Letter to the Editor
Rice Bodies in Tuberculous Tenosynovitis of Wrist
Cuerpos de arroz en la tenosinovitis tuberculosa de la muñeca
Read
3881
Timeswas read the article
1569
Total PDF
2312
Total HTML
Share statistics
array:22 [ "pii" => "S2173574318300923" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.08.003" "estado" => "S300" "fechaPublicacion" => "2018-09-01" "aid" => "1116" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2018;14:314-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 1 "PDF" => 3 ] ] "itemAnterior" => array:19 [ "pii" => "S2173574318301059" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.09.003" "estado" => "S300" "fechaPublicacion" => "2018-09-01" "aid" => "1130" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2018;14:313-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "PDF" => 3 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Edema and Dermatomyositis. Migratory Edema and Edematous and Vesiculobullous Dermatomyositis Overlap" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "314" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Edema y dermatomiositis. Edema migratorio y solapamiento de dermatomiositis edematosa y vesiculoampollosa" ] ] "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" => 900 "Ancho" => 1200 "Tamanyo" => 117913 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Erythematous and edematous plaque with superficial vasiculobullae in right upper limb. (b) Edema and erythematous and edematous plaques on thighs.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Belén Lozano-Masdemont, Ana Pulido-Pérez, Verónica Parra-Blanco, José Antonio Avilés-Izquierdo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Belén" "apellidos" => "Lozano-Masdemont" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Pulido-Pérez" ] 2 => array:2 [ "nombre" => "Verónica" "apellidos" => "Parra-Blanco" ] 3 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Avilés-Izquierdo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X17302413" "doi" => "10.1016/j.reuma.2017.09.003" "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/S1699258X17302413?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301059?idApp=UINPBA00004M" "url" => "/21735743/0000001400000005/v1_201810010939/S2173574318301059/v1_201810010939/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Rice Bodies in Tuberculous Tenosynovitis of Wrist" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "314" "paginaFinal" => "316" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Latika Gupta, Vikas Gupta, Tushant Kumar" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Latika" "apellidos" => "Gupta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Vikas" "apellidos" => "Gupta" "email" => array:1 [ 0 => "vikasgcapri@yahoo.co.in" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Tushant" "apellidos" => "Kumar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, Uttar Pradesh, India" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuerpos de arroz en la tenosinovitis tuberculosa de la muñeca" ] ] "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" => 977 "Ancho" => 1405 "Tamanyo" => 108770 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) T2W FAT SAT sagittal image show a well defined fluid intensity collection seen along the flexor tendon sheath with presence of hypointense layered rice grain (white arrow) shaped within it suggestive of tenosynovitis with multiple loose bodies. (B) T2W Coronal images show well defined fluid intensity collection anterior to the wrist joint along the flexor tendon sheath suggestive of tenosynovitis. Multiple layered hypointense loose bodies like rice grain are seen within it (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Rice body formation is an uncommon inflammatory process occurring in joints and tendon sheaths in systemic disorders.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> Since their first description in 1895 in a patient with tuberculosis, these have been described in various rheumatic diseases including rheumatoid arthritis, juvenile idiopathic arthritis, and seronegative inflammatory arthritis, in infections with atypical mycobacteria, and in subacromial bursitis.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2–5</span></a> Generally involving shoulder and knee joints, we describe here a rare case report of a patient with isolated wrist tenosynovitis with rice bodies on magnetic resonance imaging (MRI) who was diagnosed as tuberculosis based on results of microbiologic investigations.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 50-year-old lady came with progressive pain and isolated swelling of the right wrist of 9 months duration. Physical examination revealed an oblong swelling on the volar aspect of wrist extending into the forearm. Attempted active flexion at the wrist was painful though passive range of movement was normal. Laboratory investigations showed raised erythrocyte sedimentation rate of 50<span class="elsevierStyleHsp" style=""></span>mm/h. Radiograph of the wrist was normal. MRI revealed well-defined fluid intensity collection along the flexor tendon sheath with presence of hypointense-layered lucencies within suggestive of tenosynovitis with rice bodies (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). The adjacent bone and soft tissues were normal. Fluid obtained by ultrasound-guided aspiration from the tenosynovial swelling was positive for Acid Fast Bacilli. Culture grew <span class="elsevierStyleItalic">Mycobacterium Tuberculosis</span> and hence, diagnosis of tuberculosis was reached. The patient did not have diabetes and was not on any immunosuppressive drugs. Serology for Human Immunodeficiency Virus (HIV) was non-reactive. The patient responded to six months of anti-tuberculous therapy with complete resolution of pain and swelling.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Rice bodies are called so due to their resemblance to grains of polished white rice on gross examination. The pathogenesis of rice body formation is unclear, but is likely related to shedding of the infarcted synovial tissue into the joint.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> These are formed by fibrin deposits on a nidus of sloughed synovium or inflamed tissue, as evidenced by rim of fibroblasts and inflammatory cells on a nidus of collagen. Types 1, 2 as well as small amounts of type 5 collagen have been demonstrated on histopathological sections.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2,6,7</span></a> Rice bodies can be detected on both ultrasonography and MR imaging. Ultrasonography of tendon sheath may show low-level internal echoes or an apparent soft tissue mass, however, may fail to delineate individual rice bodies, particularly if these are too small.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> Therefore, MRI is considered the imaging modality of choice for rice bodies which appear iso- or hypointense to skeletal muscle on T1- and T2-weighted images.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Rice bodies are known to occur commonly in rheumatic conditions such as rheumatoid arthritis (RA), juvenile idiopathic arthritis, seronegative inflammatory arthritis, and also osteoarthritis.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2–4,9</span></a> Pigmented villonodular synovitis (PVNS) and synovial osteochondromatosis form the primary differential diagnoses. In a patient with isolated tenosynovitis, infection is highly likely, and mycobacteria are most often implicated. Rice body formation has been seen with tenosynovitis due to Mycobacterium tuberculosis, and nontuberculous mycobacteria (NTM), including <span class="elsevierStyleItalic">Mycobacterium marinum</span>, <span class="elsevierStyleItalic">Mycobacterium kansasii</span>, rapid growing mycobacterium, <span class="elsevierStyleItalic">Mycobacterium avium</span> and <span class="elsevierStyleItalic">Mycobacterium intracellulare</span>.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> The laboratory should always be informed of the possibility of NTM, as these can be differentiated on culture. Treatment includes mycobacterial therapy and tenosynovectomy to avoid complications such as tendon rupture.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> However, rarely, as in our case, resolution has been reported with antitubercular therapy without any surgical treatment.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In a patient with early polyarthritis yet negative autoantibodies, rice body formation could be a salient marker to underlying RA. In established RA, it is important to know that these solid masses are treatable; as resolution has been described with intraarticular steroids and/or disease modifying anti-rheumatic drugs in most cases without sequelae. This can obviate a surgical procedure, which although initially successful, is associated with recurrence in one-third of patients. Half of those with recurrence require re-operation.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> Lastly, rice bodies are rare in the wrist. If not identified and treated they can progress to compressive neuropathy and tendon ruptures.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 977 "Ancho" => 1405 "Tamanyo" => 108770 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) T2W FAT SAT sagittal image show a well defined fluid intensity collection seen along the flexor tendon sheath with presence of hypointense layered rice grain (white arrow) shaped within it suggestive of tenosynovitis with multiple loose bodies. (B) T2W Coronal images show well defined fluid intensity collection anterior to the wrist joint along the flexor tendon sheath suggestive of tenosynovitis. Multiple layered hypointense loose bodies like rice grain are seen within it (arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rice body formation without rheumatic disease or tuberculosis infection: a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.L. Forse" 1 => "B.L. Mucha" 2 => "M. Lauren Zabala Santos" 3 => "E.H. Ongcapin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-012-2063-8" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "1753" "paginaFinal" => "1756" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22941257" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0075" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Synovial origins of rice bodies in joint fluid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.S. Cheung" 1 => "L.M. Ryan" 2 => "F. Kozin" 3 => "D.J. McCarty" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1980" "volumen" => "23" "paginaInicial" => "72" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7352946" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0080" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frequency of occurrence, mode of development, and significance or rice bodies in rheumatoid joints" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.J. Popert" 1 => "D.L. Scott" 2 => "A.C. Wainwright" 3 => "K.W. Walton" 4 => "N. Williamson" 5 => "J.H. Chapman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "1982" "volumen" => "41" "paginaInicial" => "109" "paginaFinal" => "117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6176192" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0085" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subacromial bursitis with giant rice bodies as initial presentation of rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Subramaniam" 1 => "J.W.L. Tan" 2 => "C.Y.P. Chau" 3 => "K.T. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RHU.0b013e3182677023" "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "352" "paginaFinal" => "355" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23013846" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0090" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rice body – Mycobacterium intracellulare tenosynovitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.T. Chan" 1 => "C.C. Tseng" 2 => "P.Y. Chen" 3 => "C.M. Chao" 4 => "C.C. Lai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/qjmed/hct175" "Revista" => array:5 [ "tituloSerie" => "QJM" "fecha" => "2014" "volumen" => "107" "paginaInicial" => "395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23970187" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0095" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rice bodies of synovial origin in the knee joint" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Aşik" 1 => "L. Eralp" 2 => "O. Cetik" 3 => "L. Altinel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthroscopy" "fecha" => "2001" "volumen" => "17" "paginaInicial" => "E19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11337706" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0100" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of rice bodies in 2 children younger than 3 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Druschel" 1 => "J.F. Funk" 2 => "T. Kallinich" 3 => "A. Lieb" 4 => "R.P. Placzek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RHU.0b013e31826d6b5e" "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "35" "paginaFinal" => "37" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23319022" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0105" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rice-body formation in atypical mycobacterial tenosynovitis and bursitis: findings on sonography and MR imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.L.F. Chau" 1 => "J.F. Griffith" 2 => "P.T. Chan" 3 => "T.H. Lui" 4 => "K.S. Yu" 5 => "W.K. Ngai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.180.5.1801455" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2003" "volumen" => "180" "paginaInicial" => "1455" "paginaFinal" => "1459" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12704068" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0110" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteoarthritis with rice bodies rich in calcium microcrystals 4 cases with ultrastructural study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Bucki" 1 => "J. Lansaman" 2 => "X. Janson" 3 => "M.A. Billon-Galland" 4 => "C. Marty" 5 => "M. Ruel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Rhum Ed Fr" "fecha" => "1994" "volumen" => "61" "paginaInicial" => "415" "paginaFinal" => "420" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7833866" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0115" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple rice body formation accompanying the chronic nonspecific tenosynovitis of flexor tendons of the wrist" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Ergun" 1 => "H. Lakadamyali" 2 => "O. Aydin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11604-008-0270-7" "Revista" => array:6 [ "tituloSerie" => "Radiat Med" "fecha" => "2008" "volumen" => "26" "paginaInicial" => "545" "paginaFinal" => "548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19030963" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0120" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tubercular tenosynovitis of hand: a rare presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Jain" 1 => "R. Rohilla" 2 => "A. Devgan" 3 => "J. Wadhwani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.13107/jocr.2250-0685.638" "Revista" => array:6 [ "tituloSerie" => "J Orthop Case Rep" "fecha" => "2016" "volumen" => "6" "paginaInicial" => "69" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28507970" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0125" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term results following digital flexor tenosynovectomy in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.J. Wheen" 1 => "M.A. Tonkin" 2 => "J. Green" 3 => "M. Bronkhorst" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0363-5023(05)80433-2" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "1995" "volumen" => "20" "paginaInicial" => "790" "paginaFinal" => "794" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8522746" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0130" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral recurrent wrist flexor tenosynovitis and rice body formation in a patient with sero-negative rheumatoid arthritis: a case report and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Iyengar" 1 => "T. Manickavasagar" 2 => "J. Nadkarni" 3 => "P. Mansour" 4 => "W. Loh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijscr.2011.07.001" "Revista" => array:6 [ "tituloSerie" => "Int J Surg Case Rep" "fecha" => "2011" "volumen" => "2" "paginaInicial" => "208" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22096729" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001400000005/v1_201810010939/S2173574318300923/v1_201810010939/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001400000005/v1_201810010939/S2173574318300923/v1_201810010939/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300923?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 7 | 11 |
| 2024 October | 56 | 31 | 87 |
| 2024 September | 57 | 18 | 75 |
| 2024 August | 50 | 32 | 82 |
| 2024 July | 47 | 28 | 75 |
| 2024 June | 49 | 27 | 76 |
| 2024 May | 51 | 33 | 84 |
| 2024 April | 45 | 25 | 70 |
| 2024 March | 47 | 25 | 72 |
| 2024 February | 39 | 31 | 70 |
| 2024 January | 35 | 24 | 59 |
| 2023 December | 31 | 20 | 51 |
| 2023 November | 45 | 26 | 71 |
| 2023 October | 46 | 35 | 81 |
| 2023 September | 114 | 52 | 166 |
| 2023 August | 44 | 16 | 60 |
| 2023 July | 34 | 23 | 57 |
| 2023 June | 47 | 21 | 68 |
| 2023 May | 43 | 24 | 67 |
| 2023 April | 37 | 15 | 52 |
| 2023 March | 86 | 20 | 106 |
| 2023 February | 57 | 26 | 83 |
| 2023 January | 37 | 13 | 50 |
| 2022 December | 55 | 38 | 93 |
| 2022 November | 50 | 24 | 74 |
| 2022 October | 58 | 24 | 82 |
| 2022 September | 44 | 30 | 74 |
| 2022 August | 40 | 32 | 72 |
| 2022 July | 46 | 42 | 88 |
| 2022 June | 41 | 35 | 76 |
| 2022 May | 53 | 44 | 97 |
| 2022 April | 34 | 38 | 72 |
| 2022 March | 46 | 44 | 90 |
| 2022 February | 51 | 23 | 74 |
| 2022 January | 62 | 61 | 123 |
| 2021 December | 53 | 46 | 99 |
| 2021 November | 45 | 37 | 82 |
| 2021 October | 64 | 47 | 111 |
| 2021 September | 36 | 41 | 77 |
| 2021 August | 23 | 39 | 62 |
| 2021 July | 18 | 21 | 39 |
| 2021 June | 20 | 33 | 53 |
| 2021 May | 38 | 37 | 75 |
| 2021 April | 60 | 62 | 122 |
| 2021 March | 28 | 18 | 46 |
| 2021 February | 16 | 15 | 31 |
| 2021 January | 14 | 18 | 32 |
| 2020 December | 29 | 23 | 52 |
| 2020 November | 23 | 14 | 37 |
| 2020 October | 13 | 11 | 24 |
| 2020 September | 33 | 25 | 58 |
| 2020 August | 28 | 16 | 44 |
| 2020 July | 18 | 11 | 29 |
| 2020 June | 29 | 16 | 45 |
| 2020 May | 20 | 16 | 36 |
| 2020 April | 9 | 12 | 21 |
| 2020 March | 13 | 1 | 14 |
| 2019 September | 1 | 0 | 1 |
| 2019 May | 0 | 2 | 2 |
| 2018 November | 0 | 1 | 1 |
Show all
