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for the early diagnosis and treatment of KD&#44; incomplete KD is defined as those cases in which less than 4 criteria are met&#44; but the typical changes in the coronary arteries are identified &#40;measured by echocardiogram or arteriography&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although cardiac involvement is the most important prognostic factor&#44; arthritis has been considered a common manifestation of KD&#44; having been reported in up to 31&#37; of the patients in different publications from the preimmunoglobulin era&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> Moreover&#44; a close relationship between early acute arthritis and a poorer cardiac outcome has been demonstrated in the literature&#44; including the development of coronary aneurysms in 39&#37; of the patients with arthritis&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> versus an overall average of 19&#37;&#46; 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Spain&#44; between January 1988 and November 2013&#46; This report was approved by the hospital ethics committee&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We reviewed the clinical histories of all the pediatric patients who had been classified under the diagnostic code for &#8220;Kawasaki disease&#8221; or &#8220;mucocutaneous lymph node syndrome&#8221; provided by the information system of our records department&#46; In our hospital&#44; those children in whom KD is suspected are assessed and admitted by the pediatric department&#46; They begin to receive rheumatology care during admission&#44; following a request on the part of the pediatricians&#46; The children included in this study were diagnosed with KD in accordance with the criteria proposed by the American Academy Of Pediatrics&#47;American Heart Association&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical signs were recorded&#44; particularly those concerning the criteria of the diagnostic classification&#44; as were the demographic variables &#40;age&#44; sex&#44; race&#41;&#44; the season of the year in which the disease presented&#44; history of infections and the analytical variables at diagnosis &#40;C-reactive protein &#91;CRP&#93;&#44; erythrocyte sedimentation rate &#91;ESR&#93;&#44; biochemical data&#44; albumin&#44; hemoglobin&#44; platelets&#44; leukocytes and urinalysis results&#41;&#46; In the analytical variables collected&#44; any value that was outside the normal range established by the central laboratory services of our center was defined as anomalous&#46; For acute-phase reactants&#44; we considered CRP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mg&#47;L and ESR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cardiac involvement was based on the presence of abnormal findings in the electrocardiogram and&#47;or echocardiogram&#46; Coronary aneurysm was defined as a maximum diameter of the coronary artery greater than 3<span class="elsevierStyleHsp" style=""></span>mm in patients under 5 years of age&#44; and greater than 4<span class="elsevierStyleHsp" style=""></span>mm in those aged 5 years or older&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Moreover&#44; they were classified by size as small &#40;less than 5<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; medium &#40;5&#8211;8<span class="elsevierStyleHsp" style=""></span>mm&#41; or giant &#40;greater than 8<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; In the absence of aneurysms&#44; coronary ectasia or dilatation was considered to be the presence of a coronary artery with a diameter greater than normal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Joint involvement was based mainly on clinical signs&#44; and on the findings derived from the musculoskeletal ultrasound study &#40;since 2004&#41;&#46; It was classified as oligoarticular if the number of affected joints was &#8804;4 and polyarticular with &#8805;5 affected joints&#46; In addition&#44; we included in the study the presence of any chronic clinical manifestation &#40;sequelae&#41; of cardiac or articular nature&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The existence of a protocol-guided therapeutic management of KD&#44; adopted in the pediatric department of our hospital&#44; meant that all the children received the same treatment during the first 7&#8211;10 days after diagnosis&#46; During the acute phase&#44; according to the protocol&#44; patients should rest&#44; and acetylsalicylic acid &#40;ASA&#41; together with IVIG are prescribed at admission&#46; Initially the ASA dose is anti-inflammatory &#40;80&#8211;100<span class="elsevierStyleHsp" style=""></span>mg&#47;kg body weight &#91;bw&#93;&#47;day&#41;&#44; up to 48<span class="elsevierStyleHsp" style=""></span>h after the fever and clinical signs have disappeared&#46; At that time&#44; the amount is reduced to the levels of antiplatelet therapy&#44; with a single dose of 3&#8211;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg bw&#47;day&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> Intravenous immunoglobulins are given once&#44; in a single dose of 2<span class="elsevierStyleHsp" style=""></span>g&#47;kg bw&#44; administered slowly &#40;duration of the injection 10<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; and the fever usually disappears by the time the administration has finished&#46; If this treatment is followed within 36<span class="elsevierStyleHsp" style=""></span>h by clinical and analytical improvement&#44; but the fever returns&#44; a second dose of IVIG should be administered&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Perhaps &#8805;10&#37; of cases of KD are resistant to IVIG&#44; and are defined by persistence of fever and acute-phase reactants and&#47;or clinical signs &#8805;36<span class="elsevierStyleHsp" style=""></span>h after IVIG administration&#46; An increase in the risk of coronary artery aneurysms has also been reported in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> As second-line therapy&#44; the combination of intravenous corticosteroids &#40;methylprednisolone pulses&#44; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;kg bw&#44; for 1&#8211;3 days&#41;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a> with another dose of IVIG has been indicated&#46; Despite the good clinical response&#44; some studies conclude that corticosteroids do not manage to reduce the incidence of coronary complications&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> If resistance to treatment persists&#44; a third line of therapy could be drugs like infliximab&#44; abciximab&#44; etanercept&#44; cyclophosphamide or methotrexate&#44; which have been found to achieve good results in several published studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">For this report&#44; the response to the treatment administered was specified&#46; The pediatric follow-up of each patient depended mainly on the presence of cardiac involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> On the other hand&#44; the course of the joint disease was assessed at 1&#44; 2 and 4 weeks&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 42 patients with a diagnosis of KD was identified&#44; with a predominance of boys &#40;24 boys and 18 girls&#41;&#46; The age at diagnosis ranged between 3 months and 16 years&#44; with a mean and standard deviation of 4&#46;3 &#40;&#177;1&#46;4&#41; years&#46; The information collected from the medical record at the time of diagnosis enabled us to classify the patients in terms of complete or incomplete KD depending on whether or not they met the classification criteria&#46; In all&#44; 62&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; of the population was classified as having complete KD&#44; versus 38&#37; with incomplete KD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Caucasian race &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41; predominated&#44; versus the remaining 20&#37; who were Latin Americans&#46; We observed a higher prevalence with onset occurring during the winter and autumn months&#46; Most of the patients &#40;66&#46;6&#37;&#41; had no known history of infection&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">One hundred percent of the children had fever at onset&#46; The most widespread clinical signs were exanthema &#40;92&#46;9&#37;&#41;&#44; conjunctivitis &#40;78&#46;6&#37;&#41;&#44; oral mucosa involvement &#40;76&#46;2&#37;&#41; and unilateral lymphadenopathy &#40;71&#46;4&#37;&#41;&#44; and the least common were edema &#40;52&#46;4&#37;&#41; and subsequent desquamation &#40;46&#46;3&#37;&#41;&#46; The analytical findings at diagnosis showed elevated acute-phase reactants&#59; 92&#46;9&#37; had an increase in CRP &#40;88&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>58 &#91;38&#8211;125&#93; mg&#47;L&#41; and 78&#46;6&#37; had an increase in ESR &#40;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30 &#91;47&#46;7&#8211;92&#93; mm&#47;h&#41;&#46; Most of the children had normal leukocyte counts &#40;83&#46;3&#37;&#41;&#44; versus 14&#46;3&#37; with leukocytosis and 2&#46;4&#37; with leukopenia&#46; Another parameter that was a marker of activity like hypoalbuminemia was observed in 42&#46;9&#37; of the patients at diagnosis&#44; whereas a change in urinary sediment was found in 14&#46;3&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All of the patients followed the initial therapeutic protocol at diagnosis with ASA and IVIG&#44; as we detected no clinical parameters that indicated resistance to IVIG&#46; The major complication observed was cardiac involvement in 8 patients &#40;19&#37;&#41;&#44; with evidence in the echocardiographic study of coronary ectasias and aneurysms in 6 and 2 patients&#44; respectively&#46; Of the 42 patients&#44; 92&#46;9&#37; ultimately had no long-term complications or sequelae&#46;</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Arthritis in Patients With Kawasaki Disease</span><p id="par0075" class="elsevierStylePara elsevierViewall">The presence of joint involvement was detected in only 7 of the 42 children &#40;16&#37;&#41;&#46; Oligoarticular disease was predominant &#40;57&#37;&#41;&#44; affecting lower limbs&#44; knees and&#44; especially&#44; ankles&#46; The next most common type was monoarticular involvement of the hip &#40;29&#37;&#41;&#44; and the ultrasound study accompanying the history showed the presence of distension of the joint capsule due to effusion with no synovial hypertrophy or associated Doppler signal&#46; Finally&#44; only 1 patient &#40;14&#37;&#41; had polyarticular disease&#44; especially in ankles&#44; knees&#44; hands and proximal interphalangeal joint of right foot &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Ultrasound of large joints showed capsular distension provoked by effusion&#44; with no synovial hypertrophy or Doppler signal and accompanied by severe periarticular involvement&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">There was a predominance of girls&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Of the 7 patients&#44; 5 &#40;61&#37;&#41; were diagnosed as having complete KD and 2 had incomplete KD&#46; Conjunctivitis was among the extra-articular manifestations most closely associated with joint disease &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The analytical data recorded for these patients show an increase in the ESR and hypoalbuminemia in a high proportion of patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">With respect to treatment&#44; the utilization of ibuprofen upon arrival at the emergency department&#44; prior to diagnosis&#44; was accompanied by a poor response in terms of the patients&#8217; joints&#46; The administration of a single IVIG dose led to the disappearance of the clinical signs of joint disease in 100&#37; of the cases&#44; and the patients remained asymptomatic 2 months later without sequelae&#46; We also wish to point out that none of the patients with joint involvement had any type of associated cardiac complication&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Incomplete Kawasaki Disease</span><p id="par0090" class="elsevierStylePara elsevierViewall">There were 16 patients &#40;38&#37;&#41; with incomplete KD in the present study&#46; We again found a predominance of boys &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9 &#91;56&#37;&#93;&#41; and Caucasians &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 &#91;63&#37;&#93;&#41;&#46; All of the children had fever&#44; and other widespread manifestations were exanthema &#40;75&#37;&#41;&#44; conjunctivitis &#40;56&#37;&#41; and lymphadenopathy &#40;50&#37;&#41;&#46; Oral mucosal involvement &#40;44&#37;&#41; and edemas &#40;25&#37;&#41; were the least common signs&#46; With regard to laboratory tests&#44; we observed an elevation in acute-phase reactants &#40;CRP in 94&#37;&#44; ESR in 75&#37;&#41;&#44; again&#44; with a predominance of CRP&#46; We detected no changes in urinary sediment&#44; and few cases of leukocytosis &#40;6&#37;&#41;&#46; Another finding was a higher incidence of thrombocytopenia &#40;11&#37;&#41; and of anemia &#40;56&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Among the patients with incomplete KD&#44; we found cardiac involvement to be more frequent than in those with complete KD&#46; Of the 8 patients who developed heart disease&#44; 50&#37; were identified as having incomplete KD&#44; with a predominance of ectasia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; versus aneurysm &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Kawasaki disease is a systemic vasculitis that mostly affects children under 5 years of age&#46; Our study confirms the seasonal variation of KD&#44; with predominance of the winter months in European countries&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> The classical diagnosis is based on the presence of prolonged fever and different clinical signs&#44; which include acute arthritis&#46; The presence of 4 clinical manifestations accompanied by fever in approximately 75&#37; of the children in our study substantiated the diagnosis of complete KD&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> The prevalence of arthritis during the acute phase of KD in our study was 16&#37;&#44; less than that described in previous reports&#44; in which the rate was 31&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> but greater than that observed by Gong et al&#46; &#40;7&#46;5&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">This study shows that KD is more common among boys&#46; However&#44; it also reveals that this is reversed in the case of joint involvement&#44; in which girls predominate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#59; 71&#37;&#41;&#44; with a mean age somewhat higher than that reflected in earlier publications&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> There are no previous reports that confirm this finding&#44; but it could be of interest if we consider the known predominance of the female sex in inflammatory joint diseases&#46; The presentation as oligoarticular arthritis with predominance in the lower limbs was the most common articular manifestation in KD&#44; as was observed in our study and others&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> However&#44; Gong et al&#46; reported the polyarticular form with early acute arthritis lasting about 20 days&#44; and less acute oligoarticular involvement lasting around 15 days&#46; The rapid resolution of arthritis in 100&#37; of the patients observed after treatment with IVIG&#44; seems to presuppose a change in the outcome of arthritis in KD&#44; which is currently benign&#46; Moreover&#44; in contrast to information provided in previously mentioned reports&#44; no child required the administration of corticosteroids&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> We have found no studies proposing conjunctivitis as a clinical finding associated with arthritis in KD&#44; either complete or incomplete&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In our study population&#44; we noted the absence of parameters considered to be factors that predicted resistance to IVIG or coronary risk in KD &#40;leukocytosis &#62;30&#44;000&#47;mm&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> thrombocytopenia &#60;300&#44;000&#47;L and CRP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#44; as well as age &#60;<span class="elsevierStyleHsp" style=""></span>6 months&#41;&#44; with the exception of hypoalbuminemia&#44; that was observed in a high proportion of children with joint involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> The therapeutic response in the study &#40;81&#37; without sequelae&#41; is comparable to that reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;13</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">There is no doubt that cardiac involvement continues to determine the prognosis of this disease&#44; especially in incomplete KD&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Our study showed that&#44; although the percentage of patients with incomplete KS was low&#44; cardiac involvement developed mainly in those children&#46; The study did not demonstrate the presence of cardiac involvement in any of the patients with joint disease&#44; perhaps due to a rapid diagnosis and&#44; consequently&#44; to the early initiation of treatment with IVIG&#46; This datum cannot be confirmed by the present findings as this is solely a descriptive study&#46; A limitation to this report is the small number of patients with arthritis&#44; which impeded us from establishing a hypothesis with a sufficient scientific basis to indicate that an improvement in the arthritis was associated with an improvement in terms of cardiac involvement&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Different mechanisms of action have been proposed for IVIG in KD&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a> They include a modulation of endothelial cells&#44; inhibition of endothelial cell adhesion molecules and antibodies&#44; reduction of cytokines&#44; macrophage and monocyte modulation&#44; reduction in nitric oxide produced by neutrophils and T and B cell regulation&#46; Although the mechanism of action has yet to be completely clarified&#44; the response to early treatment with ASA plus IVIG to reduce coronary complications has been demonstrated by a number of authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;4&#44;13</span></a> There is also an evident dose-response effect&#44; that does not vary among the different commercial formulations of IVIG&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> This anti-inflammatory action of IVIG would be supported by studies that focus on the localized inflammatory activity in KD &#40;detection of inflammatory changes in the bronchial epithelium or in synovial fluid in response to certain antigens&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">12&#44;15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">As occurs in cardiac involvement&#44; we could think that IVIG could prevent or at least decrease the development of arthritis in KD and&#44; thus&#44; require a less intensive follow-up on the part of rheumatologists&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical Disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of Interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kawasaki disease &#40;KD&#41; is an acute systemic vasculitis affecting medium-sized arteries&#44; particularly the coronary arteries&#46; Classic diagnosis is based in prolonged fever and different clinical features&#44; including acute arthritis&#46; Our objective is to determine the prevalence of arthritis at the moment of the diagnosis&#44; the response to intravenous immunoglobulin infusion and the relation with cardiac findings&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study through review of medical records of 42 patients with KD from 1988 to 2013&#46; Demographic&#44; clinical&#44; laboratory variables and treatment were reviewed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Male sex was predominant &#40;57&#37;&#41;&#46; Fever &#40;100&#37;&#41;&#44; exanthema &#40;92&#46;9&#37;&#41;&#44; conjunctivitis &#40;78&#46;6&#37;&#41;&#44; oropharingeal changes &#40;76&#46;2&#37;&#41;&#44; cervical lymphadenopathy &#40;71&#46;4&#37;&#41;&#44; edema &#40;52&#46;4&#37;&#41; and peripheral desquamation &#40;46&#46;3&#37;&#41; were reported&#46; Eight patients presented ecocardiography alterations &#40;ectasia and aneurism&#41;&#46; Acute articular involvement was reported in 7 &#40;16&#37;&#41; patients&#44; including oligoarticular &#40;57&#37;&#41;&#44; monoarticular &#40;29&#37;&#41; and polyarticular &#40;14&#37;&#41; patterns&#46; All patients had elevation of acute phase reactants with neutrophilia &#40;57&#37;&#41; and hypoalbuminemia &#40;71&#46;5&#37;&#41;&#44; but showed a good therapeutic response to intravenous immunoglobulin&#44; without sequelaes&#46; Sixteen patients had incomplete KD nine males&#44; with 100&#37; of fever exanthema &#40;75&#37;&#41;&#44; conjunctivitis &#40;56&#37;&#41; and 50&#37; of cervical lymphadenopathy&#46; Whereas oropharingeal changes and edemas was described in 44&#37; and 25&#37; of them&#46; Four patients with incomplete KD had coronary artery abnormalities&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Acute arthritis was an uncommon finding &#40;16&#37;&#41; and resulted in no sequelae&#46; Maybe the treatment with intravenous immunoglobulin and aspirin prevents the development of articular abnormalities and then leading to a decrease in its follow-up requirement by reumathologist&#46; The cardiovascular sequelae&#44; mainly incomplete KD&#44; remains determining its prognosis&#46; The presence of articular involvement seems not to have influence over cardiac involvement&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La enfermedad de Kawasaki &#40;EK&#41; es una vasculitis sist&#233;mica aguda de arterias de tama&#241;o medio&#44; especialmente las coronarias&#46; Su diagn&#243;stico cl&#225;sico se basa en la presencia de fiebre prolongada y diversas manifestaciones cl&#237;nicas&#46; En la era preinmunoglobulinas&#44; la artritis aguda constitu&#237;a un hallazgo com&#250;n&#46; Nuestro objetivo es definir la prevalencia de la artritis al diagn&#243;stico&#44; su respuesta a inmunoglobulinas intravenosas y su relaci&#243;n con eventos cardiacos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 42 pacientes con EK desde enero de 1988 a noviembre de 2013&#46; Las variables demogr&#225;ficas&#44; cl&#237;nicas&#44; laboratorio y tratamiento fueron revisadas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se encontr&#243; predominio de varones &#40;57&#44;1&#37;&#41;&#44; fiebre &#40;100&#37;&#41;&#44; exantema &#40;92&#44;9&#37;&#41;&#44; conjuntivitis &#40;78&#44;6&#37;&#41;&#44; afectaci&#243;n oral &#40;76&#44;2&#37;&#41;&#44; adenopat&#237;a cervical &#40;71&#44;4&#37;&#41;&#44; edema &#40;52&#44;4&#37;&#41; y descamaci&#243;n &#40;46&#44;3&#37;&#41;&#46; Ocho pacientes presentaron cl&#237;nica cardiol&#243;gica y ecocardiograma con alteraciones coronarias&#46; Siete pacientes &#40;16&#37;&#41; presentaron afectaci&#243;n articular aguda&#46; El 57&#37; fue oligoarticular con predominio de tobillos&#44; 29&#37; monoarticular de cadera y 14&#37; poliarticular&#46; El 100&#37; aument&#243; los reactantes de fase aguda&#44; con neutrofilia &#40;57&#37;&#41; e hipoalbuminemia &#40;71&#44;5&#37;&#41;&#46; Todos respondieron a inmunoglobulinas intravenosas&#44; sin afectaci&#243;n cardiaca ni secuelas posteriores&#46; Hubo diecis&#233;is EK incompletos&#58; nueve varones&#44; con fiebre &#40;100&#37;&#41;&#44; exantema &#40;75&#37;&#41;&#44; conjuntivitis &#40;56&#37;&#41;&#44; adenopat&#237;a cervical &#40;50&#37;&#41;&#44; alteraci&#243;n de mucosa oral &#40;44&#37;&#41; y edemas &#40;25&#37;&#41;&#46; Cuatro tuvieron afectaci&#243;n cardiaca &#40;un aneurisma&#59; tres ectasias&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La artritis aguda fue poco frecuente &#40;16&#37;&#41; y sin secuelas posteriores&#46; El tratamiento con inmunoglobulinas intravenosas y &#225;cido acetilsalic&#237;lico posiblemente previene su desarrollo&#44; disminuyendo el seguimiento por Reumatolog&#237;a&#46; La afectaci&#243;n cardiaca&#44; principalmente en EK incompleta&#44; sigue marcando su pron&#243;stico&#44; sin hallar empeoramiento card&#237;aco en pacientes con artritis&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; &#193;lvarez EP&#44; Rey F&#44; Pe&#241;a SC&#44; Rubio A&#44; Calvo C&#44; Collado P&#46; &#191;La enfermedad de Kawasaki ha perdido su afectaci&#243;n articular&#63; Reumatol Clin&#46; 2017&#59;13&#58;145&#8211;149&#46;</p>"
      ]
    ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Arthritis in proximal interphalangeal &#40;PIP&#41; joint of right foot&#46; &#40;B&#41; Ancillary ultrasound examination of PIP joint of right foot&#46;</p>"
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Data are expressed as numbers &#40;n&#41; and percentages &#40;&#37;&#41; of patients&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CRP&#44; C-reactive protein&#59; ESR&#44; erythrocyte sedimentation rate&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study population &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without clinical signs of joint involvement &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With clinical signs of joint involvement &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Girls&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;43&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;5&#37;&#41;&nbsp;\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">Fever&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;100&#37;&#41;&nbsp;\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">Exanthema&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;92&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;97&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;5&#37;&#41;&nbsp;\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">Conjunctivitis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;78&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;74&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;100&#37;&#41;&nbsp;\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">Oral involvement&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;76&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;57&#46;1&#37;&#41;&nbsp;\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">Lymphadenopathy&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;71&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;71&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;5&#37;&#41;&nbsp;\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">Edema&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;52&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;45&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;85&#46;7&#37;&#41;&nbsp;\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">Desquamation&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;46&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;45&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;43&#37;&#41;&nbsp;\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">Elevated CRP&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;92&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;91&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;100&#37;&#41;&nbsp;\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">Elevated ESR&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;78&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;74&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;100&#37;&#41;&nbsp;\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">Hypoalbuminemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;5&#37;&#41;&nbsp;\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">Anemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;47&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;48&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;42&#46;8&#37;&#41;&nbsp;\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">Thrombocytopenia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#46;3&#37;&#41;&nbsp;\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">Leukopenia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\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">Leukocytosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;11&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#46;3&#37;&#41;&nbsp;\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">Neutrophilia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;9&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Clinical and Analytical Findings in Children Diagnosed With Kawasaki Disease&#46;</p>"
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Original Article
Has Articular Involment Lessened in Kawasaki Disease?
¿La enfermedad de Kawasaki ha perdido su afectación articular?
Eva Pilar Álvarez
Corresponding author
evalvareza@hotmail.com

Corresponding author.
, Francis Rey, Sara Carolina Peña, Aranzazu Rubio, Cristina Calvo, Paz Collado
Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
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Spain&#44; between January 1988 and November 2013&#46; This report was approved by the hospital ethics committee&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We reviewed the clinical histories of all the pediatric patients who had been classified under the diagnostic code for &#8220;Kawasaki disease&#8221; or &#8220;mucocutaneous lymph node syndrome&#8221; provided by the information system of our records department&#46; In our hospital&#44; those children in whom KD is suspected are assessed and admitted by the pediatric department&#46; They begin to receive rheumatology care during admission&#44; following a request on the part of the pediatricians&#46; The children included in this study were diagnosed with KD in accordance with the criteria proposed by the American Academy Of Pediatrics&#47;American Heart Association&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical signs were recorded&#44; particularly those concerning the criteria of the diagnostic classification&#44; as were the demographic variables &#40;age&#44; sex&#44; race&#41;&#44; the season of the year in which the disease presented&#44; history of infections and the analytical variables at diagnosis &#40;C-reactive protein &#91;CRP&#93;&#44; erythrocyte sedimentation rate &#91;ESR&#93;&#44; biochemical data&#44; albumin&#44; hemoglobin&#44; platelets&#44; leukocytes and urinalysis results&#41;&#46; In the analytical variables collected&#44; any value that was outside the normal range established by the central laboratory services of our center was defined as anomalous&#46; For acute-phase reactants&#44; we considered CRP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mg&#47;L and ESR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cardiac involvement was based on the presence of abnormal findings in the electrocardiogram and&#47;or echocardiogram&#46; Coronary aneurysm was defined as a maximum diameter of the coronary artery greater than 3<span class="elsevierStyleHsp" style=""></span>mm in patients under 5 years of age&#44; and greater than 4<span class="elsevierStyleHsp" style=""></span>mm in those aged 5 years or older&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Moreover&#44; they were classified by size as small &#40;less than 5<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; medium &#40;5&#8211;8<span class="elsevierStyleHsp" style=""></span>mm&#41; or giant &#40;greater than 8<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; In the absence of aneurysms&#44; coronary ectasia or dilatation was considered to be the presence of a coronary artery with a diameter greater than normal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Joint involvement was based mainly on clinical signs&#44; and on the findings derived from the musculoskeletal ultrasound study &#40;since 2004&#41;&#46; It was classified as oligoarticular if the number of affected joints was &#8804;4 and polyarticular with &#8805;5 affected joints&#46; In addition&#44; we included in the study the presence of any chronic clinical manifestation &#40;sequelae&#41; of cardiac or articular nature&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The existence of a protocol-guided therapeutic management of KD&#44; adopted in the pediatric department of our hospital&#44; meant that all the children received the same treatment during the first 7&#8211;10 days after diagnosis&#46; During the acute phase&#44; according to the protocol&#44; patients should rest&#44; and acetylsalicylic acid &#40;ASA&#41; together with IVIG are prescribed at admission&#46; Initially the ASA dose is anti-inflammatory &#40;80&#8211;100<span class="elsevierStyleHsp" style=""></span>mg&#47;kg body weight &#91;bw&#93;&#47;day&#41;&#44; up to 48<span class="elsevierStyleHsp" style=""></span>h after the fever and clinical signs have disappeared&#46; At that time&#44; the amount is reduced to the levels of antiplatelet therapy&#44; with a single dose of 3&#8211;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg bw&#47;day&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> Intravenous immunoglobulins are given once&#44; in a single dose of 2<span class="elsevierStyleHsp" style=""></span>g&#47;kg bw&#44; administered slowly &#40;duration of the injection 10<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; and the fever usually disappears by the time the administration has finished&#46; If this treatment is followed within 36<span class="elsevierStyleHsp" style=""></span>h by clinical and analytical improvement&#44; but the fever returns&#44; a second dose of IVIG should be administered&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Perhaps &#8805;10&#37; of cases of KD are resistant to IVIG&#44; and are defined by persistence of fever and acute-phase reactants and&#47;or clinical signs &#8805;36<span class="elsevierStyleHsp" style=""></span>h after IVIG administration&#46; An increase in the risk of coronary artery aneurysms has also been reported in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> As second-line therapy&#44; the combination of intravenous corticosteroids &#40;methylprednisolone pulses&#44; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;kg bw&#44; for 1&#8211;3 days&#41;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a> with another dose of IVIG has been indicated&#46; Despite the good clinical response&#44; some studies conclude that corticosteroids do not manage to reduce the incidence of coronary complications&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> If resistance to treatment persists&#44; a third line of therapy could be drugs like infliximab&#44; abciximab&#44; etanercept&#44; cyclophosphamide or methotrexate&#44; which have been found to achieve good results in several published studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">For this report&#44; the response to the treatment administered was specified&#46; The pediatric follow-up of each patient depended mainly on the presence of cardiac involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> On the other hand&#44; the course of the joint disease was assessed at 1&#44; 2 and 4 weeks&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 42 patients with a diagnosis of KD was identified&#44; with a predominance of boys &#40;24 boys and 18 girls&#41;&#46; The age at diagnosis ranged between 3 months and 16 years&#44; with a mean and standard deviation of 4&#46;3 &#40;&#177;1&#46;4&#41; years&#46; The information collected from the medical record at the time of diagnosis enabled us to classify the patients in terms of complete or incomplete KD depending on whether or not they met the classification criteria&#46; In all&#44; 62&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; of the population was classified as having complete KD&#44; versus 38&#37; with incomplete KD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Caucasian race &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41; predominated&#44; versus the remaining 20&#37; who were Latin Americans&#46; We observed a higher prevalence with onset occurring during the winter and autumn months&#46; Most of the patients &#40;66&#46;6&#37;&#41; had no known history of infection&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">One hundred percent of the children had fever at onset&#46; The most widespread clinical signs were exanthema &#40;92&#46;9&#37;&#41;&#44; conjunctivitis &#40;78&#46;6&#37;&#41;&#44; oral mucosa involvement &#40;76&#46;2&#37;&#41; and unilateral lymphadenopathy &#40;71&#46;4&#37;&#41;&#44; and the least common were edema &#40;52&#46;4&#37;&#41; and subsequent desquamation &#40;46&#46;3&#37;&#41;&#46; The analytical findings at diagnosis showed elevated acute-phase reactants&#59; 92&#46;9&#37; had an increase in CRP &#40;88&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>58 &#91;38&#8211;125&#93; mg&#47;L&#41; and 78&#46;6&#37; had an increase in ESR &#40;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30 &#91;47&#46;7&#8211;92&#93; mm&#47;h&#41;&#46; Most of the children had normal leukocyte counts &#40;83&#46;3&#37;&#41;&#44; versus 14&#46;3&#37; with leukocytosis and 2&#46;4&#37; with leukopenia&#46; Another parameter that was a marker of activity like hypoalbuminemia was observed in 42&#46;9&#37; of the patients at diagnosis&#44; whereas a change in urinary sediment was found in 14&#46;3&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All of the patients followed the initial therapeutic protocol at diagnosis with ASA and IVIG&#44; as we detected no clinical parameters that indicated resistance to IVIG&#46; The major complication observed was cardiac involvement in 8 patients &#40;19&#37;&#41;&#44; with evidence in the echocardiographic study of coronary ectasias and aneurysms in 6 and 2 patients&#44; respectively&#46; Of the 42 patients&#44; 92&#46;9&#37; ultimately had no long-term complications or sequelae&#46;</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Arthritis in Patients With Kawasaki Disease</span><p id="par0075" class="elsevierStylePara elsevierViewall">The presence of joint involvement was detected in only 7 of the 42 children &#40;16&#37;&#41;&#46; Oligoarticular disease was predominant &#40;57&#37;&#41;&#44; affecting lower limbs&#44; knees and&#44; especially&#44; ankles&#46; The next most common type was monoarticular involvement of the hip &#40;29&#37;&#41;&#44; and the ultrasound study accompanying the history showed the presence of distension of the joint capsule due to effusion with no synovial hypertrophy or associated Doppler signal&#46; Finally&#44; only 1 patient &#40;14&#37;&#41; had polyarticular disease&#44; especially in ankles&#44; knees&#44; hands and proximal interphalangeal joint of right foot &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Ultrasound of large joints showed capsular distension provoked by effusion&#44; with no synovial hypertrophy or Doppler signal and accompanied by severe periarticular involvement&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">There was a predominance of girls&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Of the 7 patients&#44; 5 &#40;61&#37;&#41; were diagnosed as having complete KD and 2 had incomplete KD&#46; Conjunctivitis was among the extra-articular manifestations most closely associated with joint disease &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The analytical data recorded for these patients show an increase in the ESR and hypoalbuminemia in a high proportion of patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">With respect to treatment&#44; the utilization of ibuprofen upon arrival at the emergency department&#44; prior to diagnosis&#44; was accompanied by a poor response in terms of the patients&#8217; joints&#46; The administration of a single IVIG dose led to the disappearance of the clinical signs of joint disease in 100&#37; of the cases&#44; and the patients remained asymptomatic 2 months later without sequelae&#46; We also wish to point out that none of the patients with joint involvement had any type of associated cardiac complication&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Incomplete Kawasaki Disease</span><p id="par0090" class="elsevierStylePara elsevierViewall">There were 16 patients &#40;38&#37;&#41; with incomplete KD in the present study&#46; We again found a predominance of boys &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9 &#91;56&#37;&#93;&#41; and Caucasians &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 &#91;63&#37;&#93;&#41;&#46; All of the children had fever&#44; and other widespread manifestations were exanthema &#40;75&#37;&#41;&#44; conjunctivitis &#40;56&#37;&#41; and lymphadenopathy &#40;50&#37;&#41;&#46; Oral mucosal involvement &#40;44&#37;&#41; and edemas &#40;25&#37;&#41; were the least common signs&#46; With regard to laboratory tests&#44; we observed an elevation in acute-phase reactants &#40;CRP in 94&#37;&#44; ESR in 75&#37;&#41;&#44; again&#44; with a predominance of CRP&#46; We detected no changes in urinary sediment&#44; and few cases of leukocytosis &#40;6&#37;&#41;&#46; Another finding was a higher incidence of thrombocytopenia &#40;11&#37;&#41; and of anemia &#40;56&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Among the patients with incomplete KD&#44; we found cardiac involvement to be more frequent than in those with complete KD&#46; Of the 8 patients who developed heart disease&#44; 50&#37; were identified as having incomplete KD&#44; with a predominance of ectasia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; versus aneurysm &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Kawasaki disease is a systemic vasculitis that mostly affects children under 5 years of age&#46; Our study confirms the seasonal variation of KD&#44; with predominance of the winter months in European countries&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> The classical diagnosis is based on the presence of prolonged fever and different clinical signs&#44; which include acute arthritis&#46; The presence of 4 clinical manifestations accompanied by fever in approximately 75&#37; of the children in our study substantiated the diagnosis of complete KD&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> The prevalence of arthritis during the acute phase of KD in our study was 16&#37;&#44; less than that described in previous reports&#44; in which the rate was 31&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> but greater than that observed by Gong et al&#46; &#40;7&#46;5&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">This study shows that KD is more common among boys&#46; However&#44; it also reveals that this is reversed in the case of joint involvement&#44; in which girls predominate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#59; 71&#37;&#41;&#44; with a mean age somewhat higher than that reflected in earlier publications&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> There are no previous reports that confirm this finding&#44; but it could be of interest if we consider the known predominance of the female sex in inflammatory joint diseases&#46; The presentation as oligoarticular arthritis with predominance in the lower limbs was the most common articular manifestation in KD&#44; as was observed in our study and others&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> However&#44; Gong et al&#46; reported the polyarticular form with early acute arthritis lasting about 20 days&#44; and less acute oligoarticular involvement lasting around 15 days&#46; The rapid resolution of arthritis in 100&#37; of the patients observed after treatment with IVIG&#44; seems to presuppose a change in the outcome of arthritis in KD&#44; which is currently benign&#46; Moreover&#44; in contrast to information provided in previously mentioned reports&#44; no child required the administration of corticosteroids&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> We have found no studies proposing conjunctivitis as a clinical finding associated with arthritis in KD&#44; either complete or incomplete&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In our study population&#44; we noted the absence of parameters considered to be factors that predicted resistance to IVIG or coronary risk in KD &#40;leukocytosis &#62;30&#44;000&#47;mm&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> thrombocytopenia &#60;300&#44;000&#47;L and CRP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#44; as well as age &#60;<span class="elsevierStyleHsp" style=""></span>6 months&#41;&#44; with the exception of hypoalbuminemia&#44; that was observed in a high proportion of children with joint involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> The therapeutic response in the study &#40;81&#37; without sequelae&#41; is comparable to that reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;13</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">There is no doubt that cardiac involvement continues to determine the prognosis of this disease&#44; especially in incomplete KD&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Our study showed that&#44; although the percentage of patients with incomplete KS was low&#44; cardiac involvement developed mainly in those children&#46; The study did not demonstrate the presence of cardiac involvement in any of the patients with joint disease&#44; perhaps due to a rapid diagnosis and&#44; consequently&#44; to the early initiation of treatment with IVIG&#46; This datum cannot be confirmed by the present findings as this is solely a descriptive study&#46; A limitation to this report is the small number of patients with arthritis&#44; which impeded us from establishing a hypothesis with a sufficient scientific basis to indicate that an improvement in the arthritis was associated with an improvement in terms of cardiac involvement&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Different mechanisms of action have been proposed for IVIG in KD&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a> They include a modulation of endothelial cells&#44; inhibition of endothelial cell adhesion molecules and antibodies&#44; reduction of cytokines&#44; macrophage and monocyte modulation&#44; reduction in nitric oxide produced by neutrophils and T and B cell regulation&#46; Although the mechanism of action has yet to be completely clarified&#44; the response to early treatment with ASA plus IVIG to reduce coronary complications has been demonstrated by a number of authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;4&#44;13</span></a> There is also an evident dose-response effect&#44; that does not vary among the different commercial formulations of IVIG&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> This anti-inflammatory action of IVIG would be supported by studies that focus on the localized inflammatory activity in KD &#40;detection of inflammatory changes in the bronchial epithelium or in synovial fluid in response to certain antigens&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">12&#44;15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">As occurs in cardiac involvement&#44; we could think that IVIG could prevent or at least decrease the development of arthritis in KD and&#44; thus&#44; require a less intensive follow-up on the part of rheumatologists&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical Disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of Interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kawasaki disease &#40;KD&#41; is an acute systemic vasculitis affecting medium-sized arteries&#44; particularly the coronary arteries&#46; Classic diagnosis is based in prolonged fever and different clinical features&#44; including acute arthritis&#46; Our objective is to determine the prevalence of arthritis at the moment of the diagnosis&#44; the response to intravenous immunoglobulin infusion and the relation with cardiac findings&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study through review of medical records of 42 patients with KD from 1988 to 2013&#46; Demographic&#44; clinical&#44; laboratory variables and treatment were reviewed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Male sex was predominant &#40;57&#37;&#41;&#46; Fever &#40;100&#37;&#41;&#44; exanthema &#40;92&#46;9&#37;&#41;&#44; conjunctivitis &#40;78&#46;6&#37;&#41;&#44; oropharingeal changes &#40;76&#46;2&#37;&#41;&#44; cervical lymphadenopathy &#40;71&#46;4&#37;&#41;&#44; edema &#40;52&#46;4&#37;&#41; and peripheral desquamation &#40;46&#46;3&#37;&#41; were reported&#46; Eight patients presented ecocardiography alterations &#40;ectasia and aneurism&#41;&#46; Acute articular involvement was reported in 7 &#40;16&#37;&#41; patients&#44; including oligoarticular &#40;57&#37;&#41;&#44; monoarticular &#40;29&#37;&#41; and polyarticular &#40;14&#37;&#41; patterns&#46; All patients had elevation of acute phase reactants with neutrophilia &#40;57&#37;&#41; and hypoalbuminemia &#40;71&#46;5&#37;&#41;&#44; but showed a good therapeutic response to intravenous immunoglobulin&#44; without sequelaes&#46; Sixteen patients had incomplete KD nine males&#44; with 100&#37; of fever exanthema &#40;75&#37;&#41;&#44; conjunctivitis &#40;56&#37;&#41; and 50&#37; of cervical lymphadenopathy&#46; Whereas oropharingeal changes and edemas was described in 44&#37; and 25&#37; of them&#46; Four patients with incomplete KD had coronary artery abnormalities&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Acute arthritis was an uncommon finding &#40;16&#37;&#41; and resulted in no sequelae&#46; Maybe the treatment with intravenous immunoglobulin and aspirin prevents the development of articular abnormalities and then leading to a decrease in its follow-up requirement by reumathologist&#46; The cardiovascular sequelae&#44; mainly incomplete KD&#44; remains determining its prognosis&#46; The presence of articular involvement seems not to have influence over cardiac involvement&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La enfermedad de Kawasaki &#40;EK&#41; es una vasculitis sist&#233;mica aguda de arterias de tama&#241;o medio&#44; especialmente las coronarias&#46; Su diagn&#243;stico cl&#225;sico se basa en la presencia de fiebre prolongada y diversas manifestaciones cl&#237;nicas&#46; En la era preinmunoglobulinas&#44; la artritis aguda constitu&#237;a un hallazgo com&#250;n&#46; Nuestro objetivo es definir la prevalencia de la artritis al diagn&#243;stico&#44; su respuesta a inmunoglobulinas intravenosas y su relaci&#243;n con eventos cardiacos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 42 pacientes con EK desde enero de 1988 a noviembre de 2013&#46; Las variables demogr&#225;ficas&#44; cl&#237;nicas&#44; laboratorio y tratamiento fueron revisadas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se encontr&#243; predominio de varones &#40;57&#44;1&#37;&#41;&#44; fiebre &#40;100&#37;&#41;&#44; exantema &#40;92&#44;9&#37;&#41;&#44; conjuntivitis &#40;78&#44;6&#37;&#41;&#44; afectaci&#243;n oral &#40;76&#44;2&#37;&#41;&#44; adenopat&#237;a cervical &#40;71&#44;4&#37;&#41;&#44; edema &#40;52&#44;4&#37;&#41; y descamaci&#243;n &#40;46&#44;3&#37;&#41;&#46; Ocho pacientes presentaron cl&#237;nica cardiol&#243;gica y ecocardiograma con alteraciones coronarias&#46; Siete pacientes &#40;16&#37;&#41; presentaron afectaci&#243;n articular aguda&#46; El 57&#37; fue oligoarticular con predominio de tobillos&#44; 29&#37; monoarticular de cadera y 14&#37; poliarticular&#46; El 100&#37; aument&#243; los reactantes de fase aguda&#44; con neutrofilia &#40;57&#37;&#41; e hipoalbuminemia &#40;71&#44;5&#37;&#41;&#46; Todos respondieron a inmunoglobulinas intravenosas&#44; sin afectaci&#243;n cardiaca ni secuelas posteriores&#46; Hubo diecis&#233;is EK incompletos&#58; nueve varones&#44; con fiebre &#40;100&#37;&#41;&#44; exantema &#40;75&#37;&#41;&#44; conjuntivitis &#40;56&#37;&#41;&#44; adenopat&#237;a cervical &#40;50&#37;&#41;&#44; alteraci&#243;n de mucosa oral &#40;44&#37;&#41; y edemas &#40;25&#37;&#41;&#46; Cuatro tuvieron afectaci&#243;n cardiaca &#40;un aneurisma&#59; tres ectasias&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La artritis aguda fue poco frecuente &#40;16&#37;&#41; y sin secuelas posteriores&#46; El tratamiento con inmunoglobulinas intravenosas y &#225;cido acetilsalic&#237;lico posiblemente previene su desarrollo&#44; disminuyendo el seguimiento por Reumatolog&#237;a&#46; La afectaci&#243;n cardiaca&#44; principalmente en EK incompleta&#44; sigue marcando su pron&#243;stico&#44; sin hallar empeoramiento card&#237;aco en pacientes con artritis&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; &#193;lvarez EP&#44; Rey F&#44; Pe&#241;a SC&#44; Rubio A&#44; Calvo C&#44; Collado P&#46; &#191;La enfermedad de Kawasaki ha perdido su afectaci&#243;n articular&#63; Reumatol Clin&#46; 2017&#59;13&#58;145&#8211;149&#46;</p>"
      ]
    ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Arthritis in proximal interphalangeal &#40;PIP&#41; joint of right foot&#46; &#40;B&#41; Ancillary ultrasound examination of PIP joint of right foot&#46;</p>"
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Data are expressed as numbers &#40;n&#41; and percentages &#40;&#37;&#41; of patients&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CRP&#44; C-reactive protein&#59; ESR&#44; erythrocyte sedimentation rate&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study population &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without clinical signs of joint involvement &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With clinical signs of joint involvement &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Girls&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;43&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;5&#37;&#41;&nbsp;\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">Fever&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;100&#37;&#41;&nbsp;\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">Exanthema&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;92&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;97&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;5&#37;&#41;&nbsp;\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">Conjunctivitis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;78&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;74&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;100&#37;&#41;&nbsp;\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">Oral involvement&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;76&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;57&#46;1&#37;&#41;&nbsp;\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">Lymphadenopathy&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;71&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;71&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;5&#37;&#41;&nbsp;\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">Edema&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;52&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;45&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;85&#46;7&#37;&#41;&nbsp;\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">Desquamation&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;46&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;45&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;43&#37;&#41;&nbsp;\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">Elevated CRP&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;92&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;91&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;100&#37;&#41;&nbsp;\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">Elevated ESR&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;78&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;74&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;100&#37;&#41;&nbsp;\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">Hypoalbuminemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;5&#37;&#41;&nbsp;\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">Anemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;47&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;48&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;42&#46;8&#37;&#41;&nbsp;\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">Thrombocytopenia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#46;3&#37;&#41;&nbsp;\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">Leukopenia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\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">Leukocytosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;11&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#46;3&#37;&#41;&nbsp;\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">Neutrophilia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;9&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Clinical and Analytical Findings in Children Diagnosed With Kawasaki Disease&#46;</p>"
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Article information
ISSN: 21735743
Original language: English
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2023 March 58 29 87
2023 February 50 20 70
2023 January 23 19 42
2022 December 79 52 131
2022 November 58 32 90
2022 October 57 24 81
2022 September 43 27 70
2022 August 34 33 67
2022 July 24 50 74
2022 June 52 26 78
2022 May 61 34 95
2022 April 57 41 98
2022 March 57 49 106
2022 February 46 33 79
2022 January 24 35 59
2021 December 28 39 67
2021 November 27 39 66
2021 October 53 53 106
2021 September 32 40 72
2021 August 33 36 69
2021 July 20 23 43
2021 June 26 26 52
2021 May 44 39 83
2021 April 96 95 191
2021 March 70 21 91
2021 February 42 26 68
2021 January 30 19 49
2020 December 31 21 52
2020 November 37 20 57
2020 October 23 15 38
2020 September 29 26 55
2020 August 22 17 39
2020 July 21 18 39
2020 June 24 20 44
2020 May 34 31 65
2020 April 20 14 34
2020 March 6 12 18
2020 February 1 0 1
2019 January 1 0 1
2018 May 5 1 6
2018 April 42 11 53
2018 March 46 9 55
2018 February 21 4 25
2018 January 17 5 22
2017 December 27 10 37
2017 November 29 13 42
2017 October 24 8 32
2017 September 16 10 26
2017 August 17 7 24
2017 July 13 9 22
2017 June 62 50 112
2017 May 62 23 85
2017 April 3 3 6
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