Case report
Myositis as the Initial Presentation of Panarteritis Nodosa
Miositis como forma de presentación de panarteritis nodosa
Romina Calvo, Melina Negri, Alberto Ortiz, Susana Roverano, Sergio Paira
Corresponding author
Servicio de Reumatología, Hospital J.M. Cullen, Santa Fe, Argentina
Read
7004
Timeswas read the article
2014
Total PDF
4990
Total HTML
Share statistics
array:24 [ "pii" => "S2173574318301370" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.10.005" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1081" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2019;15:e24-e26" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X17301699" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2017.06.010" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1081" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2019;15:e24-e26" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 895 "formatos" => array:3 [ "EPUB" => 97 "HTML" => 382 "PDF" => 416 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Miositis como forma de presentación de panarteritis nodosa" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e24" "paginaFinal" => "e26" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Myositis as the initial presentation of panarteritis nodosa" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 747 "Ancho" => 900 "Tamanyo" => 60591 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Tumoración en pantorrillas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Romina Calvo, Melina Negri, Alberto Ortiz, Susana Roverano, Sergio Paira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Romina" "apellidos" => "Calvo" ] 1 => array:2 [ "nombre" => "Melina" "apellidos" => "Negri" ] 2 => array:2 [ "nombre" => "Alberto" "apellidos" => "Ortiz" ] 3 => array:2 [ "nombre" => "Susana" "apellidos" => "Roverano" ] 4 => array:2 [ "nombre" => "Sergio" "apellidos" => "Paira" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574318301370" "doi" => "10.1016/j.reumae.2018.10.005" "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/S2173574318301370?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17301699?idApp=UINPBA00004M" "url" => "/1699258X/0000001500000005/v1_201910230648/S1699258X17301699/v1_201910230648/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574318301266" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.09.009" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1079" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2019;15:e27-e29" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Retroperitoneal Fibrosis Associated With Immunoglobulin IgG4-related Disease in the Differential Diagnosis in Retroperitoneal Tumours. Case Report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e27" "paginaFinal" => "e29" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fibrosis retroperitoneal nodular asociada a IgG4 como diagnóstico diferencial en tumores retroperitoneales. Reporte de un caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1689 "Ancho" => 1600 "Tamanyo" => 640676 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Macroscopic tumour. (B) Surgical specimen, solid well defined tumour, fibrous in appearance, which does not invade the renal parenchyma. (C) Microphotography (40×). Reaction of the indirect immunoperoxidase with anti-IgG4 antibody, with over 40 plasmatic cells. (D) Microphotography (40×) with Mason staining. Fibrosis with focally steriform pattern. (E) Microphotography (100×). Inflammatory infiltrate predominantly composed of plasmatic cells. (F) Microphotography (10×) obliterating phlebitis consistent with extensive fibrosis and lymphoplasmacytic infiltrate.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gabriela Ruiz Mar, Óscar E. Cárdenas Serrano, Jorge Roldan García, Abraham Cañavera-Constantino, Víctor M. Menéndez Trejo, Óscar Chapa Azuela" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Gabriela" "apellidos" => "Ruiz Mar" ] 1 => array:2 [ "nombre" => "Óscar E." "apellidos" => "Cárdenas Serrano" ] 2 => array:2 [ "nombre" => "Jorge" "apellidos" => "Roldan García" ] 3 => array:2 [ "nombre" => "Abraham" "apellidos" => "Cañavera-Constantino" ] 4 => array:2 [ "nombre" => "Víctor M." "apellidos" => "Menéndez Trejo" ] 5 => array:2 [ "nombre" => "Óscar" "apellidos" => "Chapa Azuela" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X17301407" "doi" => "10.1016/j.reuma.2017.06.008" "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/S1699258X17301407?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301266?idApp=UINPBA00004M" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301266/v1_201910260908/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574318301448" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.10.010" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1093" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2019;15:e21-e23" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Noninfective Endocarditis in Microscopic Polyangiitis: Report of a Case With a Successful Response to Immunosuppressive Therapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e21" "paginaFinal" => "e23" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Endocarditis no infecciosa en poliangitis microscópica: reporte de un caso con respuesta exitosa a inmunosupresión" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1126 "Ancho" => 1651 "Tamanyo" => 160522 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Vegetation 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm in the A2 scallop of the anterior valve of the mitral valve with failure.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carolina Muñoz-Grajales, Juan C. Chavarriaga, Javier D. Márquez, Luis F. Pinto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Carolina" "apellidos" => "Muñoz-Grajales" ] 1 => array:2 [ "nombre" => "Juan C." "apellidos" => "Chavarriaga" ] 2 => array:2 [ "nombre" => "Javier D." "apellidos" => "Márquez" ] 3 => array:2 [ "nombre" => "Luis F." "apellidos" => "Pinto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X1730181X" "doi" => "10.1016/j.reuma.2017.07.005" "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/S1699258X1730181X?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301448?idApp=UINPBA00004M" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301448/v1_201910260908/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Myositis as the Initial Presentation of Panarteritis Nodosa" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e24" "paginaFinal" => "e26" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Romina Calvo, Melina Negri, Alberto Ortiz, Susana Roverano, Sergio Paira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Romina" "apellidos" => "Calvo" ] 1 => array:2 [ "nombre" => "Melina" "apellidos" => "Negri" ] 2 => array:2 [ "nombre" => "Alberto" "apellidos" => "Ortiz" ] 3 => array:2 [ "nombre" => "Susana" "apellidos" => "Roverano" ] 4 => array:4 [ "nombre" => "Sergio" "apellidos" => "Paira" "email" => array:1 [ 0 => "pairasergio@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Reumatología, Hospital J.M. Cullen, Santa Fe, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miositis como forma de presentación de panarteritis nodosa" ] ] "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" => 747 "Ancho" => 900 "Tamanyo" => 60431 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Calf swelling.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Polyarteritis nodosa (PAN) is a necrosing arthritis of the small and medium-sized arteries, with no glomerulonephritis and not associated with ANCA.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The organs most affected are the skin, gastrointestinal tract, kidney, peripheral nerves, heart, liver, pancreas, testicles, the nervous system and the muscles.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Muscular manifestations are common (51%), consisting of muscular swelling, gait difficulty and myalgia, which might be due to compromised intramuscular arteries, neuropathy due to involvement of the peripheral nervous system or, more rarely, to myositis.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We describe a case of PAN presenting with calf pain due to myositis as a form of onset of this vasculitis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Observation</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 47-year-old male consulted with a one-month history of weight loss (10<span class="elsevierStyleHsp" style=""></span>kg) and spontaneous, incapacitating calf pain. Physical examination: fever (38.5<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span>) predominantly in the evening, tachycardia, blood pressure 160/100<span class="elsevierStyleHsp" style=""></span>mmHg, erythematous lumps in the twin muscles (approximately 6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm), of hard-elastic consistency and warm, and thermalgesic sensitivity was preserved (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Erythematous purpuric macules were also observed on the anterior and posterior surfaces of the legs, testicular pain on palpation, and arthritis in carpi, metacarpophalangeal and proximal interphalangeal joints.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Laboratory tests: anaemia with haemoglobin: 10<span class="elsevierStyleHsp" style=""></span>g/dl (11.9–15<span class="elsevierStyleHsp" style=""></span>g/dl), white cells 25,160<span class="elsevierStyleHsp" style=""></span>k/μl (4500–10,000), platelets 634,000<span class="elsevierStyleHsp" style=""></span>k/μl (150,000–400,000), GTO: 144<span class="elsevierStyleHsp" style=""></span>U/l (up to 38), TGP: 192<span class="elsevierStyleHsp" style=""></span>U/l (up to 46), alkaline phosphatase 448<span class="elsevierStyleHsp" style=""></span>U/l (35–105), direct bilirubin .31<span class="elsevierStyleHsp" style=""></span>mg/dl (up to .20), CPK 1232<span class="elsevierStyleHsp" style=""></span>IU/l (<135), LDH 233 (<460), aldolase 10<span class="elsevierStyleHsp" style=""></span>U/l (<3), ESR 119<span class="elsevierStyleHsp" style=""></span>mm/1<span class="elsevierStyleHsp" style=""></span>h (up to 20), CRP 317<span class="elsevierStyleHsp" style=""></span>mg/l (0–5). Renal function and serologies for hepatitis B and C; HIV, ANF (HeP-2), nDNA <span class="elsevierStyleItalic">(Crithidia)</span>, ENA, p-ANCA and c-ANCA and complements: negative or normal. MRI showed hyperintensity in the twin muscles compatible with myositis, while electromyography of the upper and lower limbs showed a motor-sensitive polyneuropathy with decreased sural nerve conduction speed. Inflammatory infiltration, atrophy and focal perifascicular regeneration was found on muscle biography (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Biopsy of the sural nerve showed moderate myelinated fibre depletion and signs of axonal degeneration along with extensive lymphocytic infiltration around the small epineurial vessels and the wall of the median artery.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The skin biopsy showed acute and chronic inflammatory infiltration of septal distribution and medium-sized vessels with vasculitic phenomena and fibrinoid necrosis of the septal wall with erythrocyte extravasation in the hypodermis. Aortography and total bone scan were normal.</p><p id="par0035" class="elsevierStylePara elsevierViewall">With a diagnosis of PAN (Chapell Hill and ACR criteria: weight loss of more than 4<span class="elsevierStyleHsp" style=""></span>kg, testicular pain, myalgia, polyneuritis demonstrated by electromyography, diastolic blood pressure higher than 90<span class="elsevierStyleHsp" style=""></span>mmHg and medium-sized artery biopsy compatible with vasculitis) 3 pulses of intravenous methylprednisolone 1<span class="elsevierStyleHsp" style=""></span>g/day were given, continuing with 60<span class="elsevierStyleHsp" style=""></span>mg/day of oral meprednisone and monthly intravenous cyclophosphamide. The patient made good progress.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">PAN is a vasculitis that predominantly affects the small and medium-sized arteries. It affects the skin (20%), gastrointestinal tract (50%), kidneys (40%–60%) and peripheral nerves (60%). Muscle compromise is not a feature of this disease. Although myalgia, swelling and impossibility of walking can present in 51% of patients,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> myositis is found in 19% of these diseases,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and there are only 14 cases reporting this compromise as a form of onset of this vasculitis.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,6,7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The muscle enzymes are elevated in only 5% of cases, as occurred in the case we describe. The CPK enzymes (5%–25%) are the most altered, and elevated LDH and aldolase have been reported in some cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">These cases must be differentiated from polymyositis and myositis of other origins, and therefore diagnosis relies on anatomical pathology. It is appropriate to choose the biopsy site by MRI, which shows increased signal intensity on the T2 and STIR sequences, indicating inflammatory changes.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–7</span></a> Almost all the patients reported underwent a muscular biopsy, compatible with vasculitis.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,9,10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">This is the first described case with myositis demonstrated by histology. These histological signs might have gone unnoticed in previous cases.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Perhaps we ought to broaden the spectrum when analysing muscle biopsies for PAN and look for signs of vasculitis as well as myositis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of people and animals</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of Interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1258190" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1165524" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1258189" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1165523" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Observation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-15" "fechaAceptado" => "2017-06-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1165524" "palabras" => array:3 [ 0 => "Vasculitis" 1 => "Myositis" 2 => "Polyarteritis nodosa" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1165523" "palabras" => array:3 [ 0 => "Vasculitis" 1 => "Miositis" 2 => "Poliarteritis nodosa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 47-year-old man presented with weight loss, bilateral calf pain, fever, hypertension, orchitis and oligoarthritis. Lab tests: anemia and elevated muscle enzymes. Resonance magnetic imaging: hyperintensity in gastrocnemius muscles (myositis). Histologic exam of the muscles: inflammatory infiltrate with atrophy and perifascicular regeneration. Treatment: methylprednisone (bolus) and cyclophosphamide. Muscle pain and swelling and difficulty in walking are common in panarteritis nodosa (PAN), whereas histologically demonstrated myositis is not. Even more rare is myositis as the initial presentation of this vasculitis.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Varón de 47 años que consulta por pérdida de peso, dolor con tumefacción en pantorrillas, fiebre, hipertensión arterial, orquitis y oligoartritis. Laboratorio: anemia y aumento de enzimas musculares. Resonancia magnética: hiperintensidad en gemelos (miositis). Histología de músculo: infiltrado inflamatorio con atrofia y regeneración perifascicular. Tratamiento: pulsos de metilprednisolona y ciclofosfamida. Mialgias, tumefacción muscular y deambulación dificultosa son hallazgos comunes en poliarteritis nodosa (PAN), no así la miositis demostrada histológicamente y más infrecuente aún como forma de inicio de esta vasculitis.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Calvo R, Negri M, Ortiz A, Roverano S, Paira S. Miositis como forma de presentación de panarteritis nodosa. Reumatol Clin. 2019;15:e24–e26.</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" => 747 "Ancho" => 900 "Tamanyo" => 60431 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Calf swelling.</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" => 725 "Ancho" => 900 "Tamanyo" => 99218 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Muscle biopsy: inflammatory infiltration, with atrophy and perifascicular regeneration.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Jennette" 1 => "R.J. Falk" 2 => "P.A. Bacon" 3 => "N. Basu" 4 => "M.C. Cid" 5 => "F. Ferrario" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Artrhitis Rheum" "fecha" => "2013" "volumen" => "65" "paginaInicial" => "1" "paginaFinal" => "11" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polyateritis nodosa presenting as polymyositis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.G. Plumley" 1 => "R. Rubio" 2 => "S. Alasfar" 3 => "H.E. Jasin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Semin Arth Rheum" "fecha" => "2002" "volumen" => "31" "paginaInicial" => "377" "paginaFinal" => "383" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Muscle involvement in polyarteritis nodosa: report of a patient presenting clinically as polymyositis and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.G. Fort" 1 => "R. Griffin" 2 => "A. Tahmoush" 3 => "J.L. Abruzzo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "1994" "volumen" => "21" "paginaInicial" => "945" "paginaFinal" => "948" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7914924" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polyarteritis nodosa presenting with clinical and radiologic features suggestive of polymyositis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Haroon" 1 => "N. Bermingham" 2 => "C. Keohane" 3 => "S. Harney" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00296-011-1828-8" "Revista" => array:6 [ "tituloSerie" => "Rheumatol Int" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "1079" "paginaFinal" => "1081" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21331572" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Three cases of primary small vessel vasculitis of the skeletal muscle – an own entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Benz" 1 => "T. Daikeler" 2 => "S. Frank" 3 => "M. Mehling" 4 => "A. Tyndall" 5 => "M. Trendelenburg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr.08.2011.4631" "Revista" => array:3 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2011" "volumen" => "2011" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of polyarteritis nodosa limited to the right calf muscles, fascia and skin: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Ahmed" 1 => "J. Kitchen" 2 => "S. Hamilton" 3 => "F. Brett" 4 => "D. Kane" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1752-1947-5-540" "Revista" => array:5 [ "tituloSerie" => "J Med Case Rep" "fecha" => "2011" "volumen" => "5" "paginaInicial" => "540" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22054018" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous inmunoglobulins in polyarteritis nodosa restricted to the limbs: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Balbir-Gurman" 1 => "A.M. Nahir" 2 => "Y. Braun- Moscovici" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Rheum" "fecha" => "2007" "volumen" => "25" "paginaInicial" => "28" "paginaFinal" => "30" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myositis as a presenting feature of polyarteritis nodosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Lupoli" 1 => "A. Gargiulo" 2 => "R. Rossi" 3 => "P.R. Ames" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2004" "volumen" => "22" "paginaInicial" => "507" "paginaFinal" => "508" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polyarteritis nodosa limited to calf muscles: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Nakamura" 1 => "K. Tomoda" 2 => "Y. Yamamura" 3 => "M. Tsukano" 4 => "I. Honda" 5 => "K. Iyama" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-002-0688-8" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2003" "volumen" => "22" "paginaInicial" => "149" "paginaFinal" => "153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12740683" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Muscle involvement in polyarteritis nodosa: report of a case presenting clinically as myophathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Sümer" 1 => "B. Oksüzoglu" 2 => "C. Sungur" 3 => "Y. Gúngen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clin Exp Rheum" "fecha" => "2002" "volumen" => "20" "paginaInicial" => "434" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301370/v1_201910260908/en/main.assets" "Apartado" => array:4 [ "identificador" => "43296" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000005/v1_201910260908/S2173574318301370/v1_201910260908/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301370?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 7 | 11 |
| 2024 October | 99 | 41 | 140 |
| 2024 September | 78 | 33 | 111 |
| 2024 August | 97 | 57 | 154 |
| 2024 July | 107 | 31 | 138 |
| 2024 June | 84 | 36 | 120 |
| 2024 May | 113 | 31 | 144 |
| 2024 April | 118 | 32 | 150 |
| 2024 March | 121 | 42 | 163 |
| 2024 February | 118 | 38 | 156 |
| 2024 January | 116 | 31 | 147 |
| 2023 December | 99 | 58 | 157 |
| 2023 November | 115 | 61 | 176 |
| 2023 October | 111 | 33 | 144 |
| 2023 September | 119 | 33 | 152 |
| 2023 August | 72 | 15 | 87 |
| 2023 July | 92 | 21 | 113 |
| 2023 June | 80 | 30 | 110 |
| 2023 May | 84 | 27 | 111 |
| 2023 April | 64 | 12 | 76 |
| 2023 March | 63 | 24 | 87 |
| 2023 February | 81 | 25 | 106 |
| 2023 January | 83 | 14 | 97 |
| 2022 December | 118 | 44 | 162 |
| 2022 November | 95 | 40 | 135 |
| 2022 October | 88 | 33 | 121 |
| 2022 September | 68 | 31 | 99 |
| 2022 August | 58 | 44 | 102 |
| 2022 July | 99 | 58 | 157 |
| 2022 June | 121 | 29 | 150 |
| 2022 May | 77 | 42 | 119 |
| 2022 April | 79 | 43 | 122 |
| 2022 March | 100 | 53 | 153 |
| 2022 February | 87 | 39 | 126 |
| 2022 January | 102 | 47 | 149 |
| 2021 December | 90 | 46 | 136 |
| 2021 November | 99 | 56 | 155 |
| 2021 October | 88 | 63 | 151 |
| 2021 September | 87 | 48 | 135 |
| 2021 August | 69 | 52 | 121 |
| 2021 July | 140 | 33 | 173 |
| 2021 June | 77 | 40 | 117 |
| 2021 May | 90 | 50 | 140 |
| 2021 April | 143 | 83 | 226 |
| 2021 March | 120 | 58 | 178 |
| 2021 February | 97 | 21 | 118 |
| 2021 January | 84 | 33 | 117 |
| 2020 December | 70 | 24 | 94 |
| 2020 November | 84 | 13 | 97 |
| 2020 October | 73 | 23 | 96 |
| 2020 September | 78 | 35 | 113 |
| 2020 August | 51 | 25 | 76 |
| 2020 July | 41 | 17 | 58 |
| 2020 June | 74 | 19 | 93 |
| 2020 May | 52 | 20 | 72 |
| 2020 April | 32 | 19 | 51 |
| 2020 March | 41 | 1 | 42 |
Show all
