Two-year Incidence of Psoriasis, Uveitis and Inflammatory Bowel Disease in Patients With Spondyloarthritis: A Study in the AQUILES Cohort

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"cabecera" => "Original Article" "titulo" => "Two-year Incidence of Psoriasis, Uveitis and Inflammatory Bowel Disease in Patients With Spondyloarthritis: A Study in the AQUILES Cohort" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "22" "paginaFinal" => "26" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rosario García-Vicuña, Pedro Zarco, Carlos M. González, Francisco Vanaclocha, Ignacio Marín-Jiménez, Luis Cea-Calvo" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Rosario" "apellidos" => "García-Vicuña" "email" => array:1 [ 0 => "vicuna111@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pedro" "apellidos" => "Zarco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Carlos M." "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Francisco" "apellidos" => "Vanaclocha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Ignacio" "apellidos" => "Marín-Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Luis" "apellidos" => "Cea-Calvo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Departamento de Reumatología, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Gastroenterología, Hospital Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Departamento de Medical Affairs, Merck Sharp & Dohme de España, S.A., Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia a los 2 años de psoriasis, uveítis y enfermedad inflamatoria intestinal en la cohorte de pacientes con espondiloartritis del estudio AQUILES" ] ] "textoCompleto" => "IntroductionSpondyloarthritis (SpAs) constitute a heterogeneous group of chronic inflammatory rheumatic diseases with a prevalence of 1.5%–2% of the general population.<a class="elsevierStyleCrossRefs" href="#bib0140">1,2</a> However, estimates vary depending on the prevalence of the HLA B27 allele, having established in a French population that its positivity increases 39 times the risk of suffering from SpA compared to HLA B27-negative subjects.<a class="elsevierStyleCrossRef" href="#bib0150">3</a> In a recent study on the prevalence of ankylosing spondylitis (AS) at a worldwide level, figures by 10.00 inhabitants from 23.8 in Europe, 16.7 in Asia, 31.9 in North America, 10.2 in Latin America and 7.4 in Africa have been described.<a class="elsevierStyleCrossRef" href="#bib0155">4</a> SpAs typically present several manifestations in the axial and peripheral skeleton (spondylitis, arthritis, enthesitis and dactylitis,) but they are usually accompanied by extra-articular manifestations,<a class="elsevierStyleCrossRefs" href="#bib0160">5,6</a> including uveitis, inflammatory bowel disease (IBD), mucocutaneous injuries and cardiovascular and renal impairments,<a class="elsevierStyleCrossRef" href="#bib0170">7</a> which determines important connotations in the patients’ diagnosis, treatment and follow-up.<a class="elsevierStyleCrossRef" href="#bib0175">8</a> Psoriasis, uveitis and IBD are diseases with their own entity that may appear and evolve independently from the SpA, and are a part of a wider group of conditions that have also been named “immune-mediated inflammatory diseases”.<a class="elsevierStyleCrossRefs" href="#bib0180">9–11</a> In addition to phenotypic manifestations, they share with the SpAs a strong familial aggregation, common pathogenetic mechanisms and some genetic determinants, such as HLA B27, NOD2 and ATG6L1 genes in the case of the SpA and IBD and polymorphisms in the IL-23R gene in psoriasis, AS and Crohn's disease.<a class="elsevierStyleCrossRefs" href="#bib0195">12–14</a> Although the frequency of these 3 diseases in patients diagnosed with SpA is more elevated than in the general population,<a class="elsevierStyleCrossRefs" href="#bib0185">10,15</a> there is not much information on their prevalence and incidence in the SpA.<a class="elsevierStyleCrossRef" href="#bib0215">16</a> The purpose of this study was to describe the incidence of new diagnoses of the 3 aforementioned extra-articular manifestations (uveitis, psoriasis and IBD) in the cohort of patients with SpA included in the AQUILES study at the 2-year follow-up.Patients and MethodsThe AQUILES study was a prospective and observational analysis of 3 independent cohorts of patients (SpA, psoriasis and IBD) defined by the diagnosis of the main disease at the time of their inclusion in the study. The investigation was carried out in 15 hospitals in Spain, with the participation of the Rheumatology, Dermatology and Digestive System departments, in conditions of usual clinical practice. The screening period extended from March 2008 to December 2010. The protocol was approved by the participating hospitals’ ethics committees and the study was performed complying with the standards of good clinical practice. Patients were included in the study in accordance with the main diagnosis made by rheumatologists, dermatologists or gastroenterologists, and the follow-up was performed by the same specialist who included them in the cohort. Baseline data referring to the 3 cohorts of patients have been previously published.<a class="elsevierStyleCrossRefs" href="#bib0220">17–19</a>The purpose of this study was to determine the incidence of psoriasis, uveitis and IBD in the 2-year follow-up in the cohort of patients with SpA. This cohort included adult patients, aged 18 years or older, for whom a rheumatologist has established the diagnosis of SpA, including AS, psoriatic arthritis (PA), undifferentiated SpA, arthritis associated to IBD or others. At the time of recruiting the subjects (2008–2010), the current term axial SpA had not been coined yet, which is why it is not gathered in the classification of our patients. The diagnosis of SpA could have been made before (that is, already known in the past) or de novo in patients visited for the first time in the Rheumatology office of the participating hospitals. Patients that, at the investigator's discretion, presented any issue preventing their follow-up for a period of 2 years were excluded from the cohort. In regards to the 3 extra-articular manifestations (uveitis, psoriasis, IBD), the diagnosis could appear in the medical records, due to being present at baseline or because the patient had suffered a previous outbreak (for example, uveitis) and, as such, diagnosis had been entered in the medical record. The follow-up of the cohort with SpA was performed by their rheumatologists and only in the case there was a clinical suspicion of extra-articular affectation, the patient was referred to other specialists (the protocol did not include a scheduled review in all patients). New diagnoses were based on the reports from the corresponding specialists, ophthalmologists for uveitis, dermatologists for psoriasis and gastroenterologists for IBD.Qualitative variables are described with their absolute frequency and their percentage. Continuous variables are presented with the mean and standard deviation or with the median and interquartile range (25 and 75 percentiles) when they did not adjust to a normal distribution. The differences in the accumulated incidence of extra-articular manifestations in the different entities of SpA were analysed with the Pearson's Chi-Square Test (χ2). A logistic regression model was used to determine the clinical and demographic variables independently associated to the incidence of new extra-articular manifestations, presenting the adjusted odds ratio (OR) and the confidence interval (CI) of 95%. The statistical significance was established with a P-value below .05. The results were analysed with the Statistical Package for the Social Sciences® version 15.0 for Windows®.ResultsA total of 601 patients were included in the SpA cohort of the AQUILES study, 513 (85.3%) of them completed the 2-year follow-up, who are those analysed in this study. Most losses during follow-up were due to the change of specialist. There were no significant differences in baseline characteristics between the 513 patients included in the follow-up and the 88 patients excluded, except for a longer duration of the disease in the followed-up patients (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The average age of the study population was 48.1 years (standard deviation 12.5); 62.5% were men and 37.5% were women.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>25.9% were smokers and 30.8% revealed alcohol consumption (moderate in 90.2% of the cases). 12.1% of the cases were diseases diagnosed at the time of entering the study, and 22.3% of the patients had a history of SpA in the direct family. 13.5% of the patients presented extra-articular manifestations different to the studied ones (conjunctivitis [4.5%], cystitis [2.3%], ungula hyperkeratosis [5.3%], balanitis [1.2%], and <1% presented pulmonary fibrosis, aortic insufficiency or renal amyloidosis). SpA diagnoses at the beginning of follow-up were as follows: AS in 285 cases (55.6%), PAs in 130 (25.3%), undifferentiated SpA in 83 (16.2%), enteropathic arthritis in 13 (2.5%) and others in 2 (0.4%). The mean duration of SpA was 7.8 years (interquartile range 2.2–15.3 years). The percentages of patients with different treatments for the SpA at inclusion in the study were: non-steroidal anti-inflammatory drugs (63.5%), glucocorticoids (8.8%), disease-modifying antirheumatic drugs (21.6%) and biologic drugs (34.7%). In patients with AS, the percentages in treatment with non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs and biologic drugs were 74.3, 2.0 and 10.5% respectively, while in PAs they were 39.4, 25.4 and 13.4%, respectively.By the 2-year follow-up, 22 new diagnoses of the 3 extra-articular studied manifestations had been established, with an accumulated incidence of 4.3% (CI of 95% 2.4–6.1) and an incidence rate of 17 cases by 10 000 patients-year. Each extra-articular manifestation's accumulated incidence and incidence rates are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The prevailing diagnosis was uveitis, with a total of 16 cases (3.1% accumulated incidence, CI of 95% 1.5–4.7). Moreover, 16 (72.7%) of the 22 new diagnoses of extra-articular manifestation were observed in patients with AS (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). On the other hand, most patients with PAs already presented psoriasis at baseline and only 2 were diagnosed with psoriasis during follow-up, without any other accompanying incidents of extra-articular manifestations (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>No significant differences were found in the incidence of new extra-articular manifestations at the 2-year follow-up in the comparisons between men and women, presence or absence of familial disease or other extra-articular manifestations from the beginning of follow-up, as well as differences based on disease duration or on the treatments that patients were receiving (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). In the multivariable analysis, the only independent predictive factor of development of other extra-articular manifestations was the diagnosis of AS compared to the PAs (OR 3.5; CI of 95% 1.0–15.3; P=.049).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThe results obtained after 2 years of follow-up in a cohort of 513 patients with SpA show the possibility of appearance of other immunity-mediated inflammatory diseases during the course of the condition and confirm that uveitis is the extra-articular manifestation with the highest incidence (16 out of the 22 new diagnoses [72.7%]), mostly in patients with AS. Uveitis is one of the most frequent extra-articular manifestations in patients with SpA.<a class="elsevierStyleCrossRef" href="#bib0235">20</a> Additionally, approximately 40% of the patients with prior uveitis present undiagnosed SpA at the time of the outbreak.<a class="elsevierStyleCrossRef" href="#bib0240">21</a> In this sense, close cooperation between ophthalmologists and rheumatologists is of paramount importance in the long-term diagnosis and prognosis of uveitis. However, there is no consensus regarding the need for systematic clinical screening or whether it is convenient to perform a routine ophthalmoscopic examination in patients with SpA. Our study did not include a specific detection strategy, so it is possible that some mild subclinical or asymptomatic outbreaks of uveitis may have gone unnoticed, and the accumulated incidence of uveitis after 2 years may have been underrated. Most cases in our series (81.2%, 13/16) were diagnosed in patients with AS, probably because they are a wide majority in the cohort, but we should not forget that it is also the most frequent extra-articular manifestation in PAs after psoriasis,<a class="elsevierStyleCrossRef" href="#bib0245">22</a> so patients with this disease should be subject to special care.The accumulated incidence of psoriasis was only 1.0%, since practically every patient with PAs had already been diagnosed with psoriasis at the beginning of the study. However, we should mention that arthritis precedes psoriasis in 10%–15% of the patients,<a class="elsevierStyleCrossRef" href="#bib0250">23</a> usually as an undifferentiated SpA, and skin affectation in these patients may take months or years to appear. In this sense, the patient should be instructed to see the dermatologist if there is presence of skin alterations and, especially, ungual lesions.The appearance of new diagnoses of IBD was very rare, since only one patient with AS developed ulcerative colitis. We must bear in mind that the IBD incidence rate in the Spanish population is very variable depending on the geographic region, and that the methodology used in epidemiological studies is still very heterogeneous.<a class="elsevierStyleCrossRef" href="#bib0255">24</a> However, as in the rest of the Occidental world, the Spanish population studies published since 2000 gather an increase in incident cases in some regions, until stabilisation with estimates that vary between 4.2 and 12.5/100 000 inhabitants-year for ulcerative colitis and 0.8–10.5/100 000 for Crohn's disease.<a class="elsevierStyleCrossRef" href="#bib0260">25</a> Therefore, the incidence in our hospital cohort would be within the range described in the general population, but it is very likely that the sample size is not capable of detecting differences and we cannot rule out subclinical profiles that do not manifest themselves because of the treatments with proved efficiency in both diseases.However, we did not find differences in the incidence of extra-articular manifestations based on the treatment received by the patients. Although some studies show that certain manifestations such as uveitis may decrease with the use of some disease-modifying antirheumatic drugs or biologic drugs,<a class="elsevierStyleCrossRefs" href="#bib0265">26,27</a> the short duration of the follow-up or the fact that precisely the most-symptomatic patients are those more treated could mask the potential effect of these drugs.As limitations to this study, it is important to mention that patients were followed up in the Rheumatology practice, and they were only referred to other specialists in cases of concomitant disease, without establishing of a follow-up protocol by other specialists or an active search protocol of extra-articular manifestations through additional diagnostic tests for all the patients, but only when they presented indications of disease. Hence, some diseases such as uveitis or even certain very mild cases of IBD or psoriasis could have certain infradiagnosis. Additionally, although the patients were seeing in conditions of clinical practice, all of them belonged to a hospital environment, so they could not be representative of the general population of patients with SpA. On the other hand, it would have been interesting to analyse a more homogeneous cohort, for example, only those patients with AS or undifferentiated forms, since most patients with PAs already have psoriasis and those who have enteropathic arthritis already have IBD. Finally, in this study, we did not gather the HLA-B27 antigen status, so another limitation is that we cannot affirm whether the incident cases of uveitis occurred in patients with positive HLA-B27.In conclusion, patients with SpA, especially those with AS, may develop immunity-mediated inflammatory diseases, especially uveitis, during the chronic course of their base disease. That determines a clinical profile with expressiveness in different systems and organs, which forces a comprehensive approach to treatment and diagnosis of the patient with SpA.Ethical ResponsibilitiesProtection of people and animalsAuthors state that no experiments were performed on human beings or animals as part of this investigation.Confidentiality of dataAuthors state that this article does not contain patient data.Right to privacy and informed consentAuthors state that this article does not contain patient data.FundingThe AQUILES study was funded by Merck Sharp & Dohme de España, S.A.Conflict of InterestsRosario García-Vicuña: consultant in hospital project for MSD; expenses associated to scientific congresses. Francisco Vanaclocha: none. Pedro Zarco: advisor and medical education programs for MSD, AbbVie and Pfizer. Carlos M. González: grant MSD, advisor or medical education programs for MSD, AbbVie, Pfizer, Roche and UCB. Ignacio Marín-Jiménez: presentations or educational projects for MSD, AbbVie, Falk Pharma y Shire, consultancy for MSD, Ferring, Falk Pharma, AbbVie, FAES and Shire. Luis Cea-Calvo: employee at MSD, Spain." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres599019" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec613489" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres599020" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec613488" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of Interests" ] 11 => array:2 [ "identificador" => "xack201743" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-20" "fechaAceptado" => "2015-01-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec613489" "palabras" => array:7 [ 0 => "Psoriatic arthritis" 1 => "Inflammatory bowel disease" 2 => "Ankylosing spondylitis" 3 => "Spondyloarthritis" 4 => "Observational study" 5 => "Prospective study" 6 => "Uveitis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec613488" "palabras" => array:7 [ 0 => "Artritis psoriásica" 1 => "Enfermedad inflamatoria intestinal" 2 => "Espondilitis anquilosante" 3 => "Espondiloartritis" 4 => "Estudio observacional" 5 => "Estudio prospectivo" 6 => "Uveítis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesTo describe the 2-year incidence of new extra-articular manifestations (uveitis, psoriasis, inflammatory bowel disease) in a cohort of patients with spondyloarthritis included in the AQUILES study. PatientsOver a period of 2 years, 513 patients with spondyloarthritis (62.5% males, mean age 48 years) diagnosed with ankylosing spondylitis (AS) (55.6%), psoriatic arthritis (25.3%), undifferentiated spondyloarthritis (16.2%), enteropathic arthritis (2.5%), and other diseases (0.4%) were followed. New diagnoses were based on reports of the corresponding specialists (ophthalmologists, dermatologists, gastroenterologists). ResultsDuring the 2-year follow-up, 22 new diagnoses of the extra-articular manifestations were established, with a cumulative incidence of 4.3% (95% confidence interval 2.4–6.1) and an incidence rate of 17 cases per 10,000 patient-year. Uveitis was the most frequent diagnosis (cumulative incidence 3.1%), predominantly in patients with AS. In the multivariate analysis, the diagnosis of AS was the only predictive variable associated to the development of new extra-articular disease. ConclusionsIn patients with spondyloarthritis, the 2-year global incidence of uveitis, psoriasis and inflammatory bowel disease (IMID) was 4.3%, particularly due to new diagnoses of uveitis in patients with AS." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosDescribir la incidencia a los 2 años de nuevas manifestaciones extraarticulares (uveítis, psoriasis, enfermedad inflamatoria intestinal) en la cohorte de pacientes con espondiloartritis del estudio AQUILES. PacientesDurante 2 años se siguieron 513 pacientes con espondiloartritis (62,5% varones, edad media 48 años) diagnosticados de espondilitis anquilosante (EA) (55,6%), artritis psoriásica (25,3%), espondiloartritis indiferenciada (16,2%), artritis enteropática (2,5%) y otros diagnósticos (0,4%). Los nuevos diagnósticos se basaron en los informes de los respectivos especialistas (oftalmólogos, dermatólogos y gastroenterólogos). ResultadosSe establecieron 22 nuevos diagnósticos de las manifestaciones extraarticulares estudiadas (incidencia acumulada: 4,3% [intervalo de confianza del 95% 2,4-6,1]; tasa de incidencia: 17 casos por 10.000 pacientes-año). La uveítis fue el diagnóstico más frecuente (incidencia acumulada del 3,1%), predominantemente en pacientes con EA. En el análisis multivariable, el diagnóstico de EA fue el único predictor de aparición de nueva manifestación extraarticular. ConclusionesEn pacientes con espondiloartritis, la incidencia de uveítis, psoriasis y enfermedad inflamatoria intestinal a los 2 años fue globalmente del 4,3%, principalmente por nuevos diagnósticos de uveítis en pacientes con EA." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: García-Vicuña R, Zarco P, González CM, Vanaclocha F, Marín-Jiménez I, Cea-Calvo L. Incidencia a los 2 años de psoriasis, uveítis y enfermedad inflamatoria intestinal en la cohorte de pacientes con espondiloartritis del estudio AQUILES. Reumatol Clin. 2016;12:22–26." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "SD, standard deviation; SpA, spondyloarthritis; IQR, interquartile range." "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Followed up (n=513) \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">Lost (n=88) \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">Average age in years (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.1 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46.7 (14.7) \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">Sex, % men/women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62.5/37.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63.2/36.8 \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">Duration of SpA in years, median (IQR)<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.8 (2.2–15.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.8 (0.6–10.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Distribution of SpA diagnoses, %</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ankylosing spondylitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53.4 \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">Psoriatic arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.9 \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">Undifferentiated spondyloarthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.9 \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">Enteropathic arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.3 \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">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab979980.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "P=0.005; the rest, without significant differences." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the Patients Followed up During 2 Years and Those Lost." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "IBD, inflammatory bowel disease; CI, confidence interval." "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">Extra-articular 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">Number of incident cases \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">Incidence at 2 years, % (CI of 95%) \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">Incidence rate by 10 000 patients-year (CI of 95%) \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">All \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><td class="td" title="table-entry " align="char" valign="top">4.3 (2.4–6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.3 (11.5–26.2) \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">IBD (ulcerative colitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 (0–1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 (0.1–4.5) \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">Psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 (0.2–2.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 (1.7–9.2) \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">Uveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 (1.5–4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.6 (7.8–20.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab979981.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Accumulated Incidence at 2-Year Follow-up of New Extra-articular Manifestations in the Cohort of Patients With Spondyloarthritis From the AQUILES Study." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "IBD, inflammatory bowel disease.Data expressed as n (%)." "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Total (n=513)<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \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">Ankylosing spondylitis (n=285) \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">Psoriatic arthritis (n=130) \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">Undifferentiated spondyloarthritis (n=83) \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">Arthritis associated to IBD (n=13) \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">Extra-articular manifestations, all \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (7.7) \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">IBD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.4) \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">0 \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></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.2) \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></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Uveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (4.6) \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">2 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (7.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab979979.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Two patients with other diagnoses of spondyloarthritis and without new diagnoses of extra-articular manifestations are not included in the table." ] ] ] "descripcion" => array:1 [ "en" => "Accumulated Incidence at 2 Years of Follow-up of New Extra-articular Manifestations in the Cohort of Patients With Spondyloarthritis From the AQUILES Study Based on the Base Spondyloarthritis.<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a>" ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "NSAIDs, non-steroidal anti-inflammatory drugs; SpA, spondyloarthritis; DMARDs, disease-modifying antirheumatic drugs." "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Incidence at 2 years, % \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="3" align="left" valign="top">Sex</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.161 \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">Female patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Duration of SpA (years)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.732 \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">4–8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">>8 \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="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Family history of SpA</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.316 \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">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Prior or new diagnosis</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">New \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.660 \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">Prior \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="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Other extra-articular manifestations at the beginning of follow-up<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.905 \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">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Treatment with NSAID</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.644 \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">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Treatment with DMARD</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.144 \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">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Treatment with biologic drugs</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.279 \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">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab979978.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Conjunctivitis, cystitis, ungual hyperkeratosis, balanitis, pulmonary fibrosis, aortic insufficiency or renal amyloidosis." ] ] ] "descripcion" => array:1 [ "en" => "Incidence After 2 Years of New Extra-articular Manifestations in Subgroups of Patients." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of axial spondyloarthritis in United States rheumatology practices: sssessment of SpondyloArthritis International Society criteria versus rheumatology expert clinical diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V. Strand" 1 => "S.A. Rao" 2 => "A.C. Shillington" 3 => "M.A. Cifaldi" 4 => "M. McGuire" 5 => "E.M. Ruderman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res (Hoboken)" "fecha" => "2013" "volumen" => "65" "paginaInicial" => "1299" "paginaFinal" => "1306" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0145" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early spondyloarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Poddubnyy" 1 => "M. 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"vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001200000001/v1_201601240019/S2173574315000532/v1_201601240019/en/main.assets" "Apartado" => array:4 [ "identificador" => "43294" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001200000001/v1_201601240019/S2173574315000532/v1_201601240019/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315000532?idApp=UINPBA00004M"]

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Original Article

Two-year Incidence of Psoriasis, Uveitis and Inflammatory Bowel Disease in Patients With Spondyloarthritis: A Study in the AQUILES Cohort

Incidencia a los 2 años de psoriasis, uveítis y enfermedad inflamatoria intestinal en la cohorte de pacientes con espondiloartritis del estudio AQUILES

Rosario García-Vicuñaa,

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vicuna111@gmail.com

Corresponding author.

, Pedro Zarcob, Carlos M. Gonzálezc, Francisco Vanaclochad, Ignacio Marín-Jiméneze, Luis Cea-Calvof

a Departamento de Reumatología, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain

b Departamento de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain

c Departamento de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, Spain

d Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain

e Departamento de Gastroenterología, Hospital Universitario Gregorio Marañón, Madrid, Spain

f Departamento de Medical Affairs, Merck Sharp & Dohme de España, S.A., Madrid, Spain

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16&#46;7 in Asia&#44; 31&#46;9 in North America&#44; 10&#46;2 in Latin America and 7&#46;4 in Africa have been described&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> SpAs typically present several manifestations in the axial and peripheral skeleton &#40;spondylitis&#44; arthritis&#44; enthesitis and dactylitis&#44;&#41; but they are usually accompanied by extra-articular manifestations&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">5&#44;6</span></a> including uveitis&#44; inflammatory bowel disease &#40;IBD&#41;&#44; mucocutaneous injuries and cardiovascular and renal impairments&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> which determines important connotations in the patients&#8217; diagnosis&#44; treatment and follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> Psoriasis&#44; uveitis and IBD are diseases with their own entity that may appear and evolve independently from the SpA&#44; and are a part of a wider group of conditions that have also been named &#8220;immune-mediated inflammatory diseases&#8221;&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">9&#8211;11</span></a> In addition to phenotypic manifestations&#44; they share with the SpAs a strong familial aggregation&#44; common pathogenetic mechanisms and some genetic determinants&#44; such as HLA B27&#44; NOD2 and ATG6L1 genes in the case of the SpA and IBD and polymorphisms in the IL-23R gene in psoriasis&#44; AS and Crohn&#39;s disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">12&#8211;14</span></a> Although the frequency of these 3 diseases in patients diagnosed with SpA is more elevated than in the general population&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;15</span></a> there is not much information on their prevalence and incidence in the SpA&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> The purpose of this study was to describe the incidence of new diagnoses of the 3 aforementioned extra-articular manifestations &#40;uveitis&#44; psoriasis and IBD&#41; in the cohort of patients with SpA included in the AQUILES study at the 2-year follow-up&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">The AQUILES study was a prospective and observational analysis of 3 independent cohorts of patients &#40;SpA&#44; psoriasis and IBD&#41; defined by the diagnosis of the main disease at the time of their inclusion in the study&#46; The investigation was carried out in 15 hospitals in Spain&#44; with the participation of the Rheumatology&#44; Dermatology and Digestive System departments&#44; in conditions of usual clinical practice&#46; The screening period extended from March 2008 to December 2010&#46; The protocol was approved by the participating hospitals&#8217; ethics committees and the study was performed complying with the standards of good clinical practice&#46; 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which is why it is not gathered in the classification of our patients&#46; The diagnosis of SpA could have been made before &#40;that is&#44; already known in the past&#41; or <span class="elsevierStyleItalic">de novo</span> in patients visited for the first time in the Rheumatology office of the participating hospitals&#46; Patients that&#44; at the investigator&#39;s discretion&#44; presented any issue preventing their follow-up for a period of 2 years were excluded from the cohort&#46; In regards to the 3 extra-articular manifestations &#40;uveitis&#44; psoriasis&#44; IBD&#41;&#44; the diagnosis could appear in the medical records&#44; due to being present at baseline or because the patient had suffered a previous outbreak &#40;for example&#44; uveitis&#41; and&#44; as such&#44; diagnosis had been entered in the medical record&#46; The follow-up of the cohort with SpA was performed by their rheumatologists and only in the case there was a clinical suspicion of extra-articular affectation&#44; the patient was referred to other specialists &#40;the protocol did not include a scheduled review in all patients&#41;&#46; New diagnoses were based on the reports from the corresponding specialists&#44; ophthalmologists for uveitis&#44; dermatologists for psoriasis and gastroenterologists for IBD&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Qualitative variables are described with their absolute frequency and their percentage&#46; Continuous variables are presented with the mean and standard deviation or with the median and interquartile range &#40;25 and 75 percentiles&#41; when they did not adjust to a normal distribution&#46; The differences in the accumulated incidence of extra-articular manifestations in the different entities of SpA were analysed with the Pearson&#39;s Chi-Square Test &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#41;&#46; A logistic regression model was used to determine the clinical and demographic variables independently associated to the incidence of new extra-articular manifestations&#44; presenting the adjusted odds ratio &#40;OR&#41; and the confidence interval &#40;CI&#41; of 95&#37;&#46; The statistical significance was established with a <span class="elsevierStyleItalic">P</span>-value below &#46;05&#46; The results were analysed with the <span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span><span class="elsevierStyleSup">&#174;</span> version 15&#46;0 for Windows<span class="elsevierStyleSup">&#174;</span>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 601 patients were included in the SpA cohort of the AQUILES study&#44; 513 &#40;85&#46;3&#37;&#41; of them completed the 2-year follow-up&#44; who are those analysed in this study&#46; Most losses during follow-up were due to the change of specialist&#46; There were no significant differences in baseline characteristics between the 513 patients included in the follow-up and the 88 patients excluded&#44; except for a longer duration of the disease in the followed-up patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The average age of the study population was 48&#46;1 years &#40;standard deviation 12&#46;5&#41;&#59; 62&#46;5&#37; were men and 37&#46;5&#37; were women&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">25&#46;9&#37; were smokers and 30&#46;8&#37; revealed alcohol consumption &#40;moderate in 90&#46;2&#37; of the cases&#41;&#46; 12&#46;1&#37; of the cases were diseases diagnosed at the time of entering the study&#44; and 22&#46;3&#37; of the patients had a history of SpA in the direct family&#46; 13&#46;5&#37; of the patients presented extra-articular manifestations different to the studied ones &#40;conjunctivitis &#91;4&#46;5&#37;&#93;&#44; cystitis &#91;2&#46;3&#37;&#93;&#44; ungula hyperkeratosis &#91;5&#46;3&#37;&#93;&#44; balanitis &#91;1&#46;2&#37;&#93;&#44; and &#60;1&#37; presented pulmonary fibrosis&#44; aortic insufficiency or renal amyloidosis&#41;&#46; SpA diagnoses at the beginning of follow-up were as follows&#58; AS in 285 cases &#40;55&#46;6&#37;&#41;&#44; PAs in 130 &#40;25&#46;3&#37;&#41;&#44; undifferentiated SpA in 83 &#40;16&#46;2&#37;&#41;&#44; enteropathic arthritis in 13 &#40;2&#46;5&#37;&#41; and others in 2 &#40;0&#46;4&#37;&#41;&#46; The mean duration of SpA was 7&#46;8 years &#40;interquartile range 2&#46;2&#8211;15&#46;3 years&#41;&#46; The percentages of patients with different treatments for the SpA at inclusion in the study were&#58; non-steroidal anti-inflammatory drugs &#40;63&#46;5&#37;&#41;&#44; glucocorticoids &#40;8&#46;8&#37;&#41;&#44; disease-modifying antirheumatic drugs &#40;21&#46;6&#37;&#41; and biologic drugs &#40;34&#46;7&#37;&#41;&#46; In patients with AS&#44; the percentages in treatment with non-steroidal anti-inflammatory drugs&#44; disease-modifying antirheumatic drugs and biologic drugs were 74&#46;3&#44; 2&#46;0 and 10&#46;5&#37; respectively&#44; while in PAs they were 39&#46;4&#44; 25&#46;4 and 13&#46;4&#37;&#44; respectively&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">By the 2-year follow-up&#44; 22 new diagnoses of the 3 extra-articular studied manifestations had been established&#44; with an accumulated incidence of 4&#46;3&#37; &#40;CI of 95&#37; 2&#46;4&#8211;6&#46;1&#41; and an incidence rate of 17 cases by 10 000 patients-year&#46; Each extra-articular manifestation&#39;s accumulated incidence and incidence rates are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The prevailing diagnosis was uveitis&#44; with a total of 16 cases &#40;3&#46;1&#37; accumulated incidence&#44; CI of 95&#37; 1&#46;5&#8211;4&#46;7&#41;&#46; Moreover&#44; 16 &#40;72&#46;7&#37;&#41; of the 22 new diagnoses of extra-articular manifestation were observed in patients with AS &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; On the other hand&#44; most patients with PAs already presented psoriasis at baseline and only 2 were diagnosed with psoriasis during follow-up&#44; without any other accompanying incidents of extra-articular manifestations &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">No significant differences were found in the incidence of new extra-articular manifestations at the 2-year follow-up in the comparisons between men and women&#44; presence or absence of familial disease or other extra-articular manifestations from the beginning of follow-up&#44; as well as differences based on disease duration or on the treatments that patients were receiving &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; In the multivariable analysis&#44; the only independent predictive factor of development of other extra-articular manifestations was the diagnosis of AS compared to the PAs &#40;OR 3&#46;5&#59; CI of 95&#37; 1&#46;0&#8211;15&#46;3&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;049&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The results obtained after 2 years of follow-up in a cohort of 513 patients with SpA show the possibility of appearance of other immunity-mediated inflammatory diseases during the course of the condition and confirm that uveitis is the extra-articular manifestation with the highest incidence &#40;16 out of the 22 new diagnoses &#91;72&#46;7&#37;&#93;&#41;&#44; mostly in patients with AS&#46; Uveitis is one of the most frequent extra-articular manifestations in patients with SpA&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> Additionally&#44; approximately 40&#37; of the patients with prior uveitis present undiagnosed SpA at the time of the outbreak&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> In this sense&#44; close cooperation between ophthalmologists and rheumatologists is of paramount importance in the long-term diagnosis and prognosis of uveitis&#46; However&#44; there is no consensus regarding the need for systematic clinical screening or whether it is convenient to perform a routine ophthalmoscopic examination in patients with SpA&#46; Our study did not include a specific detection strategy&#44; so it is possible that some mild subclinical or asymptomatic outbreaks of uveitis may have gone unnoticed&#44; and the accumulated incidence of uveitis after 2 years may have been underrated&#46; Most cases in our series &#40;81&#46;2&#37;&#44; 13&#47;16&#41; were diagnosed in patients with AS&#44; probably because they are a wide majority in the cohort&#44; but we should not forget that it is also the most frequent extra-articular manifestation in PAs after psoriasis&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> so patients with this disease should be subject to special care&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The accumulated incidence of psoriasis was only 1&#46;0&#37;&#44; since practically every patient with PAs had already been diagnosed with psoriasis at the beginning of the study&#46; However&#44; we should mention that arthritis precedes psoriasis in 10&#37;&#8211;15&#37; of the patients&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> usually as an undifferentiated SpA&#44; and skin affectation in these patients may take months or years to appear&#46; In this sense&#44; the patient should be instructed to see the dermatologist if there is presence of skin alterations and&#44; especially&#44; ungual lesions&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The appearance of new diagnoses of IBD was very rare&#44; since only one patient with AS developed ulcerative colitis&#46; We must bear in mind that the IBD incidence rate in the Spanish population is very variable depending on the geographic region&#44; and that the methodology used in epidemiological studies is still very heterogeneous&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> However&#44; as in the rest of the Occidental world&#44; the Spanish population studies published since 2000 gather an increase in incident cases in some regions&#44; until stabilisation with estimates that vary between 4&#46;2 and 12&#46;5&#47;100 000 inhabitants-year for ulcerative colitis and 0&#46;8&#8211;10&#46;5&#47;100 000 for Crohn&#39;s disease&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> Therefore&#44; the incidence in our hospital cohort would be within the range described in the general population&#44; but it is very likely that the sample size is not capable of detecting differences and we cannot rule out subclinical profiles that do not manifest themselves because of the treatments with proved efficiency in both diseases&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">However&#44; we did not find differences in the incidence of extra-articular manifestations based on the treatment received by the patients&#46; Although some studies show that certain manifestations such as uveitis may decrease with the use of some disease-modifying antirheumatic drugs or biologic drugs&#44;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">26&#44;27</span></a> the short duration of the follow-up or the fact that precisely the most-symptomatic patients are those more treated could mask the potential effect of these drugs&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">As limitations to this study&#44; it is important to mention that patients were followed up in the Rheumatology practice&#44; and they were only referred to other specialists in cases of concomitant disease&#44; without establishing of a follow-up protocol by other specialists or an active search protocol of extra-articular manifestations through additional diagnostic tests for all the patients&#44; but only when they presented indications of disease&#46; Hence&#44; some diseases such as uveitis or even certain very mild cases of IBD or psoriasis could have certain infradiagnosis&#46; Additionally&#44; although the patients were seeing in conditions of clinical practice&#44; all of them belonged to a hospital environment&#44; so they could not be representative of the general population of patients with SpA&#46; On the other hand&#44; it would have been interesting to analyse a more homogeneous cohort&#44; for example&#44; only those patients with AS or undifferentiated forms&#44; since most patients with PAs already have psoriasis and those who have enteropathic arthritis already have IBD&#46; Finally&#44; in this study&#44; we did not gather the HLA-B27 antigen status&#44; so another limitation is that we cannot affirm whether the incident cases of uveitis occurred in patients with positive HLA-B27&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; patients with SpA&#44; especially those with AS&#44; may develop immunity-mediated inflammatory diseases&#44; especially uveitis&#44; during the chronic course of their base disease&#46; That determines a clinical profile with expressiveness in different systems and organs&#44; which forces a comprehensive approach to treatment and diagnosis of the patient with SpA&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical Responsibilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of people and animals</span><p id="par0075" class="elsevierStylePara elsevierViewall">Authors state that no experiments were performed on human beings or animals as part of this investigation&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0080" class="elsevierStylePara elsevierViewall">Authors state that this article does not contain patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0085" class="elsevierStylePara elsevierViewall">Authors state that this article does not contain patient data&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0090" class="elsevierStylePara elsevierViewall">The AQUILES study was funded by <span class="elsevierStyleGrantSponsor" id="gs19">Merck Sharp &#38; Dohme de Espa&#241;a&#44; S&#46;A</span>&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of Interests</span><p id="par0095" class="elsevierStylePara elsevierViewall">Rosario Garc&#237;a-Vicu&#241;a&#58; consultant in hospital project for MSD&#59; expenses associated to scientific congresses&#46; Francisco Vanaclocha&#58; none&#46; Pedro Zarco&#58; advisor and medical education programs for MSD&#44; AbbVie and Pfizer&#46; Carlos M&#46; Gonz&#225;lez&#58; grant MSD&#44; advisor or medical education programs for MSD&#44; AbbVie&#44; Pfizer&#44; Roche and UCB&#46; Ignacio Mar&#237;n-Jim&#233;nez&#58; presentations or educational projects for MSD&#44; AbbVie&#44; Falk Pharma y Shire&#44; consultancy for MSD&#44; Ferring&#44; Falk Pharma&#44; AbbVie&#44; FAES and Shire&#46; Luis Cea-Calvo&#58; employee at MSD&#44; Spain&#46;</p></span></span>"
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    "fechaRecibido" => "2014-11-20"
    "fechaAceptado" => "2015-01-11"
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          "clase" => "keyword"
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            0 => "Psoriatic arthritis"
            1 => "Inflammatory bowel disease"
            2 => "Ankylosing spondylitis"
            3 => "Spondyloarthritis"
            4 => "Observational study"
            5 => "Prospective study"
            6 => "Uveitis"
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          "palabras" => array:7 [
            0 => "Artritis psori&#225;sica"
            1 => "Enfermedad inflamatoria intestinal"
            2 => "Espondilitis anquilosante"
            3 => "Espondiloartritis"
            4 => "Estudio observacional"
            5 => "Estudio prospectivo"
            6 => "Uve&#237;tis"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the 2-year incidence of new extra-articular manifestations &#40;uveitis&#44; psoriasis&#44; inflammatory bowel disease&#41; in a cohort of patients with spondyloarthritis included in the AQUILES study&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Over a period of 2 years&#44; 513 patients with spondyloarthritis &#40;62&#46;5&#37; males&#44; mean age 48 years&#41; diagnosed with ankylosing spondylitis &#40;AS&#41; &#40;55&#46;6&#37;&#41;&#44; psoriatic arthritis &#40;25&#46;3&#37;&#41;&#44; undifferentiated spondyloarthritis &#40;16&#46;2&#37;&#41;&#44; enteropathic arthritis &#40;2&#46;5&#37;&#41;&#44; and other diseases &#40;0&#46;4&#37;&#41; were followed&#46; New diagnoses were based on reports of the corresponding specialists &#40;ophthalmologists&#44; dermatologists&#44; gastroenterologists&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During the 2-year follow-up&#44; 22 new diagnoses of the extra-articular manifestations were established&#44; with a cumulative incidence of 4&#46;3&#37; &#40;95&#37; confidence interval 2&#46;4&#8211;6&#46;1&#41; and an incidence rate of 17 cases per 10&#44;000 patient-year&#46; Uveitis was the most frequent diagnosis &#40;cumulative incidence 3&#46;1&#37;&#41;&#44; predominantly in patients with AS&#46; In the multivariate analysis&#44; the diagnosis of AS was the only predictive variable associated to the development of new extra-articular disease&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In patients with spondyloarthritis&#44; the 2-year global incidence of uveitis&#44; psoriasis and inflammatory bowel disease &#40;IMID&#41; was 4&#46;3&#37;&#44; particularly due to new diagnoses of uveitis in patients with AS&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir la incidencia a los 2 a&#241;os de nuevas manifestaciones extraarticulares &#40;uve&#237;tis&#44; psoriasis&#44; enfermedad inflamatoria intestinal&#41; en la cohorte de pacientes con espondiloartritis del estudio AQUILES&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Durante 2 a&#241;os se siguieron 513 pacientes con espondiloartritis &#40;62&#44;5&#37; varones&#44; edad media 48 a&#241;os&#41; diagnosticados de espondilitis anquilosante &#40;EA&#41; &#40;55&#44;6&#37;&#41;&#44; artritis psori&#225;sica &#40;25&#44;3&#37;&#41;&#44; espondiloartritis indiferenciada &#40;16&#44;2&#37;&#41;&#44; artritis enterop&#225;tica &#40;2&#44;5&#37;&#41; y otros diagn&#243;sticos &#40;0&#44;4&#37;&#41;&#46; Los nuevos diagn&#243;sticos se basaron en los informes de los respectivos especialistas &#40;oftalm&#243;logos&#44; dermat&#243;logos y gastroenter&#243;logos&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se establecieron 22 nuevos diagn&#243;sticos de las manifestaciones extraarticulares estudiadas &#40;incidencia acumulada&#58; 4&#44;3&#37; &#91;intervalo de confianza del 95&#37; 2&#44;4-6&#44;1&#93;&#59; tasa de incidencia&#58; 17 casos por 10&#46;000 pacientes-a&#241;o&#41;&#46; La uve&#237;tis fue el diagn&#243;stico m&#225;s frecuente &#40;incidencia acumulada del 3&#44;1&#37;&#41;&#44; predominantemente en pacientes con EA&#46; En el an&#225;lisis multivariable&#44; el diagn&#243;stico de EA fue el &#250;nico predictor de aparici&#243;n de nueva manifestaci&#243;n extraarticular&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En pacientes con espondiloartritis&#44; la incidencia de uve&#237;tis&#44; psoriasis y enfermedad inflamatoria intestinal a los 2 a&#241;os fue globalmente del 4&#44;3&#37;&#44; principalmente por nuevos diagn&#243;sticos de uve&#237;tis en pacientes con EA&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Garc&#237;a-Vicu&#241;a R&#44; Zarco P&#44; Gonz&#225;lez CM&#44; Vanaclocha F&#44; Mar&#237;n-Jim&#233;nez I&#44; Cea-Calvo L&#46; Incidencia a los 2 a&#241;os de psoriasis&#44; uve&#237;tis y enfermedad inflamatoria intestinal en la cohorte de pacientes con espondiloartritis del estudio AQUILES&#46; Reumatol Clin&#46; 2016&#59;12&#58;22&#8211;26&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#59; SpA&#44; spondyloarthritis&#59; IQR&#44; interquartile range&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Followed up &#40;n&#61;513&#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">Lost &#40;n&#61;88&#41;&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"><span class="elsevierStyleItalic">Average age in years &#40;SD&#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">48&#46;1 &#40;12&#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">46&#46;7 &#40;14&#46;7&#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">Sex&#44; &#37; men&#47;women</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;5&#47;37&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#46;2&#47;36&#46;8&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">Duration of SpA in years&#44; median &#40;IQR&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;8 &#40;2&#46;2&#8211;15&#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">3&#46;8 &#40;0&#46;6&#8211;10&#46;0&#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  " colspan="3" 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="3" align="left" valign="top"><span class="elsevierStyleItalic">Distribution of SpA diagnoses&#44; &#37;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ankylosing spondylitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#46;4&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>Psoriatic arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;9&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>Undifferentiated spondyloarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;9&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>Enteropathic arthritis&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;5&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&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>Others&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;4&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;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">P</span>&#61;0&#46;005&#59; the rest&#44; without significant differences&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the Patients Followed up During 2 Years and Those Lost&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IBD&#44; inflammatory bowel disease&#59; CI&#44; confidence interval&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Extra-articular 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">Number of incident cases&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">Incidence at 2 years&#44; &#37; &#40;CI of 95&#37;&#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">Incidence rate by 10 000 patients-year &#40;CI of 95&#37;&#41;&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">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3 &#40;2&#46;4&#8211;6&#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">17&#46;3 &#40;11&#46;5&#8211;26&#46;2&#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">IBD &#40;ulcerative colitis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2 &#40;0&#8211;1&#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">0&#46;8 &#40;0&#46;1&#8211;4&#46;5&#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">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0 &#40;0&#46;2&#8211;2&#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">4&#46;0 &#40;1&#46;7&#8211;9&#46;2&#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">Uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1 &#40;1&#46;5&#8211;4&#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">12&#46;6 &#40;7&#46;8&#8211;20&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab979981.png"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Accumulated Incidence at 2-Year Follow-up of New Extra-articular Manifestations in the Cohort of Patients With Spondyloarthritis From the AQUILES Study&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">IBD&#44; inflammatory bowel disease&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Data expressed as n &#40;&#37;&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Total &#40;n&#61;513&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">Ankylosing spondylitis &#40;n&#61;285&#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">Psoriatic arthritis &#40;n&#61;130&#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">Undifferentiated spondyloarthritis &#40;n&#61;83&#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">Arthritis associated to IBD &#40;n&#61;13&#41;&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">Extra-articular manifestations&#44; all&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;4&#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">16 &#40;5&#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">2 &#40;1&#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">3 &#40;3&#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">1 &#40;7&#46;7&#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">IBD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#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">1 &#40;0&#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">0&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">0&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">Psoriasis&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;1&#46;0&#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;0&#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">2 &#40;1&#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">1 &#40;1&#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">0&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">Uveitis&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;3&#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;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">0&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&#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">1 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab979979.png"
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Two patients with other diagnoses of spondyloarthritis and without new diagnoses of extra-articular manifestations are not included in the table&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Accumulated Incidence at 2 Years of Follow-up of New Extra-articular Manifestations in the Cohort of Patients With Spondyloarthritis From the AQUILES Study Based on the Base Spondyloarthritis&#46;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">NSAIDs&#44; non-steroidal anti-inflammatory drugs&#59; SpA&#44; spondyloarthritis&#59; DMARDs&#44; disease-modifying antirheumatic drugs&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Incidence at 2 years&#44; &#37;&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="3" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#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;161&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>Female patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="3" 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="3" align="left" valign="top"><span class="elsevierStyleItalic">Duration of SpA &#40;years&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">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;732&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>4&#8211;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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>&#62;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="3" 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="3" align="left" valign="top"><span class="elsevierStyleItalic">Family history of SpA</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0&nbsp;\t\t\t\t\t\t\n
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        "texto" => "<p id="par0100" class="elsevierStylePara elsevierViewall">We hereby thank the investigators for their cooperation in the inclusion and follow-up of study patients&#46; The statistical analysis was performed by Cristina Fern&#225;ndez P&#233;rez &#40;Alal&#225;s&#44; S&#46; A&#46;&#41; and the document writing received the cooperation of Dr&#46; Marta Pulido and Content Ed Net Communications&#44; S&#46; L&#46;&#44; Madrid&#46;</p>"
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2015.03.011

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Year/Month	Html	Pdf	Total

2024 November	6	5	11
2024 October	32	40	72
2024 September	43	14	57
2024 August	58	46	104
2024 July	97	39	136
2024 June	69	44	113
2024 May	56	41	97
2024 April	59	31	90
2024 March	46	36	82
2024 February	40	33	73
2024 January	62	32	94
2023 December	41	28	69
2023 November	43	35	78
2023 October	26	26	52
2023 September	119	47	166
2023 August	37	9	46
2023 July	25	24	49
2023 June	34	24	58
2023 May	45	22	67
2023 April	19	21	40
2023 March	71	38	109
2023 February	41	34	75
2023 January	46	37	83
2022 December	81	43	124
2022 November	54	33	87
2022 October	70	41	111
2022 September	43	29	72
2022 August	34	40	74
2022 July	33	39	72
2022 June	32	35	67
2022 May	37	45	82
2022 April	47	70	117
2022 March	47	47	94
2022 February	34	31	65
2022 January	59	48	107
2021 December	48	40	88
2021 November	65	54	119
2021 October	58	63	121
2021 September	35	43	78
2021 August	38	46	84
2021 July	33	26	59
2021 June	39	36	75
2021 May	47	48	95
2021 April	88	73	161
2021 March	52	29	81
2021 February	40	26	66
2021 January	43	27	70
2020 December	46	32	78
2020 November	30	21	51
2020 October	23	20	43
2020 September	41	35	76
2020 August	26	23	49
2020 July	35	17	52
2020 June	48	26	74
2020 May	57	34	91
2020 April	40	23	63
2020 March	23	7	30
2020 February	2	0	2
2018 May	6	1	7
2018 April	34	14	48
2018 March	47	10	57
2018 February	36	7	43
2018 January	24	8	32
2017 December	28	25	53
2017 November	30	12	42
2017 October	27	9	36
2017 September	21	10	31
2017 August	27	18	45
2017 July	29	16	45
2017 June	46	9	55
2017 May	48	15	63
2017 April	43	16	59
2017 March	34	22	56
2017 February	19	11	30
2017 January	32	15	47
2016 December	56	17	73
2016 November	43	17	60
2016 October	69	15	84
2016 September	82	16	98
2016 August	73	13	86
2016 July	34	15	49
2016 June	1	0	1
2016 February	3	34	37
2016 January	1	42	43

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