Images in Clinical Rheumatology
Tophaceous Gout of the Shoulder Joint
Afectación del hombro en la gota tofácea
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array:24 [ "pii" => "S2173574318301229" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.09.005" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1070" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2019;15:e55-e56" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X17301298" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2017.05.011" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1070" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2019;15:e55-e56" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1727 "formatos" => array:3 [ "EPUB" => 82 "HTML" => 1240 "PDF" => 405 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Reumatología Clínica en imágenes</span>" "titulo" => "Afectación del hombro en la gota tofácea" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e55" "paginaFinal" => "e56" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Tophaceous gout of the shoulder joint" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3326 "Ancho" => 1031 "Tamanyo" => 181925 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A) Imagen por RM de hombro derecho en adquisición coronal en secuencia potenciada en T1. En una imagen superponible a la radiografía de la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> B se observan los tofos como masas de tejidos blandos hipointensas en T1 en el borde superior del extremo clavicular distal (1) y en la bursa subacromiodeltoidea (2). B) Imagen en adquisición axial T2 eco de gradiente. La RM revela una lesión compatible con tofo gotoso (1) en el borde articular glenohumeral no claramente visible en la radiografía simple. Es hiperintenso en secuencia potenciada en T2, interrumpe la corteza ósea y tiene un reborde muy hipointenso por la esclerosis ósea (2). Se asocia un discreto derrame synovial (3). C) Imagen en adquisición sagital en densidad protónica que permite ver la sección de los tendones que forman en manguito de los rotadores: redondo menor (1), infraespinoso (2), supraespinoso (3) y subescapular (4). El supraespinoso está especialmente desestructurado por la presencia de un nódulo sugestivo de tofo intratendinoso (*). Como en la secuencia potenciada en T2, el tofo óseo es hiperintenso (5).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana María Tierra Rodriguez, Lucía Pantoja Zarza, Pelayo Brañanova López, Carolina Diez Morrondo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana María" "apellidos" => "Tierra Rodriguez" ] 1 => array:2 [ "nombre" => "Lucía" "apellidos" => "Pantoja Zarza" ] 2 => array:2 [ "nombre" => "Pelayo" "apellidos" => "Brañanova López" ] 3 => array:2 [ "nombre" => "Carolina" "apellidos" => "Diez Morrondo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574318301229" "doi" => "10.1016/j.reumae.2018.09.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301229?idApp=UINPBA00004M" ] 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Radiological Findings" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e57" "paginaFinal" => "e59" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miositis osificante circunscrita en codo simulando un sarcoma de partes blandas: hallazgos clínico-radiológicos similares" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1394 "Ancho" => 2083 "Tamanyo" => 199058 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Plain X-ray of left elbow in lateral projection (A) and anteroposterior (B) projection.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 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=> "e54" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolismo pulmonar central bilateral asintomático por cemento tras vertebroplastia múltiple" ] ] "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" => 1083 "Ancho" => 1400 "Tamanyo" => 125747 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) CT sagittal view where one may observe the cement material in the 5 vertebral bodies (short arrows). Note the presence of a cement leakage from the fifth vertebra towards the right common iliac vein (long arrow); this leakage is probably responsible for the cement emboli in the pulmonary arteries. (B and C) Axial (B) and coronal (C) images of CT (maximum intensity projection) with very high density lineal repletion defected (arrows) in the lumen of the main pulmonary arteries and which represent the cement material.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe Sarasúa, Paola Arrieta, Deisy Barrios-Barreto, Carlos de la Puente-Bujido" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] 1 => array:2 [ "nombre" => "Paola" "apellidos" => "Arrieta" ] 2 => array:2 [ "nombre" => "Deisy" "apellidos" => "Barrios-Barreto" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "de la Puente-Bujido" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X17301365" "doi" => "10.1016/j.reuma.2017.06.004" "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/S1699258X17301365?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301230?idApp=UINPBA00004M" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301230/v1_201910260908/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Tophaceous Gout of the Shoulder Joint" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e55" "paginaFinal" => "e56" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana María Tierra Rodriguez, Lucía Pantoja Zarza, Pelayo Brañanova López, Carolina Diez Morrondo" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Ana María" "apellidos" => "Tierra Rodriguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "Lucía" "apellidos" => "Pantoja Zarza" "email" => array:1 [ 0 => "lpantojazarza@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Pelayo" "apellidos" => "Brañanova López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Carolina" "apellidos" => "Diez Morrondo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad Reumatología, Hospital El Bierzo, Ponferrada, León, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio Medicina Interna, Hospital El Bierzo, Ponferrada, León, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio Radiodiagnóstico, Hospital El Bierzo, Ponferrada, León, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Afectación del hombro en la gota tofácea" ] ] "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" => 943 "Ancho" => 2500 "Tamanyo" => 165670 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Hands with multiple tophi. (1) Simple X-ray of right shoulder in anteroposterior projection. In the clavicle region of the right acromioclavicular joint a punched-out eccentric bony erosion is observed, formed by the replacement of the bone by a less dense tophus (1). Due to the slow, benign growth the bone reacts forming a sclerotic “ring” which surrounds the tophus and even overlaps the anatomical limits of the bone forming a raised edge (→). The change in the glenohumeral joint is mainly apparent in plain X-ray due to the occupation of the subacromiodeltoid bursa (2).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a male aged 58, a smoker of 60 packs of cigarettes per year and drinker of 80<span class="elsevierStyleHsp" style=""></span>g of alcohol per day, was diagnosed with gouty arthropathy in 1999 from observation of monosodium urate (MSU) crystal deposits in proximal interphalangeal joint of the fourth finger of the right hand. At that time he did not present with tophi or a history of nephritic colics. No analysis was carried out and the patient did not return to the surgery until 2005, when he had been diagnosed with high blood pressure and dyslipidemia. Tophi were then observed in his hands and elbows (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Uricaemia was at 10.4<span class="elsevierStyleHsp" style=""></span>mg/dl, uricosuria at 745<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h, whilst liver and kidney functions were normal. Since that time the patient has attended check-ups with great irregularity and is treated with anti-inflammatory drugs and a 15–30<span class="elsevierStyleHsp" style=""></span>mg/day dose of prednisone, 1<span class="elsevierStyleHsp" style=""></span>mg/day dose of colchincine and 300<span class="elsevierStyleHsp" style=""></span>mg/day dose of allopurinol according to his own criteria. In 2011 he started treatment with febuxostat, which he takes inconsistently. In 2012 he was operated on in another hospital for articular retraction of the fifth finger and carpal tunnel syndrome due to tophaceous material. In 2013, amputation of the distal phalanx of the second finger on the right hand was performed due to epidermoid carcinoma. In 2014, he suffered a transient ischaemic attack due to complete thrombosis-occlusion of the right internal carotid artery. In 2015 the patient presented with omalgia of the right shoulder of 4 month onset when making certain movements and when lying down on his side at night. Examination revealed limitation in the last degrees of internal rotation and active and passive abduction. Plain X-ray was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) and magnetic resonance (MR) of the right shoulder (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A–<span class="elsevierStyleSmallCaps">C</span>) with analgesic treatment leading to an improvement in clinical symptoms.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The presence of tophaceous gout is correlated with persistence over time of hyperuricaemia and/or ineffective treatment. Tophi deposits have been described in many atypical locations,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> but of these the glenohumeral joint is rare.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> The first description was made by O’Leary, when the tophi were observed after performing an arthroscopy as they had not been detected in the MR.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Radiologic characteristics of tophi include erosions with well defined margins, preservation of joint space and dense nodules of soft tissues which are sometimes calcified.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Ultrasound scan is more sensitive and specific for the detection of microcrystalline deposits in bursae, tendons, ligaments and soft tissues.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Double energy computerised tomography (DECT) is also used for the detection and measurement of tophi in unusual locations or when they mimic infection or malignancy, as 3d reconstruction of images is enabled. The highest limitation is radiation and its use in major joints such as the shoulder and hip, where precision is lost.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> MR provides information for deep tissue joints and for intraosseous deposits, but although it is highly sensitive for detection, the tophi offer a non specific pattern similar to other soft tissue masses, with low intensive signalling in T1 and variable intensity in T2. As a result the patient's medical history is required for accurate diagnosis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Liabilities</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of people and animals</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experimentation has been carried out on human beings or animals.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Data confidentiality</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to the protocol of their centre of work on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of the patients and/or subjects referred to in this article. This document is held by the corresponding author.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of Interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Liabilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-03-18" "fechaAceptado" => "2017-05-27" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Tierra Rodriguez AM, Pantoja Zarza L, Brañanova López P, Diez Morrondo C. Afectación del hombro en la gota tofácea. Reumatol Clin. 2019;15:e55–e56.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 943 "Ancho" => 2500 "Tamanyo" => 165670 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Hands with multiple tophi. (1) Simple X-ray of right shoulder in anteroposterior projection. In the clavicle region of the right acromioclavicular joint a punched-out eccentric bony erosion is observed, formed by the replacement of the bone by a less dense tophus (1). Due to the slow, benign growth the bone reacts forming a sclerotic “ring” which surrounds the tophus and even overlaps the anatomical limits of the bone forming a raised edge (→). The change in the glenohumeral joint is mainly apparent in plain X-ray due to the occupation of the subacromiodeltoid bursa (2).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3326 "Ancho" => 1031 "Tamanyo" => 181925 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) MR image of the right shoulder in coronal plane in T1 weighted sequence. In one image superimposed onto the X-ray of <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B we may observe the tophi as hypointense soft tissue masses in T1 along the upper ridge of the distal end of the clavicle (1) and in the subacromiodeltoid bursa (2). (B) Image in axial T2 gradient-echo plane. The MR reveals a lesion compatible with gouty tophus (1) in the glenohumeral joint edge which is not clearly visible in plain X-ray. It is hyperintense in T2 weighted sequence, interrupts the bony cortex and has a highly hypointense ridge from bone sclerosis (2). Mild synovial effusion is present (3). (C) Proton density image in sagittal plane which enables vision of the section of the tendon which forms in the sleeve of the rotator cuffs: teres menor (1), infraespinatus (2), supraespinatus (3) and subescapularis (4). The supraspinatus is particularly de-structured by the presence of a nodule suggestive of intratendinous tophus (*). Similarly to the T2 weighted sequence, the bony tophus is hyperintense (5).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.J. Forbess" 1 => "T.R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 54 | 10 | 64 |
| 2024 September | 120 | 9 | 129 |
| 2024 August | 137 | 31 | 168 |
| 2024 July | 140 | 31 | 171 |
| 2024 June | 114 | 36 | 150 |
| 2024 May | 146 | 25 | 171 |
| 2024 April | 112 | 25 | 137 |
| 2024 March | 139 | 33 | 172 |
| 2024 February | 118 | 30 | 148 |
| 2024 January | 171 | 26 | 197 |
| 2023 December | 135 | 20 | 155 |
| 2023 November | 194 | 33 | 227 |
| 2023 October | 211 | 48 | 259 |
| 2023 September | 188 | 42 | 230 |
| 2023 August | 230 | 21 | 251 |
| 2023 July | 140 | 27 | 167 |
| 2023 June | 122 | 28 | 150 |
| 2023 May | 137 | 37 | 174 |
| 2023 April | 142 | 35 | 177 |
| 2023 March | 230 | 228 | 458 |
| 2023 February | 204 | 211 | 415 |
| 2023 January | 193 | 173 | 366 |
| 2022 December | 217 | 182 | 399 |
| 2022 November | 181 | 199 | 380 |
| 2022 October | 230 | 249 | 479 |
| 2022 September | 209 | 217 | 426 |
| 2022 August | 175 | 252 | 427 |
| 2022 July | 181 | 214 | 395 |
| 2022 June | 170 | 226 | 396 |
| 2022 May | 205 | 233 | 438 |
| 2022 April | 236 | 192 | 428 |
| 2022 March | 182 | 264 | 446 |
| 2022 February | 304 | 410 | 714 |
| 2022 January | 283 | 659 | 942 |
| 2021 December | 189 | 678 | 867 |
| 2021 November | 197 | 117 | 314 |
| 2021 October | 242 | 62 | 304 |
| 2021 September | 149 | 47 | 196 |
| 2021 August | 134 | 41 | 175 |
| 2021 July | 182 | 25 | 207 |
| 2021 June | 145 | 46 | 191 |
| 2021 May | 145 | 52 | 197 |
| 2021 April | 471 | 123 | 594 |
| 2021 March | 261 | 55 | 316 |
| 2021 February | 211 | 28 | 239 |
| 2021 January | 163 | 20 | 183 |
| 2020 December | 166 | 30 | 196 |
| 2020 November | 143 | 19 | 162 |
| 2020 October | 115 | 16 | 131 |
| 2020 September | 181 | 33 | 214 |
| 2020 August | 168 | 16 | 184 |
| 2020 July | 82 | 24 | 106 |
| 2020 June | 65 | 18 | 83 |
| 2020 May | 66 | 26 | 92 |
| 2020 April | 45 | 21 | 66 |
| 2020 March | 11 | 3 | 14 |
| 2019 November | 1 | 0 | 1 |
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