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"tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "59" "paginaFinal" => "60" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Manuel José Moreno Ramos, Maria José Moreno Martinez, Luis Francisco Linares Ferrando" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Manuel José" "apellidos" => "Moreno Ramos" "email" => array:1 [ 0 => "mjmoreno1@yahoo.es" ] "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" => "Maria José" "apellidos" => "Moreno Martinez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Luis Francisco" "apellidos" => "Linares Ferrando" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Reumatología, Hospital Rafael Méndez, Lorca, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Espondiloartritis axiales: ¿se pueden clasificar todas?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The history of ankylosing spondylitis (AS) has evolved since the first descriptions (2000 years BC), passing through the Middle Ages and, especially, the second half of the 20th century, with the discovery of HLA B27 (1973). In the fifties of the last century, there were 2 opposing schools of thought: the North American (“lumpers”) and the European (“splitters”), which considered AS to be a variant of rheumatoid arthritis (RA), or as a different entity, respectively. Then evidence arose that was favorable to their separation, grouping AS and other similar diseases as “seronegative arthritides” or “spondyloarthritides” (Moss and Wright, 1976). At the present time, we prefer calling them “spondyloarthritis” (SpA), a name that indicates its inflammatory nature.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">With respect to the diagnosis, classification tools have been appearing, from the criteria of Boland and Present (1945),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> then those of Rome (1961),<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> New York (1966)<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and their modification (1984).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Their major drawback is the limited sensitivity in the initial stages, as they require the radiographic diagnosis of sacroiliitis. To make up for these limitations, in the nineties we had the publication of the criteria of Amor<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and those of the European Spondyloarthropathy Study Group (ESSG),<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> which included radiographic sacroiliitis but not as a necessary requirement, extending the diagnostic spectrum to the group of undifferentiated spondyloarthritis. Recently, the criteria of the Assessment of Spondyloarthritis International Society (ASAS) have enabled us to improve its early diagnosis, classifying SpA into 2 groups. One group is comprised of predominantly axial SpA (2009),<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> which includes classical AS (radiographic sacroiliitis, meeting the modified New York criteria) and pre-radiographic or non-radiographic axial SpA (with the support of sacroiliac magnetic resonance imaging). The other consists of predominantly peripheral SpA (2011),<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> including psoriatic and reactive arthritis and arthritis associated with inflammatory bowel disease and undifferentiated SpA.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless, there are patients who cannot be classified using the new ASAS criteria, although their clinical data suggest SpA, as occurs in the following clinical setting: a 40-year-old man with a 1-year history of inflammatory low back pain, HLA B27-negative, normal levels of acute-phase reactants, good response to nonsteroidal anti-inflammatory drugs (NSAID) and 2 earlier episodes of uveitis. First-degree family history of psoriasis. Radiographs showing bilateral sacroiliitis (left, grade 2, and right, grade 1), with no MRI evidence of edema/osteitis in sacroiliac joints.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Within the group of non-radiographic “or pre-radiographic” axial spondyloarthritides (nr axSpA)<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> includes those patients with a normal radiography or initial sacroiliitis, that does not meet the modified New York criteria (no AS), have MRI-evidence of edema in sacroiliac joints; however, what would occur if we found patients without edema in MRI and without radiographic damage in the sacroiliac joints? How would they be classified?</p><p id="par0045" class="elsevierStylePara elsevierViewall">Introducing certain small changes into the nomenclature, we could speak of non-radiographic (or pre-radiographic) axial SpA in those cases in which MRI is positive for sacroiliac involvement, according to ASAS criteria, with normal radiographies or minimal changes in these joints, but do not meet the modified New York criteria. However, on the other hand, radiographic axSpA that is not AS, patients in whom there are initial radiographic changes in the sacroiliac joints (without meeting the modified New York criteria) and whose MRI is negative (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In any case, studies in which the sensitivity and specificity of these modifications is evaluated are necessary. They could make it easier to achieve a better classification of those patients with incipient radiographic changes during the initial stages who have a negative MRI study.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Moreno Ramos MJ, Moreno Martinez MJ, Linares Ferrando LF. Espondiloartritis axiales: ¿se pueden clasificar todas? Reumatol Clin. 2017;13:59–60.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AS, ankylosing spondylitis; CIBD, chronic inflammatory bowel disease; MRI, magnetic resonance imaging; nr axSpA, non-radiographic (or pre-radiographic) axial spondyloarthritis; radiographic axSpA no AS, radiographic axial spondyloarthritis no ankylosing spondylitis; SpA, spondyloarthritis;</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">Axial SpA \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">Peripheral SpA \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AS (+ radiographies) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reactive arthritis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">nr axSpA (MRI+ radiography−) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psoriatic arthritis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radiographic axSpA not AS (radiography+ not AS, MRI−) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arthritis associated with CIBD \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">Undifferentiated SpA \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1338633.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Classification of Spondyloarthritis With the Introduction of the Concept We Refer to as Radiographic axSpA That Is not AS.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A historical perspective of the spondyloarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. 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Year/Month | Html | Total | |
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2024 November | 15 | 16 | 31 |
2024 October | 64 | 40 | 104 |
2024 September | 83 | 17 | 100 |
2024 August | 69 | 31 | 100 |
2024 July | 72 | 29 | 101 |
2024 June | 63 | 46 | 109 |
2024 May | 71 | 29 | 100 |
2024 April | 88 | 27 | 115 |
2024 March | 50 | 37 | 87 |
2024 February | 48 | 15 | 63 |
2024 January | 51 | 32 | 83 |
2023 December | 27 | 29 | 56 |
2023 November | 62 | 28 | 90 |
2023 October | 46 | 32 | 78 |
2023 September | 89 | 37 | 126 |
2023 August | 42 | 24 | 66 |
2023 July | 48 | 28 | 76 |
2023 June | 36 | 19 | 55 |
2023 May | 50 | 22 | 72 |
2023 April | 36 | 11 | 47 |
2023 March | 82 | 43 | 125 |
2023 February | 59 | 31 | 90 |
2023 January | 47 | 18 | 65 |
2022 December | 79 | 41 | 120 |
2022 November | 52 | 34 | 86 |
2022 October | 74 | 34 | 108 |
2022 September | 39 | 36 | 75 |
2022 August | 46 | 33 | 79 |
2022 July | 59 | 41 | 100 |
2022 June | 48 | 36 | 84 |
2022 May | 52 | 32 | 84 |
2022 April | 68 | 50 | 118 |
2022 March | 62 | 60 | 122 |
2022 February | 74 | 28 | 102 |
2022 January | 47 | 49 | 96 |
2021 December | 42 | 39 | 81 |
2021 November | 43 | 42 | 85 |
2021 October | 91 | 56 | 147 |
2021 September | 55 | 52 | 107 |
2021 August | 41 | 42 | 83 |
2021 July | 44 | 25 | 69 |
2021 June | 56 | 27 | 83 |
2021 May | 72 | 50 | 122 |
2021 April | 117 | 93 | 210 |
2021 March | 80 | 28 | 108 |
2021 February | 33 | 25 | 58 |
2021 January | 31 | 14 | 45 |
2020 December | 44 | 27 | 71 |
2020 November | 44 | 19 | 63 |
2020 October | 22 | 12 | 34 |
2020 September | 46 | 19 | 65 |
2020 August | 34 | 16 | 50 |
2020 July | 31 | 14 | 45 |
2020 June | 33 | 22 | 55 |
2020 May | 28 | 22 | 50 |
2020 April | 23 | 22 | 45 |
2020 March | 13 | 5 | 18 |
2020 February | 2 | 0 | 2 |
2018 May | 5 | 0 | 5 |
2018 April | 30 | 6 | 36 |
2018 March | 50 | 8 | 58 |
2018 February | 22 | 5 | 27 |
2018 January | 18 | 9 | 27 |
2017 December | 23 | 8 | 31 |
2017 November | 38 | 7 | 45 |
2017 October | 22 | 5 | 27 |
2017 September | 25 | 6 | 31 |
2017 August | 23 | 4 | 27 |
2017 July | 35 | 17 | 52 |
2017 June | 43 | 11 | 54 |
2017 May | 51 | 14 | 65 |
2017 April | 40 | 25 | 65 |
2017 March | 58 | 18 | 76 |
2017 February | 40 | 22 | 62 |
2017 January | 5 | 12 | 17 |
2016 December | 5 | 3 | 8 |