Multicentric Prevalence Study of Anti-P Ribosomal Autoantibodies in Juvenile Onset Systemic Lupus Erythematosus Compared With Adult Onset Systemic Lupus Erythematosus

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Pisoni, Sebastián Andrés Muñoz, Carolina Carrizo, Micaela Cosatti, Analía Álvarez, Diana Dubinsky, Eleonora Bresan, Ricardo Russo, Ezequiel Borgia, Mercedes García, Pierina Sansinanea, María Cristina Basta, Maria Agustina D¿Amico, Juan Carlos Barreira, Eliana Lancioni, Enrique Soriano, Carmen de Cunto, Ana Beron, Alicia Eimon" "autores" => array:19 [ 0 => array:2 [ "nombre" => "Cecilia N." 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Pisoni, Sebastián Andrés Muñoz, Carolina Carrizo, Micaela Cosatti, Analía Álvarez, Diana Dubinsky, Eleonora Bresan, Ricardo Russo, Ezequiel Borgia, Mercedes García, Pierina Sansinanea, María Cristina Basta, Maria Agustina D’Amico, Juan Carlos Barreira, Eliana Lancioni, Enrique Soriano, Carmen de Cunto, Ana Beron, Alicia Eimon" "autores" => array:19 [ 0 => array:4 [ "nombre" => "Cecilia N." 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Fernández, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección Reumatología, Departamento de Medicina Interna, Hospital General de Agudos José Penna, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "División Reumatología, Departamento de Medicina, Hospital de Clínicas José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Inmunología y Reumatología, Hospital de Pediatría Profesor Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Interzonal General de Agudos General José de San Martín, La Plata, Provincia de Buenos Aires, Argentina" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Británico Central, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Sección Reumatología, Departamento de Medicina, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio multicéntrico de prevalencia de anticuerpos antirribosomal P en lupus eritematoso sistémico de comienzo juvenil comparado con lupus eritematoso sistémico del adulto" ] ] "textoCompleto" => "IntroductionSystemic lupus erythematosus (SLE) is an autoimmune disease that can affect virtually any organ or system, manifested clinically by exacerbations and remission periods and serologically characterized by the presence of antinuclear (ANA), anti-native DNA and anti-Sm antibodies. While it is more common in adults, 15%–20% of patients with SLE are first diagnosed before age 16.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a> In patients with juvenile SLE, the highest incidence is between 12 and 14 years, being rare before.<a class="elsevierStyleCrossRefs" href="#bib0025">5,4</a>Anti-P ribosomal antibodies are directed against a family of phosphoproteins related to the 60s ribosomal subunit. The antibodies target 3 phosphoproteins P0 (38kDa), P1 (19kDa), and P2 (17kDa). Several clinical studies have observed clinical and serological differences between juvenile and adult SLE patients. The disease in patients with juvenile SLE is more severe, treatments are more aggressive and patients accumulate more damage during its progression.<a class="elsevierStyleCrossRefs" href="#bib0015">3,5</a> This is due to a higher incidence of renal and central nervous system involvement in patients under 16.<a class="elsevierStyleCrossRefs" href="#bib0005">1,6–9</a>A high prevalence of anti-P ribosomal antibodies has been reported in some series of patients with juvenile SLE,<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> while other groups have found a higher prevalence of anti-native DNA, anti-Sm, and anti-nRNP.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> The anti-P ribosomal antibody prevalence in patients with SLE varies from 6% to 36% depending on ethnicity, age, and certain clinical variables.<a class="elsevierStyleCrossRefs" href="#bib0070">14–16</a>Anti-P ribosomal antibodies have been associated with the presence of nephritis,<a class="elsevierStyleCrossRefs" href="#bib0085">17–23</a> autoimmune hepatitis, and neurological involvement.<a class="elsevierStyleCrossRefs" href="#bib0120">24–27</a> Three studies assessed the prevalence and association with clinical manifestations of anti-P ribosomal antibodies in youths, but the findings from these studies differ.<a class="elsevierStyleCrossRefs" href="#bib0035">7,11,28</a>There are no data in the literature on the prevalence of anti-P ribosomal antibodies and their association with clinical manifestations in Argentine patients.The objective of our study was to determine the prevalence and clinical correlation in Argentine patients of anti-P ribosomal antibodies in juvenile SLE compared with adult SLE. As a secondary objective we compared the cumulative clinical manifestations of juvenile and adult SLE.Patients and MethodsPatientsAll patients included in this study met 4 or more classification criteria for SLE as proposed by the American College of Rheumatology 1997 revised criteria.<a class="elsevierStyleCrossRefs" href="#bib0145">29,30</a> We consider juvenile SLE patients those who began their disease before age 16. We included 30 patients with juvenile SLE and 92 adult SLE patients in the study, from 7 reference centers in Argentina: Center for Medical Education and Clinical Research Norberto Quirno (CEMIC), Italian Hospital of Buenos Aires, Acute General Hospital José Penna, Hospital de Clinicas José de San Martín, Acute General Hospital Juan Antonio Fernández, Hospital San Martín de La Plata, Buenos Aires British Hospital and Pediatrics Hospital Prof. Dr. Juan P. Garrahan.Clinical DataA specific questionnaire was designed for the study, where clinical data based on the examination and review of the clinical history of the patient was collected. Clinical manifestations presented by patients from diagnosis to the time of inclusion in the study (cumulative events) were detailed. The following events were considered: Discoid rash, oral ulcers, photosensitivity, alopecia, malar rash, Raynaud's phenomenon, leukopenia, hemolytic anemia, thrombocytopenia, serositis, arthritis, psychosis, seizures, neuropathy, transverse myelitis, acute confusional state, glomerulonephritis, vasculitis, dry mouth, dry eyes. Information was obtained on treatments received from the time of diagnosis of the disease to inclusion in the study. Activity was calculated using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) at the time of sample collection. Antibody results were also recorded during the patient's history (ANA, anti-DNA, anti-Ro/SSA, anti-La/SSB, anti-Sm, and anti-nRNP).All participants signed informed consent; the study was conducted after approval by the ethics committees of each institution.Specimen Collection and Laboratory DeterminationsBlood samples for determination of antibodies were taken in the participating centers, and were analyzed centrally in the CEMIC laboratory of Immunology and Rheumatology. Measurement of anti-Ro/SSA, anti-La/SSB, anti-Sm, and anti-nRNP antibodies was performed by double-diffusion technique. The anti-P ribosomal antibodies were evaluated by enzyme-linked immunosorbent assay (ELISA) using as antigen, a purified protein from bovine and/or rabbit thymus (ImmunoVision, Inc.) absorbed at 0.5μg/well (Maxisorb polystyrene plate; Nunc). Samples were considered positive when values ≥11U. Measurement of anti-Ro/SSA, anti-La/SSB, anti-Sm, and anti-P ribosomal antibodies nRNP was performed simultaneously on all samples.Statistical AnalysisQualitative variables are presented as numbers and percentages, and quantitative variables as mean/median and standard deviation/minimum and maximum values. To determine an association, we employed chi-square (χ2) or Fisher exact tests. To quantify the strength of association we used odds ratios (OR) and their 95% confidence intervals (95% CI). For analysis of the SLEDAI in patients with positive and negative anti-P ribosomal antibodies and between adult vs juveniles, Wilcoxon and Mann–Whitney's tests were used. Significance was considered as a P<.05. Statistical analysis was performed using the Epi Info statistical package™ 7 (Centers for Disease Control and Prevention [CDC]).ResultsDemographicsTwenty-four patients (80%) in the youth group and 81 (88%) adults had Caucasian ethnicity. Two (6.7%) of the patients with juvenile SLE and 6 (6.5%) patients in the adult SLE group were males. The mean age at diagnosis in patients with juvenile SLE was 12.67±3.56 and for adults, 30±11.46 years. The mean age of patients at the time of inclusion in the study was 22.9±8.4 and 39.76±12.37 years for the group of juvenile and adult SLE respectively; the average duration of the disease at the time of inclusion in the study was 10.63±7.16 years in youths and 9.36±7.75 years in adults.Clinical manifestations and treatment received:The prevalence of different clinical manifestations in both groups (adults and juveniles) is detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Malar rash (OR=3.9, 95% CI=1.1–14.25), photosensitivity (OR=2.64, 95% CI=1.03–6.76), vasculitis (OR=5.33, 95% CI=1.7–16.0), non-discoid rash (OR=3.0, 95% CI=1.09–8.4) and neurological involvement: seizures (OR=3.85, 95% CI=1.12–13.22) and psychosis (OR=4, 95% CI=1.15–13.79) were found more frequently in the juvenile SLE. Five adult patients developed neurological manifestations (not in the ACR criteria): cognitive impairment in 3 patients, peripheral sensory polyneuropathy of the lower limbs in 1 patient and 1 patient with acute confusional state. No patient developed transverse myelitis or multiple mononeuritis.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Patients used the following immunosuppressive therapy: methotrexate (MTX), mycophenolate mofetil (MMF), azathioprine (AZA), cyclophosphamide (CF), glucocorticoids (prednisone or equivalent) >20mg; there were no statistically significant differences between adult and juvenile patients or between the patients positive or negative anti-P ribosomal antibodies (data not shown). Adult patients received hydroxychloroquine more frequently than juveniles (95.6% vs 83.3%; P=.025).The SLEDAI score in the total population (adults and juveniles) was mean 3.89 (SD 4.68) in patients with juvenile SLE and 5.11 (SD 5.33) and 3.56 in adults (SD 4.44; P=.09).Prevalence of AntibodiesThe prevalence of antibodies is detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Of the antibodies determined, the presence of anti-P ribosomal antibodies (OR=5.21, 95% CI=1.6–16.5) was significantly higher in the group of patients with juvenile SLE.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Relationship of Anti-P Ribosomal Antibodies With Other Antibodies<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the prevalence of other autoantibodies in patients with adult and juvenile SLE, according to whether they were positive or negative for anti-P ribosomal antibodies. The prevalence of all other autoantibodies was similar in both groups.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Relationship Between Anti-P Ribosomal Antibodies With Clinical Manifestations<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the prevalence of anti-P ribosomal antibodies detailed according to the clinical manifestations. Alopecia (OR=10.11, 95% CI=1.25–97) and skin rash (non-discoid) (OR=4.1, 95% CI=1.25–13.89) were the only clinical manifestations that were significantly associated with the presence of anti-P ribosomal antibodies.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The SLEDAI score in the population with negative anti-P ribosomal antibodies was, on average 3.93 (SD 4.76) and, in patients with positive anti-P ribosomal antibodies, on average 3.58 (SD 4.12; P=.97).DiscussionIn our study we analyzed the clinical and laboratory characteristics of SLE patients who presented their disease onset before age 16 (young) and compared them with adult SLE patients. The presence of malar rash, photosensitivity, vasculitis, skin rash and neurological involvement (seizures and psychosis) was more frequent in patients with juvenile SLE. When we compared the profile of autoantibodies between the 2 groups of patients, we found that anti-P ribosomal antibodies were significantly more prevalent in juvenile SLE (27% vs 5.62%). We found no association of anti-P ribosomal antibodies with other autoantibodies. Alopecia and rash (non-discoid) were the only clinical manifestations that were significantly associated with the presence of anti-P ribosomal antibodies.Most of the studies reported above agree that there is a higher prevalence of anti-P ribosomal antibodies in juvenile SLE; our study confirmed these findings. It is known that certain characteristics of the study population, such as ethnicity, disease status (higher prevalence of anti-P ribosomal antibodies in active SLE) and treatment intensity makes the prevalence of this autoantibody variable and differs between different studies. Reichlin et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> reported a prevalence of anti-P ribosomal antibodies in 42% of patients with juvenile SLE where a large percentage of them had active SLE. Hoffmann et al.,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> unlike previous authors, found a prevalence of 25%, and Press et al.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> in a previously published study reported a prevalence of 20%. These last 2 studies showed no detail on the activity of the disease and had a prevalence of anti-P ribosomal antibodies similar to that of our study. There is considerable discrepancy in the literature regarding the association between anti-P ribosomal antibodies and different clinical manifestations in juvenile SLE. Reichlin et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> found that anti-P ribosomal antibodies were associated with renal involvement. Quite the opposite was reported by Hoffman et al.,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> who described that the presence of anti-P ribosomal antibodies in the absence of anti-DNA acted as a protector from kidney involvement. In the adult SLE population, other authors found no association between anti-P ribosomal antibodies and the presence of membranous nephropathy.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Like us, Press et al.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> found no association between this autoantibody and kidney involvement.The association of anti-P ribosomal antibodies with neurological manifestations in patients with juvenile SLE is also controversial. Aldar et al. observed autoantibody more frequently<a class="elsevierStyleCrossRef" href="#bib0140">28</a> in patients with juvenile SLE and anxiety, but not with more severe clinical manifestations of the central nervous system. Reichlin et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> and Hoffman et al.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> do not mention the association between anti-P ribosomal antibodies and neurological compromise. In our study, although we found a higher prevalence of neurological manifestations (psychosis and seizures) in juvenile SLE, we did not find a statistically significant association between the anti-P ribosomal antibodies and such events, either in the analysis of the total patient population studied or in juvenile SLE.It has been reported the anti-P ribosomal antibodies correlate with disease activity as measured by SLEDAI and with the presence of anti-DNA. In our study no relationship between disease activity measured by SLEDAI and anti-P ribosomal antibodies<a class="elsevierStyleCrossRef" href="#bib0155">31</a> was found.One of the major limitations of our study is the small number of patients with juvenile SLE due to difficulties in recruitment. The anti-P ribosomal antibodies were measured in a single determination, so we could not have detected their presence in patients who were inactive at the time of sampling. On the other hand, in the sample there are only 14 patients with positive anti-P ribosomal antibodies; this may have limited the possibility of finding statistically significant associations between antibody presence and clinical manifestations.Despite the limitations, this study confirms the increased prevalence of anti-P ribosomal antibodies in patients with juvenile SLE and found no association of their presence with renal and CNS manifestations. Alopecia and rash (non-discoid) were the only clinical manifestations that were statistically associated with the presence of anti-P ribosomal antibodies.Ethical ResponsibilitiesProtection of people and animalsThe authors declare that this research has not performed experiments on humans or animals.Data confidentialityThe authors declare that they have followed the protocols of their workplace on the publication of data from patients and all patients included in the study have received sufficient information and gave 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.Conflict of InterestThe authors have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres436709" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec459945" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres436708" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec459944" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical Data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Specimen Collection and Laboratory Determinations" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical Analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Demographics" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Prevalence of Antibodies" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Relationship of Anti-P Ribosomal Antibodies With Other Antibodies" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Relationship Between Anti-P Ribosomal Antibodies With Clinical Manifestations" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0065" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0080" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-08-18" "fechaAceptado" => "2014-03-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec459945" "palabras" => array:2 [ 0 => "Systemic lupus erythematosus" 1 => "Anti-P ribosomal" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec459944" "palabras" => array:3 [ 0 => "Lupus eritematoso sistémico" 1 => "Lupus juvenil" 2 => "Antirribosomal P" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo investigate the prevalence and associations with clinical manifestations of anti-P ribosomal antibodies in patients with juvenile-onset and adult-onset systemic lupus erythematosus (SLE). MethodsClinical and serological data of 30 patients with juvenile-onset SLE (age at onset younger than 16 years) were compared with data of 92 patients with adult-onset SLE. Symptoms occurring during the entire disease course were considered. Anti-P ribosomal antibodies were tested by ELISA. ResultsAnti-P ribosomal antibodies were found significantly more often in pediatric-onset SLE patients (26.7% vs 6.5%; OR=5.21 [95% CI=1.6–16.5], P=.003). Alopecia (OR=10.11, 95% CI=1.25–97) and skin rash (non-discoid) (OR=4.1, 95% CI=1.25–13.89) were significantly associated with anti-P ribosomal antibodies. ConclusionAnti-ribosomal P antibodies are more often found in patients with juvenile SLE. Alopecia and skin rash were the only clinical manifestations associated to anti-ribosomal P antibodies." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoDeterminar la prevalencia y correlación clínica de los anticuerpos antirribosomal P en lupus eritematoso sistémico (LES) juvenil y compararlos con LES del adulto. MétodosSe incluyeron en el estudio 30 pacientes con LES juvenil y 92 pacientes con LES del adulto. Consideramos LES de comienzo juvenil a todos aquellos pacientes que comenzaron su enfermedad antes de los 16 años. Se consideraron las manifestaciones clínicas y serológicas que presentaron los pacientes desde el diagnóstico hasta el momento de inclusión en el estudio (manifestaciones acumuladas). El anticuerpo antirribosomal P fue evaluado mediante la técnica de enzimo-inmunoensayo (ELISA). ResultadosLa presencia de antirribosomal P fue significativamente mayor en el grupo de pacientes con LES juvenil comparado con LES del adulto (26,7% vs. 6,5%; OR=5.21 [95% CI=1,6–16,5], p=0,003). La alopecía (OR=10,11; 95% CI=1,25–97) y rash cutáneo (no discoide) (OR=4,1; 95% CI=1,25–13,89) fueron las únicas manifestaciones clínicas que se asociaron en forma estadísticamente significativa con la presencia del anticuerpo antirribosomal P. ConclusiónEste estudio confirma una mayor prevalencia de anticuerpos antirribosomal P en pacientes con LES juvenil. La alopecia y el rash cutáneo fueros las únicas manifestaciones clínicas asociadas a la presencia de antirribosomal P." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Pisoni CN, Muñoz SA, Carrizo C, Cosatti M, Álvarez A, Dubinsky D, et al. Estudio multicéntrico de prevalencia de anticuerpos antirribosomal P en lupus eritematoso sistémico de comienzo juvenil comparado con lupus eritematoso sistémico del adulto. Reumatol Clin. 2015;11:73–77." ] ] "multimedia" => array:4 [ 0 => 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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical manifestations \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Juvenile SLE (n=30), n (%, 95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SLE adult (n=92), n (%, 95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR; 95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="char" valign="top">Skin and appendages</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Malar erythema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (89.7, 78.9–99.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.5, 2.6–10.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.9; 1.11–14.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Discoid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (7.1, 0–14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2, 0.1–3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3; 0.41–22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Skin rash (other) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (30, 15–45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (12, 7–17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3; 1.09–8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Photosensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (76.7, 63–90.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (55, 46–64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.64; 1.03–6.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Alopecia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (53.3, 35.7–70.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (36, 27–45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.97; 0.85–4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Raynaud \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (24.1, 10.4–37.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (36, 27–45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.53; 0.20–1.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Oral ulcers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (43.3, 25.7–60.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (37, 28–46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.3; 0.56–3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (83.3, 70–96.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (86, 81–91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.82; 0.26–2.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Serositis</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pleuritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (20.7, 7–34.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (25, 18–32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.70; 0.25–1.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pericarditis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (16.6, 4.9–28.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (18, 11–25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.83; 0.27–2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glomerulonephritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (66.7, 51.1–82.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (52, 43–61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.83; 0.77–4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Neurological</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Seizures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (23, 9.3–36.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.5, 2.6–10.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.85; 1.12–13.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Psychosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (24, 10.3–37.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.5, 2.6–10.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4; 1.15–13.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Hematologic</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Leukopenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (64.3, 48.7–79.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (40, 31–49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.3; 0.96–5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hemolytic anemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (20.7, 7–34.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (11, 6–16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.93; 0.63–5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Thrombocytopenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (24.1, 10.4–37.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (14, 9–19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.78; 0.63–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vasculitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (30; 14,4–45-6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (7.6, 3.6–11.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.33; 1.7–16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Sicca syndrome</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dry eye \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (7.1, 0–14.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (14, 9–19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.41; 0.08–1.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dry mouth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (4; 0.1–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.30; 0.01–5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.43 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab681835.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of Clinical Manifestations: Juvenile SLE Compared With Adult SLE." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autoantibody \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Juvenile SLE (n=30) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adult SLE (n=92) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR; 95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-P ribosomal antibodies; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (26.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.21; 1.6–16.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-La/SSB; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.23; 0.01–4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-Ro/SSA; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (31.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.47; 0.16–1.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-Sm; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (5.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.1; 0.47–9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-nRNP; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (23.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (21.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.22; 0.45–3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.68 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab681833.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of Autoantibodies in Patients With Juvenile SLE Compared to Adult SLE." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autoantibody \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-P ribosomal antibodies (+) (n=14) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-P ribosomal antibodies (−) (n=108) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR; 95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-La/SSB; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.61; 0.03–11.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-Ro/SSA; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.80; 0.20–3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-Sm; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.33; 0.59–18.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anti-nRNP; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.13; 0.28–4.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab681836.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of Other Autoantibodies in Patients With Positive and Negative Anti-P Ribosomal Antibodies." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical manifestations \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-P ribosomal antibodies (+) (n=14) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-P ribosomal antibodies (−) (n=108) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR; 95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="char" valign="top">Skin and appendages; n (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Malar erythema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (92.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (70.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.4; 0.68–43.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Discoid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.72; 0.03–14.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Skin rash (other) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.1; 1.25–13.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Photosensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (78.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (58.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.6; 0.69–9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Alopecia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.1; 1.25–97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Raynaud; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (28.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (43.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.64; 0.18–2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Oral ulcers; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (35.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (38.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.87; 0.27–2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Arthritis; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (92.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (84.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.4; 0.29–19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Serositis; n (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pleuritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.22; 0.64–7.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pericarditis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.33; 0.04–2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glomerulonephritis; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (56.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.77; 0.25–2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Neurological; n (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Seizures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.79; 0.09–6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Psychosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (14.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.9; 0.36–10.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Hematology; n (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Leukopenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (57.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (45.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.38; 0.44–4.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hemolytic anemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (12.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.67; 0.41–6.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Thrombocytopenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (18.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.13; 0.00–2.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vasculitis; n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (28.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.86; 0.78–10.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Sicca syndrome; n (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dry eye \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.20; 0.01–3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dry mouth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.77; 0.03–15.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab681834.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Differences in Clinical Manifestations Between Positive and Negative Anti-P Ribosomal Antibody-Patients." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparison with SLE characteristics in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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Original Article

Multicentric Prevalence Study of Anti-P Ribosomal Autoantibodies in Juvenile Onset Systemic Lupus Erythematosus Compared With Adult Onset Systemic Lupus Erythematosus

Estudio multicéntrico de prevalencia de anticuerpos antirribosomal P en lupus eritematoso sistémico de comienzo juvenil comparado con lupus eritematoso sistémico del adulto

Cecilia N. Pisonia,

Corresponding author

ceciliapisoni@gmail.com

Corresponding author.

, Sebastián Andrés Muñozb, Carolina Carrizoa, Micaela Cosattia, Analía Álvarezc, Diana Dubinskyd, Eleonora Bresand, Ricardo Russoe, Ezequiel Borgiae, Mercedes Garcíaf, Pierina Sansinaneaf, María Cristina Bastab, Maria Agustina D’Amicog, Juan Carlos Barreirag, Eliana Lancionih, Enrique Sorianoh, Carmen de Cuntoh, Ana Berond, Alicia Eimona

a Sección Reumatología, Departamento de Medicina, Centro de Educación Médica y de Investigaciones Clínicas Norberto Quirno (CEMIC), Ciudad Autónoma de Buenos Aires, Argentina

b División Clínica Médica, Departamento de Medicina Interna, Hospital General de Agudos Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina

c Sección Reumatología, Departamento de Medicina Interna, Hospital General de Agudos José Penna, Ciudad Autónoma de Buenos Aires, Argentina

d División Reumatología, Departamento de Medicina, Hospital de Clínicas José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina

e Servicio de Inmunología y Reumatología, Hospital de Pediatría Profesor Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina

f Servicio de Reumatología, Hospital Interzonal General de Agudos General José de San Martín, La Plata, Provincia de Buenos Aires, Argentina

g Servicio de Reumatología, Hospital Británico Central, Ciudad Autónoma de Buenos Aires, Argentina

h Sección Reumatología, Departamento de Medicina, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

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    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Estudio multic&#233;ntrico de prevalencia de anticuerpos antirribosomal P en lupus eritematoso sist&#233;mico de comienzo juvenil comparado con lupus eritematoso sist&#233;mico del adulto"
      ]
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic lupus erythematosus &#40;SLE&#41; is an autoimmune disease that can affect virtually any organ or system&#44; manifested clinically by exacerbations and remission periods and serologically characterized by the presence of antinuclear &#40;ANA&#41;&#44; anti-native DNA and anti-Sm antibodies&#46; While it is more common in adults&#44; 15&#37;&#8211;20&#37; of patients with SLE are first diagnosed before age 16&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> In patients with juvenile SLE&#44; the highest incidence is between 12 and 14 years&#44; being rare before&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Anti-P ribosomal antibodies are directed against a family of phosphoproteins related to the 60s ribosomal subunit&#46; The antibodies target 3 phosphoproteins P0 &#40;38<span class="elsevierStyleHsp" style=""></span>kDa&#41;&#44; P1 &#40;19<span class="elsevierStyleHsp" style=""></span>kDa&#41;&#44; and P2 &#40;17<span class="elsevierStyleHsp" style=""></span>kDa&#41;&#46; Several clinical studies have observed clinical and serological differences between juvenile and adult SLE patients&#46; The disease in patients with juvenile SLE is more severe&#44; treatments are more aggressive and patients accumulate more damage during its progression&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a> This is due to a higher incidence of renal and central nervous system involvement in patients under 16&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6&#8211;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A high prevalence of anti-P ribosomal antibodies has been reported in some series of patients with juvenile SLE&#44;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> while other groups have found a higher prevalence of anti-native DNA&#44; anti-Sm&#44; and anti-nRNP&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> The anti-P ribosomal antibody prevalence in patients with SLE varies from 6&#37; to 36&#37; depending on ethnicity&#44; age&#44; and certain clinical variables&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Anti-P ribosomal antibodies have been associated with the presence of nephritis&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;23</span></a> autoimmune hepatitis&#44; and neurological involvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;27</span></a> Three studies assessed the prevalence and association with clinical manifestations of anti-P ribosomal antibodies in youths&#44; but the findings from these studies differ&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;11&#44;28</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There are no data in the literature on the prevalence of anti-P ribosomal antibodies and their association with clinical manifestations in Argentine patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The objective of our study was to determine the prevalence and clinical correlation in Argentine patients of anti-P ribosomal antibodies in juvenile SLE compared with adult SLE&#46; As a secondary objective we compared the cumulative clinical manifestations of juvenile and adult SLE&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0035" class="elsevierStylePara elsevierViewall">All patients included in this study met 4 or more classification criteria for SLE as proposed by the American College of Rheumatology 1997 revised criteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a> We consider juvenile SLE patients those who began their disease before age 16&#46; We included 30 patients with juvenile SLE and 92 adult SLE patients in the study&#44; from 7 reference centers in Argentina&#58; Center for Medical Education and Clinical Research Norberto Quirno &#40;CEMIC&#41;&#44; Italian Hospital of Buenos Aires&#44; Acute General Hospital Jos&#233; Penna&#44; Hospital de Clinicas Jos&#233; de San Mart&#237;n&#44; Acute General Hospital Juan Antonio Fern&#225;ndez&#44; Hospital San Mart&#237;n de La Plata&#44; Buenos Aires British Hospital and Pediatrics Hospital Prof&#46; Dr&#46; Juan P&#46; Garrahan&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Clinical Data</span><p id="par0040" class="elsevierStylePara elsevierViewall">A specific questionnaire was designed for the study&#44; where clinical data based on the examination and review of the clinical history of the patient was collected&#46; Clinical manifestations presented by patients from diagnosis to the time of inclusion in the study &#40;cumulative events&#41; were detailed&#46; The following events were considered&#58; Discoid rash&#44; oral ulcers&#44; photosensitivity&#44; alopecia&#44; malar rash&#44; Raynaud&#39;s phenomenon&#44; leukopenia&#44; hemolytic anemia&#44; thrombocytopenia&#44; serositis&#44; arthritis&#44; psychosis&#44; seizures&#44; neuropathy&#44; transverse myelitis&#44; acute confusional state&#44; glomerulonephritis&#44; vasculitis&#44; dry mouth&#44; dry eyes&#46; Information was obtained on treatments received from the time of diagnosis of the disease to inclusion in the study&#46; Activity was calculated using the Systemic Lupus Erythematosus Disease Activity Index &#40;SLEDAI&#41; at the time of sample collection&#46; Antibody results were also recorded during the patient&#39;s history &#40;ANA&#44; anti-DNA&#44; anti-Ro&#47;SSA&#44; anti-La&#47;SSB&#44; anti-Sm&#44; and anti-nRNP&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All participants signed informed consent&#59; the study was conducted after approval by the ethics committees of each institution&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Specimen Collection and Laboratory Determinations</span><p id="par0050" class="elsevierStylePara elsevierViewall">Blood samples for determination of antibodies were taken in the participating centers&#44; and were analyzed centrally in the CEMIC laboratory of Immunology and Rheumatology&#46; Measurement of anti-Ro&#47;SSA&#44; anti-La&#47;SSB&#44; anti-Sm&#44; and anti-nRNP antibodies was performed by double-diffusion technique&#46; The anti-P ribosomal antibodies were evaluated by enzyme-linked immunosorbent assay &#40;ELISA&#41; using as antigen&#44; a purified protein from bovine and&#47;or rabbit thymus &#40;ImmunoVision&#44; Inc&#46;&#41; absorbed at 0&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;well &#40;Maxisorb polystyrene plate&#59; Nunc&#41;&#46; Samples were considered positive when values &#8805;11<span class="elsevierStyleHsp" style=""></span>U&#46; Measurement of anti-Ro&#47;SSA&#44; anti-La&#47;SSB&#44; anti-Sm&#44; and anti-P ribosomal antibodies nRNP was performed simultaneously on all samples&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical Analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Qualitative variables are presented as numbers and percentages&#44; and quantitative variables as mean&#47;median and standard deviation&#47;minimum and maximum values&#46; To determine an association&#44; we employed chi-square &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#41; or Fisher exact tests&#46; To quantify the strength of association we used odds ratios &#40;OR&#41; and their 95&#37; confidence intervals &#40;95&#37; CI&#41;&#46; For analysis of the SLEDAI in patients with positive and negative anti-P ribosomal antibodies and between adult vs juveniles&#44; Wilcoxon and Mann&#8211;Whitney&#39;s tests were used&#46; Significance was considered as a <span class="elsevierStyleItalic">P</span>&#60;&#46;05&#46; Statistical analysis was performed using the Epi Info statistical package&#8482; 7 &#40;Centers for Disease Control and Prevention &#91;CDC&#93;&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Demographics</span><p id="par0060" class="elsevierStylePara elsevierViewall">Twenty-four patients &#40;80&#37;&#41; in the youth group and 81 &#40;88&#37;&#41; adults had Caucasian ethnicity&#46; Two &#40;6&#46;7&#37;&#41; of the patients with juvenile SLE and 6 &#40;6&#46;5&#37;&#41; patients in the adult SLE group were males&#46; The mean age at diagnosis in patients with juvenile SLE was 12&#46;67&#177;3&#46;56 and for adults&#44; 30&#177;11&#46;46 years&#46; The mean age of patients at the time of inclusion in the study was 22&#46;9&#177;8&#46;4 and 39&#46;76&#177;12&#46;37 years for the group of juvenile and adult SLE respectively&#59; the average duration of the disease at the time of inclusion in the study was 10&#46;63&#177;7&#46;16 years in youths and 9&#46;36&#177;7&#46;75 years in adults&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Clinical manifestations and treatment received&#58;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The prevalence of different clinical manifestations in both groups &#40;adults and juveniles&#41; is detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Malar rash &#40;OR&#61;3&#46;9&#44; 95&#37; CI&#61;1&#46;1&#8211;14&#46;25&#41;&#44; photosensitivity &#40;OR&#61;2&#46;64&#44; 95&#37; CI&#61;1&#46;03&#8211;6&#46;76&#41;&#44; vasculitis &#40;OR&#61;5&#46;33&#44; 95&#37; CI&#61;1&#46;7&#8211;16&#46;0&#41;&#44; non-discoid rash &#40;OR&#61;3&#46;0&#44; 95&#37; CI&#61;1&#46;09&#8211;8&#46;4&#41; and neurological involvement&#58; seizures &#40;OR&#61;3&#46;85&#44; 95&#37; CI&#61;1&#46;12&#8211;13&#46;22&#41; and psychosis &#40;OR&#61;4&#44; 95&#37; CI&#61;1&#46;15&#8211;13&#46;79&#41; were found more frequently in the juvenile SLE&#46; Five adult patients developed neurological manifestations &#40;not in the ACR criteria&#41;&#58; cognitive impairment in 3 patients&#44; peripheral sensory polyneuropathy of the lower limbs in 1 patient and 1 patient with acute confusional state&#46; No patient developed transverse myelitis or multiple mononeuritis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Patients used the following immunosuppressive therapy&#58; methotrexate &#40;MTX&#41;&#44; mycophenolate mofetil &#40;MMF&#41;&#44; azathioprine &#40;AZA&#41;&#44; cyclophosphamide &#40;CF&#41;&#44; glucocorticoids &#40;prednisone or equivalent&#41; &#62;20<span class="elsevierStyleHsp" style=""></span>mg&#59; there were no statistically significant differences between adult and juvenile patients or between the patients positive or negative anti-P ribosomal antibodies &#40;data not shown&#41;&#46; Adult patients received hydroxychloroquine more frequently than juveniles &#40;95&#46;6&#37; vs 83&#46;3&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;025&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The SLEDAI score in the total population &#40;adults and juveniles&#41; was mean 3&#46;89 &#40;SD 4&#46;68&#41; in patients with juvenile SLE and 5&#46;11 &#40;SD 5&#46;33&#41; and 3&#46;56 in adults &#40;SD 4&#46;44&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;09&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Prevalence of Antibodies</span><p id="par0085" class="elsevierStylePara elsevierViewall">The prevalence of antibodies is detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Of the antibodies determined&#44; the presence of anti-P ribosomal antibodies &#40;OR&#61;5&#46;21&#44; 95&#37; CI&#61;1&#46;6&#8211;16&#46;5&#41; was significantly higher in the group of patients with juvenile SLE&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Relationship of Anti-P Ribosomal Antibodies With Other Antibodies</span><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the prevalence of other autoantibodies in patients with adult and juvenile SLE&#44; according to whether they were positive or negative for anti-P ribosomal antibodies&#46; The prevalence of all other autoantibodies was similar in both groups&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Relationship Between Anti-P Ribosomal Antibodies With Clinical Manifestations</span><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the prevalence of anti-P ribosomal antibodies detailed according to the clinical manifestations&#46; Alopecia &#40;OR&#61;10&#46;11&#44; 95&#37; CI&#61;1&#46;25&#8211;97&#41; and skin rash &#40;non-discoid&#41; &#40;OR&#61;4&#46;1&#44; 95&#37; CI&#61;1&#46;25&#8211;13&#46;89&#41; were the only clinical manifestations that were significantly associated with the presence of anti-P ribosomal antibodies&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The SLEDAI score in the population with negative anti-P ribosomal antibodies was&#44; on average 3&#46;93 &#40;SD 4&#46;76&#41; and&#44; in patients with positive anti-P ribosomal antibodies&#44; on average 3&#46;58 &#40;SD 4&#46;12&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;97&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">In our study we analyzed the clinical and laboratory characteristics of SLE patients who presented their disease onset before age 16 &#40;young&#41; and compared them with adult SLE patients&#46; The presence of malar rash&#44; photosensitivity&#44; vasculitis&#44; skin rash and neurological involvement &#40;seizures and psychosis&#41; was more frequent in patients with juvenile SLE&#46; When we compared the profile of autoantibodies between the 2 groups of patients&#44; we found that anti-P ribosomal antibodies were significantly more prevalent in juvenile SLE &#40;27&#37; vs 5&#46;62&#37;&#41;&#46; We found no association of anti-P ribosomal antibodies with other autoantibodies&#46; Alopecia and rash &#40;non-discoid&#41; were the only clinical manifestations that were significantly associated with the presence of anti-P ribosomal antibodies&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Most of the studies reported above agree that there is a higher prevalence of anti-P ribosomal antibodies in juvenile SLE&#59; our study confirmed these findings&#46; It is known that certain characteristics of the study population&#44; such as ethnicity&#44; disease status &#40;higher prevalence of anti-P ribosomal antibodies in active SLE&#41; and treatment intensity makes the prevalence of this autoantibody variable and differs between different studies&#46; Reichlin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> reported a prevalence of anti-P ribosomal antibodies in 42&#37; of patients with juvenile SLE where a large percentage of them had active SLE&#46; Hoffmann et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> unlike previous authors&#44; found a prevalence of 25&#37;&#44; and Press et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> in a previously published study reported a prevalence of 20&#37;&#46; These last 2 studies showed no detail on the activity of the disease and had a prevalence of anti-P ribosomal antibodies similar to that of our study&#46; There is considerable discrepancy in the literature regarding the association between anti-P ribosomal antibodies and different clinical manifestations in juvenile SLE&#46; Reichlin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> found that anti-P ribosomal antibodies were associated with renal involvement&#46; Quite the opposite was reported by Hoffman et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> who described that the presence of anti-P ribosomal antibodies in the absence of anti-DNA acted as a protector from kidney involvement&#46; In the adult SLE population&#44; other authors found no association between anti-P ribosomal antibodies and the presence of membranous nephropathy&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Like us&#44; Press et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> found no association between this autoantibody and kidney involvement&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The association of anti-P ribosomal antibodies with neurological manifestations in patients with juvenile SLE is also controversial&#46; Aldar et al&#46; observed autoantibody more frequently<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> in patients with juvenile SLE and anxiety&#44; but not with more severe clinical manifestations of the central nervous system&#46; Reichlin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and Hoffman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> do not mention the association between anti-P ribosomal antibodies and neurological compromise&#46; In our study&#44; although we found a higher prevalence of neurological manifestations &#40;psychosis and seizures&#41; in juvenile SLE&#44; we did not find a statistically significant association between the anti-P ribosomal antibodies and such events&#44; either in the analysis of the total patient population studied or in juvenile SLE&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">It has been reported the anti-P ribosomal antibodies correlate with disease activity as measured by SLEDAI and with the presence of anti-DNA&#46; In our study no relationship between disease activity measured by SLEDAI and anti-P ribosomal antibodies<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> was found&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">One of the major limitations of our study is the small number of patients with juvenile SLE due to difficulties in recruitment&#46; The anti-P ribosomal antibodies were measured in a single determination&#44; so we could not have detected their presence in patients who were inactive at the time of sampling&#46; On the other hand&#44; in the sample there are only 14 patients with positive anti-P ribosomal antibodies&#59; this may have limited the possibility of finding statistically significant associations between antibody presence and clinical manifestations&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Despite the limitations&#44; this study confirms the increased prevalence of anti-P ribosomal antibodies in patients with juvenile SLE and found no association of their presence with renal and CNS manifestations&#46; Alopecia and rash &#40;non-discoid&#41; were the only clinical manifestations that were statistically associated with the presence of anti-P ribosomal antibodies&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Ethical Responsibilities</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Protection of people and animals</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that this research has not performed experiments on humans or animals&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Data confidentiality</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of data from patients and all patients included in the study have received sufficient information and gave written informed consent to participate in the study&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Right to privacy and informed consent</span><p id="par0145" 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="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of Interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Resumen"
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          "titulo" => "Palabras clave"
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          "identificador" => "sec0005"
          "titulo" => "Introduction"
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          "identificador" => "sec0010"
          "titulo" => "Patients and Methods"
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              "titulo" => "Patients"
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              "titulo" => "Clinical Data"
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              "identificador" => "sec0025"
              "titulo" => "Specimen Collection and Laboratory Determinations"
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              "titulo" => "Statistical Analysis"
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          "titulo" => "Results"
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            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Demographics"
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            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Prevalence of Antibodies"
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              "identificador" => "sec0050"
              "titulo" => "Relationship of Anti-P Ribosomal Antibodies With Other Antibodies"
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              "identificador" => "sec0055"
              "titulo" => "Relationship Between Anti-P Ribosomal Antibodies With Clinical Manifestations"
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          "titulo" => "Discussion"
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          "titulo" => "Ethical Responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Protection of people and animals"
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            1 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Data confidentiality"
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            2 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Right to privacy and informed consent"
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          "identificador" => "sec0085"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2013-08-18"
    "fechaAceptado" => "2014-03-06"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
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            0 => "Systemic lupus erythematosus"
            1 => "Anti-P ribosomal"
          ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:3 [
            0 => "Lupus eritematoso sist&#233;mico"
            1 => "Lupus juvenil"
            2 => "Antirribosomal P"
          ]
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      ]
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To investigate the prevalence and associations with clinical manifestations of anti-P ribosomal antibodies in patients with juvenile-onset and adult-onset systemic lupus erythematosus &#40;SLE&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical and serological data of 30 patients with juvenile-onset SLE &#40;age at onset younger than 16 years&#41; were compared with data of 92 patients with adult-onset SLE&#46; Symptoms occurring during the entire disease course were considered&#46; Anti-P ribosomal antibodies were tested by ELISA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Anti-P ribosomal antibodies were found significantly more often in pediatric-onset SLE patients &#40;26&#46;7&#37; vs 6&#46;5&#37;&#59; OR&#61;5&#46;21 &#91;95&#37; CI&#61;1&#46;6&#8211;16&#46;5&#93;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41;&#46; Alopecia &#40;OR&#61;10&#46;11&#44; 95&#37; CI&#61;1&#46;25&#8211;97&#41; and skin rash &#40;non-discoid&#41; &#40;OR&#61;4&#46;1&#44; 95&#37; CI&#61;1&#46;25&#8211;13&#46;89&#41; were significantly associated with anti-P ribosomal antibodies&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Anti-ribosomal P antibodies are more often found in patients with juvenile SLE&#46; Alopecia and skin rash were the only clinical manifestations associated to anti-ribosomal P antibodies&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
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            "titulo" => "Results"
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            "titulo" => "Conclusion"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar la prevalencia y correlaci&#243;n cl&#237;nica de los anticuerpos antirribosomal P en lupus eritematoso sist&#233;mico &#40;LES&#41; juvenil y compararlos con LES del adulto&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el estudio 30 pacientes con LES juvenil y 92 pacientes con LES del adulto&#46; Consideramos LES de comienzo juvenil a todos aquellos pacientes que comenzaron su enfermedad antes de los 16 a&#241;os&#46; Se consideraron las manifestaciones cl&#237;nicas y serol&#243;gicas que presentaron los pacientes desde el diagn&#243;stico hasta el momento de inclusi&#243;n en el estudio &#40;manifestaciones acumuladas&#41;&#46; El anticuerpo antirribosomal P fue evaluado mediante la t&#233;cnica de enzimo-inmunoensayo &#40;ELISA&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La presencia de antirribosomal P fue significativamente mayor en el grupo de pacientes con LES juvenil comparado con LES del adulto &#40;26&#44;7&#37; vs&#46; 6&#44;5&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;21 &#91;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;6&#8211;16&#44;5&#93;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; La alopec&#237;a &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#44;11&#59; 95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;25&#8211;97&#41; y rash cut&#225;neo &#40;no discoide&#41; &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;1&#59; 95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;25&#8211;13&#44;89&#41; fueron las &#250;nicas manifestaciones cl&#237;nicas que se asociaron en forma estad&#237;sticamente significativa con la presencia del anticuerpo antirribosomal P&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este estudio confirma una mayor prevalencia de anticuerpos antirribosomal P en pacientes con LES juvenil&#46; La alopecia y el rash cut&#225;neo fueros las &#250;nicas manifestaciones cl&#237;nicas asociadas a la presencia de antirribosomal P&#46;</p></span>"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pisoni CN&#44; Mu&#241;oz SA&#44; Carrizo C&#44; Cosatti M&#44; &#193;lvarez A&#44; Dubinsky D&#44; et al&#46; Estudio multic&#233;ntrico de prevalencia de anticuerpos antirribosomal P en lupus eritematoso sist&#233;mico de comienzo juvenil comparado con lupus eritematoso sist&#233;mico del adulto&#46; Reumatol Clin&#46; 2015&#59;11&#58;73&#8211;77&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical manifestations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Juvenile SLE &#40;n&#61;30&#41;&#44; n &#40;&#37;&#44; 95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SLE adult &#40;n&#61;92&#41;&#44; n &#40;&#37;&#44; 95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&#59; 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="char" valign="top"><span class="elsevierStyleItalic">Skin and appendages</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Malar erythema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;89&#46;7&#44; 78&#46;9&#8211;99&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;5&#44; 2&#46;6&#8211;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;9&#59; 1&#46;11&#8211;14&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Discoid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;7&#46;1&#44; 0&#8211;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#44; 0&#46;1&#8211;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#59; 0&#46;41&#8211;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Skin rash &#40;other&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;30&#44; 15&#8211;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;12&#44; 7&#8211;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#59; 1&#46;09&#8211;8&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Photosensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;76&#46;7&#44; 63&#8211;90&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;55&#44; 46&#8211;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;64&#59; 1&#46;03&#8211;6&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alopecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;53&#46;3&#44; 35&#46;7&#8211;70&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;36&#44; 27&#8211;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;97&#59; 0&#46;85&#8211;4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Raynaud</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;24&#46;1&#44; 10&#46;4&#8211;37&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;36&#44; 27&#8211;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;53&#59; 0&#46;20&#8211;1&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Oral ulcers</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;43&#46;3&#44; 25&#46;7&#8211;60&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;37&#44; 28&#8211;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;3&#59; 0&#46;56&#8211;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Arthritis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;83&#46;3&#44; 70&#8211;96&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;86&#44; 81&#8211;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;82&#59; 0&#46;26&#8211;2&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Serositis</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pleuritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;20&#46;7&#44; 7&#8211;34&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;25&#44; 18&#8211;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;70&#59; 0&#46;25&#8211;1&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pericarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;16&#46;6&#44; 4&#46;9&#8211;28&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;18&#44; 11&#8211;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;83&#59; 0&#46;27&#8211;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Glomerulonephritis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;66&#46;7&#44; 51&#46;1&#8211;82&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;52&#44; 43&#8211;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;83&#59; 0&#46;77&#8211;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Neurological</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Seizures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;23&#44; 9&#46;3&#8211;36&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;5&#44; 2&#46;6&#8211;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;85&#59; 1&#46;12&#8211;13&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Psychosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;24&#44; 10&#46;3&#8211;37&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;5&#44; 2&#46;6&#8211;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#59; 1&#46;15&#8211;13&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Hematologic</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Leukopenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;64&#46;3&#44; 48&#46;7&#8211;79&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;40&#44; 31&#8211;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;3&#59; 0&#46;96&#8211;5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemolytic anemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;20&#46;7&#44; 7&#8211;34&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;11&#44; 6&#8211;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;93&#59; 0&#46;63&#8211;5&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Thrombocytopenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;24&#46;1&#44; 10&#46;4&#8211;37&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;14&#44; 9&#8211;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;78&#59; 0&#46;63&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Vasculitis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;30&#59; 14&#44;4&#8211;45-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;7&#46;6&#44; 3&#46;6&#8211;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;33&#59; 1&#46;7&#8211;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sicca syndrome</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dry eye&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;7&#46;1&#44; 0&#8211;14&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;14&#44; 9&#8211;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;41&#59; 0&#46;08&#8211;1&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dry mouth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;4&#59; 0&#46;1&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;30&#59; 0&#46;01&#8211;5&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autoantibody&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Juvenile SLE &#40;n&#61;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adult SLE &#40;n&#61;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&#59; 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anti-P ribosomal antibodies&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;21&#59; 1&#46;6&#8211;16&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anti-La&#47;SSB&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;23&#59; 0&#46;01&#8211;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anti-Ro&#47;SSA&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;31&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;47&#59; 0&#46;16&#8211;1&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anti-Sm&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;1&#59; 0&#46;47&#8211;9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anti-nRNP&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;23&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;22&#59; 0&#46;45&#8211;3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autoantibody&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-P ribosomal antibodies &#40;&#43;&#41; &#40;n&#61;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-P ribosomal antibodies &#40;&#8722;&#41; &#40;n&#61;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&#59; 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;61&#59; 0&#46;03&#8211;11&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anti-Ro&#47;SSA&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;80&#59; 0&#46;20&#8211;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anti-Sm&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;33&#59; 0&#46;59&#8211;18&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anti-nRNP&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;13&#59; 0&#46;28&#8211;4&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical manifestations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-P ribosomal antibodies &#40;&#43;&#41; &#40;n&#61;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-P ribosomal antibodies &#40;&#8722;&#41; &#40;n&#61;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&#59; 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="char" valign="top"><span class="elsevierStyleItalic">Skin and appendages&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Malar erythema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;92&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;70&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;4&#59; 0&#46;68&#8211;43&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Discoid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;72&#59; 0&#46;03&#8211;14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Skin rash &#40;other&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;1&#59; 1&#46;25&#8211;13&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Photosensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;78&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;58&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;6&#59; 0&#46;69&#8211;9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alopecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;1&#59; 1&#46;25&#8211;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Raynaud&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;28&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;43&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;64&#59; 0&#46;18&#8211;2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Oral ulcers&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;38&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;87&#59; 0&#46;27&#8211;2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Arthritis&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;92&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91 &#40;84&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;4&#59; 0&#46;29&#8211;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Serositis&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pleuritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;22&#59; 0&#46;64&#8211;7&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pericarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;33&#59; 0&#46;04&#8211;2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Glomerulonephritis&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;56&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;77&#59; 0&#46;25&#8211;2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Neurological&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Seizures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;79&#59; 0&#46;09&#8211;6&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Psychosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;9&#59; 0&#46;36&#8211;10&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Hematology&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Leukopenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;45&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;38&#59; 0&#46;44&#8211;4&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemolytic anemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;67&#59; 0&#46;41&#8211;6&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Thrombocytopenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;18&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;13&#59; 0&#46;00&#8211;2&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Vasculitis&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;28&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;86&#59; 0&#46;78&#8211;10&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sicca syndrome&#59;</span> n <span class="elsevierStyleItalic">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dry eye&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;20&#59; 0&#46;01&#8211;3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dry mouth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2014.03.015

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	11	19
2024 October	56	28	84
2024 September	54	13	67
2024 August	67	27	94
2024 July	46	26	72
2024 June	59	32	91
2024 May	48	33	81
2024 April	53	23	76
2024 March	37	37	74
2024 February	29	31	60
2024 January	55	17	72
2023 December	18	29	47
2023 November	27	27	54
2023 October	39	40	79
2023 September	74	36	110
2023 August	35	15	50
2023 July	32	25	57
2023 June	26	22	48
2023 May	38	32	70
2023 April	20	9	29
2023 March	40	21	61
2023 February	35	23	58
2023 January	32	22	54
2022 December	55	33	88
2022 November	44	17	61
2022 October	50	29	79
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2022 August	43	46	89
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2022 June	30	27	57
2022 May	25	31	56
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2022 March	39	46	85
2022 February	23	27	50
2022 January	37	37	74
2021 December	27	31	58
2021 November	28	38	66
2021 October	107	54	161
2021 September	44	41	85
2021 August	34	33	67
2021 July	29	35	64
2021 June	27	25	52
2021 May	53	36	89
2021 April	42	49	91
2021 March	51	31	82
2021 February	58	18	76
2021 January	48	15	63
2020 December	29	16	45
2020 November	42	26	68
2020 October	22	12	34
2020 September	28	27	55
2020 August	17	21	38
2020 July	25	16	41
2020 June	54	24	78
2020 May	40	10	50
2020 April	30	30	60
2020 March	23	19	42
2020 February	1	0	1
2018 May	3	0	3
2018 April	47	5	52
2018 March	60	4	64
2018 February	36	4	40
2018 January	26	6	32
2017 December	31	13	44
2017 November	36	7	43
2017 October	32	10	42
2017 September	44	9	53
2017 August	59	9	68
2017 July	54	15	69
2017 June	67	17	84
2017 May	67	10	77
2017 April	46	7	53
2017 March	48	10	58
2017 February	23	7	30
2017 January	30	10	40
2016 December	62	22	84
2016 November	37	13	50
2016 October	55	8	63
2016 September	76	11	87
2016 August	71	10	81
2016 July	36	15	51
2015 December	2	0	2
2015 November	1	19	20
2015 October	1	20	21
2015 September	2	0	2
2015 August	1	0	1
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2015 June	43	11	54
2015 May	60	21	81
2015 April	65	21	86
2015 March	52	18	70
2015 February	11	4	15

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