Original Article
Effect of Weight Loss on Activity in Psoriatic Arthritis: A Systematic Review
Efecto de la pérdida de peso en la actividad en artritis psoriásica: una revisión sistemática
Read
5040
Timeswas read the article
2043
Total PDF
2997
Total HTML
Share statistics
array:24 [ "pii" => "S217357431830056X" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.01.009" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1011" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2018;14:207-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "PDF" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X1730030X" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2017.01.010" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1011" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2018;14:207-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3294 "formatos" => array:3 [ "EPUB" => 158 "HTML" => 2411 "PDF" => 725 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Efecto de la pérdida de peso en la actividad en artritis psoriásica: una revisión sistemática" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "207" "paginaFinal" => "210" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Effect of weight loss on activity in psoriatic arthritis: A systematic review" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1599 "Ancho" => 1645 "Tamanyo" => 168384 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flujo de la búsqueda y selección de estudios.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raquel Almodóvar, Pedro Zarco, Teresa Otón, Loreto Carmona" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Raquel" "apellidos" => "Almodóvar" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Zarco" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "Otón" ] 3 => array:2 [ "nombre" => "Loreto" "apellidos" => "Carmona" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357431830056X" "doi" => "10.1016/j.reumae.2017.01.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431830056X?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1730030X?idApp=UINPBA00004M" "url" => "/1699258X/0000001400000004/v2_201808030430/S1699258X1730030X/v2_201808030430/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574318300741" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.01.001" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1195" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Reumatol Clin. 2018;14:211-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "formatos" => array:2 [ "HTML" => 1 "PDF" => 1 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "HPV Vaccination Syndrome: A Clinical Mirage, or a New Tragic Fibromyalgia Model" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "211" "paginaFinal" => "214" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome posvacunal VPH. ¿Un espejismo clínico, o un nuevo modelo trágico de fibromialgia?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Martínez-Lavín" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Martínez-Lavín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X18300354" "doi" => "10.1016/j.reuma.2018.01.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X18300354?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300741?idApp=UINPBA00004M" "url" => "/21735743/0000001400000004/v1_201808070503/S2173574318300741/v1_201808070503/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574318300534" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.01.007" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1008" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2018;14:202-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "PDF" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "The Value of Power Doppler Ultrasound in Patients With Rheumatoid Arthritis in Clinical Remission: Reclassifying Disease Activity?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "206" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor de la ecografía con Doppler de poder en pacientes con artritis reumatoide en remisión clínica: ¿reclasificación de la actividad de la enfermedad?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 716 "Ancho" => 1620 "Tamanyo" => 54632 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ultrasonographic findings in the evaluated joints. PD, power Doppler.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Facundo Vergara, Santiago Ruta, Javier Rosa, Josefina Marín, Ricardo García-Mónaco, Enrique R. Soriano" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Facundo" "apellidos" => "Vergara" ] 1 => array:2 [ "nombre" => "Santiago" "apellidos" => "Ruta" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Rosa" ] 3 => array:2 [ "nombre" => "Josefina" "apellidos" => "Marín" ] 4 => array:2 [ "nombre" => "Ricardo" "apellidos" => "García-Mónaco" ] 5 => array:2 [ "nombre" => "Enrique R." "apellidos" => "Soriano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X17300268" "doi" => "10.1016/j.reuma.2017.01.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17300268?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300534?idApp=UINPBA00004M" "url" => "/21735743/0000001400000004/v1_201808070503/S2173574318300534/v1_201808070503/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Effect of Weight Loss on Activity in Psoriatic Arthritis: A Systematic Review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "207" "paginaFinal" => "210" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Raquel Almodóvar, Pedro Zarco, Teresa Otón, Loreto Carmona" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Raquel" "apellidos" => "Almodóvar" "email" => array:1 [ 0 => "ralmodovar@fhalcorcon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pedro" "apellidos" => "Zarco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Teresa" "apellidos" => "Otón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Loreto" "apellidos" => "Carmona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Salud Musculoesquelética, InMusc, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto de la pérdida de peso en la actividad en artritis psoriásica: una revisión sistemática" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1575 "Ancho" => 1645 "Tamanyo" => 161352 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart documenting the search and selection of studies.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The prevalence of overweight and obesity in persons with psoriasis and psoriatic arthritis (PsA) is greater than that of the general population.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1,2</span></a> In turn, it has been seen that obesity can be a risk factor for the development of psoriatic disease,<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3–6</span></a> as well as for greater disease activity and severity. This could be explained by the proinflammatory state provoked by the accumulation of adipose tissue, with changes in the expression of cytokines, such as tumor necrosis factor (TNF) α, interleukin (IL) 6 and adipokines (leptin, adiponectin).<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7–10</span></a> Patients with psoriasis who are also obese have a very serious skin disease and have a poorer response to treatments.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11,12</span></a> In patients with PsA, obesity also predicts a poor joint response to treatment, whether or not the latter was biological.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13,14</span></a> It has been found that caloric restriction reduces the levels of inflammatory cytokines in obese individuals<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15,16</span></a> and can considerably improve psoriasis<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>; however, its effect on arthritis is not clear. In the attempt to support a series of recommendations for the management of PsA, we decided to conduct a systematic review, the purpose of which was to evaluate the effect of weight loss on disease activity and the response to treatment in PsA patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">We carried out a systemic literature review. For this we designed a search strategy in the bibliographic databases MEDLINE (from 1960), EMBASE (from 1980) and the Cochrane Central Library from inception to April 2015. The search included MeSH terms and free text (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The search was limited to studies involving humans and to studies published in English and Spanish. Moreover, a manual search was performed using the bibliography of the included articles and from rheumatology meetings held in the United States and Europe over the preceding 2 years.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Two reviewers (RA and LC) independently examined the titles and abstracts of the articles retrieved for the selection criteria. We then recorded the data of the selected studies.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We included only: (1) randomized controlled trials (RCT), in which (2) the population to be treated consisted of PsA patients; (3) the intervention was any measure aimed at weight control (diet, exercise, prescribed drugs, surgery, etc.); (4) the latter be compared with a group in which no intervention or control was introduced; and (5) the implementation of some measure of evaluation of the activity, either peripheral (66/68 joint count, Disease Activity Score in 28 joints [DAS28], DAS, visual analogue scale (VAS), enthesitis index) or axial (Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index), acute-phase reactants (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) or imaging, or other efficacy scores documented in the article.</p><p id="par0025" class="elsevierStylePara elsevierViewall">All of the articles obtained were reviewed in detail with the aid of ad hoc designed data collection sheets. We gathered all the data on the description of the sample and on the specific results of weight control on inflammatory activity. We likewise evaluated the risk of biases using the domains proposed by the Cochrane Collaboration.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We performed a qualitative analysis of the information collected for type of study and the population being studied, for quality and specific results, as well as a qualitative evaluation of the heterogeneity.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">In the diagram in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> we describe the results of the search. In the search strategy, we identified a total of 215 articles, 5 of which were selected for a detailed review after the exclusion of 210 references on the basis of their title and abstract. Finally, 3 articles were excluded (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> specifies the excluded studies and the reasons for their exclusion).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the data on the 2 articles that were ultimately included in the analysis.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13,19</span></a> There were 2 RCT, 1 of which had the format of an abstract. The risks of biases are moderate in the study by Di Minno et al. and high in that of Abou-Raya et al., in the latter due to lack of information.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In the study of Di Minno et al.,<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> patients with PsA and obesity were randomized to receive a hypocaloric diet based on an intake of fat of 30%–35% of the total daily intake and an increase in fiber and fish to at least one day a week, or a free diet, receiving certain nutritional advice. At the same time, and given the lack of symptomatic control, the patients, who had not taken biological therapy before commencing the study, began treatment with anti-tumor necrosis factor (TNF) drugs. In all, 58.7% lost weight (≥5%), which occurred more frequently in the hypocaloric diet group (49 of 63) than in the free diet group (25 of 63; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001). Both diets resulted in the achievement of a significant improvement in joint counts, in enthesis, and in the Psoriasis Area Severity Index (PASI), Health Assessment Questionnaire (HAQ), VAS, CRP and ESR at 6 months. The patients who lost more than 5% of their weight more frequently had a minimal disease activity, according to Coates and Helliwell<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> (50%), than those who lost less weight (23%; odds ratio<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.20; 95% confidence interval, 1.82–9.66; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The objective of the study by Abou-Raya et al.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> was to evaluate whether weight loss achieved by exercise or diet, or by both, was more effective than standard treatment alone (nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, anti-TNF-α) in improving the symptoms (pain, physical function, fatigue, depression) and systemic inflammation in obese adults with PsA. The mean reduction in body weight was 15% in all of the intervention groups versus 2% in the control group (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001). In the exercise group, there was a significant improvement (20%) in the American College of Rheumatology criteria (ACR20), HAQ, Beck Depression Inventory, fatigue, PASI and Physician's Global Assessment (PGA), and in the diet group there was a significant improvement in ACR20 and PASI 75 response (75% reduction) and certain significant reductions in systemic inflammatory markers. In the diet and exercise group, there was a significant improvement in ACR20, HAQ, depression, fatigue, DAS28-CRP, PASI and PGA, together with significant reductions in the serum levels of high-sensitivity CRP, IL-6, IL-17 and TNF in comparison with controls. There was a moderate correlation between the percentage of weight loss and the reduction of PASI (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.587).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">A number of studies have reported an elevated prevalence of cardiovascular risk factors, such as hypertension, obesity, diabetes mellitus and dyslipidemia, in PsA patients.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">21–27</span></a> Moreover, evidence indicates that obesity, insulin resistance, psoriasis and PsA may share a common predisposition in terms of low-grade inflammation.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a> It has also been found that body mass index is associated in PsA with a poorer response to treatment.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a> What was not that clear is whether weight reduction could have an effect on activity. In this systematic review we found 2 studies that support this hypothesis, 1 with a high level of evidence and another with a level somewhat lower, as it was only in the format of an abstract at that time.</p><p id="par0060" class="elsevierStylePara elsevierViewall">There are close links between the metabolic system and the immune system.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> For example, IL-6 is a key proinflammatory cytokine that can stimulate the hypothalamus, which is associated with central obesity, hypertension and insulin resistance, and induces the production of CRP.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a> Moreover there is evidence that caloric restriction reduces the levels of CRP and TNF-α<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a> and, thus, patients whose dietary intake is 1500 calories/day can show decreases in CRP levels for this reason, and not only for a reduction in inflammatory activity. This could explain the effect observed on the disease activity in these studies.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Other factors could have an effect on weight and on activity. For example, in the study published by Di Minno et al.,<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> 20% of the patients were receiving chronic treatment with oral hypoglycemic agents, and the effect on body weight that can be induced by glucagon-like peptide-1 agonists, metformin and sulfonylurea is well known; moreover, treatment was begun with an anti-TNF agent. Although the patients were taking stable doses of hypoglycemic drugs and all initiated anti-TNF therapy, it is not possible to rule out that the effect of body weight on disease activity would in part be due to those other treatments. It could even be considered that the patients that most firmly adhered to diet or exercise would be more adherent to the treatments.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Our review was limited by the small number of published studies and by their intermediate quality. The hypothesis that weight loss in PsA could be linked to a reduction in disease activity, although indicative, is only based on 2 randomized studies, 1 of them presented in the form of an abstract. Thus, we conclude that this should be investigated in greater depth.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of human and animal subjects</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0090" class="elsevierStylePara elsevierViewall">The present report was financed by <span class="elsevierStyleGrantSponsor" id="gs1">MSD</span>.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1069481" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1016767" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1069480" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1016766" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-03-02" "fechaAceptado" => "2017-01-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1016767" "palabras" => array:6 [ 0 => "Body mass index" 1 => "Obesity" 2 => "Psoriatic arthritis" 3 => "Weight loss" 4 => "Diet" 5 => "Response to treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1016766" "palabras" => array:6 [ 0 => "Índice de masa corporal" 1 => "Obesidad" 2 => "Artritis psoriásica" 3 => "Pérdida de peso" 4 => "Dieta" 5 => "Respuesta al tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the association between weight loss and changes in disease activity in patients with psoriatic arthritis (PsA).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a systematic review of the literature, with searches in Medline, Embase and Cochrane Central Library from inception until April 2015. Inclusion criteria: (1) randomized controlled trials (RCT); (2) PsA patients; (3) interventions were any intervention aimed at weight control; and (4) a PsA activity-related outcome measure was evaluated. Risks of bias were assessed by the Cochrane Collaboration scale.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 215 articles identified, only 2 RCT met the inclusion criteria, 1 in abstract format. Both showed moderate risk of bias. Patients who managed to lose weight-by any method-had better results in terms of activity and inflammation. The percentage of weight loss correlated moderately with changes in inflammatory outcomes.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Weight loss in PsA could be associated with less inflammation; however, the evidence to support this is limited.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la asociación entre la pérdida de peso y cambios en la actividad en pacientes con artritis psoriásica (APs).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se llevó a cabo una revisión sistemática en Medline, Embase y Cochrane Central desde el inicio hasta abril del 2015. Criterios de inclusión: <span class="elsevierStyleItalic">1)</span> ensayos clínicos aleatorizados controlados (ECA); <span class="elsevierStyleItalic">2)</span> pacientes con APs; <span class="elsevierStyleItalic">3)</span> cualquier intervención encaminada al control de peso, y <span class="elsevierStyleItalic">4)</span> evaluación de la actividad de la APs. Se evaluaron los riesgos de sesgos según la escala Cochrane.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De 215 artículos identificados, solo 2 ECA cumplieron los criterios de inclusión, uno de ellos en formato abstract. Ambos tenían riesgos de sesgos moderados. Los pacientes que lograban perder peso, por cualquier método, mostraban menores niveles de actividad e inflamación. El porcentaje de pérdida de peso correlaciona moderadamente con cambios en medidas de inflamación.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La pérdida de peso en APs podría asociarse a menor inflamación, si bien la evidencia que lo apoya es limitada.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Almodóvar R, Zarco P, Otón T, Carmona L. Efecto de la pérdida de peso en la actividad en artritis psoriásica: una revisión sistemática. Reumatol Clin. 2018;14:207–210.</p>" ] ] "multimedia" => array:14 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1575 "Ancho" => 1645 "Tamanyo" => 161352 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart documenting the search and selection of studies.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">#1 “psoriatic arthritis” \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">#2 “psoriatic arthritis”/exp \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">#3 #1 OR #2 \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">#4 “diet” \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">#5 “weight control” \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">#6 “weight reduction” \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">#7 “weight reduction”/exp \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">#8 “antiobesity agents” \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">#9 “antiobesity agents” \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">#10 “anti obesity agents” \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">#11 “metformin” \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">#12 “sibutramine” \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">#13 “orlistat” \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">#14 “xenical” \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">#15 “meridia” \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">#16 “glucophage” \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">#17 “low calorie diet” \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">#18 “low fat diet” \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">#19 nutrition$ AND (intervention$ OR education$) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">#20 diet$ AND (intervention$ OR education$) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">#21 “weight loss” AND (intervention$ OR education$) \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">#22 weight AND reduction \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">#23 “weight reduction”/exp \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">#24 (#4 - #23) OR \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">#25 #3 AND #24 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1823869.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Search Strategy.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ACR20, 20% improvement in American College of Rheumatology criteria; GLP-1, glucagon-like peptide; HAQ, Health Assessment Questionnaire; PsA, psoriatic arthritis; TNF, tumor necrosis factor.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author, year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reason for exclusion \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">Schett et al., 2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Does not analyze the effect of weight control. It is a 24-week randomized controlled trial that evaluates the impact of weight and baseline body mass index on the clinical response (ACR20 and HAQ) to apremilast in PsA patients, rather than a change in body weight \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">Di Minnet et al., 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abstract submitted to a congress. It evaluates weight reduction through diet, to reach the minimal activity in overweight/obese PsA patients, who began treatment with anti-TNF. It was excluded because it was subsequently published in 2014 and is included in the present systematic review \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">Sullivan et al., 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A 24-week open trial that analyzes the effect of GLP-1 (liraglutide) on disease activity in 15 patients with inflammatory arthritis (11 with rheumatoid arthritis and 4 with PsA) and type 2 diabetes mellitus. It does not provide separate data and the sample size is too small \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1823870.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Excluded Studies and Reasons.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The colors indicate the adaptation of certain domains of the risk scale.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ACR20, 20% improvement in American College of Rheumatology criteria; BDI, Beck Depression Inventory; BMI, body mass index; CRP, C-reactive protein; DAS28, Disease Activity Score in 28 joints; ESR, erythrocyte sedimentation rate; HAQ, Health Assessment Questionnaire; PASI, Psoriasis Area Severity Index; PGA, Physician's Global Assessment; PsA, psoriatic arthritis; SJC, swollen joint count; TJC, tender joint count; TNF, tumor necrosis factor; VAS, visual analogue scale.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Article \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">Design \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients \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">Intervention \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">Activity measurements \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">Randomized sequence \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">Blinded participants \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">Blinded assessors \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">Missing outcome measures \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">Selective communication \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">Di Minno et al., 2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6-month single-blind RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No.<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>126 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypocaloric diet group<br>Free-managed diet group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TJC, SJC, PASI, VAS pain, HAQ, ESR and CRP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="201808070503388101"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="201808070503388102"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="201808070503388103"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="201808070503388104"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="201808070503388105"></elsevierMultimedia> \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">Abou-Raya et al., 2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12-month single-blind RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No.<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>55<br>Adults with PsA and BMI<br>≥30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Control<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>standard treatment<br>Diet<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>standard treatment<br>Exercise<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>standard treatment<br>Diet<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>exercise<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>standard treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ACR20, HAQ, BDI, fatigue, PASI, PGA, DAS28-CRP, high-sensitivity CRP, IL-6. IL-17 and TNF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="201808070503388106"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="201808070503388107"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="201808070503388108"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="201808070503388109"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><elsevierMultimedia ident="2018080705033881010"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1823868.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the Included Studies.</p>" ] ] 4 => array:5 [ "identificador" => "201808070503388101" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 51 "Ancho" => 53 "Tamanyo" => 871 ] ] ] 5 => array:5 [ "identificador" => "201808070503388102" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx2.jpeg" "Alto" => 51 "Ancho" => 52 "Tamanyo" => 927 ] ] ] 6 => array:5 [ "identificador" => "201808070503388103" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx3.jpeg" "Alto" => 51 "Ancho" => 52 "Tamanyo" => 764 ] ] ] 7 => array:5 [ "identificador" => "201808070503388104" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 51 "Ancho" => 53 "Tamanyo" => 871 ] ] ] 8 => array:5 [ "identificador" => "201808070503388105" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 51 "Ancho" => 53 "Tamanyo" => 871 ] ] ] 9 => array:5 [ "identificador" => "201808070503388106" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx3.jpeg" "Alto" => 51 "Ancho" => 52 "Tamanyo" => 764 ] ] ] 10 => array:5 [ "identificador" => "201808070503388107" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx2.jpeg" "Alto" => 51 "Ancho" => 52 "Tamanyo" => 927 ] ] ] 11 => array:5 [ "identificador" => "201808070503388108" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx3.jpeg" "Alto" => 51 "Ancho" => 52 "Tamanyo" => 764 ] ] ] 12 => array:5 [ "identificador" => "201808070503388109" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx3.jpeg" "Alto" => 51 "Ancho" => 52 "Tamanyo" => 764 ] ] ] 13 => array:5 [ "identificador" => "2018080705033881010" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx3.jpeg" "Alto" => 51 "Ancho" => 52 "Tamanyo" => 764 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differences in body mass index among individuals with PsA, psoriasis, RA and the general population" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.M. Bhole" 1 => "H.K. Choi" 2 => "L.C. Burns" 3 => "C. Vera Kellet" 4 => "D.V. Lacaille" 5 => "D.D. Gladman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2012" "volumen" => "51" "paginaInicial" => "552" "paginaFinal" => "556" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0165" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Jamnitski" 1 => "D. Symmons" 2 => "M.J. Peters" 3 => "N. Sattar" 4 => "I. McInnes" 5 => "M.T. Nurmohamed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2011-201194" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2013" "volumen" => "72" "paginaInicial" => "211" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22532629" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0170" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity, waist circumference, weight change and the risk of psoriasis in US women" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Kumar" 1 => "J. Han" 2 => "T. Li" 3 => "A.A. Qureshi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.12001" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "1293" "paginaFinal" => "1298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23057623" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0175" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and the risk of psoriatic arthritis: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.J. Love" 1 => "Y. Zhu" 2 => "Y. Zhang" 3 => "L. Wall-Burns" 4 => "A. Ogdie" 5 => "J.M. Gelfand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2012-201299" "Revista" => array:7 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2012" "volumen" => "71" "paginaInicial" => "1273" "paginaFinal" => "1277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22586165" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1525861013000972" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0180" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and risk of incident psoriatic arthritis in US women" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Li" 1 => "J. Han" 2 => "A.A. Qureshi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2011-201273" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2012" "volumen" => "71" "paginaInicial" => "1267" "paginaFinal" => "1272" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22562978" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0185" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.W. Armstrong" 1 => "C.T. Harskamp" 2 => "E.J. Armstrong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nutd.2012.26" "Revista" => array:5 [ "tituloSerie" => "Nutr Diabetes" "fecha" => "2012" "volumen" => "2" "paginaInicial" => "e54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23208415" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0190" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adipose tissue as an endocrine organ" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.S. Ahima" 1 => "J.S. Flier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Trends Endocrinol Metab" "fecha" => "2000" "volumen" => "11" "paginaInicial" => "327" "paginaFinal" => "332" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10996528" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0195" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.S. Yudkin" 1 => "C.D. Stehouwer" 2 => "J.J. Emeis" 3 => "S.W. Coppack" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arterioscler Thromb Vasc Biol" "fecha" => "1999" "volumen" => "19" "paginaInicial" => "972" "paginaFinal" => "978" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10195925" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0200" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Inflammatory biomarkers: the link between obesity and associated pathologies]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. Zulet" 1 => "B. Puchau" 2 => "C. Navarro" 3 => "A. Marti" 4 => "J.A. Martinez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nutr Hosp" "fecha" => "2007" "volumen" => "22" "paginaInicial" => "511" "paginaFinal" => "527" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17970534" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0205" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adipocyte-derived hormones, cytokines, and mediators" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.M. Rondinone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1385/ENDO:29:1:181" "Revista" => array:7 [ "tituloSerie" => "Endocrine" "fecha" => "2006" "volumen" => "29" "paginaInicial" => "81" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16622295" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1525861015003400" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0210" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body mass index in patients with moderate-to-severe psoriasis in Spain and its impact as an independent risk factor for therapy withdrawal: results of the Biobadaderm Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Carrascosa" 1 => "M. Vilavella" 2 => "I. Garcia-Doval" 3 => "G. Carretero" 4 => "F. Vanaclocha" 5 => "E. Dauden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.12208" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "907" "paginaFinal" => "914" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23848131" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0215" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of overweight and obesity on psoriasis patients in Chinese Han population: a hospital-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Zhang" 1 => "K.J. Zhu" 2 => "H.F. Zheng" 3 => "Y. Cui" 4 => "F.S. Zhou" 5 => "Y.L. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2010.03706.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "87" "paginaFinal" => "91" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20477922" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0220" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor alpha blockers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.N. Di Minno" 1 => "R. Peluso" 2 => "S. Iervolino" 3 => "A. Russolillo" 4 => "R. Lupoli" 5 => "R. Scarpa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2012-202812" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2014" "volumen" => "73" "paginaInicial" => "1157" "paginaFinal" => "1162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23771989" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0225" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Eder" 1 => "A. Thavaneswaran" 2 => "V. Chandran" 3 => "R.J. Cook" 4 => "D.D. Gladman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2013-204448" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2015" "volumen" => "74" "paginaInicial" => "813" "paginaFinal" => "817" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24431392" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0230" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Discriminated benefits of a Mediterranean dietary pattern within a hypocaloric diet program on plasma RBP4 concentrations and other inflammatory markers in obese subjects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.H. Hermsdorff" 1 => "M.A. Zulet" 2 => "I. Abete" 3 => "J.A. Martinez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12020-009-9248-1" "Revista" => array:6 [ "tituloSerie" => "Endocrine" "fecha" => "2009" "volumen" => "36" "paginaInicial" => "445" "paginaFinal" => "451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19816812" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0235" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.J. Nicklas" 1 => "W. Ambrosius" 2 => "S.P. Messier" 3 => "G.D. Miller" 4 => "B.W. Penninx" 5 => "R.F. Loeser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ajcn/79.4.544" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Nutr" "fecha" => "2004" "volumen" => "79" "paginaInicial" => "544" "paginaFinal" => "551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15051595" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0240" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of weight loss on the severity of psoriasis: a randomized clinical study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Jensen" 1 => "C. Zachariae" 2 => "R. Christensen" 3 => "N.R. Geiker" 4 => "B.K. Schaadt" 5 => "S. Stender" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2013.722" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2013" "volumen" => "149" "paginaInicial" => "795" "paginaFinal" => "801" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23752669" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0245" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations by Cochrane Review Groups for assessment of the risk of bias in studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Lundh" 1 => "P.C. Gotzsche" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2288-8-22" "Revista" => array:5 [ "tituloSerie" => "BMC Med Res Methodol" "fecha" => "2008" "volumen" => "8" "paginaInicial" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18426565" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0250" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of exercise and dietary weight loss on symptoms and systemic inflammation in obese adults with psoriatic arthritis: randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Abou-Raya" 1 => "S. Abou-Raya" 2 => "M. Helmii" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2014" "paginaInicial" => "74" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0255" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of minimal disease activity criteria for psoriatic arthritis using interventional trial data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.C. Coates" 1 => "P.S. Helliwell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res (Hoboken)" "fecha" => "2010" "volumen" => "62" "paginaInicial" => "965" "paginaFinal" => "969" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0260" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality studies in psoriatic arthritis: results from a single outpatient center. II. Prognostic indicators for death" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.D. Gladman" 1 => "V.T. Farewell" 2 => "K. Wong" 3 => "J. Husted" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1529-0131(199806)41:6<1103::AID-ART18>3.0.CO;2-N" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1998" "volumen" => "41" "paginaInicial" => "1103" "paginaFinal" => "1110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9627021" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0265" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular morbidity in psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.D. Gladman" 1 => "M. Ang" 2 => "L. Su" 3 => "B.D. Tom" 4 => "C.T. Schentag" 5 => "V.T. Farewell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2008.094839" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2009" "volumen" => "68" "paginaInicial" => "1131" "paginaFinal" => "1135" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18697777" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0270" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and risk factors of atherosclerosis in patients with psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Kimhi" 1 => "D. Caspi" 2 => "N.M. Bornstein" 3 => "N. Maharshak" 4 => "A. Gur" 5 => "Y. Arbel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2006.09.001" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2007" "volumen" => "36" "paginaInicial" => "203" "paginaFinal" => "209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17067658" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0275" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of atherosclerotic risk factors and the metabolic syndrome in patients with chronic inflammatory arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.C. Mok" 1 => "G.T. Ko" 2 => "L.Y. Ho" 3 => "K.L. Yu" 4 => "P.T. Chan" 5 => "C.H. To" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res (Hoboken)" "fecha" => "2011" "volumen" => "63" "paginaInicial" => "195" "paginaFinal" => "202" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0280" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased prevalence of the metabolic syndrome in patients with psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.K. Raychaudhuri" 1 => "S. Chatterjee" 2 => "C. Nguyen" 3 => "M. Kaur" 4 => "I. Jialal" 5 => "S.P. Raychaudhuri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/met.2009.0124" "Revista" => array:6 [ "tituloSerie" => "Metab Syndr Relat Disord" "fecha" => "2010" "volumen" => "8" "paginaInicial" => "331" "paginaFinal" => "334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20367239" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0285" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular risk profile of patients with psoriatic arthritis compared to controls—the role of inflammation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.S. Tam" 1 => "B. Tomlinson" 2 => "T.T. Chu" 3 => "M. Li" 4 => "Y.Y. Leung" 5 => "L.W. Kwok" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "718" "paginaFinal" => "723" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0290" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and demographic characteristics of patients with psoriatic arthritis in northern Israel" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Zisman" 1 => "L. Eder" 2 => "M. Elias" 3 => "A. Laor" 4 => "H. Bitterman" 5 => "M. Rozenbaum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00296-010-1673-1" "Revista" => array:6 [ "tituloSerie" => "Rheumatol Int" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "595" "paginaFinal" => "600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21120489" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0295" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is obesity in psoriatic arthritis associated with a poorer therapeutic response and more adverse effects of treatment with an anchor drug?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Galindez" 1 => "L. Carmona" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2015.12.005" "Revista" => array:7 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2016" "volumen" => "12" "paginaInicial" => "307" "paginaFinal" => "312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26830438" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1525861017301895" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0300" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance, chronic inflammatory state and the link with systemic lupus erythematosus-related coronary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.O. Escarcega" 1 => "M. Garcia-Carrasco" 2 => "S. Fuentes-Alexandro" 3 => "L.J. Jara" 4 => "J. Rojas-Rodriguez" 5 => "L.E. Escobar-Linares" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2006.07.001" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2006" "volumen" => "6" "paginaInicial" => "48" "paginaFinal" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17110317" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0305" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammation, obesity, stress and coronary heart disease: is interleukin-6 the link?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.S. Yudkin" 1 => "M. Kumari" 2 => "S.E. Humphries" 3 => "V. Mohamed-Ali" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Atherosclerosis" "fecha" => "2000" "volumen" => "148" "paginaInicial" => "209" "paginaFinal" => "214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10657556" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0310" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Illness and treatment perceptions are associated with adherence to medications, diet, and exercise in diabetic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Broadbent" 1 => "L. Donkin" 2 => "J.C. Stroh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc10-1779" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2011" "volumen" => "34" "paginaInicial" => "338" "paginaFinal" => "340" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21270191" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001400000004/v1_201808070503/S217357431830056X/v1_201808070503/en/main.assets" "Apartado" => array:4 [ "identificador" => "43294" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001400000004/v1_201808070503/S217357431830056X/v1_201808070503/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431830056X?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 100 | 37 | 137 |
| 2024 September | 98 | 23 | 121 |
| 2024 August | 92 | 51 | 143 |
| 2024 July | 68 | 31 | 99 |
| 2024 June | 72 | 28 | 100 |
| 2024 May | 70 | 28 | 98 |
| 2024 April | 88 | 26 | 114 |
| 2024 March | 74 | 37 | 111 |
| 2024 February | 37 | 26 | 63 |
| 2024 January | 50 | 39 | 89 |
| 2023 December | 23 | 23 | 46 |
| 2023 November | 47 | 29 | 76 |
| 2023 October | 42 | 42 | 84 |
| 2023 September | 92 | 53 | 145 |
| 2023 August | 36 | 15 | 51 |
| 2023 July | 50 | 21 | 71 |
| 2023 June | 42 | 29 | 71 |
| 2023 May | 56 | 22 | 78 |
| 2023 April | 45 | 13 | 58 |
| 2023 March | 72 | 40 | 112 |
| 2023 February | 56 | 28 | 84 |
| 2023 January | 32 | 22 | 54 |
| 2022 December | 83 | 45 | 128 |
| 2022 November | 50 | 31 | 81 |
| 2022 October | 81 | 53 | 134 |
| 2022 September | 64 | 61 | 125 |
| 2022 August | 51 | 47 | 98 |
| 2022 July | 34 | 49 | 83 |
| 2022 June | 48 | 42 | 90 |
| 2022 May | 43 | 37 | 80 |
| 2022 April | 50 | 56 | 106 |
| 2022 March | 57 | 64 | 121 |
| 2022 February | 50 | 41 | 91 |
| 2022 January | 50 | 60 | 110 |
| 2021 December | 36 | 37 | 73 |
| 2021 November | 42 | 51 | 93 |
| 2021 October | 48 | 56 | 104 |
| 2021 September | 33 | 44 | 77 |
| 2021 August | 45 | 38 | 83 |
| 2021 July | 36 | 33 | 69 |
| 2021 June | 47 | 34 | 81 |
| 2021 May | 43 | 53 | 96 |
| 2021 April | 120 | 116 | 236 |
| 2021 March | 83 | 39 | 122 |
| 2021 February | 45 | 23 | 68 |
| 2021 January | 43 | 28 | 71 |
| 2020 December | 67 | 25 | 92 |
| 2020 November | 46 | 39 | 85 |
| 2020 October | 40 | 26 | 66 |
| 2020 September | 46 | 29 | 75 |
| 2020 August | 33 | 34 | 67 |
| 2020 July | 20 | 18 | 38 |
| 2020 June | 30 | 26 | 56 |
| 2020 May | 48 | 21 | 69 |
| 2020 April | 22 | 15 | 37 |
| 2020 March | 14 | 5 | 19 |
| 2020 February | 1 | 0 | 1 |
| 2018 December | 0 | 1 | 1 |
Show all
