was read the article
array:24 [ "pii" => "S2173574316300879" "issn" => "21735743" "doi" => "10.1016/j.reumae.2015.12.002" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "870" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2016;12:307-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1034 "formatos" => array:3 [ "EPUB" => 61 "HTML" => 632 "PDF" => 341 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X15002296" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2015.12.005" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "870" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2016;12:307-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4638 "formatos" => array:3 [ "EPUB" => 187 "HTML" => 3329 "PDF" => 1122 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "¿Se asocia la obesidad en la artritis psoriásica a una menor respuesta terapéutica y más efectos adversos con el tratamiento de fondo?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "307" "paginaFinal" => "312" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Is obesity in psoriatic arthritis associated with a poorer therapeutic response and more adverse effects of treatment with an anchor drug?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1499 "Ancho" => 2189 "Tamanyo" => 173818 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flujo de la búsqueda y selección de estudios.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eva Galíndez, Loreto Carmona" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Eva" "apellidos" => "Galíndez" ] 1 => array:2 [ "nombre" => "Loreto" "apellidos" => "Carmona" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574316300879" "doi" => "10.1016/j.reumae.2015.12.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316300879?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15002296?idApp=UINPBA00004M" "url" => "/1699258X/0000001200000006/v1_201610280501/S1699258X15002296/v1_201610280501/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574316300776" "issn" => "21735743" "doi" => "10.1016/j.reumae.2016.07.002" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "855" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2016;12:313-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1093 "formatos" => array:3 [ "EPUB" => 60 "HTML" => 714 "PDF" => 319 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Epidemiological Profile of Colombian Patients With Rheumatoid Arthritis in a Specialized Care Clinic" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "318" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perfil epidemiológico de pacientes colombianos con artritis reumatoide evaluados en una clínica especializada de atención integral" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Wilson Bautista-Molano, Daniel Fernández-Avila, Ruth Jiménez, Rosa Cardozo, Andrés Marín, María del Pilar Soler, Olga Gómez, Oscar Ruiz" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Wilson" "apellidos" => "Bautista-Molano" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Fernández-Avila" ] 2 => array:2 [ "nombre" => "Ruth" "apellidos" => "Jiménez" ] 3 => array:2 [ "nombre" => "Rosa" "apellidos" => "Cardozo" ] 4 => array:2 [ "nombre" => "Andrés" "apellidos" => "Marín" ] 5 => array:2 [ "nombre" => "María del Pilar" "apellidos" => "Soler" ] 6 => array:2 [ "nombre" => "Olga" "apellidos" => "Gómez" ] 7 => array:2 [ "nombre" => "Oscar" "apellidos" => "Ruiz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X15002041" "doi" => "10.1016/j.reuma.2015.11.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15002041?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316300776?idApp=UINPBA00004M" "url" => "/21735743/0000001200000006/v1_201611050033/S2173574316300776/v1_201611050033/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S217357431630096X" "issn" => "21735743" "doi" => "10.1016/j.reumae.2016.07.004" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "957" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2016;12:303-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1930 "formatos" => array:3 [ "EPUB" => 56 "HTML" => 1439 "PDF" => 435 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Selective Phosphodiesterase Inhibitors: A New Therapeutic Option in Inflammation and Autoimmunity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "303" "paginaFinal" => "306" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Inhibidores selectivos de fosfodiesterasas, una nueva opción terapéutica en inflamación y autoinmunidad" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2805 "Ancho" => 2136 "Tamanyo" => 467610 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mechanism of action of PDE4 and effect of its inhibition. AC, adenylate cyclase; 5′-AMP, 5′-adenylic acid; ATF, activating transcription factor 1; ATP, adenosine triphosphate; Bcl-6, B-cell lymphoma protein 6; cAMP, cyclic adenosine monophosphate; CREB, cAMP response element-binding protein; Egr-1, early growth response protein 1; Elk-1, E-26-like protein 1; ERK, extracellular signal-regulated kinase; GP, G protein; GPCR, G protein-coupled receptors; IKK, inhibitor of nuclear factor kappa-B kinase subunit beta; LPS, lipopolysaccharides; MAPK, mitogen-activated protein kinases; NFKB, nuclear factor KB; PDE4, phosphodiesterase type 4; PKA, protein kinase A; Raf, rapidly accelerated fibrosarcoma protein kinases; RTK, receptor tyrosine kinases.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Diana Hernández-Flórez, Lara Valor" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Diana" "apellidos" => "Hernández-Flórez" ] 1 => array:2 [ "nombre" => "Lara" "apellidos" => "Valor" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X16300924" "doi" => "10.1016/j.reuma.2016.07.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16300924?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431630096X?idApp=UINPBA00004M" "url" => "/21735743/0000001200000006/v1_201611050033/S217357431630096X/v1_201611050033/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Is Obesity in Psoriatic Arthritis Associated With a Poorer Therapeutic Response and More Adverse Effects of Treatment With an Anchor Drug?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "307" "paginaFinal" => "312" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Eva Galíndez, Loreto Carmona" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Eva" "apellidos" => "Galíndez" "email" => array:1 [ 0 => "evagalindez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Loreto" "apellidos" => "Carmona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Salud Musculoesquelética, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Se asocia la obesidad en la artritis psoriásica a una menor respuesta terapéutica y más efectos adversos con el tratamiento de fondo?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1499 "Ancho" => 2189 "Tamanyo" => 169668 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of the search and study selection.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Obesity and its complications are common in patients with psoriatic disease.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1–5</span></a> A number of epidemiological studies have identified a higher risk of developing certain metabolic alterations in patients with psoriasis and psoriatic arthritis (PsA), which also includes obesity. This is also because obesity and psoriasis seem to be linked by a common pathophysiological mechanism, which is explained by a chronic low-grade inflammation,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> with an increase in local and systemic inflammatory markers. In obesity, adipocytes show an imbalance resulting in an excessive secretion of the cytokines most detrimental from the cardiovascular point of view, such as interleukin (IL)-6, IL-18, tumor necrosis factor-alpha (TNFα) and leptin, as well as, a decreased release of protective cytokines, like adiponectin.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">2,6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is known that obesity is associated with a higher incidence and severity of psoriasis, and that its presence affects the therapeutic response.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7–9</span></a> This relationship is less widely studied in PsA. On the other hand, treatment with TNFα inhibitors (TNFαi) has been associated with an increase in weight both in psoriasis and in PsA,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> a fact that should be taken into account in the follow-up of these patients. It is for this reason that we propose studying whether obesity is associated with a higher incidence of adverse effects than treatments using an anchor drug in PsA, including the lack of response as an adverse effect.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">The study involved a systematic review of the literature, in a search for observational studies, using the guidelines of the MOOSE consensus.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Search Strategy</span><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a search using Medline (via PubMed) and EMBASE databases (until 28 May 2015). The major PICO terms used for this analysis were “obesity” and “psoriatic arthritis”. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the terms utilized for the search. We introduced no limits concerning language, dates or ages, and only considered studies in humans.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study Selection</span><p id="par0025" class="elsevierStylePara elsevierViewall">The following selection criteria were established: (1) all the patients should have PsA or there should be an analysis differentiating patients with PsA; (2) the effect of the obesity factor or body mass index (BMI) should have been studied as a primary or secondary outcome measure; (3) the study had to be a clinical trial, a prospective or retrospective longitudinal or a case-control design, but series of case reports were not accepted; and (4) the outcome (primary measure) could be toxicity, whether specific or in general: hepatotoxicity (increase in enzymes, fibrosis, cirrhosis, hepatocarcinoma), insulin resistance, dyslipidemia, hypertension, hyperuricemia, a shorter survival than that attributed to the treatment or better therapeutic efficacy.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Two reviewers screened the articles according to title and abstract, and maintained for in-depth review any that offered doubts as to whether or not they complied with the selection criteria. We include the articles selected using this system, and record those that were not. The reason for exclusion is offered in the detailed review.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables and Data Collection</span><p id="par0035" class="elsevierStylePara elsevierViewall">From the articles reviewed in detail, we gathered all the data from the sample description and the study objective, the design and duration of patient follow-up, the drugs employed, the definition of obesity, the variables utilized and their units of measure, with and without adjustment, as well as the variables included in the adjustment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The quality was measured using an ad hoc risk of bias tool, that included: (1) design (low bias in prospective longitudinal and high bias in retrospective or case-control studies); (2) drug exposure time (high bias if the time is short, less than 3 months); (3) clarity in the definition of both the factor (obesity) and outcome (toxicity); and (4) effect measure (high bias if it is not adjusted).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The qualitative analysis of the information collected, depending on the study type and population studied, was done in terms of quality and specific results. We did a qualitative analysis of the heterogeneity.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The search strategy encountered 1043 titles, most of which were excluded on the basis of their title or abstract (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). We reviewed 10 studies in detail,<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">12–21</span></a> and excluded 3: that of Santiago García et al., as it was a cross-sectional study<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a>; that of Koehm et al., because it did not include obesity among the predictors of adverse effects and efficacy failures<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a>; and that of di Minno et al. of 2014, as it was really a clinical trial to see the effect of weight loss on activity, which is a different research question.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> Of the 7 included, 1 was a multicenter trial and the remainder were longitudinal observational studies (3 prospective and 3 retrospective) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The study of Greenberg et al.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> analyzes whether obesity contributes to treatment survival and that of Schmajuk et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> the effect of obesity on transaminases. The remainder of the studies include analyzing the effect on patient response. According to our risk of bias scale, the designs are appropriate but, except in that of Schmajuk et al., the outcome variables are not exactly toxicity.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The population studied included patients with active PsA and different degrees of BMI and mostly treated with TNFαi. The majority of the studies define obesity as a BMI>30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, although, in Haddad et al.,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> it is not defined. With regard to outcome measures, the authors mostly study the percentage of patients with minimal disease activity (MDA), but there are other response measures in PsA.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Four studies reveal the impact of obesity on the clinical response of patients with PsA being treated with TNFαi. Three of them conclude with statistically significant results indicating that overweight and obesity are associated with a lower rate of achieving MDA and maintaining it over time. In their clinical trial, Cassano et al. evaluate Psoriasis Area and Severity Index (PASI-50), with results that show significantly that the rate of response of psoriasis to treatment with adalimumab is lower in patients with a BMI>30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> The study of Iannone et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> is the only article in which BMI does not appear to influence the rate of remission of the disease in patients with PsA and TNFαi therapy (for a summary of the results, see <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The study of di Minno et al.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> includes 135 patients with PsA who are overweight and/or obese and 135 with PsA and a normal body weight. The prevalence of obesity is higher in patients who do not achieve MDA after 12 months (64.0% vs 25.5%; <span class="elsevierStyleItalic">P</span><.001), and is associated with a lower rate of maintaining it after 24 months (hazard ratio [HR] 2.04, 95% confidence interval [CI], 1.015–3.61; <span class="elsevierStyleItalic">P</span>=.014).</p><p id="par0075" class="elsevierStylePara elsevierViewall">The study of Iannone et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> did not have the same results and, as limitations, it is retrospective, the patient cohort is smaller and the characteristics of the patients are different (they have no axial involvement, a very low PASI and very few had a second degree of obesity).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The study by Greenberg et al.,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> with data from the CORRONA registry, evaluates the influence of weight and BMI in the persistence of TNFαi therapy in patients with PsA and observes that the risk of interruption is significantly greater in patients with a BMI≥30. The adjusted risk of interruption of the treatment in persons with a BMI≥30 is HR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.52 (95% CI of 1.08–2.1); <span class="elsevierStyleItalic">P</span>=.017, with persistence at 18 months of 80% vs 63% in obese individuals. Patients with a fixed dose of TNFαi showed a higher risk of interruption (the cause is not specified) than those with a dose established in relation to their weight, with an adjusted HR of 1.3 (95% CI of 0.9–2.0) and the persistence of 75% vs 70% at 18 months. Additionally, they evaluate other variables that determine the risk of interruption of the treatment, including pain during their baseline visit, gender, previous disability and cardiovascular comorbidity, with significant differences regarding gender (woman vs man; <span class="elsevierStyleItalic">P</span>=.004), baseline pain (≥4 vs <4; <span class="elsevierStyleItalic">P</span>=.026) and cardiovascular comorbidity (<span class="elsevierStyleItalic">P</span>=.007).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Finally, in the study of Schmajuk et al.,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> which includes 659 patients, 142 (22%) of whom, had psoriasis/PsA and 31% had a BMI≥30.0<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, there was a trend toward a moderate increase in transaminases in obese patients receiving methotrexate (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">This review concludes that obesity is associated with a higher risk of not achieving and maintaining MDA in PsA and is, in short, a negative predictive factor of the clinical response to TNFαi.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> There are tests with a moderate risk of bias in which obesity is associated with a shorter survival of drugs with TNFαi. This is probably due more to a lack of efficacy for the reasons mentioned above rather than for toxicity. A shorter survival was also observed with TNFαi drugs administered with a fixed dose, as was shown by the study of Greenberg et al.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">However, the study of di Minno et al.,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> in accordance with the results (MDA achieved in 15.6% of the patients with infliximab, 21.3% with etanercept and 18.6% with adalimumab), we must decide whether obesity should be considered a determining factor in the indication for treatment with TNFαi with doses related to the weight of patients with PsA.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the clinical trial published by di Minno et al.,<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> ultimately, excluded from this review, it is observed that a loss of weight (≥ 5% with respect to the baseline weight) is associated with a greater probability of achieving MDA at 6 months (odds ratio [OR]=4.20; 95% CI, 1.82–9.66; <span class="elsevierStyleItalic">P</span><.001). Moreover, this probability of achieving MDA increases proportionally to the loss of weight; weight losses of <5%, 5%–10% and >10% are associated with a MDA of 23.1%, 44.8% and 59.5%, respectively.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Likewise, in obese patients with PsA receiving methotrexate, there has been evidence of a moderate increase in transaminases. Unfortunately, we have found no article that approaches adverse effects other than hepatotoxicity or with other drugs. The case is that the question remains only partially answered. On the other hand, the development of hepatic steatosis does not appear to be influenced by biologic therapy in patients with PsA and is related more to risk factors, like metabolic syndrome and the activity of the disease itself.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In short, obesity is a negative predictive factor of the clinical response in patients with PsA to drugs with TNFαi and, probably, of a somewhat more serious hepatotoxicity because of methotrexate. We found, with an evidence level of 3, that obesity is associated with a less marked therapeutic response to drugs with TNFαi and, probably to other treatments for PsA. Thus, obesity should be considered an indication for adjusting the dose of those drugs to the weight of the patient. Likewise, and although our studies must be confirmed, obesity is still associated with a moderate increase in transaminases in patients being treated for PsA with methotrexate. Therefore, the patient should intend to lose weight or watch his or her liver enzymes, or both.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical Disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">Merck Sharp & Dohme España financed the performance of the systematic review as part of a global document offering recommendations concerning the management of comorbidities in PsA.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of Interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres752398" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec754790" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres752399" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec754789" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Search Strategy" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study Selection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Variables and Data Collection" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0045" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-29" "fechaAceptado" => "2015-12-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec754790" "palabras" => array:5 [ 0 => "Obesity" 1 => "Psoriatic arthritis" 2 => "Adverse events" 3 => "Biologics" 4 => "Disease-modifying anti-inflammatory drugs" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec754789" "palabras" => array:5 [ 0 => "Obesidad" 1 => "Artritis psoriásica" 2 => "Efectos adversos" 3 => "Biológicos" 4 => "Fármacos modificadores de la enfermedad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the association between obesity, control of inflammatory activity and increased adverse effects in psoriatic arthritis (PsA) with disease-modifying anti-inflammatory drugs (DMARD).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A systematic literature review was performed using MEDLINE and EMBASE databases following the guidelines of the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) consensus statement. Studies were selected if they included patients with PsA, obesity was studied as a predictive factor, and the outcome was adverse effects, including efficacy failure. Quality was assessed using an ad hoc risk of bias tool. A qualitative analysis was carried out by type of study and study population, quality and specific results.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We found 1043 articles, discarding most of them on the basis of title and abstract. Ten articles were studied in detail and finally excluded three. The majority concluded, with statistically significant results, that in patients with PsA and treated with TNFα inhibitors (TNFαi), obesity is associated with poorer chances of achieving and maintaining a minimal disease activity, higher treatment discontinuation rates, and lower skin response. Regarding conventional synthetic DMARD, a trend toward a moderate increase in transaminases with methotrexate (MTX) was observed in obese patients with PsA.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Obesity is a negative predictor of clinical response in patients with PsA being treated with TNFαi. Except MTX hepatotoxicity, no other adverse effects, either with TNFαi or other drugs, were found in relation to obesity in PsA.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudiar si en la artritis psoriásica (APs) hay asociación entre la obesidad, el control de la actividad inflamatoria y el aumento de efectos adversos con los fármacos modificadores de la enfermedad (FAME).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisión sistemática de la literatura utilizando las bases de datos Medline y Embase según las guías del consenso MOOSE. Se incluyeron estudios en pacientes con APs, en los que la obesidad fuera factor predictor de efectos adversos y el desenlace fuera toxicidad, incluido fallo de eficacia. La calidad se evaluó mediante una escala de riesgo de sesgos ad hoc. Se realizó un análisis cualitativo por tipo de estudio y población estudiada, calidad y resultados específicos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se encontraron 1.043 artículos, la mayoría se descartaron por título y abstract. Se estudiaron en detalle 10, excluyéndose finalmente 3. La mayoría concluye con resultados estadísticamente significativos que la obesidad en pacientes con APs e inhibidores del TNF-α (iTNF-α) se asocia a una probabilidad menor de alcanzar y mantener la mínima actividad inflamatoria, con mayor tasa de interrupción del tratamiento y menor tasa de respuesta cutánea. En relación con los FAME sintéticos convencionales, se observó en obesos una tendencia a un aumento moderado de las transaminasas con metotrexato (MTX).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La obesidad es un factor predictivo negativo de la respuesta clínica en pacientes con APs e iTNF-α. Exceptuando la hepatotoxicidad por el MTX, no se encontraron otros efectos adversos ni por otros fármacos en relación con la obesidad.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Galíndez E, Carmona L. ¿Se asocia la obesidad en la artritis psoriásica a una menor respuesta terapéutica y más efectos adversos con el tratamiento de fondo? Reumatol Clin. 2016;12:307–312.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1499 "Ancho" => 2189 "Tamanyo" => 169668 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of the search and study selection.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Medline \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">EMBASE \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">“Obesity” [Mesh]<br>Obesity [tw]<br>Obesity [ti]<br>Obesity [ab]<br>“Overweight” [Mesh]<br>“Overweight” [tw]<br>“Overweight” [ti]<br>“Overweight” [ab]<br>“Body Mass Index” [Mesh]<br>“Body Mass Index” [tw]<br>“Body Mass Index” [ti]<br>“Body Mass Index” [ab]<br>“Body Weight/adverse effects” [Mesh]<br>“Body Weight/drug effects” [Mesh]<br>“Abdominal Obesities” OR “Abdominal Obesity” OR “Obesities, Abdominal” OR “Central Obesity” OR “Central Obesities” OR “Obesities, Central” OR “Obesity, Central” OR “Obesity, Visceral” OR “Obesities, Visceral” OR “Visceral Obesities” OR “Visceral Obesity” OR “Morbid Obesities” OR “Obesities, Morbid” OR “Obesity, Severe” OR “Obesities, Severe” OR “Severe Obesities” OR “Severe Obesity” OR “Morbid Obesity”<br>(“Arthritis, Psoriatic” [Mesh] OR “psoriatic arthritis” OR (psoriasis AND arthritic) OR (arthritic AND psoriasis) OR “Psoriasis Arthropathica” OR (arthritis AND psoriasis)) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">“Obesity”/exp<br>“Overweight”/exp<br>–––––––––––––<br>Weight gain/exp<br>–––––––––<br>Adipose tissue hyperplasia<br>Adipositas<br>Adiposity<br>Alimentary obesity<br>Body weight, excess<br>Fat overload syndrome<br>Nutritional obesity<br>Obesitas<br>Overweight<br>IMC (body mass index)<br>Body ban mass<br>Body mass index<br>Quetelet index<br>Weight increase<br>–––––––<br>“Psoriasis” AND “arthritic”<br>“Psoriatic” AND “arthritis”<br>“Psoriasis” AND “arthritis”<br>“Psoriatic arthritis”/exp OR “Psoriatic arthritis” \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245352.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Search strategies.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BMI, body mass index; BSA; body surface area; DMARD, disease-modifying antirheumatic drug; NSAID, nonsteroid anti-inflammatory drug; PASI: Psoriasis Area Severity Index; Ps, psoriasis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; TNF-αi, tumor necrosis factor α inhibitor.</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">Authors, year<br>Type study and duration \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">Patients included \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">Drugs included \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">Variables obesity/BMI studied \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">Outcome variables studied \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">Schmajuk et al., 2014<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a><br>Retrospective (227<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>147 days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">659 patients<br>RA: 379 (57%)<br>Ps/PsA: 142 (22%)<br>Others: 138 (21%)<br>Obese: 203 (31%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Methotrexate (mean dose<span class="elsevierStyleHsp" style=""></span><15<span class="elsevierStyleHsp" style=""></span>mg/week) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Obesity: BMI≥30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hepatotoxicity \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">Greenberg et al., 2011<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a><br>Retrospective CORRONA registry 2/02-03/11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">392 patients with PsA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept<br>Adalimumab<br>Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Obesity: BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Drug survival \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">Di Minno et al., 2013<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a><br>Prospective 24 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">135 patients with PsA and overweight/obese<br>135 patients with PsA with normal weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept<br>Adalimumab<br>Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Overweight: BMI 25–30<br>Obesity: BMI>30 or waist circumference<span class="elsevierStyleHsp" style=""></span>>102<span class="elsevierStyleHsp" style=""></span>cm in men and >88<span class="elsevierStyleHsp" style=""></span>cm in women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Therapeutic efficacy \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">Iannone et al., 2012<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a><br>Retrospective 36 months (mean; range 6–79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PsA: 135 obese<br>47 overweight<br>Normal weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept<br>Adalimumab<br>Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal: BMI<25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span><br>Overweight: BMI 25–30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span><br>Obesity: BMI>30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Therapeutic efficacy \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">Cassano et al., 2008<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> Open prospective multicenter trial to 12 weeks (Primary outcome) 24 weeks (follow-up) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">147 with active PsA and plaques from chronic Ps (BSA>10% and PASI≥10) or BSA<10% but Ps in visible regions or difficult to treat<br>144 complete 12 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adalimumab 40<span class="elsevierStyleHsp" style=""></span>mg/2 week<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>12 weeks<br>40<span class="elsevierStyleHsp" style=""></span>mg/week (in patients who did not respond by week 12) until week 24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Obesity: BMI>30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Therapeutic efficacy \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">Eder et al., 2015<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a><br>Prospective 2003 to 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">557 patients<br>36% overweight<br>35% obese \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Synthetic DMARD<br>TNFαi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal weight: BMI<25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span><br>Overweight: BMI 25–30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span><br>Obesity: BMI>30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Therapeutic efficacy \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">Haddad et al., 2013<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a><br>Prospective (not specified) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">227 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TNFαi<br>Synthetic DMARD NSAID \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Greatest BMI (do not define obesity) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Therapeutic efficacy \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245353.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Table Showing Evidence for Studies Included.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">BMI, body mass index; CI, confidence interval; DAS28, Disease Activity Score; EULAR, European League Against Rheumatism; HAQ, Health Assessment Questionnaire; HR, hazard ratio; IQR, interquartile range; MDA minimal disease activity; OR, odds ratio; PASI, Psoriasis Area Severity Index; SD, standard deviation; SDAI, Simplified Disease Activity Index; TNFαi; tumor necrosis factor α inhibitor.</p>" "tablatextoimagen" => array:3 [ 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">Author, year \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">Outcome measure \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">Results related to the association between obesity/BMI \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">Di Minno, 2013<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MDA (12 months)<br>Sustained MDA (12–24 months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prevalence of obesity is higher in patients who do not achieve MDA with regard to those who do (64.0% vs 25.5%; <span class="elsevierStyleItalic">P</span><.001)<br>Patients whose <span class="elsevierStyleBold">BMI>30</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">kg/m</span><span class="elsevierStyleSup"><span class="elsevierStyleBold">2</span></span> do not achieve MDA<br>HR 4.90; 95% CI, 3.04–7.87; <span class="elsevierStyleItalic">P</span><.001<br>BMI 30–35<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span><br><span class="elsevierStyleHsp" style=""></span>HR 3.98; 95% CI, 1.96–8.06; <span class="elsevierStyleItalic">P</span><.001<br>BMI 35–40<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span><br><span class="elsevierStyleHsp" style=""></span>HR 5.40; 95% CI, 3.09–9.43; <span class="elsevierStyleItalic">P</span><.001<br>Obesity is associated with a poorer probability of maintaining MDA to up to 24 months<br>HR 2.04; 95% CI, 1.015–3.61; <span class="elsevierStyleItalic">P</span>=.014 \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">Greenberg, 2011<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Drug survival \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retention is poorer with obesity. Risk of interruption with BMI>30: adjusted HR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.52; 95% CI, 1.08–2.1; <span class="elsevierStyleItalic">P</span>=.017<br><span class="elsevierStyleHsp" style=""></span>Treatment retention to up to 18 months BMI<30 vs BMI>30: 80% vs 63%. There is greater risk of interruption of TNFαi at a fixed dose than a dose adjusted to patient weight: adjusted HR 1.3; 95% CI, 0.9–2.1; <span class="elsevierStyleItalic">P</span>=.140<br><span class="elsevierStyleHsp" style=""></span>Retention to up to 18 months of TNFαi at an adjusted dose vs fixed dose: 75% vs 70% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245357.png" ] ] 1 => 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">Iannone, 2012<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normal weight</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Overweight</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Obese</th><th class="td" title="table-head " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr><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="" 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">Mean (SD) \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">Median (IQR) \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">Mean (SD) \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">Median (IQR) \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">Mean (SD) \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">Median (IQR) \t\t\t\t\t\t\n \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HAQ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.81 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.75 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DAS28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 (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 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.42 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SDAI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.7 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.6 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.0 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.0 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DAS28<2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37% \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><td class="td" title="table-entry " align="char" valign="top">.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SDAI<3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21% \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><td class="td" title="table-entry " align="char" valign="top">38% \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><td class="td" title="table-entry " align="char" valign="top">21% \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><td class="td" title="table-entry " align="char" valign="top">.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">EULAR response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.5% \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><td class="td" title="table-entry " align="char" valign="top">63.8% \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><td class="td" title="table-entry " align="char" valign="top">62.8% \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><td class="td" title="table-entry " align="char" valign="top">.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245356.png" ] ] 2 => 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">Cassano, 2008<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></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">PASI 50 \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">BMI<30 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI>30 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \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="" valign="top"> \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><td class="td" title="table-entry " align="left" valign="top">79% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Eder, 2015<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MDA sustained for at least 1 year \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><td class="td" title="table-entry " align="left" valign="top">BMI 25–30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BMI>30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="left" valign="top">OR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \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><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.0001 \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">Haddad, 2013<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="3" align="left" valign="top">146 patients achieved MDA after a mean duration of 1.3 years.<br>Patients who did not achieve MDA had a baseline BMI>31.6 vs 28.5; <span class="elsevierStyleItalic">P</span>=.02</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245355.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Results of the Effect of Obesity on Patient Response.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AST upper limit of normal<span class="elsevierStyleHsp" style=""></span>=35<span class="elsevierStyleHsp" style=""></span>mg/mL. ALT upper limit of normal<span class="elsevierStyleHsp" style=""></span>=60<span class="elsevierStyleHsp" style=""></span>mg/mL.</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Abnormality: mild<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>ULN<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.5; moderate<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>ULN<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.5; severe<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>ULN<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10.</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; CI, confidence interval; OR, odds ratio; ULN, upper limit of normal.</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Taken from Schmajuk et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a></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"> \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">Normal AST/ALT (n=533) \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">AST/ALT<br><1.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>ULN<br>(n=81) \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">AST/ALT<br>≥1.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>ULN<br>(n=45) \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> \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">BMI≥30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">159 (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 (44%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.12 \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">Adjusted OR (95% CI)<br>BMI≥30 vs <30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Primary analysis<br>≥1.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>ULN \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><td class="td" title="table-entry " align="left" valign="top">Secondary analysis<br>≥ 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>ULN \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="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.9 (1.0–3.6) \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><td class="td" title="table-entry " align="left" valign="top">1.7 (0.6–4.3) \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 => "xTab1245354.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Results for Hepatotoxicity in the Study by Schmajuk et al., 2014.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Higher rates and clustering of abnormal lipids, obesity, and diabetes mellitus in psoriatic arthritis compared with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Labitigan" 1 => "A. Bahce-Altuntas" 2 => "J.M. Kremer" 3 => "G. Reed" 4 => "J.D. Greenberg" 5 => "N. Jordan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2014" "volumen" => "66" "paginaInicial" => "600" "paginaFinal" => "607" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0120" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationships between adipose tissue and psoriasis, with or without arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Toussirot" 1 => "F. Aubin" 2 => "G. Dumoulin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fimmu.2014.00368" "Revista" => array:5 [ "tituloSerie" => "Front Immunol" "fecha" => "2014" "volumen" => "5" "paginaInicial" => "368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25161652" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0125" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of the metabolic syndrome in psoriasis: results from the National Health and Nutrition Examination Survey, 2003–2006" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.J. Love" 1 => "A.A. Qureshi" 2 => "E.W. Karlson" 3 => "J.M. Gelfand" 4 => "H.K. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2011" "volumen" => "147" "paginaInicial" => "419" "paginaFinal" => "424" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0130" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High prevalence of metabolic syndrome and of insulin resistance in psoriatic arthritis is associated with the severity of underlying disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Haroon" 1 => "P. Gallagher" 2 => "E. Heffernan" 3 => "O. FitzGerald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.140021" "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2014" "volumen" => "41" "paginaInicial" => "1357" "paginaFinal" => "1365" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24931949" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0135" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased prevalence of metabolic syndrome in patients with psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Pehlevan" 1 => "D.O. Yetkin" 2 => "C. Bahadir" 3 => "F. Goktay" 4 => "Y. Pehlevan" 5 => "K. Kayatas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/met.2013.0039" "Revista" => array:6 [ "tituloSerie" => "Metab Syndr Relat Disord" "fecha" => "2014" "volumen" => "12" "paginaInicial" => "43" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24206172" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0140" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity in autoimmune diseases: not a passive bystander" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Versini" 1 => "P.Y. Jeandel" 2 => "E. Rosenthal" 3 => "Y. Shoenfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2014.07.001" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2014" "volumen" => "13" "paginaInicial" => "981" "paginaFinal" => "1000" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25092612" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0145" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of weight on the efficacy and safety of ustekinumab in patients with moderate to severe psoriasis: rationale for dosing recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Lebwohl" 1 => "N. Yeilding" 2 => "P. Szapary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2009.11.012" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "571" "paginaFinal" => "579" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20599293" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0150" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of weight on the efficacy of biologic therapy in patients with psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Clark" 1 => "M. Lebwohl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "443" "paginaFinal" => "446" "itemHostRev" => array:3 [ "pii" => "S0264410X11020779" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0155" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of body mass index and obesity on clinical response to systemic treatment for psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Naldi" 1 => "A. Addis" 2 => "S. Chimenti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatology" "fecha" => "2008" "volumen" => "217" "paginaInicial" => "365" "paginaFinal" => "373" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0160" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TNFalpha blockade for inflammatory rheumatic diseases is associated with a significant gain in android fat mass and has varying effects on adipokines: a 2-year prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Toussirot" 1 => "L. Mourot" 2 => "B. Dehecq" 3 => "D. Wendling" 4 => "E. Grandclement" 5 => "G. Dumoulin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Clin Nutr" "fecha" => "2014" "volumen" => "53" "paginaInicial" => "951" "paginaFinal" => "961" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0165" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.F. Stroup" 1 => "J.A. Berlin" 2 => "S.C. Morton" 3 => "I. Olkin" 4 => "G.D. Williamson" 5 => "D. Rennie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2000" "volumen" => "283" "paginaInicial" => "2008" "paginaFinal" => "2012" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10789670" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0170" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of body mass index, comorbidities and prior systemic therapies on the response of psoriasis to adalimumab: an exploratory analysis from the APHRODITE data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Cassano" 1 => "A. Galluccio" 2 => "C. de Simone" 3 => "F. Loconsole" 4 => "S.D. Massimino" 5 => "A. Plumari" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Biol Regul Homeost Agents" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "233" "paginaFinal" => "237" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19036225" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0175" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and the prediction of minimal disease activity: a prospective study in psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.N. Di Minno" 1 => "R. Peluso" 2 => "S. Iervolino" 3 => "R. Lupoli" 4 => "A. Russolillo" 5 => "R. Scarpa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2013" "volumen" => "65" "paginaInicial" => "141" "paginaFinal" => "147" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0180" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor alpha blockers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.N. Di Minno" 1 => "R. Peluso" 2 => "S. Iervolino" 3 => "A. Russolillo" 4 => "R. Lupoli" 5 => "R. Scarpa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2012-202812" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2014" "volumen" => "73" "paginaInicial" => "1157" "paginaFinal" => "1162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23771989" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0185" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity is associated with lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Eder" 1 => "A. Thavaneswaran" 2 => "V. Chandran" 3 => "R. Cook" 4 => "D.D. Gladman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2013-204448" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2015" "volumen" => "74" "paginaInicial" => "813" "paginaFinal" => "817" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24431392" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0190" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of weight, body mass index and weight-based dosing on persistency of anti-TNFs in psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.D. Greenberg" 1 => "R. Bolce" 2 => "Y. Shan" 3 => "K.C. Saunders" 4 => "G. Reed" 5 => "J.M. Kremer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.38216" "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2011" "volumen" => "Suppl. 10" "paginaInicial" => "2595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24085684" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0195" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The characteristics and predictors of minimal disease activity in patients with psoriatic arthritis on TNF blockers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Haddad" 1 => "A. Thavaneswaran" 2 => "I. Ruiz Arruza" 3 => "V. Chandran" 4 => "R. Cook" 5 => "D. Gladman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2013" "volumen" => "Suppl. 3" "paginaInicial" => "675" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24822273" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0200" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body mass does not affect the remission of psoriatic arthritis patients on anti-TNF-alpha therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Iannone" 1 => "R. Fanizzi" 2 => "C. Scioscia" 3 => "M.G. Anelli" 4 => "G. Lapadula" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "2013" "volumen" => "42" "paginaInicial" => "41" "paginaFinal" => "44" "itemHostRev" => array:3 [ "pii" => "S1542356508008446" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0205" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differences in disease characteristics of patients with active psoriatic arthritis prior to adalimumab treatment who failed at least two antiTNF-therapies in comparison to those who failed conventional DMARDS only" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Koehm" 1 => "F. Behrens" 2 => "D. Thaci" 3 => "B. Krummel-Lorenz" 4 => "G. Greger" 5 => "B. Wittig" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2014" "volumen" => "72" "numero" => "Suppl. 3" "paginaInicial" => "948" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0210" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liver diseases in rheumatoid and psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Santiago Garcia" 1 => "E. Saturansky" 2 => "D. Poncino" 3 => "V. Ortiz" 4 => "Y. Martinez Artola" 5 => "S. Rosenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Acta Gastroenterol Latinoam" "fecha" => "2012" "volumen" => "42" "paginaInicial" => "112" "paginaFinal" => "119" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22876713" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1590865809002072" "estado" => "S300" "issn" => "15908658" ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0215" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of risk factors for elevated transaminases in methotrexate users through an electronic health record" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Schmajuk" 1 => "Y. Miao" 2 => "J. Yazdany" 3 => "W.J. Boscardin" 4 => "D.I. Daikh" 5 => "M.A. Steinman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2014" "volumen" => "66" "paginaInicial" => "1159" "paginaFinal" => "1166" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0220" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatic steatosis and disease activity in subjects with psoriatic arthritis receiving tumor necrosis factor-alpha blockers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.N. Di Minno" 1 => "S. Iervolino" 2 => "R. Peluso" 3 => "A. Russolillo" 4 => "R. Lupoli" 5 => "R. Scarpa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.111391" "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "1042" "paginaFinal" => "1046" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22422493" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001200000006/v1_201611050033/S2173574316300879/v1_201611050033/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/21735743/0000001200000006/v1_201611050033/S2173574316300879/v1_201611050033/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316300879?idApp=UINPBA00004M" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 October | 40 | 30 | 70 |
2024 September | 49 | 48 | 97 |
2024 August | 51 | 58 | 109 |
2024 July | 63 | 28 | 91 |
2024 June | 91 | 40 | 131 |
2024 May | 50 | 29 | 79 |
2024 April | 52 | 19 | 71 |
2024 March | 44 | 35 | 79 |
2024 February | 33 | 25 | 58 |
2024 January | 32 | 22 | 54 |
2023 December | 26 | 32 | 58 |
2023 November | 44 | 27 | 71 |
2023 October | 57 | 30 | 87 |
2023 September | 72 | 45 | 117 |
2023 August | 34 | 14 | 48 |
2023 July | 29 | 24 | 53 |
2023 June | 37 | 22 | 59 |
2023 May | 36 | 29 | 65 |
2023 April | 33 | 16 | 49 |
2023 March | 83 | 27 | 110 |
2023 February | 55 | 35 | 90 |
2023 January | 25 | 15 | 40 |
2022 December | 78 | 30 | 108 |
2022 November | 60 | 30 | 90 |
2022 October | 60 | 32 | 92 |
2022 September | 34 | 36 | 70 |
2022 August | 25 | 36 | 61 |
2022 July | 36 | 38 | 74 |
2022 June | 25 | 37 | 62 |
2022 May | 30 | 41 | 71 |
2022 April | 20 | 36 | 56 |
2022 March | 24 | 40 | 64 |
2022 February | 26 | 31 | 57 |
2022 January | 36 | 35 | 71 |
2021 December | 31 | 41 | 72 |
2021 November | 34 | 40 | 74 |
2021 October | 39 | 51 | 90 |
2021 September | 33 | 44 | 77 |
2021 August | 22 | 32 | 54 |
2021 July | 20 | 24 | 44 |
2021 June | 27 | 29 | 56 |
2021 May | 38 | 44 | 82 |
2021 April | 90 | 82 | 172 |
2021 March | 63 | 31 | 94 |
2021 February | 37 | 24 | 61 |
2021 January | 93 | 25 | 118 |
2020 December | 45 | 24 | 69 |
2020 November | 51 | 26 | 77 |
2020 October | 25 | 16 | 41 |
2020 September | 33 | 27 | 60 |
2020 August | 29 | 27 | 56 |
2020 July | 29 | 18 | 47 |
2020 June | 39 | 18 | 57 |
2020 May | 34 | 22 | 56 |
2020 April | 24 | 31 | 55 |
2020 March | 14 | 11 | 25 |
2020 February | 1 | 0 | 1 |
2019 January | 1 | 0 | 1 |
2018 May | 4 | 1 | 5 |
2018 April | 46 | 8 | 54 |
2018 March | 43 | 19 | 62 |
2018 February | 27 | 10 | 37 |
2018 January | 21 | 6 | 27 |
2017 December | 27 | 14 | 41 |
2017 November | 27 | 26 | 53 |
2017 October | 15 | 5 | 20 |
2017 September | 30 | 14 | 44 |
2017 August | 22 | 5 | 27 |
2017 July | 25 | 10 | 35 |
2017 June | 37 | 12 | 49 |
2017 May | 47 | 24 | 71 |
2017 April | 32 | 15 | 47 |
2017 March | 23 | 38 | 61 |
2017 February | 15 | 11 | 26 |
2017 January | 46 | 29 | 75 |
2016 December | 85 | 46 | 131 |
2016 November | 54 | 41 | 95 |
2016 October | 4 | 7 | 11 |