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such as Utsinger &#40;1985&#41; who presented other criteria that included extraspinal involvement of the disease&#44; and even enabled diagnosis of DISH without spinal involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> This author already noted that the patients who did not meet the classical criteria of the disease could have early stages of it&#46; For years other diagnostic proposals have been published that differ essentially in the number of bony bridges between affected vertebrae&#44; with or without a description of preserved disc or sacroiliac space&#44; and&#47;or the presence of enthesis ossification&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#8211;6</span></a> Given the need to standardise and update diagnosis of DISH&#44; Mader et al&#46; sought to revise the definition of the disease and design new criteria to include specific clinical manifestations&#44; such as extraspinal involvement or the association with certain metabolic disorders&#44; but reached no final consensus&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present 3 patients who could not be classified as having DISH using Resnick&#39;s criteria&#44; but who without doubt had a clinical form with peripheral predominance that is widely described in hyperostotic disease&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 63-year-old woman&#44; monitored by the rheumatology clinic over 47 years&#46; The initial reason for consultation was pain and progressive restriction of bilateral coxofemoral mobility&#46; She had no personal or family history of psoriasis&#44; no other diseases related to spondyloarthritis&#44; and no intake of retinoids or other vitamin A derivatives&#46; Her blood tests showed no elevation of acute phase reactants or phosphocalcium metabolism disorders&#44; and HLAB27 was negative&#46; Of interest in her medical history were glucose intolerance and high blood pressure&#46; She showed no sign of vertebral involvement in the initial study&#44; but there was already exuberant bony proliferation on her iliac crests&#44; ischial and trochanteric tuberosities&#44; and lateral acetabular prominences with preserved joint space&#46; Subsequently&#44; there was the addition of other sites&#44; such as insertions in the calcaneus&#44; Achilles tendon&#44; triceps&#44; olecranons and patellae &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Various radiological studies of the spine were performed as the condition progressed that found no alterations suggestive of calcification of the anterior common vertebral ligament &#40;ACVL&#41; until the last radiographic check&#44; when an incipient bony bridge was revealed in the cervical spine&#46; The patient underwent various operations&#44; such as resection of the ossification in the bilateral Achilles insertion&#44; because it was impossible for her to put her shoes on&#44; and hip arthroscopy to resect the acetabular ossification in order to improve her joint balance&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 47-year-old woman&#44; with a four-year history of bilateral Achilles tendon pain and swelling&#46; The patient was obese&#44; but with no associated metabolic or cardiovascular disease&#46; She had no family or personal history of psoriasis&#44; spondyloarthritis or retinoid intake&#46; Her blood tests were normal&#44; but vertebral radiology revealed incipient radiographic signs of hyperostosis in the dorsal and lumbar spine that did not meet Resnick&#39;s criteria&#46; A more extensive radiological study was requested that showed ossifications in the entheses of the pelvis&#44; knees&#44; feet and shoulders&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case 3</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 50-year-old woman&#44; with a history of bilateral epicondylitis&#44; who initially consulted with bilateral plantar fasciitis resistant to local corticosteroid-anaesthetic injections&#44; orthesis and physiotherapy&#46; The patient had no personal&#44; family or drug history of interest&#44; and blood tests were not significant&#46; No vertebral radiological changes were detected&#44; but prominent coxofemoral ossifications were found&#44; with no loss of joint space&#44; and extraspinal involvement in the Achilles tendon&#44; plantar&#44; patellar and olecranon entheses&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">We consider that the 3 cases presented had a DISH &#40;Utsinger&#39;s criteria&#41;&#44; although they did not meet Resnick&#39;s classical criteria due to incipient or no vertebral involvement&#46; We were struck by a series of particularities that differ from those traditionally described in the disease&#44; such as the patients&#8217; age and sex&#44; the &#8220;non benign&#8221; nature of the disease course&#44; and minimal or no spinal manifestations&#44; even after a course of years&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">DISH has been traditionally considered a disease that predominates in males&#44; and whose prevalence increases with age&#46; The most significant epidemiological studies achieve a diagnosis of the disease based exclusively on the findings of conventional radiology or computed tomography of the spine&#46; The prevalence of DISH is estimated at between 3&#46;6&#37; and 28&#37; in males and from 0&#46;8&#37; to 13&#46;9&#37; in women&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">8&#8211;11</span></a> In a recent study in an Asian population the prevalence was 10&#46;8&#37; &#40;ratio 5&#58;1&#41;&#44; and although it has traditionally been described in people of advanced age&#44; these authors already observed 1&#46;8&#37; males and &#46;7&#37; in women aged under 50 years of age&#46; Given the diversity of classification criteria&#44; the epidemiological data published are very variable&#44; and do not include the forms where peripheral ossification predominates over vertebral ossification&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Resnick and Niwayama pointed out that DISH might not be a disease <span class="elsevierStyleItalic">per se</span>&#44; but rather a state of extensive ossification&#46; It is described in the literature that levels of vertebral pain are lower in hyperostotic disease than in spondyloarthrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> However&#44; Mata et al&#46;&#44; although they corroborate the above in terms of pain and rigidity in the lumbar segment&#44; they did not observe this in other sites studied such as the cervical or dorsal spine or the extremities&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> In reality&#44; functional capacity evaluation has only been undertaken in one single study where the authors detected poor functional status&#44; regardless of body mass index&#44; measured through the abbreviated HAQ questionnaire compared to a healthy population&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> in our first case&#44; the exuberant bony excrescences resulted in several operations due to their impact on the person&#39;s physical function and quality of life&#46; In the other cases&#44; the involvement of the Achilles tendon and calcaneus enthuses required various treatments&#44; and resulted in long periods of functional incapacity and sick leave&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Since Forestier&#39;s definition&#44; certain metabolic or constitutional factors are considered to be linked to the disease&#46; Our 3 patients were overweight&#44; and the first case also had hypertension and oral glucose intolerance that developed into type 2 diabetes mellitus&#46; In recent years the physiopathogenic role of metabolic dysfunction in the ossification of ligaments and entheses has been researched&#46; In this regard&#44; Mader et al&#46; performed a study where they found that the likelihood of developing a DISH in the fifth decade of life was 5 times greater in a patient of the same age and sex if they had 3 clinical parameters such as obesity&#44; a first-degree relative with a history of hypertension or diabetes&#44; and back or chest pain or enthesitis or tendinitis&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Finally&#44; in the cases we present we wanted to highlight the predominance of extraspinal manifestations over little or no axial involvement&#46; Although according to Utsinger these would be early stages&#44; our first patient was followed up over 15 years without presenting a single radiological sign in the vertebrae&#46; Based on these observations it may well be that these were not different stages of the disease&#44; but different phenotypes of it&#46; We describe a pattern of peripheral predominance that would not meet the classical classification criteria of Resnick&#44; that would be more prevalent in females&#44; and which would start at younger ages&#46; However&#44; studies are required with larger numbers of patients&#44; but that include forms with predominant extraspinal involvement in particular&#46; We agree with the authors that uphold the need to create new more complete classification criteria that take into account all the manifestations of the disease&#44; such as peripheral involvement in the form of enthesis ossification or the presence of comorbidities&#46; These would provide us greater knowledge of the entire clinical spectrum of the disease&#44; access to epidemiological data&#44; to real data on disability and quality of life&#44; as has been researched in other rheumatic diseases&#46; In short&#44; we would be able to identify patients in earlier stages in order to apply therapies that might change the course of the DISH&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">DISH is a relatively common rheumatic disease&#44; with a broad spectrum of manifestations&#44; which is currently diagnosed in advanced stages or with major complications of spinal involvement&#46; Extraspinal manifestations often go unnoticed&#44; but can be a sign of early disease&#46; Finally&#44; we stress the need to consider a diagnosis of DISH in a patient presenting with one or various enthesopathies in order to make an early diagnosis&#44; and consider therapeutic measures in less advanced stages of the disease&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ethical Responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protection of people and animals</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that neither human nor animal testing has been carried out under this research&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Data confidentiality</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have complied with their work centre protocols for the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Privacy rights and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no patients&#8217; data appear in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of Interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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            0 => "Diffuse idiopathic skeletal hyperostosis"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diffuse idiopathic skeletal hyperostosis is a bone disease characterised by ossification of spinal ligaments and peripheral entheses&#46; Currently&#44; we still use the classic classification criteria that do not include extraspinal manifestations&#46; A number of authors agree on the need to revise them&#46; We present 3 patients in which a diagnosis of diffuse idiopathic skeletal hyperostosis could not be established if we apply those criteria&#44; but they have fully compatible clinical and radiological manifestations of hyperostotic disease&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La hiperostosis esquel&#233;tica difusa idiop&#225;tica es una enfermedad caracterizada por la osificaci&#243;n de ligamentos vertebrales y de entesis perif&#233;ricas&#46; Actualmente&#44; siguen utiliz&#225;ndose los criterios clasificatorios cl&#225;sicos que se basan en hallazgos radiol&#243;gicos vertebrales&#44; pero que no incluyen otras manifestaciones clinicopatol&#243;gicas que conforman el espectro de la enfermedad&#46; Diversos autores abogan por la revisi&#243;n y actualizaci&#243;n de dichos criterios&#46; A continuaci&#243;n describimos 3 casos cl&#237;nicos en los que no se podr&#237;a establecer un diagn&#243;stico de hiperostosis esquel&#233;tica difusa idiop&#225;tica pero que presentan unas manifestaciones cl&#237;nico-radiol&#243;gicas totalmente compatibles con la enfermedad hiperostosante&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Clavaguera T&#44; Reyner P&#44; Valls R&#44; de Cendra E&#44; Rodr&#237;guez-Jimeno MC&#46; Hiperostosis esquel&#233;tica difusa idiop&#225;tica&#58; &#191;existe un patr&#243;n de predominio perif&#233;rico&#63; Reumatol Clin&#46; 2019&#59;15&#58;301&#8211;304&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Radiological study of case 1&#46; &#40;A and B&#41; Lateral projections of the dorsal and lumbar spine with signs of spondyloarthrosis of lumbar predominance with no ossification of the ACVL&#46; &#40;C&#41; Prominent acetabular bony excrescences with preserved joint space &#40;&#42;&#41;&#44; and multiple enthesis ossifications on the iliac spines and the trochanters &#40;arrows&#41;&#46; &#40;D&#41; Prominent bony excrescences on the plantar and Achilles tendon entheses&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Senile ankylosing hyperostosis of the spine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Forestier"
                            1 => "J&#46; Rotes-Querol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.9.4.321"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "1950"
                        "volumen" => "9"
                        "paginaInicial" => "321"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14800245"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiographic and pathologic features of spinal involvement in DISH"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Resnick"
                            1 => "G&#46; Niwayama"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/119.3.559"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "1976"
                        "volumen" => "119"
                        "paginaInicial" => "559"
                        "paginaFinal" => "568"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/935390"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diffuse idiopathic skeletal hyperostosis PD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;D&#46; Utsinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheum Dis"
                        "fecha" => "1985"
                        "volumen" => "11"
                        "paginaInicial" => "325"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3899489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyperostosis of the spine in an adult population&#46; Its relation to hyperglycaemia and obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Julkunen"
                            1 => "O&#46;P&#46; Heinonen"
                            2 => "K&#46; Pyorala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.30.6.605"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "1971"
                        "volumen" => "30"
                        "paginaInicial" => "605"
                        "paginaFinal" => "612"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5130140"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La maladie hyperostosique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Arlet"
                            1 => "B&#46; Mazi&#232;res"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Med Intern"
                        "fecha" => "1985"
                        "volumen" => "5"
                        "paginaInicial" => "553"
                        "paginaFinal" => "564"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of diagnostic criteria for hyperostotic disease on a series of skeletons&#46; Epidemiological implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Crub&#233;zy"
                            1 => "E&#46; Crub&#233;zy-Ibanez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Rhum &#40;Ed Fr&#41;"
                        "fecha" => "1993"
                        "volumen" => "60"
                        "paginaInicial" => "586"
                        "paginaFinal" => "590"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Developing new classification criteria for diffuse idiopathic skeletal hyperostosis&#58; back to square one"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Mader"
                            1 => "D&#46; Buskila"
                            2 => "J&#46;J&#46; Verlaan"
                            3 => "F&#46; Atzeni"
                            4 => "I&#46; Olivieri"
                            5 => "N&#46; Pappone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/kes257"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2013"
                        "volumen" => "52"
                        "paginaInicial" => "326"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23024057"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in the Netherlands"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;A&#46; Westerveld"
                            1 => "H&#46;M&#46; van Ufford"
                            2 => "J&#46;J&#46; Verlaan"
                            3 => "F&#46;C&#46; Oner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2008"
                        "volumen" => "35"
                        "paginaInicial" => "1635"
                        "paginaFinal" => "1638"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18528963"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of diffuse idiopathic skeletal hyperostosis &#40;DISH&#41; of the whole spine and its association with lumbar spondylosis and knee osteoarthritis&#58; the ROAD study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Kagotani"
                            1 => "M&#46; Yoshida"
                            2 => "S&#46; Muraki"
                            3 => "H&#46; Oka"
                            4 => "H&#46; Hashizume"
                            5 => "H&#46; Yamada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00774-014-0583-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Metab"
                        "fecha" => "2015"
                        "volumen" => "33"
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                      "titulo" => "The prevalence of diffuse idiopathic skeletal hyperostosis in Japan &#8211; the first report of measurement by CT and review of the literature"
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                        "paginaInicial" => "287"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The prevalence of diffuse idiopathic skeletal hyperostosis in Korea"
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                        "paginaInicial" => "2032"
                        "paginaFinal" => "2035"
                        "link" => array:1 [
                          0 => array:2 [
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2011"
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                        "paginaInicial" => "131"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                            5 => "S&#46; Craig"
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                        "paginaFinal" => "117"
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                    ]
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                        "paginaInicial" => "1911"
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                        "link" => array:1 [
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                        "tituloSerie" => "Osteoarthritis Cartilage"
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                        "paginaFinal" => "828"
                        "link" => array:1 [
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Case Report
Diffuse Idiopathic Skeletal Hyperostosis: Can We Identify a Peripheral Pattern?
Hiperostosis esquelética difusa idiopática: ¿existe un patrón de predominio periférico?
Teresa Clavagueraa,
Corresponding author
, Patrícia Reynera, Ramón Vallsb, Eulàlia de Cendrac, Mari Carmen Rodríguez-Jimenob
a Unidad de Reumatología, Hospital Universitario Doctor Trueta/Santa Caterina, Gerona, Spain
b Unidad de Reumatología, Hospital de Palamós, Palamós, Gerona, Spain
c Unidad de Reumatología, Hospital Santa Caterina, Salt, Gerona, Spain
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Radiological study of case 1&#46; &#40;A and B&#41; Lateral projections of the dorsal and lumbar spine with signs of spondyloarthrosis of lumbar predominance with no ossification of the ACVL&#46; &#40;C&#41; Prominent acetabular bony excrescences with preserved joint space &#40;&#42;&#41;&#44; and multiple enthesis ossifications on the iliac spines and the trochanters &#40;arrows&#41;&#46; &#40;D&#41; Prominent bony excrescences on the plantar and Achilles tendon entheses&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Diffuse idiopathic skeletal hyperostosis &#40;DISH&#41; was defined more than 60 years ago by Forrestier and Rot&#233;s&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> This disease is characterised by ossification of the anterior longitudinal ligament of the spine&#44; and multiple areas of the entheses of the ligament&#44; tendon&#44; joint capsule or annulus fibrosus&#46; The classification criteria of Resnick-Niwayama &#40;1976&#41; are still used to diagnose the condition&#44; and are solely based on characteristic vertebral radiographic signs&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> This classification has been questioned by various authors&#44; such as Utsinger &#40;1985&#41; who presented other criteria that included extraspinal involvement of the disease&#44; and even enabled diagnosis of DISH without spinal involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> This author already noted that the patients who did not meet the classical criteria of the disease could have early stages of it&#46; For years other diagnostic proposals have been published that differ essentially in the number of bony bridges between affected vertebrae&#44; with or without a description of preserved disc or sacroiliac space&#44; and&#47;or the presence of enthesis ossification&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#8211;6</span></a> Given the need to standardise and update diagnosis of DISH&#44; Mader et al&#46; sought to revise the definition of the disease and design new criteria to include specific clinical manifestations&#44; such as extraspinal involvement or the association with certain metabolic disorders&#44; but reached no final consensus&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present 3 patients who could not be classified as having DISH using Resnick&#39;s criteria&#44; but who without doubt had a clinical form with peripheral predominance that is widely described in hyperostotic disease&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 63-year-old woman&#44; monitored by the rheumatology clinic over 47 years&#46; The initial reason for consultation was pain and progressive restriction of bilateral coxofemoral mobility&#46; She had no personal or family history of psoriasis&#44; no other diseases related to spondyloarthritis&#44; and no intake of retinoids or other vitamin A derivatives&#46; Her blood tests showed no elevation of acute phase reactants or phosphocalcium metabolism disorders&#44; and HLAB27 was negative&#46; Of interest in her medical history were glucose intolerance and high blood pressure&#46; She showed no sign of vertebral involvement in the initial study&#44; but there was already exuberant bony proliferation on her iliac crests&#44; ischial and trochanteric tuberosities&#44; and lateral acetabular prominences with preserved joint space&#46; Subsequently&#44; there was the addition of other sites&#44; such as insertions in the calcaneus&#44; Achilles tendon&#44; triceps&#44; olecranons and patellae &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Various radiological studies of the spine were performed as the condition progressed that found no alterations suggestive of calcification of the anterior common vertebral ligament &#40;ACVL&#41; until the last radiographic check&#44; when an incipient bony bridge was revealed in the cervical spine&#46; The patient underwent various operations&#44; such as resection of the ossification in the bilateral Achilles insertion&#44; because it was impossible for her to put her shoes on&#44; and hip arthroscopy to resect the acetabular ossification in order to improve her joint balance&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 47-year-old woman&#44; with a four-year history of bilateral Achilles tendon pain and swelling&#46; The patient was obese&#44; but with no associated metabolic or cardiovascular disease&#46; She had no family or personal history of psoriasis&#44; spondyloarthritis or retinoid intake&#46; Her blood tests were normal&#44; but vertebral radiology revealed incipient radiographic signs of hyperostosis in the dorsal and lumbar spine that did not meet Resnick&#39;s criteria&#46; A more extensive radiological study was requested that showed ossifications in the entheses of the pelvis&#44; knees&#44; feet and shoulders&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case 3</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 50-year-old woman&#44; with a history of bilateral epicondylitis&#44; who initially consulted with bilateral plantar fasciitis resistant to local corticosteroid-anaesthetic injections&#44; orthesis and physiotherapy&#46; The patient had no personal&#44; family or drug history of interest&#44; and blood tests were not significant&#46; No vertebral radiological changes were detected&#44; but prominent coxofemoral ossifications were found&#44; with no loss of joint space&#44; and extraspinal involvement in the Achilles tendon&#44; plantar&#44; patellar and olecranon entheses&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">We consider that the 3 cases presented had a DISH &#40;Utsinger&#39;s criteria&#41;&#44; although they did not meet Resnick&#39;s classical criteria due to incipient or no vertebral involvement&#46; We were struck by a series of particularities that differ from those traditionally described in the disease&#44; such as the patients&#8217; age and sex&#44; the &#8220;non benign&#8221; nature of the disease course&#44; and minimal or no spinal manifestations&#44; even after a course of years&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">DISH has been traditionally considered a disease that predominates in males&#44; and whose prevalence increases with age&#46; The most significant epidemiological studies achieve a diagnosis of the disease based exclusively on the findings of conventional radiology or computed tomography of the spine&#46; The prevalence of DISH is estimated at between 3&#46;6&#37; and 28&#37; in males and from 0&#46;8&#37; to 13&#46;9&#37; in women&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">8&#8211;11</span></a> In a recent study in an Asian population the prevalence was 10&#46;8&#37; &#40;ratio 5&#58;1&#41;&#44; and although it has traditionally been described in people of advanced age&#44; these authors already observed 1&#46;8&#37; males and &#46;7&#37; in women aged under 50 years of age&#46; Given the diversity of classification criteria&#44; the epidemiological data published are very variable&#44; and do not include the forms where peripheral ossification predominates over vertebral ossification&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Resnick and Niwayama pointed out that DISH might not be a disease <span class="elsevierStyleItalic">per se</span>&#44; but rather a state of extensive ossification&#46; It is described in the literature that levels of vertebral pain are lower in hyperostotic disease than in spondyloarthrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> However&#44; Mata et al&#46;&#44; although they corroborate the above in terms of pain and rigidity in the lumbar segment&#44; they did not observe this in other sites studied such as the cervical or dorsal spine or the extremities&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> In reality&#44; functional capacity evaluation has only been undertaken in one single study where the authors detected poor functional status&#44; regardless of body mass index&#44; measured through the abbreviated HAQ questionnaire compared to a healthy population&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> in our first case&#44; the exuberant bony excrescences resulted in several operations due to their impact on the person&#39;s physical function and quality of life&#46; In the other cases&#44; the involvement of the Achilles tendon and calcaneus enthuses required various treatments&#44; and resulted in long periods of functional incapacity and sick leave&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Since Forestier&#39;s definition&#44; certain metabolic or constitutional factors are considered to be linked to the disease&#46; Our 3 patients were overweight&#44; and the first case also had hypertension and oral glucose intolerance that developed into type 2 diabetes mellitus&#46; In recent years the physiopathogenic role of metabolic dysfunction in the ossification of ligaments and entheses has been researched&#46; In this regard&#44; Mader et al&#46; performed a study where they found that the likelihood of developing a DISH in the fifth decade of life was 5 times greater in a patient of the same age and sex if they had 3 clinical parameters such as obesity&#44; a first-degree relative with a history of hypertension or diabetes&#44; and back or chest pain or enthesitis or tendinitis&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Finally&#44; in the cases we present we wanted to highlight the predominance of extraspinal manifestations over little or no axial involvement&#46; Although according to Utsinger these would be early stages&#44; our first patient was followed up over 15 years without presenting a single radiological sign in the vertebrae&#46; Based on these observations it may well be that these were not different stages of the disease&#44; but different phenotypes of it&#46; We describe a pattern of peripheral predominance that would not meet the classical classification criteria of Resnick&#44; that would be more prevalent in females&#44; and which would start at younger ages&#46; However&#44; studies are required with larger numbers of patients&#44; but that include forms with predominant extraspinal involvement in particular&#46; We agree with the authors that uphold the need to create new more complete classification criteria that take into account all the manifestations of the disease&#44; such as peripheral involvement in the form of enthesis ossification or the presence of comorbidities&#46; These would provide us greater knowledge of the entire clinical spectrum of the disease&#44; access to epidemiological data&#44; to real data on disability and quality of life&#44; as has been researched in other rheumatic diseases&#46; In short&#44; we would be able to identify patients in earlier stages in order to apply therapies that might change the course of the DISH&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">DISH is a relatively common rheumatic disease&#44; with a broad spectrum of manifestations&#44; which is currently diagnosed in advanced stages or with major complications of spinal involvement&#46; Extraspinal manifestations often go unnoticed&#44; but can be a sign of early disease&#46; Finally&#44; we stress the need to consider a diagnosis of DISH in a patient presenting with one or various enthesopathies in order to make an early diagnosis&#44; and consider therapeutic measures in less advanced stages of the disease&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ethical Responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protection of people and animals</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that neither human nor animal testing has been carried out under this research&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Data confidentiality</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have complied with their work centre protocols for the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Privacy rights and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no patients&#8217; data appear in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of Interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diffuse idiopathic skeletal hyperostosis is a bone disease characterised by ossification of spinal ligaments and peripheral entheses&#46; Currently&#44; we still use the classic classification criteria that do not include extraspinal manifestations&#46; A number of authors agree on the need to revise them&#46; We present 3 patients in which a diagnosis of diffuse idiopathic skeletal hyperostosis could not be established if we apply those criteria&#44; but they have fully compatible clinical and radiological manifestations of hyperostotic disease&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La hiperostosis esquel&#233;tica difusa idiop&#225;tica es una enfermedad caracterizada por la osificaci&#243;n de ligamentos vertebrales y de entesis perif&#233;ricas&#46; Actualmente&#44; siguen utiliz&#225;ndose los criterios clasificatorios cl&#225;sicos que se basan en hallazgos radiol&#243;gicos vertebrales&#44; pero que no incluyen otras manifestaciones clinicopatol&#243;gicas que conforman el espectro de la enfermedad&#46; Diversos autores abogan por la revisi&#243;n y actualizaci&#243;n de dichos criterios&#46; A continuaci&#243;n describimos 3 casos cl&#237;nicos en los que no se podr&#237;a establecer un diagn&#243;stico de hiperostosis esquel&#233;tica difusa idiop&#225;tica pero que presentan unas manifestaciones cl&#237;nico-radiol&#243;gicas totalmente compatibles con la enfermedad hiperostosante&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Clavaguera T&#44; Reyner P&#44; Valls R&#44; de Cendra E&#44; Rodr&#237;guez-Jimeno MC&#46; Hiperostosis esquel&#233;tica difusa idiop&#225;tica&#58; &#191;existe un patr&#243;n de predominio perif&#233;rico&#63; Reumatol Clin&#46; 2019&#59;15&#58;301&#8211;304&#46;</p>"
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                      "titulo" => "Senile ankylosing hyperostosis of the spine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Forestier"
                            1 => "J&#46; Rotes-Querol"
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                        "tituloSerie" => "Ann Rheum Dis"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Resnick"
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                      "doi" => "10.1148/119.3.559"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/935390"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diffuse idiopathic skeletal hyperostosis PD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;D&#46; Utsinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheum Dis"
                        "fecha" => "1985"
                        "volumen" => "11"
                        "paginaInicial" => "325"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3899489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyperostosis of the spine in an adult population&#46; Its relation to hyperglycaemia and obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Julkunen"
                            1 => "O&#46;P&#46; Heinonen"
                            2 => "K&#46; Pyorala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.30.6.605"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "1971"
                        "volumen" => "30"
                        "paginaInicial" => "605"
                        "paginaFinal" => "612"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5130140"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La maladie hyperostosique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Arlet"
                            1 => "B&#46; Mazi&#232;res"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Med Intern"
                        "fecha" => "1985"
                        "volumen" => "5"
                        "paginaInicial" => "553"
                        "paginaFinal" => "564"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of diagnostic criteria for hyperostotic disease on a series of skeletons&#46; Epidemiological implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Crub&#233;zy"
                            1 => "E&#46; Crub&#233;zy-Ibanez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Rhum &#40;Ed Fr&#41;"
                        "fecha" => "1993"
                        "volumen" => "60"
                        "paginaInicial" => "586"
                        "paginaFinal" => "590"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Developing new classification criteria for diffuse idiopathic skeletal hyperostosis&#58; back to square one"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Mader"
                            1 => "D&#46; Buskila"
                            2 => "J&#46;J&#46; Verlaan"
                            3 => "F&#46; Atzeni"
                            4 => "I&#46; Olivieri"
                            5 => "N&#46; Pappone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/kes257"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2013"
                        "volumen" => "52"
                        "paginaInicial" => "326"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23024057"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in the Netherlands"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;A&#46; Westerveld"
                            1 => "H&#46;M&#46; van Ufford"
                            2 => "J&#46;J&#46; Verlaan"
                            3 => "F&#46;C&#46; Oner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2008"
                        "volumen" => "35"
                        "paginaInicial" => "1635"
                        "paginaFinal" => "1638"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18528963"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of diffuse idiopathic skeletal hyperostosis &#40;DISH&#41; of the whole spine and its association with lumbar spondylosis and knee osteoarthritis&#58; the ROAD study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Kagotani"
                            1 => "M&#46; Yoshida"
                            2 => "S&#46; Muraki"
                            3 => "H&#46; Oka"
                            4 => "H&#46; Hashizume"
                            5 => "H&#46; Yamada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00774-014-0583-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Metab"
                        "fecha" => "2015"
                        "volumen" => "33"
                        "paginaInicial" => "221"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24623190"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of diffuse idiopathic skeletal hyperostosis in Japan &#8211; the first report of measurement by CT and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Hirasawa"
                            1 => "N&#46; Wakao"
                            2 => "M&#46; Kamiya"
                            3 => "M&#46; Takeuchi"
                            4 => "K&#46; Kawanami"
                            5 => "K&#46; Murotani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jos.2016.02.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Orthop Sci"
                        "fecha" => "2016"
                        "volumen" => "21"
                        "paginaInicial" => "287"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26948246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of diffuse idiopathic skeletal hyperostosis in Korea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;K&#46; Kim"
                            1 => "B&#46;R&#46; Choi"
                            2 => "C&#46;G&#46; Kim"
                            3 => "S&#46;H&#46; Chung"
                            4 => "J&#46;Y&#46; Choe"
                            5 => "K&#46;B&#46; Joo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2004"
                        "volumen" => "31"
                        "paginaInicial" => "2032"
                        "paginaFinal" => "2035"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15468371"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men&#58; the MrOS study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Osteoporotic fractures in men &#40;MrOS&#41; Study Group"
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;F&#46; Holton"
                            1 => "P&#46;J&#46; Denard"
                            2 => "J&#46;U&#46; Yoo"
                            3 => "D&#46;M&#46; Kado"
                            4 => "E&#46; Barrett-Connor"
                            5 => "L&#46;M&#46; Marshall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2011.01.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2011"
                        "volumen" => "41"
                        "paginaInicial" => "131"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21377195"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A controlled study of diffuse idiopathic skeletal hyperostosis&#46; Clinical features and funcional status"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Mata"
                            1 => "P&#46; Fortin"
                            2 => "M&#46;A&#46; Fritzcharles"
                            3 => "M&#46;R&#46; Starr"
                            4 => "L&#46; Joseph"
                            5 => "S&#46; Craig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Medicine &#40;Baltimore&#41;"
                        "fecha" => "1997"
                        "volumen" => "76"
                        "paginaInicial" => "104"
                        "paginaFinal" => "117"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonarticular tenderness and functional status in patients with diffuse idiopathic skeletal hyperostosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Mader"
                            1 => "I&#46; Novofastovski"
                            2 => "E&#46; Rosner"
                            3 => "M&#46; Adawi"
                            4 => "P&#46; Herer"
                            5 => "D&#46; Buskila"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3899/jrheum.091008"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2010"
                        "volumen" => "37"
                        "paginaInicial" => "1911"
                        "paginaFinal" => "1916"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20551104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diabetes mellitus and hypertension as risk factors for early diffuse idiopathic skeletal hyperostosis &#40;DISH&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Mader"
                            1 => "I&#46; Lavi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.joca.2008.12.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoarthritis Cartilage"
                        "fecha" => "2009"
                        "volumen" => "17"
                        "paginaInicial" => "825"
                        "paginaFinal" => "828"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19176286"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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Idiomas
Reumatología Clínica (English Edition)
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