        "paginaInicial" => "521"
                        "paginaFinal" => "528"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15728421"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chopstick arthropathy&#58; the Beijing Osteoarthritis Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;J&#46; Hunter"
                            1 => "Y&#46; Zhang"
                            2 => "M&#46;C&#46; Nevitt"
                            3 => "L&#46; Xu"
                            4 => "J&#46; Niu"
                            5 => "L&#46;Y&#46; Lui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.20145"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2004"
                        "volumen" => "50"
                        "paginaInicial" => "1495"
                        "paginaFinal" => "1500"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15146419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound-detected synovitis with power Doppler signal is associated with severe radiographic damage and reduced cartilage thickness in hand osteoarthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Mancarella"
                            1 => "M&#46; Magnani"
                            2 => "O&#46; Addimanda"
                            3 => "E&#46; Pignotti"
                            4 => "S&#46; Galletti"
                            5 => "R&#46; Meliconi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.joca.2010.06.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoarthr Cartil"
                        "fecha" => "2010"
                        "volumen" => "18"
                        "paginaInicial" => "1263"
                        "paginaFinal" => "1268"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20656045"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "In erosive hand osteoarthritis more inflammatory signs on ultrasound are found than in the rest of hand osteoarthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;C&#46; Kortekaas"
                            1 => "W&#46;Y&#46; Kwok"
                            2 => "M&#46; Reijnierse"
                            3 => "T&#46;W&#46;J&#46; Huizinga"
                            4 => "M&#46; Kloppenburg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2009.124875"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2010"
                        "volumen" => "69"
                        "paginaInicial" => "1367"
                        "paginaFinal" => "1369"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20472595"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound features of nonstructural lesions of the proximal and distal interphalangeal joints of the hands in patients with finger osteoarthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Arrestier"
                            1 => "C&#46; Rosenberg"
                            2 => "F&#46; Etchepare"
                            3 => "S&#46; Rozenberg"
                            4 => "V&#46; Foltz"
                            5 => "B&#46; Fautrel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jbspin.2010.05.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Joint Bone Spine"
                        "fecha" => "2011"
                        "volumen" => "78"
                        "paginaInicial" => "65"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20599415"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and ultrasonographic changes in patients with symptomatic knee osteoarthritis treated with celecoxib"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Uson"
                            1 => "R&#46; Miguelez-Sanchez"
                            2 => "M&#46;C&#46; Fernandez-Espartero"
                            3 => "R&#46; Gonzalez-Crespo"
                            4 => "V&#46; Villaverde-Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Ann Reum Dis"
                        "fecha" => "2006"
                        "volumen" => "65"
                        "paginaInicial" => "61"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do non-steroidal anti-inflammatory drugs have a significant effect on detection and grading of ultrasound-detected synovitis in patients with rheumatoid arthritis&#63; Results from a randomised study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;S&#46; Zayat"
                            1 => "P&#46;G&#46; Conaghan"
                            2 => "M&#46; Sharif"
                            3 => "J&#46;E&#46; Freeston"
                            4 => "C&#46; Wenham"
                            5 => "E&#46;M&#46; Hensor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2011-200017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "1746"
                        "paginaFinal" => "1751"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21803749"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonographic assessment of osteophytes in 127 patients with hand osteoarthritis&#58; exploring reliability and associations with MRI&#44; radiographs and clinical joint findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Mathiessen"
                            1 => "I&#46;K&#46; Haugen"
                            2 => "B&#46; Slatkowsky-Christensen"
                            3 => "P&#46; B&#248;yesen"
                            4 => "T&#46;K&#46; Kvien"
                            5 => "H&#46;B&#46; Hammer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2011-201195"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2013"
                        "volumen" => "72"
                        "paginaInicial" => "51"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22523427"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "A&#46;L&#46; Tan"
                            1 => "A&#46;J&#46; Grainger"
                            2 => "S&#46;F&#46; Tanner"
                            3 => "D&#46;M&#46; Shelley"
                            4 => "C&#46; Pease"
                            5 => "P&#46; Emery"
                            6 => "D&#46; McGonagle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.21210"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2005"
                        "volumen" => "52"
                        "paginaInicial" => "2355"
                        "paginaFinal" => "2365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16052535"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Structural and inflammatory sonographic findings in erosive and non-erosive osteoarthritis of the interphalangeal finger joints"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Wittoek"
                            1 => "P&#46; Carron"
                            2 => "G&#46; Verbruggen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2010.128504"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2010"
                        "volumen" => "69"
                        "paginaInicial" => "2173"
                        "paginaFinal" => "2176"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20693271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Vlychou"
                            1 => "A&#46; Koutroumpas"
                            2 => "K&#46; Malizos"
                            3 => "L&#46;I&#46; Sakkas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Osteoarthr Cartilage"
                        "fecha" => "2009"
                        "volumen" => "17"
                        "paginaInicial" => "1283"
                        "paginaFinal" => "1287"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Osteophytes and joint space narrowing are independently associated with pain in finger joints in hand osteoarthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;C&#46; Kortekaas"
                            1 => "W&#46;-Y&#46; Kwok"
                            2 => "M&#46; Reijnierse"
                            3 => "T&#46;W&#46;J&#46; Huizinga"
                            4 => "M&#46; Kloppenburg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2010.147553"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "1835"
                        "paginaFinal" => "1837"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21742640"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001000000005/v1_201409070108/S217357431400080X/v1_201409070108/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "17338"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Original Article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001000000005/v1_201409070108/S217357431400080X/v1_201409070108/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431400080X?idApp=UINPBA00004M"
]

Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2014.01.008

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	6	3	9
2024 October	62	40	102
2024 September	69	13	82
2024 August	78	31	109
2024 July	54	32	86
2024 June	68	28	96
2024 May	61	51	112
2024 April	66	24	90
2024 March	82	27	109
2024 February	50	23	73
2024 January	98	25	123
2023 December	52	43	95
2023 November	64	34	98
2023 October	58	32	90
2023 September	103	39	142
2023 August	46	20	66
2023 July	62	24	86
2023 June	46	27	73
2023 May	62	19	81
2023 April	66	6	72
2023 March	90	33	123
2023 February	76	21	97
2023 January	54	20	74
2022 December	91	34	125
2022 November	76	32	108
2022 October	70	37	107
2022 September	81	33	114
2022 August	72	54	126
2022 July	72	46	118
2022 June	62	41	103
2022 May	83	46	129
2022 April	55	41	96
2022 March	61	37	98
2022 February	55	27	82
2022 January	44	50	94
2021 December	42	49	91
2021 November	55	46	101
2021 October	49	61	110
2021 September	51	42	93
2021 August	45	50	95
2021 July	34	34	68
2021 June	43	37	80
2021 May	43	36	79
2021 April	158	82	240
2021 March	69	29	98
2021 February	54	21	75
2021 January	48	23	71
2020 December	37	22	59
2020 November	75	28	103
2020 October	89	15	104
2020 September	30	22	52
2020 August	21	24	45
2020 July	21	18	39
2020 June	24	32	56
2020 May	37	12	49
2020 April	16	20	36
2020 March	13	11	24
2018 May	9	2	11
2018 April	81	10	91
2018 March	93	5	98
2018 February	81	6	87
2018 January	75	2	77
2017 December	42	6	48
2017 November	48	8	56
2017 October	58	8	66
2017 September	58	6	64
2017 August	62	12	74
2017 July	51	8	59
2017 June	78	5	83
2017 May	82	12	94
2017 April	64	7	71
2017 March	72	2	74
2017 February	49	8	57
2017 January	37	8	45
2016 December	90	17	107
2016 November	102	10	112
2016 October	108	7	115
2016 September	109	6	115
2016 August	73	6	79
2016 July	40	5	45
2016 June	2	0	2
2016 February	1	0	1
2015 December	2	0	2
2015 September	1	0	1
2015 August	2	0	2
2015 July	21	7	28
2015 June	57	14	71
2015 May	84	19	103
2015 April	64	10	74
2015 March	51	14	65
2015 February	61	7	68
2015 January	95	13	108
2014 December	70	15	85
2014 November	51	14	65
2014 October	68	23	91
2014 September	24	16	40

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter