Editorial
Psychosocial aspects of rheumatic and musculoskeletal diseases
Aspectos psicosociales de las enfermedades reumáticas y musculoesqueléticas
Leticia Leon Mateos
IDISSC, Reumatología, Hospital Clínico San Carlos, Madrid, Spain
Read
4546
Timeswas read the article
1567
Total PDF
2979
Total HTML
Share statistics
array:23 [ "pii" => "S2173574319300450" "issn" => "21735743" "doi" => "10.1016/j.reumae.2019.02.006" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1320" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2020;16:1-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X19300312" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2019.02.001" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1320" "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. 2020;16:1-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 86 "formatos" => array:2 [ "HTML" => 65 "PDF" => 21 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Aspectos psicosociales de las enfermedades reumáticas y musculoesqueléticas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "2" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Psychosocial aspects of rheumatic and musculoskeletal diseases" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Leticia Leon Mateos" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Leticia" "apellidos" => "Leon Mateos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574319300450" "doi" => "10.1016/j.reumae.2019.02.006" "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/S2173574319300450?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X19300312?idApp=UINPBA00004M" "url" => "/1699258X/0000001600000001/v1_202001221232/S1699258X19300312/v1_202001221232/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574319301881" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.11.018" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1310" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2020;16:3-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special Article</span>" "titulo" => "Hierarchical nomenclature in rheumatology" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "3" "paginaFinal" => "10" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nomenclátor jerarquizado en reumatología" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz Yoldi Muñoz, María Auxiliadora Martín Martínez, Marta Valero Expósito, Carlos Plana Veret, José Luis Andreu Sánchez, José Vicente Moreno Muelas" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Yoldi Muñoz" ] 1 => array:2 [ "nombre" => "María Auxiliadora" "apellidos" => "Martín Martínez" ] 2 => array:2 [ "nombre" => "Marta" "apellidos" => "Valero Expósito" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Plana Veret" ] 4 => array:2 [ "nombre" => "José Luis" "apellidos" => "Andreu Sánchez" ] 5 => array:2 [ "nombre" => "José Vicente" "apellidos" => "Moreno Muelas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X1830264X" "doi" => "10.1016/j.reuma.2018.11.010" "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/S1699258X1830264X?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301881?idApp=UINPBA00004M" "url" => "/21735743/0000001600000001/v2_202002132029/S2173574319301881/v2_202002132029/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Psychosocial aspects of rheumatic and musculoskeletal diseases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "2" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Leticia Leon Mateos" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Leticia" "apellidos" => "Leon Mateos" "email" => array:1 [ 0 => "lleon@salud.madrid.org" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "IDISSC, Reumatología, Hospital Clínico San Carlos, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aspectos psicosociales de las enfermedades reumáticas y musculoesqueléticas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The majority of rheumatic and musculoskeletal diseases (R&MSD) affect the individual on a cognitive, emotional and behavioural level from the moment the patient receives their diagnosis. The patient begins with a series of clinical symptoms which may affect their mobility to different degrees and also lead to impairment or loss of some of daily life functions, such as personal care, work and other basic activities, thereby leading to direct or indirect alterations to the person's financial independence and social roles.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is important to consider this disease from a biopsychosocial perspective, as a system where the modification of one dimension may lead to changes in others. In this sense, the severity over the course of the disease may lead to an increase in negative emotions (anxiety, rage or sadness), pain, disability and reduction of the ability to work, carry out everyday tasks and social activities. The currently recommended biopsychosocial model for an approach to any pathology, calls upon the detection and treatment of patients’ psychological and social problems, not a mere focus on their physical problems, since it has been proven that control of psychological problems, offering information and correct adaptation improves the doctor-patient relationship and the course of the disease.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Cognitive assessment which is the patient's interpretation of the status of their disease has essential repercussions on their mood and how they are able to cope. Patients with a more negative view of their disease (catastrophist) or who have a low level of belief in their ability to function as a result of the disease are less susceptible to carrying out effective behavioural strategies such as adhering to medical recommendations or adopting active methods of coping such as, for example, performing the recommended physical activity.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> In contrast, those people with greater resources in coping with their disease and who are able to seek alternatives or solutions for themselves usually have a more favourable evolution.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Certain beliefs and attitudes towards disease prognosis, the need from treatment or fear of side effects of drugs may lead to poor treatment adherence.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">During the course of the disease attention must be paid to the patient's emotional sphere. With regard to symptoms of anxiety and/or depression, it appears that the first three months subsequent to diagnosis are those of the greatest risk in this sense, and from 3 years onwards the incidence largely decreases. Among the factors which are associated with a higher risk of psychological distress are: female gender; a primary educational level; being an active employee and having a lower income level. The clinical activity of the disease and the extent to which functional levels are affected are also determining factors with regard to the possibility of psychological distress.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The novelty, unpredictability and uncontrollability of the disease and of the different situations accompanying it may be major factors of stress. From the minute a person begins to experience symptoms, when the diagnosis of the disease is received, when they are facing therapeutic failure, when they have to start a new treatment, etc. the patients are facing situations which meet all the typical traits that triggering off stress: new situations for them, about which there is little information, difficult to predict their appearance and their evolution and with major consequences for their life and their everyday existence that they sometimes regard as limited.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The clinical symptoms which are the major stressors for patients with R&MSD are the ones mainly affecting their quality of life.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Firstly pain, which is present to a greater or lesser extent during the course of these diseases and is one of its major stressors. Patients consider this to be key when assessments on their state of health and the state of their condition are made.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In people with R&MSD disability presents as a consequence of disease and pain. It has a limiting effect on them for many of their activities, and is perceived by patients as one of the most frustrating aspects of their illness. Limitations and depending on others as a result, linked to the before-mentioned pain, are the most outstanding stressors associated with R&MSD in most studies. In many cases their ability to walk and do exercise is limited, occasionally affecting their ability to carry out domestic tasks. Patients who are sportspeople are particularly disadvantaged as the practice of these activities is drastically reduced.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Fatigue is a subjective sensation of tiredness or exhaustion which is not relieved by resting. Patients describe the fatigue as physical, cognitive and emotional, which is highly incapacitating for them and the percentages of severe fatigue vary between 35% and 80%, depending on the pathology.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">On many occasions these stressors are accompanied by complications with finances and employment. It has been noted that the support from colleagues, perception of the importance of work and self-sufficiency in the workplace are factors which help the patient to remain in an active situation of employment.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Many patients with R&MSD refer to relevant changes in social and family relationships. Half of patients suffer from dysfunction in areas of social interaction, in communication with others and in emotional behaviour and two thirds state that they have experienced a drastic reduction in leisure or pleasurable activities. This is seriously damaging to their quality of life since apart from reducing social activities the patient loses the ability to enjoy him or herself, due to pain and the difficulty in performing some of these activities. Pastimes and hobbies of these patients are diminished, particularly in those cases where some kind of physical effort is required. The patient goes out less for leisure activities, such as going out to dinner, the cinema or shopping. Meeting friends is also affected, sometimes because the patient is not able to spend long hours in the same place or in the same posture. A similar thing occurs with inviting friends home, as this always requires extra effort for the host and if this is a patient, they prefer to avoid it.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Many patients with R&MSD perceive of not being understood in their enviornment.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> At present new treatment strategies and drugs result in external manifestations of the disease not being obvious in the majority of cases and experiences such as fatigue, stiffness or pain itself and its impact are not appropriately appreciated by other people. This situation may have an effect on the family and the social support the patient receives, which is of vital importance.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The appearance of the disease greatly affects the previously established family dynamics and requires a period of adaptation and restructuring of this dynamic or family functioning. The roles of the family usually change temporarily or permanently, since the patient often has to withdraw from their normal activities which are taken on by other family members. It is important that all members of the patient's family have the necessary resources to understand and be familiar with the disease, so as to make it into a source of positive social support for the patient and help them manage their disease appropriately.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Sexuality may also be affected in R&MSD, and is also usually accompanied by high levels of stress. Sexuality is part of the whole quality of life and therefore not being able to enjoy it is a type of disability. Approximately half of patients with R&MSD suffer from some type of problem in their relationships and problems with several joints during their sexual activities.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> However, this is rarely discussed at the surgery.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> If problems are detected in the sexual sphere, there are resources which may be of use to the patients,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> and in cases of doubt or serious dysfunction, the patient may be referred to the appropriate specialist.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Finally an area which is very highly affected in patients with R&MSD is the quality of sleep. It has been estimated that between 50% and 70% of patients with R&MSD present with some type of problem with sleep such as difficulty getting to sleep, or sleep not being reparative, or they have insomnia, wake up during the night or are overtired during the day.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Our main conclusion is that R&MSD have a high impact on the psychosocial sphere of the patients, and therefore a biopsychosocial approach to them is needed, with treatment being carried out by a multidisciplinary team. Improvements in patients’ education and information, together with the involvement of the family and social environment in the process of the disease are key factors, aimed at the patient acquiring the necessary support resources for appropriate adjustment to the disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Leon Mateos L. Documento de recomendaciones de experto sobre las necesidades psicológicas del paciente con artritis reumatoide. Reumatol Clin. 2020;16:1–2.</p>" ] ] "bibliografia" => array:2 [ "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" => "Patient–physician communication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.E. Suarez-Almazor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00002281-200403000-00003" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Rheumatol" "fecha" => "2004" "volumen" => "16" "paginaInicial" => "91" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14770091" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspectos cognitivos y afectivos del dolor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. García Campayo" 1 => "B. Rodero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2009.07.001" "Revista" => array:7 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2009" "volumen" => "5" "numero" => "Suppl. E2" "paginaInicial" => "9" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21794661" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0090" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determinants of psychological distress and its course in the first year after diagnosis in rheumatoid arthritis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.W. Evers" 1 => "F.W. Kraaimaat" 2 => "R. Geenen" 3 => "J.W. Bijlsma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1023/a:1025555600896" "Revista" => array:6 [ "tituloSerie" => "J Behav Med" "fecha" => "1997" "volumen" => "20" "paginaInicial" => "489" "paginaFinal" => "504" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9415858" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0095" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why do patients with chronic inflammatory rheumatic diseases discontinue their biologics? An assessment of patients’ adherence using a self-report questionnaire" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.L. Betegnie" 1 => "A. Gauchet" 2 => "A. Lehmann" 3 => "L. Grange" 4 => "M. Roustit" 5 => "M. Baudrant" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.150414" "Revista" => array:7 [ "tituloSerie" => "J Rheumatol" "fecha" => "2016" "volumen" => "43" "paginaInicial" => "724" "paginaFinal" => "730" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26879361" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1808869415307138" "estado" => "S300" "issn" => "18088694" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0100" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychological distress over time in early rheumatoid arthritis: results from a longitudinal study in an early arthritis cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Bacconnier" 1 => "N. Rincheval" 2 => "R.M. Flipo" 3 => "P. Goupille" 4 => "J.P. Daures" 5 => "J.P. Boulenger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2015" "volumen" => "54" "paginaInicial" => "520" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0105" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El dolor en los pacientes con artritis reumatoide: variables psicológicas relacionadas e intervención" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.M. Redondo" 1 => "L. León Mateos" 2 => "M.A. Pérez Nieto" 3 => "J.A. Jover Jover" 4 => "L. Abasolo Alcazar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clín Salud" "fecha" => "2008" "volumen" => "19" "paginaInicial" => "359" "paginaFinal" => "378" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0110" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of severe fatigue in rheumatic diseases: an international study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.L. Overman" 1 => "M.B. Kool" 2 => "J.A. da Silva" 3 => "R. Geenen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-015-3035-6" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "409" "paginaFinal" => "415" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26272057" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0115" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of modifiable work-related factors that influence the risk of work disability in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Lacaille" 1 => "S. Sheps" 2 => "J.J. Spinelli" 3 => "A. Chalmers" 4 => "J.M. Esdaile" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.20690" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2004" "volumen" => "51" "paginaInicial" => "843" "paginaFinal" => "852" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15478162" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0120" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lack of understanding in fibromyalgia and rheumatoid arthritis: the Illness Invalidation Inventory (3*I)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B. Kool" 1 => "H. van Middendorp" 2 => "M.A. Lumley" 3 => "Y. Schenk" 4 => "J.W. Jacobs" 5 => "J.W. Bijlsma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2009.123224" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2010" "volumen" => "69" "paginaInicial" => "1990" "paginaFinal" => "1995" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20498203" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0125" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perceptions in rheumatoid arthritis: comparative study between patients and their close families" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Bouhouche" 1 => "S. Rostom" 2 => "Z.M. Idrissi" 3 => "R. Bahiri" 4 => "N. Hajjaj-Hassouni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RHU.0000000000000478" "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "262" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28099218" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0130" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perceptions about perceived functional disabilities and pain of people with rheumatoid arthritis: differences between patients and their spouses and correlates with well-being" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.P. Riemsma" 1 => "E. Taal" 2 => "J.J. Rasker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1529-0131(200010)13:5<255::aid-anr3>3.0.co;2-3" "Revista" => array:6 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2000" "volumen" => "13" "paginaInicial" => "255" "paginaFinal" => "261" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14635293" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0135" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rheumatic diseases and sexuality: disease impact and self-management strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Helland" 1 => "I. Kjeken" 2 => "E. Steen" 3 => "T.K. Kvien" 4 => "M.I. Hauge" 5 => "H. Dagfinrud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/acr.20424" "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res (Hoboken)" "fecha" => "2011" "volumen" => "63" "paginaInicial" => "743" "paginaFinal" => "750" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0140" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors associated with sexual dysfunction in Taiwanese females with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.C. Lin" 1 => "M.C. Lu" 2 => "H. Livneh" 3 => "N.S. Lai" 4 => "H.R. Guo" 5 => "T.Y. Tsai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12905-017-0363-5" "Revista" => array:5 [ "tituloSerie" => "BMC Womens Health" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28196535" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0145" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El dolor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.M. Redondo" 1 => "L. León" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2014" "editorial" => "Grupo 5" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0150" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep and rheumatologic disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.C. Abad" 1 => "P.S. Sarinas" 2 => "C. Guilleminault" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.smrv.2007.09.001" "Revista" => array:6 [ "tituloSerie" => "Sleep Med Rev" "fecha" => "2008" "volumen" => "12" "paginaInicial" => "211" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18486034" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001600000001/v2_202002132029/S2173574319300450/v2_202002132029/en/main.assets" "Apartado" => array:4 [ "identificador" => "17335" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001600000001/v2_202002132029/S2173574319300450/v2_202002132029/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300450?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 63 | 35 | 98 |
| 2024 September | 76 | 30 | 106 |
| 2024 August | 89 | 46 | 135 |
| 2024 July | 90 | 35 | 125 |
| 2024 June | 77 | 28 | 105 |
| 2024 May | 95 | 33 | 128 |
| 2024 April | 101 | 32 | 133 |
| 2024 March | 59 | 30 | 89 |
| 2024 February | 78 | 41 | 119 |
| 2024 January | 73 | 23 | 96 |
| 2023 December | 42 | 22 | 64 |
| 2023 November | 72 | 38 | 110 |
| 2023 October | 74 | 36 | 110 |
| 2023 September | 141 | 49 | 190 |
| 2023 August | 44 | 14 | 58 |
| 2023 July | 59 | 48 | 107 |
| 2023 June | 63 | 18 | 81 |
| 2023 May | 70 | 29 | 99 |
| 2023 April | 49 | 19 | 68 |
| 2023 March | 85 | 21 | 106 |
| 2023 February | 64 | 29 | 93 |
| 2023 January | 57 | 17 | 74 |
| 2022 December | 67 | 29 | 96 |
| 2022 November | 64 | 19 | 83 |
| 2022 October | 65 | 39 | 104 |
| 2022 September | 46 | 27 | 73 |
| 2022 August | 44 | 31 | 75 |
| 2022 July | 40 | 33 | 73 |
| 2022 June | 42 | 35 | 77 |
| 2022 May | 39 | 30 | 69 |
| 2022 April | 52 | 38 | 90 |
| 2022 March | 52 | 47 | 99 |
| 2022 February | 64 | 29 | 93 |
| 2022 January | 64 | 38 | 102 |
| 2021 December | 40 | 32 | 72 |
| 2021 November | 47 | 53 | 100 |
| 2021 October | 52 | 37 | 89 |
| 2021 September | 39 | 37 | 76 |
| 2021 August | 29 | 31 | 60 |
| 2021 July | 33 | 27 | 60 |
| 2021 June | 34 | 20 | 54 |
| 2021 May | 35 | 43 | 78 |
| 2021 April | 59 | 55 | 114 |
| 2021 March | 54 | 29 | 83 |
| 2021 February | 35 | 19 | 54 |
| 2021 January | 28 | 14 | 42 |
| 2020 December | 34 | 22 | 56 |
| 2020 November | 16 | 15 | 31 |
| 2020 October | 14 | 14 | 28 |
| 2020 September | 40 | 22 | 62 |
| 2020 August | 75 | 16 | 91 |
| 2020 July | 51 | 11 | 62 |
Show all
