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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Axial spondyloarthritis &#40;axSpA&#41; is a chronic inflammatory disease that mainly affects the spine and sacroiliac joints&#46; Structural damage in axSpA is characterized by new bone formation leading to syndesmophytes&#44; bone bridges and complete ankylosis&#46; The complex systems that underlie new bone formation in patients with axSpA involve Wingless protein &#40;Wnt&#41; signaling and growth factors such as the bone morphogenetic proteins &#40;BMPs&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">An important inhibitor of the Wnt signaling is dickkopf-related protein 1 &#40;DKK-1&#41;&#44; which seems to be enhanced by tumor necrosis factor alpha &#40;TNF&#41;&#46; Serum DKK-1 levels are decreased in patients with axSpA compared with healthy controls<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> and other rheumatic inflammatory diseases such as rheumatoid arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> Additionally&#44; it has been shown that DKK-1 serum levels are related to radiographic progression in patients with axSpA&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Specifically&#44; high levels of functional DKK-1 seems to be protective of the development of syndesmophytes&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> and DKK-1 blockade leads to the fusion of sacroiliac joints in an animal model of arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Furthermore&#44; the mechanisms and characteristics influencing serum DKK-1 levels in patients with axSpA are unclear&#46; In principle&#44; the most accepted hypothesis is that TNF induces DKK-1&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> which down-regulates bone formation through inhibition of Wnt signaling&#46; However&#44; the change produced in DKK-1 serum levels after treatment with TNF blockers is not yet conclusive since different results &#40;decrease&#44; increase and even no change on DKK-1&#41; have been reported in this sense&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7&#8211;9</span></a> In addition&#44; TNF blockers have shown clinical efficacy in patients with axSpA&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> but inhibition or slowing radiographic progression with this therapy has not been demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#8211;13</span></a> Based on this&#44; it may be hypothesized that inflammation and radiographic progression are uncoupled processes in axSpA&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Furthermore&#44; all these data come from studies including patients with long-standing and established disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#8211;13</span></a> The influence of disease duration on DKK-1 levels is unknown since no study has previously assessed whether or not patients at early stages of the disease have the same decreased levels of DKK-1 than patients with longstanding and established disease&#46; Based on this&#44; the aim of this study is to investigate if disease duration influences on serum levels of DKK-1 in patients with axSpA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design&#44; population and data collection</span><p id="par0025" class="elsevierStylePara elsevierViewall">A cross-sectional study in which consecutive patients with axSpA attending the outpatient clinic of a tertiary hospital between January 2011 and June 2014 were included&#46; Patients should fulfill Assessment of SpondyloArthritis International Society &#40;ASAS&#41; classification criteria for axSpA and be na&#239;ve for treatment with TNF blockers or other biological therapy&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The following data were collected&#58; demographic characteristics including age and gender&#59; disease characteristics specifying symptoms duration&#44; human leukocyte antigen B27 &#40;HLA-B27&#41; and presence or previous history of SpA features including psoriasis&#44; inflammatory bowel disease&#44; uveitis or peripheral arthritis&#59; and concomitant treatment&#46; Disease Activity was measured by the Bath Ankylosing Spondylitis Disease Activity Index &#40;BASDAI&#41;&#44; the Ankylosing Spondylitis Disease Activity Score &#40;ASDAS&#41;&#44; patient&#39;s visual analog score of disease activity &#40;Patient&#39;s VAS&#41; and C-Reactive Protein &#40;CRP&#41;&#46; Enthesitis was assessed using the Maastricht Ankylosing Spondylitis Enthesitis Score &#40;MASES&#41; and function was evaluated through the Bath Ankylosing Spondylitis Functional Index &#40;BASFI&#41;&#46; A physical examination was also performed to assess mobility&#44; measured by the Bath Ankylosing Spondylitis Mobility Index &#40;BASMI&#41;&#46; Blood samples to determine Dkk-1 serum levels by enzyme immunoassay were collected too&#46; In addition&#44; based on symptoms duration patients were classified in two groups&#58; early axSpA &#40;less than or equal to 5 years&#41; and established axSpA &#40;more than 5 years&#41;&#46; This study was approved by the local ethical committee&#44; and all patients signed a written informed consent before being included&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Quantification of dickkopf-1 &#40;Dkk-1&#41; levels</span><p id="par0035" class="elsevierStylePara elsevierViewall">Serum samples were obtained through venous punctures and stored at &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C until assays were performed&#46; Commercially available kit was used &#40;Biomedica Medizinprodukte GmbH &#38; Co KG&#44; A-1210 Wien&#44; Divischgasse 4&#41;&#46; Serum samples were diluted 2&#58;7 and were processed by an enzyme immunoassay&#46; DKK-1 levels were estimated by means of colourimetric measurements at 450<span class="elsevierStyleHsp" style=""></span>nm and by interpolation from a standard curve &#40;0&#8211;160<span class="elsevierStyleHsp" style=""></span>pM&#41; on an ELISA plate reader&#44; obtaining DKK-1 serum concentrations in pM&#46; The intra- and inter-assay coefficients of variation were &#60;3&#37;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">First&#44; a descriptive analysis was performed&#46; For this purpose&#44; collected variables between patients with early and established axSpA were compared using Student <span class="elsevierStyleItalic">t</span>-test for continuous variables and chi-square test for categorical variables&#46; The results are presented as mean and standard deviation &#40;SD&#41; for continuous variables and as percentage and relative frequencies for categorical variables&#46; Second&#44; separate linear regression models adjusted for age and gender were employed for identifying the variables related to serum levels of DKK-1&#46; For all the analyses&#44; SPSS software version 21&#46;0 was employed and <span class="elsevierStyleItalic">p</span>-values less than 0&#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Ninety patients with axSpA were included in this study&#46; Sixty-eight patients were classified as early axSpA and 22 as established disease&#46; Results for demographic&#44; disease characteristics and biomarkers in each group of patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Compared to patients with established disease&#44; patients with early axSpA were younger&#44; had a higher proportion of females&#44; lower degree of disease activity and less enthesis involvement&#46; As expected&#44; they also had higher mobility range aside from a better function&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Importantly&#44; DKK-1 serum levels were found to be statistically significant higher in patients with early axSpA compared with patients with established disease &#40;22&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6 vs 16&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7<span class="elsevierStyleHsp" style=""></span>pM&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#44; respectively&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Furthermore&#44; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results for the separate linear regression models evaluating the association between DKK-1 serum levels and symptom duration&#44; disease activity&#44; function and mobility&#46; Among all the tested variables&#44; only symptom duration was statistically significant related to DKK-1 serum levels &#40;standard <span class="elsevierStyleItalic">&#946;</span>&#58; &#8722;0&#46;041&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; This relationship was inverse&#58; as disease duration increased&#44; DKK-1 serum levels decreased&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">This study shows that DKK-1 serum levels in patients with axSpA depend on symptom duration&#46; Independently of the age and gender&#44; patients with early axSpA have higher serum DKK-1 levels compared with patients with established disease&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">These findings are consistent with published data&#44; in which low serum levels of DKK-1 in patients with established ankylosing spondylitis have been observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;14&#44;15</span></a> On the other hand&#44; opposite to a previous study&#44; an association between disease activity and DKK-1 levels was not found&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> In our study&#44; most patients had active or very active disease activity while in the study of Korskos et al&#46; the degree of disease activity was more heterogeneous&#46; This may explain the difference on the results between the studies&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The difference on DKK-1 serum levels found in our study between patients with early and established axSpA may be relevant to understand why despite suppressing inflammation&#44; TNF blockers have not shown to inhibit the development of syndesmophytes in patients with axSpA&#46; On one hand&#44; disease activity has been longitudinally related to radiographic progression in patients with axSpA&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> On the other hand&#44; TNF blockers decrease disease activity but have not shown to inhibit new bone formation in patients with axSpA&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition&#44; it has been shown that low levels of serum DKK-1 are necessary to develop syndesmophytes&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> What is unclear is the relationship between TNF and DKK-1&#46; TNF stimulates DKK-1 but previous studies have found that inhibition of TNF by TNF-blockers does not necessarily lead to the decrease of serum DKK-1&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7&#44;9</span></a> This highlights the fact that there may be more important factors different than TNF regulating DKK-1 production&#46; As shown in the results of our study&#44; in patients with established axSpA DKK-1 serum levels are already decreased&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> This may explain why despite suppressing disease activity&#44; the administration of a more intensive therapy such as TNF-blockers in a late stage of the disease is not able to avoid the development of syndesmophytes&#46; Nevertheless&#44; this situation may be different in patients at an early stage of the disease&#44; in which DKK-1 serum levels are not decreased yet&#46; Based on this&#44; initiation of TNF-blockers at early stages of the disease in patients with axSpA could have a different &#40;better&#41; outcome on inhibiting or slowing radiographic progression&#46; So&#44; these results support the hypothesis of a window of opportunity to treat patients with axSpA if the avoidance of irreversible radiographic damage is desired&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The following process has been postulated to explain how inflammation could lead to new bone formation in axSpA<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a>&#58; First&#44; the initial development of inflammation causes erosive cartilage and bone destruction&#46; Later&#44; these lesions are filled in by fibrous tissue&#46; And finally&#44; this tissue is ossified leading to syndesmophytes&#46; This process is mediated by TNF-alfa and Dkk-1&#46; TNF-blockers target the sites of active inflammation but have no direct effects on osteoproliferation&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> In other words&#44; it could be postulated that TNF-blockers block the transformation from inflammation to erosion&#59; however&#44; they don&#8217;t block the transformation from erosion to osteoproliferation&#44; where non-steroidal anti-inflammatory drugs might have a role&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> This may explain why initiation of TNF-blockers at early stages of the disease could have a better outcome on the development of radiographic progression&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Furthermore&#44; several limitations of this study should be taken into account when interpreting its results&#46; First&#44; this is a cross-sectional study&#44; which does not allow investigating if DKK-1 serum levels truly decrease overtime&#46; Second&#44; no control group was included so it is not possible to know whether patients with early axSpA have similar or lower serum levels of DKK-1 than healthy population&#46; Third&#44; the group of patients with established disease was substantially smaller than the group with early disease and a bigger sample size in this group could have an impact&#46; Finally&#44; no radiographs were available to assess radiographic damage or progression in these patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In summary&#44; DKK-1 serum levels depend on symptom duration in patients with axSpA&#46; Patients with early disease have higher serum DKK-1 levels compared with patients with established axSpA&#46; Based on the results of the current study&#44; it can be concluded that serum DKK-1 levels are not decreased from the beginning of the disease in patients with axSpA but they decrease as disease duration increases&#46; This could underlie a window of opportunity to avoid development of new bone formation through TNF-blockers in patients with axSpA&#46; Nevertheless&#44; further data from longitudinal studies are necessary to confirm this&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical responsibilities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of people and animals</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors state that the procedures conformed to the ethical standards of human experimentation committee responsible and according to the World Medical Association and the Declaration of Helsinki&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidentiality of data</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of the workplace on the publication of patient data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to privacy and informed consent</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that this article does not appear patient data&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">This work was supported by an Initiated Investigator Research &#40;<span class="elsevierStyleGrantSponsor" id="gs1">IIR</span>&#41; grant from Pfizer&#44; the <span class="elsevierStyleGrantSponsor" id="gs2">Institute Carlos III</span> &#40;PI10&#47;01963&#41; and the <span class="elsevierStyleGrantSponsor" id="gs3">Spanish Society of Rheumatology</span> &#40;call 2010&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">All authors declare no conflicts of interest in this manuscript&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial spondyloarthritis &#40;axSpA&#41; is characterized by new bone formation&#46; The complex systems underlying this process involve Wnt-signaling pathway&#46; It has been observed that serum levels of dickkopf-1 &#40;DKK-1&#41;&#44; an important inhibitor of Wnt-signaling&#44; are decreased in patients with axSpA&#46; However&#44; these data are from studies including only patients with long-standing disease&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to investigate if symptom duration influences on serum DKK-1 levels in patients with axSpA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study including consecutive patients with axSpA &#40;ASAS criteria&#41; na&#239;ve for anti-TNF therapy&#46; Collected data included demographic and disease characteristics&#44; time since first symptom onset&#44; assessment of disease activity and function&#44; and determination of DKK-1 serum levels&#46; Patients were classified as early axSpA &#40;symptom duration &#8804;5 years&#41; and established axSpA &#40;&#62;5 years&#41;&#46; Linear regression models were employed to investigate the variables related to DKK-1 serum levels&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In total&#44; 90 patients were included&#46; Sixty-eight patients had early axSpA and 22 had established disease&#46; Serum levels of DKK-1 were significantly higher in patients with early axSpA compared with established axSpA &#40;22&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6 vs 16&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7<span class="elsevierStyleHsp" style=""></span>pM&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; Among all tested variables&#44; only symptom duration was significantly and inversely correlated with DKK-1 serum levels &#40;beta&#58; &#8722;0&#46;041&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Serum DKK-1 levels in axSpA depend on disease duration&#46; As disease duration increases&#44; DKK-1 serum levels decrease&#46; Based on this&#44; an intensive treatment at early stages of the disease could have a better outcome on inhibiting&#47;slowing radiographic progression in patients with axSpA&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Espondiloartritis axial &#40;EsPax&#41; se caracteriza por nueva formaci&#243;n &#243;sea&#46; El complejo sistema que subyace este proceso incluye la v&#237;a de se&#241;al Wnt&#46; Se ha demostrado que niveles s&#233;ricos de dickkopf-1 &#40;DKK-1&#41;&#44; un importante inhibidor de la v&#237;a de se&#241;al Wnt&#44; est&#225; disminuidos en pacientes con EsPax&#46; Sin embargo&#44; estos datos proceden exclusivamente de pacientes con EsPax de larga duraci&#243;n&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es investigar si la duraci&#243;n de la enfermedad influye en niveles s&#233;ricos de DKK-1 en pacientes con EsPax&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal en pacientes con EsPax sin terapia anti-TNF&#46; Se recogieron datos demogr&#225;ficos y de la enfermedad&#44; y se determinaron niveles de DKK-1 s&#233;ricos en la misma visita&#46; Los pacientes fueron clasificados en base a la duraci&#243;n de s&#237;ntomas en EsPax precoz &#40;&#8804;5 a&#241;os&#41; y establecida &#40;&#62;5 a&#241;os&#41;&#46; Se emplearon modelos de regresi&#243;n lineal para investigar las variables asociadas con los niveles de DKK-1&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 90 pacientes&#44; 68 con EsPax precoz y 22 con EsPax establecida&#46; Los niveles de DKK-1 fueron superiores en EsPax precoz comparado con EsPax establecida &#40;22&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6 vs 16&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7<span class="elsevierStyleHsp" style=""></span>pM&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; De todas las variables&#44; s&#243;lo la duraci&#243;n de s&#237;ntomas se asoci&#243; significativamente con DKK-1 &#40;beta&#58; &#8722;0&#46;041&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los niveles s&#233;ricos de DKK-1 en EsPax&#44; dependen de la duraci&#243;n de la enfermedad&#46; A medida que la duraci&#243;n de la enfermedad aumenta&#44; niveles s&#233;ricos de DKK-1 disminuye&#46; Por lo tanto&#44; el tratamiento intensivo en estadios tempranos de la enfermedad podr&#237;a tener un mejor resultado en inhibir&#47;disminuir la progresi&#243;n radiol&#243;gica en pacientes con EsPax&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">BASDAI&#58; Bath Ankylosing Spondylitis Disease Activity Index&#59; ASDAS&#58; Ankylosing Spondylitis Disease Activity Score&#59; CRP&#58; C Reactive Protein&#59; Patient&#39;s VAS&#58; patient&#39;s global visual analog scale&#59; BASFI&#58; Bath Ankylosing Spondylitis Functional Index&#59; MASES&#58; Maastricht Ankylosing Spondylitis Enthesitis Score&#59; BASMI&#58; Bath Ankylosing Spondylitis Metrology Index&#59; NSAID&#58; Nonsteroidal Anti-Inflammatory Drugs&#59; DKK-1&#58; Dickkopf-1&#46; Results are shown as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or absolute number with percentages&#46; <span class="elsevierStyleItalic">p</span> value in bold&#58; with statistical significance&#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">Early axSpA<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&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">Established axSpA<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&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">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">Gender &#40;male&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;70&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;90&#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"><span class="elsevierStyleBold">&#60;0&#46;05</span>&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">Symptoms duration &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">183&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>112&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">Uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;4&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;31&#46;8&#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"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">Peripheral arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;55&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;63&#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">0&#46;5&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">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;5&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;18&#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">0&#46;09&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">Inflammatory bowel disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;14&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;4&#46;8&#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&#46;2&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">HLA-B27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;68&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;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&#46;1&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">BASDAI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;001</span>&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">ASDAS-CRP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">CRP &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1&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">Patient&#39;s VAS &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">BASFI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">MASES &#40;0&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">BASMI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">Concomitant NSAID&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;58&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;68&#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"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">DKK-1 &#40;pM&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;04</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; disease characteristics and biomarkers based on symptoms duration&#46;</p>"
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      1 => array:8 [
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        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BASDAI&#58; Bath Ankylosing Spondylitis Disease Activity Index&#59; ASDAS&#58; Ankylosing Spondylitis Disease Activity Score&#59; CRP&#58; C Reactive Protein&#59; Patient&#39;s VAS&#58; patient&#39;s global visual analog scale of disease activity&#59; BASFI&#58; Bath Ankylosing Spondylitis Functional Index&#59; MASES&#58; Maastricht Ankylosing Spondylitis Enthesitis Score&#59; BASMI&#58; Bath Ankylosing Spondylitis Metrology Index&#59; Beta&#58; unstandardized beta coefficient&#59; Std&#46; error&#58; standard error&#46; All models are adjusted for age and gender&#46; <span class="elsevierStyleItalic">p</span> value in bold&#58; with statistical significance&#46;</p>"
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                  <table border="0" frame="\n
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                  \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">Beta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;041&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;671&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;386&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;454&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;809&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;687&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;589&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&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">ASDAS &#40;CRP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;034&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;231&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&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">CRP &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;055&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&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">Patient&#39;s VAS &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;075&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;479&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;499&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&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">BASMI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Separate linear regression models for the association between DKK-1 and disease characteristics&#46;</p>"
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Original Article
Association between serum dickkopf-1 levels and disease duration in axial spondyloarthritis
Asociación entre niveles séricos de Dickkopf-1 y duración de la enfermedad en espondiloartritis axial
Roxana Rubio Vargasa,
Corresponding author
roxanarubio27@gmail.com

Corresponding author.
, Enrique Melguizo Madridb, Concepción González Rodríguezb, Federico Navarro Sarabiaa, Carmen Dominguez Quesadaa, Rafael Ariza Arizaa, Victoria Navarro Compánc
a Department of Rheumatology, University Hospital Virgen Macarena, Seville, Spain
b Biochemistry Department, University Hospital Virgen Macarena, Seville, Spain
c Department of Rheumatology, IdiPaz, University Hospital La Paz, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Axial spondyloarthritis &#40;axSpA&#41; is a chronic inflammatory disease that mainly affects the spine and sacroiliac joints&#46; Structural damage in axSpA is characterized by new bone formation leading to syndesmophytes&#44; bone bridges and complete ankylosis&#46; The complex systems that underlie new bone formation in patients with axSpA involve Wingless protein &#40;Wnt&#41; signaling and growth factors such as the bone morphogenetic proteins &#40;BMPs&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">An important inhibitor of the Wnt signaling is dickkopf-related protein 1 &#40;DKK-1&#41;&#44; which seems to be enhanced by tumor necrosis factor alpha &#40;TNF&#41;&#46; Serum DKK-1 levels are decreased in patients with axSpA compared with healthy controls<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> and other rheumatic inflammatory diseases such as rheumatoid arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> Additionally&#44; it has been shown that DKK-1 serum levels are related to radiographic progression in patients with axSpA&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Specifically&#44; high levels of functional DKK-1 seems to be protective of the development of syndesmophytes&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> and DKK-1 blockade leads to the fusion of sacroiliac joints in an animal model of arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Furthermore&#44; the mechanisms and characteristics influencing serum DKK-1 levels in patients with axSpA are unclear&#46; In principle&#44; the most accepted hypothesis is that TNF induces DKK-1&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> which down-regulates bone formation through inhibition of Wnt signaling&#46; However&#44; the change produced in DKK-1 serum levels after treatment with TNF blockers is not yet conclusive since different results &#40;decrease&#44; increase and even no change on DKK-1&#41; have been reported in this sense&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7&#8211;9</span></a> In addition&#44; TNF blockers have shown clinical efficacy in patients with axSpA&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> but inhibition or slowing radiographic progression with this therapy has not been demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#8211;13</span></a> Based on this&#44; it may be hypothesized that inflammation and radiographic progression are uncoupled processes in axSpA&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Furthermore&#44; all these data come from studies including patients with long-standing and established disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#8211;13</span></a> The influence of disease duration on DKK-1 levels is unknown since no study has previously assessed whether or not patients at early stages of the disease have the same decreased levels of DKK-1 than patients with longstanding and established disease&#46; Based on this&#44; the aim of this study is to investigate if disease duration influences on serum levels of DKK-1 in patients with axSpA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design&#44; population and data collection</span><p id="par0025" class="elsevierStylePara elsevierViewall">A cross-sectional study in which consecutive patients with axSpA attending the outpatient clinic of a tertiary hospital between January 2011 and June 2014 were included&#46; Patients should fulfill Assessment of SpondyloArthritis International Society &#40;ASAS&#41; classification criteria for axSpA and be na&#239;ve for treatment with TNF blockers or other biological therapy&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The following data were collected&#58; demographic characteristics including age and gender&#59; disease characteristics specifying symptoms duration&#44; human leukocyte antigen B27 &#40;HLA-B27&#41; and presence or previous history of SpA features including psoriasis&#44; inflammatory bowel disease&#44; uveitis or peripheral arthritis&#59; and concomitant treatment&#46; Disease Activity was measured by the Bath Ankylosing Spondylitis Disease Activity Index &#40;BASDAI&#41;&#44; the Ankylosing Spondylitis Disease Activity Score &#40;ASDAS&#41;&#44; patient&#39;s visual analog score of disease activity &#40;Patient&#39;s VAS&#41; and C-Reactive Protein &#40;CRP&#41;&#46; Enthesitis was assessed using the Maastricht Ankylosing Spondylitis Enthesitis Score &#40;MASES&#41; and function was evaluated through the Bath Ankylosing Spondylitis Functional Index &#40;BASFI&#41;&#46; A physical examination was also performed to assess mobility&#44; measured by the Bath Ankylosing Spondylitis Mobility Index &#40;BASMI&#41;&#46; Blood samples to determine Dkk-1 serum levels by enzyme immunoassay were collected too&#46; In addition&#44; based on symptoms duration patients were classified in two groups&#58; early axSpA &#40;less than or equal to 5 years&#41; and established axSpA &#40;more than 5 years&#41;&#46; This study was approved by the local ethical committee&#44; and all patients signed a written informed consent before being included&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Quantification of dickkopf-1 &#40;Dkk-1&#41; levels</span><p id="par0035" class="elsevierStylePara elsevierViewall">Serum samples were obtained through venous punctures and stored at &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C until assays were performed&#46; Commercially available kit was used &#40;Biomedica Medizinprodukte GmbH &#38; Co KG&#44; A-1210 Wien&#44; Divischgasse 4&#41;&#46; Serum samples were diluted 2&#58;7 and were processed by an enzyme immunoassay&#46; DKK-1 levels were estimated by means of colourimetric measurements at 450<span class="elsevierStyleHsp" style=""></span>nm and by interpolation from a standard curve &#40;0&#8211;160<span class="elsevierStyleHsp" style=""></span>pM&#41; on an ELISA plate reader&#44; obtaining DKK-1 serum concentrations in pM&#46; The intra- and inter-assay coefficients of variation were &#60;3&#37;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">First&#44; a descriptive analysis was performed&#46; For this purpose&#44; collected variables between patients with early and established axSpA were compared using Student <span class="elsevierStyleItalic">t</span>-test for continuous variables and chi-square test for categorical variables&#46; The results are presented as mean and standard deviation &#40;SD&#41; for continuous variables and as percentage and relative frequencies for categorical variables&#46; Second&#44; separate linear regression models adjusted for age and gender were employed for identifying the variables related to serum levels of DKK-1&#46; For all the analyses&#44; SPSS software version 21&#46;0 was employed and <span class="elsevierStyleItalic">p</span>-values less than 0&#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Ninety patients with axSpA were included in this study&#46; Sixty-eight patients were classified as early axSpA and 22 as established disease&#46; Results for demographic&#44; disease characteristics and biomarkers in each group of patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Compared to patients with established disease&#44; patients with early axSpA were younger&#44; had a higher proportion of females&#44; lower degree of disease activity and less enthesis involvement&#46; As expected&#44; they also had higher mobility range aside from a better function&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Importantly&#44; DKK-1 serum levels were found to be statistically significant higher in patients with early axSpA compared with patients with established disease &#40;22&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6 vs 16&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7<span class="elsevierStyleHsp" style=""></span>pM&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#44; respectively&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Furthermore&#44; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results for the separate linear regression models evaluating the association between DKK-1 serum levels and symptom duration&#44; disease activity&#44; function and mobility&#46; Among all the tested variables&#44; only symptom duration was statistically significant related to DKK-1 serum levels &#40;standard <span class="elsevierStyleItalic">&#946;</span>&#58; &#8722;0&#46;041&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; This relationship was inverse&#58; as disease duration increased&#44; DKK-1 serum levels decreased&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">This study shows that DKK-1 serum levels in patients with axSpA depend on symptom duration&#46; Independently of the age and gender&#44; patients with early axSpA have higher serum DKK-1 levels compared with patients with established disease&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">These findings are consistent with published data&#44; in which low serum levels of DKK-1 in patients with established ankylosing spondylitis have been observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;14&#44;15</span></a> On the other hand&#44; opposite to a previous study&#44; an association between disease activity and DKK-1 levels was not found&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> In our study&#44; most patients had active or very active disease activity while in the study of Korskos et al&#46; the degree of disease activity was more heterogeneous&#46; This may explain the difference on the results between the studies&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The difference on DKK-1 serum levels found in our study between patients with early and established axSpA may be relevant to understand why despite suppressing inflammation&#44; TNF blockers have not shown to inhibit the development of syndesmophytes in patients with axSpA&#46; On one hand&#44; disease activity has been longitudinally related to radiographic progression in patients with axSpA&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> On the other hand&#44; TNF blockers decrease disease activity but have not shown to inhibit new bone formation in patients with axSpA&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition&#44; it has been shown that low levels of serum DKK-1 are necessary to develop syndesmophytes&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> What is unclear is the relationship between TNF and DKK-1&#46; TNF stimulates DKK-1 but previous studies have found that inhibition of TNF by TNF-blockers does not necessarily lead to the decrease of serum DKK-1&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7&#44;9</span></a> This highlights the fact that there may be more important factors different than TNF regulating DKK-1 production&#46; As shown in the results of our study&#44; in patients with established axSpA DKK-1 serum levels are already decreased&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> This may explain why despite suppressing disease activity&#44; the administration of a more intensive therapy such as TNF-blockers in a late stage of the disease is not able to avoid the development of syndesmophytes&#46; Nevertheless&#44; this situation may be different in patients at an early stage of the disease&#44; in which DKK-1 serum levels are not decreased yet&#46; Based on this&#44; initiation of TNF-blockers at early stages of the disease in patients with axSpA could have a different &#40;better&#41; outcome on inhibiting or slowing radiographic progression&#46; So&#44; these results support the hypothesis of a window of opportunity to treat patients with axSpA if the avoidance of irreversible radiographic damage is desired&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The following process has been postulated to explain how inflammation could lead to new bone formation in axSpA<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a>&#58; First&#44; the initial development of inflammation causes erosive cartilage and bone destruction&#46; Later&#44; these lesions are filled in by fibrous tissue&#46; And finally&#44; this tissue is ossified leading to syndesmophytes&#46; This process is mediated by TNF-alfa and Dkk-1&#46; TNF-blockers target the sites of active inflammation but have no direct effects on osteoproliferation&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> In other words&#44; it could be postulated that TNF-blockers block the transformation from inflammation to erosion&#59; however&#44; they don&#8217;t block the transformation from erosion to osteoproliferation&#44; where non-steroidal anti-inflammatory drugs might have a role&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> This may explain why initiation of TNF-blockers at early stages of the disease could have a better outcome on the development of radiographic progression&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Furthermore&#44; several limitations of this study should be taken into account when interpreting its results&#46; First&#44; this is a cross-sectional study&#44; which does not allow investigating if DKK-1 serum levels truly decrease overtime&#46; Second&#44; no control group was included so it is not possible to know whether patients with early axSpA have similar or lower serum levels of DKK-1 than healthy population&#46; Third&#44; the group of patients with established disease was substantially smaller than the group with early disease and a bigger sample size in this group could have an impact&#46; Finally&#44; no radiographs were available to assess radiographic damage or progression in these patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In summary&#44; DKK-1 serum levels depend on symptom duration in patients with axSpA&#46; Patients with early disease have higher serum DKK-1 levels compared with patients with established axSpA&#46; Based on the results of the current study&#44; it can be concluded that serum DKK-1 levels are not decreased from the beginning of the disease in patients with axSpA but they decrease as disease duration increases&#46; This could underlie a window of opportunity to avoid development of new bone formation through TNF-blockers in patients with axSpA&#46; Nevertheless&#44; further data from longitudinal studies are necessary to confirm this&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical responsibilities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of people and animals</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors state that the procedures conformed to the ethical standards of human experimentation committee responsible and according to the World Medical Association and the Declaration of Helsinki&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidentiality of data</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of the workplace on the publication of patient data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to privacy and informed consent</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that this article does not appear patient data&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">This work was supported by an Initiated Investigator Research &#40;<span class="elsevierStyleGrantSponsor" id="gs1">IIR</span>&#41; grant from Pfizer&#44; the <span class="elsevierStyleGrantSponsor" id="gs2">Institute Carlos III</span> &#40;PI10&#47;01963&#41; and the <span class="elsevierStyleGrantSponsor" id="gs3">Spanish Society of Rheumatology</span> &#40;call 2010&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">All authors declare no conflicts of interest in this manuscript&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Quantification of dickkopf-1 &#40;Dkk-1&#41; levels"
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    "fechaRecibido" => "2016-01-26"
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            2 => "Axial spondyloarthritis"
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            1 => "Duraci&#243;n de la enfermedad"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial spondyloarthritis &#40;axSpA&#41; is characterized by new bone formation&#46; The complex systems underlying this process involve Wnt-signaling pathway&#46; It has been observed that serum levels of dickkopf-1 &#40;DKK-1&#41;&#44; an important inhibitor of Wnt-signaling&#44; are decreased in patients with axSpA&#46; However&#44; these data are from studies including only patients with long-standing disease&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to investigate if symptom duration influences on serum DKK-1 levels in patients with axSpA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study including consecutive patients with axSpA &#40;ASAS criteria&#41; na&#239;ve for anti-TNF therapy&#46; Collected data included demographic and disease characteristics&#44; time since first symptom onset&#44; assessment of disease activity and function&#44; and determination of DKK-1 serum levels&#46; Patients were classified as early axSpA &#40;symptom duration &#8804;5 years&#41; and established axSpA &#40;&#62;5 years&#41;&#46; Linear regression models were employed to investigate the variables related to DKK-1 serum levels&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In total&#44; 90 patients were included&#46; Sixty-eight patients had early axSpA and 22 had established disease&#46; Serum levels of DKK-1 were significantly higher in patients with early axSpA compared with established axSpA &#40;22&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6 vs 16&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7<span class="elsevierStyleHsp" style=""></span>pM&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; Among all tested variables&#44; only symptom duration was significantly and inversely correlated with DKK-1 serum levels &#40;beta&#58; &#8722;0&#46;041&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Serum DKK-1 levels in axSpA depend on disease duration&#46; As disease duration increases&#44; DKK-1 serum levels decrease&#46; Based on this&#44; an intensive treatment at early stages of the disease could have a better outcome on inhibiting&#47;slowing radiographic progression in patients with axSpA&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
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            "titulo" => "Results"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Espondiloartritis axial &#40;EsPax&#41; se caracteriza por nueva formaci&#243;n &#243;sea&#46; El complejo sistema que subyace este proceso incluye la v&#237;a de se&#241;al Wnt&#46; Se ha demostrado que niveles s&#233;ricos de dickkopf-1 &#40;DKK-1&#41;&#44; un importante inhibidor de la v&#237;a de se&#241;al Wnt&#44; est&#225; disminuidos en pacientes con EsPax&#46; Sin embargo&#44; estos datos proceden exclusivamente de pacientes con EsPax de larga duraci&#243;n&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es investigar si la duraci&#243;n de la enfermedad influye en niveles s&#233;ricos de DKK-1 en pacientes con EsPax&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal en pacientes con EsPax sin terapia anti-TNF&#46; Se recogieron datos demogr&#225;ficos y de la enfermedad&#44; y se determinaron niveles de DKK-1 s&#233;ricos en la misma visita&#46; Los pacientes fueron clasificados en base a la duraci&#243;n de s&#237;ntomas en EsPax precoz &#40;&#8804;5 a&#241;os&#41; y establecida &#40;&#62;5 a&#241;os&#41;&#46; Se emplearon modelos de regresi&#243;n lineal para investigar las variables asociadas con los niveles de DKK-1&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 90 pacientes&#44; 68 con EsPax precoz y 22 con EsPax establecida&#46; Los niveles de DKK-1 fueron superiores en EsPax precoz comparado con EsPax establecida &#40;22&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6 vs 16&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7<span class="elsevierStyleHsp" style=""></span>pM&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; De todas las variables&#44; s&#243;lo la duraci&#243;n de s&#237;ntomas se asoci&#243; significativamente con DKK-1 &#40;beta&#58; &#8722;0&#46;041&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los niveles s&#233;ricos de DKK-1 en EsPax&#44; dependen de la duraci&#243;n de la enfermedad&#46; A medida que la duraci&#243;n de la enfermedad aumenta&#44; niveles s&#233;ricos de DKK-1 disminuye&#46; Por lo tanto&#44; el tratamiento intensivo en estadios tempranos de la enfermedad podr&#237;a tener un mejor resultado en inhibir&#47;disminuir la progresi&#243;n radiol&#243;gica en pacientes con EsPax&#46;</p></span>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">BASDAI&#58; Bath Ankylosing Spondylitis Disease Activity Index&#59; ASDAS&#58; Ankylosing Spondylitis Disease Activity Score&#59; CRP&#58; C Reactive Protein&#59; Patient&#39;s VAS&#58; patient&#39;s global visual analog scale&#59; BASFI&#58; Bath Ankylosing Spondylitis Functional Index&#59; MASES&#58; Maastricht Ankylosing Spondylitis Enthesitis Score&#59; BASMI&#58; Bath Ankylosing Spondylitis Metrology Index&#59; NSAID&#58; Nonsteroidal Anti-Inflammatory Drugs&#59; DKK-1&#58; Dickkopf-1&#46; Results are shown as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or absolute number with percentages&#46; <span class="elsevierStyleItalic">p</span> value in bold&#58; with statistical significance&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" 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">Early axSpA<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&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">Established axSpA<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&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">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">Gender &#40;male&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;70&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;90&#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"><span class="elsevierStyleBold">&#60;0&#46;05</span>&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">Symptoms duration &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">183&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>112&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">Uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;4&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;31&#46;8&#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"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">Peripheral arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;55&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;63&#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">0&#46;5&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">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;5&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;18&#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">0&#46;09&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">Inflammatory bowel disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;14&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;4&#46;8&#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&#46;2&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">HLA-B27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;68&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;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&#46;1&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">BASDAI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;001</span>&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">ASDAS-CRP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">CRP &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1&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">Patient&#39;s VAS &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">BASFI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">MASES &#40;0&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">BASMI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&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">Concomitant NSAID&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;58&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;68&#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"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">DKK-1 &#40;pM&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;04</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BASDAI&#58; Bath Ankylosing Spondylitis Disease Activity Index&#59; ASDAS&#58; Ankylosing Spondylitis Disease Activity Score&#59; CRP&#58; C Reactive Protein&#59; Patient&#39;s VAS&#58; patient&#39;s global visual analog scale of disease activity&#59; BASFI&#58; Bath Ankylosing Spondylitis Functional Index&#59; MASES&#58; Maastricht Ankylosing Spondylitis Enthesitis Score&#59; BASMI&#58; Bath Ankylosing Spondylitis Metrology Index&#59; Beta&#58; unstandardized beta coefficient&#59; Std&#46; error&#58; standard error&#46; All models are adjusted for age and gender&#46; <span class="elsevierStyleItalic">p</span> value in bold&#58; with statistical significance&#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">Beta&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">Std&#46; error&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&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">Symptom duration &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;01</span>&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">HLA-B27 positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;626&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&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">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;281&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;671&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&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">Inflammatory bowel disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;214&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;386&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&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">Uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;454&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&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">Peripheral arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;809&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;687&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&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">BASDAI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;589&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&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">ASDAS &#40;CRP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;034&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;231&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&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">CRP &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;055&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&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">Patient&#39;s VAS &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&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">BASFI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;075&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;479&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&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">MASES &#40;0&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;499&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&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">BASMI &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information
ISSN: 21735743
Original language: English
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Idiomas
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