array:24 [
  "pii" => "S2173574319300607"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2018.01.009"
  "estado" => "S300"
  "fechaPublicacion" => "2020-01-01"
  "aid" => "1188"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Reumatol Clin. 2020;16:59-61"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X18300287"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2018.01.008"
      "estado" => "S300"
      "fechaPublicacion" => "2020-01-01"
      "aid" => "1188"
      "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;16:59-61"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 609
        "formatos" => array:3 [
          "EPUB" => 39
          "HTML" => 326
          "PDF" => 244
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Reumatolog&#237;a Cl&#237;nica en im&#225;genes</span>"
        "titulo" => "Rara asociaci&#243;n entre la enfermedad de Vogt-Koyanagi-Harada y la artritis reumatoide&#46; Reporte de un caso cl&#237;nico de la consulta multidisciplinar de uve&#237;tis"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "59"
            "paginaFinal" => "61"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Rare association between Vogt-Koyanagi-Harada disease and rheumatoid arthritis&#58; Report of a clinical case from the unit of multidisciplinary uveitis"
          ]
        ]
        "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" => 1255
                "Ancho" => 2335
                "Tamanyo" => 330339
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ojo derecho&#58; A&#41; Al diagn&#243;stico&#46; B&#41; Siete d&#237;as tras el diagn&#243;stico&#46; Desprendimiento seroso &#62; 450 &#40;flecha gris&#41; tabicado &#40;asterisco&#41;&#46; Puntos hiperreflectivos &#40;flecha blanca&#41;&#46; Pliegues del epitelio pigmentario de la retina &#40;punta de flecha negra&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juan Alberto Paz-Solarte, Marisa Hern&#225;ndez-Garfella, Amalia Rueda-Cid, Cristina Campos-Fern&#225;ndez, Javier Calvo-Catala"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "Juan Alberto"
                "apellidos" => "Paz-Solarte"
              ]
              1 => array:2 [
                "nombre" => "Marisa"
                "apellidos" => "Hern&#225;ndez-Garfella"
              ]
              2 => array:2 [
                "nombre" => "Amalia"
                "apellidos" => "Rueda-Cid"
              ]
              3 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Campos-Fern&#225;ndez"
              ]
              4 => array:2 [
                "nombre" => "Javier"
                "apellidos" => "Calvo-Catala"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574319300607"
          "doi" => "10.1016/j.reumae.2018.01.009"
          "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/S2173574319300607?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X18300287?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001600000001/v1_202001221232/S1699258X18300287/v1_202001221232/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574319300565"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2018.01.006"
    "estado" => "S300"
    "fechaPublicacion" => "2020-01-01"
    "aid" => "1185"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2020;16:62-3"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "HTML" => 1
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
      "titulo" => "Bilateral pathologic mandibular fracture in maxillary osteonecrosis induced by bisphosphonates"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "62"
          "paginaFinal" => "63"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fractura patol&#243;gica mandibular bilateral en osteonecrosis maxilar inducida por bisfosfonatos"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 624
              "Ancho" => 1300
              "Tamanyo" => 72931
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image showing the bilateral fracture of the jaw in a mandibular osteonecrosis induced by biphosphonate &#40;the 2 arrows mark the fracture lines&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jose Dar&#237;o S&#225;nchez L&#243;pez, Paolo Cariati, Miguel Angel Perez de Perveval Tara"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Jose Dar&#237;o"
              "apellidos" => "S&#225;nchez L&#243;pez"
            ]
            1 => array:2 [
              "nombre" => "Paolo"
              "apellidos" => "Cariati"
            ]
            2 => array:2 [
              "nombre" => "Miguel Angel"
              "apellidos" => "Perez de Perveval Tara"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X18300251"
        "doi" => "10.1016/j.reuma.2018.01.005"
        "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/S1699258X18300251?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300565?idApp=UINPBA00004M"
    "url" => "/21735743/0000001600000001/v2_202002132029/S2173574319300565/v2_202002132029/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173574319300553"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2018.01.005"
    "estado" => "S300"
    "fechaPublicacion" => "2020-01-01"
    "aid" => "1182"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2020;16:56-8"
    "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" => "Pyle&#39;s disease&#58; A human model of differentiated cortical and trabecular homeostasis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "56"
          "paginaFinal" => "58"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad de Pyle&#58; un modelo humano de homeostasis corticotrabecular diferenciada"
        ]
      ]
      "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&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 725
              "Ancho" => 950
              "Tamanyo" => 71021
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distinctive image of the knees&#44; with surgical material from surgery during childhood for genu valgum and the characteristic morphology in &#8220;Erlenmeyer flask&#8221; of the distal femur&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Luis Arboleya, Rub&#233;n Queiro, Mercedes Alperi, Jos&#233; Andr&#233;s Lorenzo, Javier Ballina"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Arboleya"
            ]
            1 => array:2 [
              "nombre" => "Rub&#233;n"
              "apellidos" => "Queiro"
            ]
            2 => array:2 [
              "nombre" => "Mercedes"
              "apellidos" => "Alperi"
            ]
            3 => array:2 [
              "nombre" => "Jos&#233; Andr&#233;s"
              "apellidos" => "Lorenzo"
            ]
            4 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Ballina"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X18300226"
        "doi" => "10.1016/j.reuma.2018.01.002"
        "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/S1699258X18300226?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300553?idApp=UINPBA00004M"
    "url" => "/21735743/0000001600000001/v2_202002132029/S2173574319300553/v2_202002132029/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
    "titulo" => "Rare association between Vogt&#8211;Koyanagi&#8211;Harada disease and rheumatoid arthritis&#58; Report of a clinical case from the unit of multidisciplinary uveitis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "59"
        "paginaFinal" => "61"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Juan Alberto Paz-Solarte, Marisa Hern&#225;ndez-Garfella, Amalia Rueda-Cid, Cristina Campos-Fern&#225;ndez, Javier Calvo-Catala"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Juan Alberto"
            "apellidos" => "Paz-Solarte"
            "email" => array:1 [
              0 => "juanalbertopazsolarte@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Marisa"
            "apellidos" => "Hern&#225;ndez-Garfella"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Amalia"
            "apellidos" => "Rueda-Cid"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Cristina"
            "apellidos" => "Campos-Fern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Javier"
            "apellidos" => "Calvo-Catala"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Cl&#237;nico Universitario&#44; Valencia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Oftalmolog&#237;a&#44; Consorcio Hospital General Universitario&#44; Valencia&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a y Metabolismo &#211;seo&#44; Consorcio Hospital General Universitario&#44; Valencia&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Rara asociaci&#243;n entre la enfermedad de Vogt-Koyanagi-Harada y la artritis reumatoide&#46; Reporte de un caso cl&#237;nico de la consulta multidisciplinar de uve&#237;tis"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1253
            "Ancho" => 2335
            "Tamanyo" => 194131
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Left eye&#58; &#40;A&#41; On diagnosis&#46; &#40;B&#41; Seven days after diagnosis&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vogt&#8211;Koyanagi&#8211;Harada &#40;VKH&#41; disease is a rare multi-systemic disease&#44; of autoimmune origin that affects the ear&#44; eyes&#44; central nervous system &#40;CNS&#41;&#44; and the skin&#46; It shares some autoimmune mechanisms with rheumatoid arthritis &#40;RA&#41; but is extremely rare in association&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="par0010" class="elsevierStylePara elsevierViewall">To describe the clinical features of the presentation of VKH disease in a patient with a previous diagnosis of RA in clinical remission&#46;</p></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">We describe the case of a 47-year-old female patient with RA &#40;RF&#43; ACCP&#43;&#41; diagnosed in 2014&#44; initially treated with methotrexate&#44; and then with hydroxychloroquine&#46; We highlight the presence of associated metabolic syndrome&#44; and increasingly evident alopecia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient attended the emergency department with intense headache and blurred vision&#46; Given the suspicion of intracranial hypertension&#44; she was admitted to the neurology department who then consulted the rheumatology and ophthalmology departments who&#44; after their initial examination described the following findings&#58;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Visual acuity &#40;VA&#41; &#46;16 and &#46;3&#44; respectively&#44; with no inflammatory signs in the anterior segment&#46; OCT-spectralis&#174; &#40;Heidelberg&#41; &#40;SD-OCT&#41;showed&#58; multilobulated serous detachments affecting the macular and peripapillary area&#44; septation of the detachments was observed together with increased choroid thickness &#40;734<span class="elsevierStyleHsp" style=""></span>&#956;&#44; <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Autofluorescence revealed hypoautofluorescence with a hyperautofluorescent halo surrounding the detachments&#44; and fluorescein angiography showed the typical &#8220;starry sky&#8221; image with multiple leakage sites&#44; and diffusion in the late stages&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnostic criteria for Vogt&#8211;Koyanagi&#8211;Harada disease</span><p id="par0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">No history of perforating trauma or prior surgeries&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">No evidence of previous eye disease&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Bilateral eye involvement &#40;A or B&#44; according to the stage of the disease&#41;&#58;</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">A&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Early manifestations&#58;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Presence of diffuse choroiditis &#40;focal areas of subretinal fluid or bullous serous retinal detachment&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">If the lesions are not that evident&#44; there should be&#58; areas of delayed choroidal filling &#40;FAG&#41;&#44; placoid areas of hyperfluorescence&#44; and optic nerve staining&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Diffuse thickening with no posterior scleritis &#40;ultrasound&#41;&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">B&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Late manifestations&#58;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">History of previous manifestations&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Ocular depigmentation&#58; Sugiura sign or sunset glow fundus&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Others such as numerous chorioretinal scars&#44; recurring or chronic anterior uveitis&#46;</p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">4&#46;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Neurological and or auditory findings&#58;</p></li></ul></p><p id="par0120" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Meningismus&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Tinnitus and&#47;or hearing loss&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Pleocytosis in cerebrospinal fluid&#46;</p></li></ul></p><p id="par0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">5&#46;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Dermatological findings&#44; after uveitis&#58;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Alopecia&#44; vitiligo&#44; poliosis&#46;</p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall">VKH syndrome is defined as&#58;</p><p id="par0165" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Complete&#44; when the patient meets criteria 1 to 5&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Incomplete&#44; when the patient meets criteria 1 to 3&#44; plus the 4th or 5th criteria&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Probable&#44; when only ocular criteria 1 to 3 are present&#46;</p></li></ul></p><p id="par0185" class="elsevierStylePara elsevierViewall">Therefore&#44; our patient fully met the clinical criteria established by the American Uveitis Society &#40;AUS&#41;&#44; published in 2001&#44; in sections 1&#44; 2&#44; 3A&#44; 4&#58; pleocytes in CSF&#44; and 5 alopecia&#46; Finally&#44; a diagnosis of complete acute uveitic stage VKH was made&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">CSF showed the presence of pleocytosis&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Microbiological study discounted acute or latent tuberculosis infection&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">QuantiFERON&#174;-TB gold&#58; negative&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">CSF culture at 45 days&#58; culture negative for mycobacteria&#44; negative for bacteria&#44; and negative for mycosis&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Serology for hepatitis C virus&#44; hepatitis C&#44; HIV and syphilis was negative&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">There is currently no consensus as to the therapeutic regimen for patients with VKH disease&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Treatment was started with 3 1<span class="elsevierStyleHsp" style=""></span>g boluses of methylprednisolone and improved VA was achieved&#58; &#46;7 in both eyes&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">In relation to the pharmacological management of our patient&#44; it is important to highlight her history of an associated metabolic syndrome manifested by chronic hypertension&#44; type 2 diabetes mellitus treated with oral antidiabetic agents&#44; obesity and dyslipidaemia&#46; After induction treatment with intravenous boluses of corticosteroids&#44; the patient suffered metabolic decompensation complicated by sustained hyperglycaemia and hypertensive crisis&#44; therefore we decided to start early treatment with an oral immunosuppressant as a steroid saver&#44; which would also ensure induction initiated with corticosteroids to serve as bridge therapy until starting biological therapy&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">We studied the different treatment options and straight away discounted methotrexate due to a fatty liver and hypertransaminasaemia&#44; and known prior intolerance&#46; We ruled out cyclosporine due to its potential nephrotoxic effect&#44; and the coexistence of kidney failure risk factors &#40;chronic hypertension and diabetes mellitus&#41;&#46; A major limitation to treatment in our case was the patient&#39;s obesity&#46; Therefore&#44; given our experience with the drug we decided to start mycophenolate mofetil as a steroid saver until we could establish biological therapy as the definitive treatment&#44; in this case adalimumab&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The patient was monitored using SD-OCT &#40;Heidelberg&#41; obtaining sequential images that showed a reduction in the serous detachments&#44; persistent impairment of the external retina&#44; and residual perimacular hyperautofluorescence&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0240" class="elsevierStylePara elsevierViewall">Diagnosis of VKH disease is clinical&#46; The characteristic eye involvement is non-infectious granulomatous panuveitis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The presence of neurological manifestations makes an urgent differential diagnosis necessary given the possibility of infection of the CSF&#46; Therefore&#44; detailed medical history and a complete examination are compulsory&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">RA associated with VKH disease is extremely rare&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The most common eye involvement in RA is keratoconjunctivitis sicca&#44; which is present in 25&#37; of patients&#46; In contrast&#44; bilateral panuveitis is unusual&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">By means of CT and MRI we ruled out the presence of space-occupying&#44; vascular or inflammatory lesions&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">By testing the CSF&#44; we found the presence of pleocytosis&#44; and the microbiological study discounted acute or latent tuberculosis infection&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Given the patient&#39;s history of RA&#44; ocular ultrasound ruled out posterior scleritis&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Eventually we made a diagnosis of complete VKH in the acute uveitic phase&#46; Our patient fully met the clinical criteria of the AUS&#44; published in 2001&#44; in sections 1&#44; 2&#44; 3A&#44; 4&#58; pleocytosis in CSF&#44; and 5&#58; alopecia&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Our patient responded favourably to systemic corticosteroids&#44; however&#44; due to her prior metabolic syndrome and to prevent complications associated with prolonged steroid use&#44; administration of immunosuppressant treatment was necessary from the start of the disease&#46; To achieve complete remission&#44; mycophenolate mofetil was prescribed as bridge therapy until starting a TNF inhibitor&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#8211;6</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="par0275" class="elsevierStylePara elsevierViewall">Diagnosis of VKH disease is challenging&#44; and differential diagnosis is compulsory&#46; A multidisciplinary approach to autoimmune diseases enables diagnosis and prompt treatment&#44; improves the prognosis of these diseases&#44; and significantly reduces sequelae to the vital organs&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interests</span><p id="par0280" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:6 [
        0 => array:3 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0010"
              "titulo" => "Objective"
            ]
          ]
        ]
        1 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Case report"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Diagnostic criteria for Vogt&#8211;Koyanagi&#8211;Harada disease"
            ]
          ]
        ]
        2 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        3 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conclusion"
        ]
        4 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflict of interests"
        ]
        5 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-08-17"
    "fechaAceptado" => "2018-01-04"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Paz-Solarte JA&#44; Hern&#225;ndez-Garfella M&#44; Rueda-Cid A&#44; Campos-Fern&#225;ndez C&#44; Calvo-Catala J&#46; Rara asociaci&#243;n entre la enfermedad de Vogt-Koyanagi-Harada y la artritis reumatoide&#46; Reporte de un caso cl&#237;nico de la consulta multidisciplinar de uve&#237;tis&#46; Reumatol Clin&#46; 2020&#59;16&#58;59&#8211;61&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1255
            "Ancho" => 2335
            "Tamanyo" => 330662
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right eye&#58; &#40;A&#41; On diagnosis&#46; &#40;B&#41; Seven days after diagnosis&#46; Serous detachment<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>450 &#40;grey arrow&#41; septated &#40;asterisk&#41;&#46; Hyperreflective points &#40;white arrow&#41;&#46; Retinal pigment epithelial folds &#40;tip of the black arrow&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1253
            "Ancho" => 2335
            "Tamanyo" => 194131
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Left eye&#58; &#40;A&#41; On diagnosis&#46; &#40;B&#41; Seven days after diagnosis&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changing patterns of intraocular inflammatory disease in Japan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Wakabayashi"
                            1 => "Y&#46; Morimura"
                            2 => "Y&#46; Miyamoto"
                            3 => "A&#46;A&#46; Okada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1076/ocii.11.4.277.18260"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ocul Immunol Inflamm"
                        "fecha" => "2003"
                        "volumen" => "11"
                        "paginaInicial" => "277"
                        "paginaFinal" => "286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14704899"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vogt&#8211;Koyanagi&#8211;Harada disease associated with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Ali Tufan"
                            1 => "A&#46; Akbal"
                            2 => "S&#46; Arikan"
                            3 => "B&#46; Gencer"
                            4 => "S&#46; Kara"
                            5 => "A&#46; Tufan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Turk J Rheumatol"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "212"
                        "paginaFinal" => "215"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of ocular complications in rheumatoid arthritis and the relation of keratoconjunctivitis sicca with its systemic activity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Matsuo"
                            1 => "R&#46; Kono"
                            2 => "N&#46; Matsuo"
                            3 => "K&#46; Ezawa"
                            4 => "M&#46; Natsumeda"
                            5 => "K&#46; Soda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/03009749709115829"
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Rheumatol"
                        "fecha" => "1997"
                        "volumen" => "26"
                        "paginaInicial" => "113"
                        "paginaFinal" => "116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9137326"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunomodulatory therapy for Vogt&#8211;Koyanagi&#8211;Harada patients as first-line therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Paredes"
                            1 => "M&#46; Ahmed"
                            2 => "C&#46;S&#46; Foster"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ocul Immunol Inflamm"
                        "fecha" => "2006"
                        "volumen" => "14"
                        "paginaInicial" => "87"
                        "paginaFinal" => "90"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful use of infliximab therapy in sight-threatening corticosteroid-resistant Vogt&#8211;Koyanagi&#8211;Harada disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Zmuda"
                            1 => "K&#46;P&#46; Tiev"
                            2 => "J&#46; Knoeri"
                            3 => "E&#46; Heron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/09273948.2013.775312"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ocul Immunol Inflamm"
                        "fecha" => "2013"
                        "volumen" => "21"
                        "paginaInicial" => "310"
                        "paginaFinal" => "316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23617262"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adalimumab therapy for Vogt&#8211;Koyanagi&#8211;Harada syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Diaz Llopis"
                            1 => "L&#46; Amselem"
                            2 => "F&#46;J&#46; Romero"
                            3 => "S&#46; Garcia-Delpech"
                            4 => "M&#46;L&#46; Hernandez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4321/s0365-66912007000300003"
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Soc Esp Oftalmol"
                        "fecha" => "2007"
                        "volumen" => "82"
                        "paginaInicial" => "131"
                        "paginaFinal" => "132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17357888"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0030666515000870"
                          "estado" => "S300"
                          "issn" => "00306665"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001600000001/v2_202002132029/S2173574319300607/v2_202002132029/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5795"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Images in Clinical Rheumatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001600000001/v2_202002132029/S2173574319300607/v2_202002132029/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300607?idApp=UINPBA00004M"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Images in Clinical Rheumatology
Rare association between Vogt–Koyanagi–Harada disease and rheumatoid arthritis: Report of a clinical case from the unit of multidisciplinary uveitis
Rara asociación entre la enfermedad de Vogt-Koyanagi-Harada y la artritis reumatoide. Reporte de un caso clínico de la consulta multidisciplinar de uveítis
Juan Alberto Paz-Solartea,
Corresponding author
juanalbertopazsolarte@gmail.com

Corresponding author.
, Marisa Hernández-Garfellab, Amalia Rueda-Cidc, Cristina Campos-Fernándezc, Javier Calvo-Catalac
a Servicio de Reumatología, Hospital Clínico Universitario, Valencia, Spain
b Servicio de Oftalmología, Consorcio Hospital General Universitario, Valencia, Spain
c Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario, Valencia, Spain
Read
5935
Times
was read the article
1507
Total PDF
4428
Total HTML
Share statistics
 array:24 [
  "pii" => "S2173574319300607"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2018.01.009"
  "estado" => "S300"
  "fechaPublicacion" => "2020-01-01"
  "aid" => "1188"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Reumatol Clin. 2020;16:59-61"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X18300287"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2018.01.008"
      "estado" => "S300"
      "fechaPublicacion" => "2020-01-01"
      "aid" => "1188"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Reumatol Clin. 2020;16:59-61"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 609
        "formatos" => array:3 [
          "EPUB" => 39
          "HTML" => 326
          "PDF" => 244
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Reumatolog&#237;a Cl&#237;nica en im&#225;genes</span>"
        "titulo" => "Rara asociaci&#243;n entre la enfermedad de Vogt-Koyanagi-Harada y la artritis reumatoide&#46; Reporte de un caso cl&#237;nico de la consulta multidisciplinar de uve&#237;tis"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "59"
            "paginaFinal" => "61"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Rare association between Vogt-Koyanagi-Harada disease and rheumatoid arthritis&#58; Report of a clinical case from the unit of multidisciplinary uveitis"
          ]
        ]
        "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" => 1255
                "Ancho" => 2335
                "Tamanyo" => 330339
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ojo derecho&#58; A&#41; Al diagn&#243;stico&#46; B&#41; Siete d&#237;as tras el diagn&#243;stico&#46; Desprendimiento seroso &#62; 450 &#40;flecha gris&#41; tabicado &#40;asterisco&#41;&#46; Puntos hiperreflectivos &#40;flecha blanca&#41;&#46; Pliegues del epitelio pigmentario de la retina &#40;punta de flecha negra&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juan Alberto Paz-Solarte, Marisa Hern&#225;ndez-Garfella, Amalia Rueda-Cid, Cristina Campos-Fern&#225;ndez, Javier Calvo-Catala"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "Juan Alberto"
                "apellidos" => "Paz-Solarte"
              ]
              1 => array:2 [
                "nombre" => "Marisa"
                "apellidos" => "Hern&#225;ndez-Garfella"
              ]
              2 => array:2 [
                "nombre" => "Amalia"
                "apellidos" => "Rueda-Cid"
              ]
              3 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Campos-Fern&#225;ndez"
              ]
              4 => array:2 [
                "nombre" => "Javier"
                "apellidos" => "Calvo-Catala"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574319300607"
          "doi" => "10.1016/j.reumae.2018.01.009"
          "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/S2173574319300607?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X18300287?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001600000001/v1_202001221232/S1699258X18300287/v1_202001221232/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574319300565"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2018.01.006"
    "estado" => "S300"
    "fechaPublicacion" => "2020-01-01"
    "aid" => "1185"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2020;16:62-3"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "HTML" => 1
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
      "titulo" => "Bilateral pathologic mandibular fracture in maxillary osteonecrosis induced by bisphosphonates"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "62"
          "paginaFinal" => "63"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fractura patol&#243;gica mandibular bilateral en osteonecrosis maxilar inducida por bisfosfonatos"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 624
              "Ancho" => 1300
              "Tamanyo" => 72931
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image showing the bilateral fracture of the jaw in a mandibular osteonecrosis induced by biphosphonate &#40;the 2 arrows mark the fracture lines&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jose Dar&#237;o S&#225;nchez L&#243;pez, Paolo Cariati, Miguel Angel Perez de Perveval Tara"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Jose Dar&#237;o"
              "apellidos" => "S&#225;nchez L&#243;pez"
            ]
            1 => array:2 [
              "nombre" => "Paolo"
              "apellidos" => "Cariati"
            ]
            2 => array:2 [
              "nombre" => "Miguel Angel"
              "apellidos" => "Perez de Perveval Tara"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X18300251"
        "doi" => "10.1016/j.reuma.2018.01.005"
        "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/S1699258X18300251?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300565?idApp=UINPBA00004M"
    "url" => "/21735743/0000001600000001/v2_202002132029/S2173574319300565/v2_202002132029/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173574319300553"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2018.01.005"
    "estado" => "S300"
    "fechaPublicacion" => "2020-01-01"
    "aid" => "1182"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2020;16:56-8"
    "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" => "Pyle&#39;s disease&#58; A human model of differentiated cortical and trabecular homeostasis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "56"
          "paginaFinal" => "58"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad de Pyle&#58; un modelo humano de homeostasis corticotrabecular diferenciada"
        ]
      ]
      "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&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 725
              "Ancho" => 950
              "Tamanyo" => 71021
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distinctive image of the knees&#44; with surgical material from surgery during childhood for genu valgum and the characteristic morphology in &#8220;Erlenmeyer flask&#8221; of the distal femur&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Luis Arboleya, Rub&#233;n Queiro, Mercedes Alperi, Jos&#233; Andr&#233;s Lorenzo, Javier Ballina"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Arboleya"
            ]
            1 => array:2 [
              "nombre" => "Rub&#233;n"
              "apellidos" => "Queiro"
            ]
            2 => array:2 [
              "nombre" => "Mercedes"
              "apellidos" => "Alperi"
            ]
            3 => array:2 [
              "nombre" => "Jos&#233; Andr&#233;s"
              "apellidos" => "Lorenzo"
            ]
            4 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Ballina"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X18300226"
        "doi" => "10.1016/j.reuma.2018.01.002"
        "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/S1699258X18300226?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300553?idApp=UINPBA00004M"
    "url" => "/21735743/0000001600000001/v2_202002132029/S2173574319300553/v2_202002132029/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
    "titulo" => "Rare association between Vogt&#8211;Koyanagi&#8211;Harada disease and rheumatoid arthritis&#58; Report of a clinical case from the unit of multidisciplinary uveitis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "59"
        "paginaFinal" => "61"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Juan Alberto Paz-Solarte, Marisa Hern&#225;ndez-Garfella, Amalia Rueda-Cid, Cristina Campos-Fern&#225;ndez, Javier Calvo-Catala"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Juan Alberto"
            "apellidos" => "Paz-Solarte"
            "email" => array:1 [
              0 => "juanalbertopazsolarte@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Marisa"
            "apellidos" => "Hern&#225;ndez-Garfella"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Amalia"
            "apellidos" => "Rueda-Cid"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Cristina"
            "apellidos" => "Campos-Fern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Javier"
            "apellidos" => "Calvo-Catala"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Cl&#237;nico Universitario&#44; Valencia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Oftalmolog&#237;a&#44; Consorcio Hospital General Universitario&#44; Valencia&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a y Metabolismo &#211;seo&#44; Consorcio Hospital General Universitario&#44; Valencia&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Rara asociaci&#243;n entre la enfermedad de Vogt-Koyanagi-Harada y la artritis reumatoide&#46; Reporte de un caso cl&#237;nico de la consulta multidisciplinar de uve&#237;tis"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1253
            "Ancho" => 2335
            "Tamanyo" => 194131
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Left eye&#58; &#40;A&#41; On diagnosis&#46; &#40;B&#41; Seven days after diagnosis&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vogt&#8211;Koyanagi&#8211;Harada &#40;VKH&#41; disease is a rare multi-systemic disease&#44; of autoimmune origin that affects the ear&#44; eyes&#44; central nervous system &#40;CNS&#41;&#44; and the skin&#46; It shares some autoimmune mechanisms with rheumatoid arthritis &#40;RA&#41; but is extremely rare in association&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="par0010" class="elsevierStylePara elsevierViewall">To describe the clinical features of the presentation of VKH disease in a patient with a previous diagnosis of RA in clinical remission&#46;</p></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">We describe the case of a 47-year-old female patient with RA &#40;RF&#43; ACCP&#43;&#41; diagnosed in 2014&#44; initially treated with methotrexate&#44; and then with hydroxychloroquine&#46; We highlight the presence of associated metabolic syndrome&#44; and increasingly evident alopecia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient attended the emergency department with intense headache and blurred vision&#46; Given the suspicion of intracranial hypertension&#44; she was admitted to the neurology department who then consulted the rheumatology and ophthalmology departments who&#44; after their initial examination described the following findings&#58;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Visual acuity &#40;VA&#41; &#46;16 and &#46;3&#44; respectively&#44; with no inflammatory signs in the anterior segment&#46; OCT-spectralis&#174; &#40;Heidelberg&#41; &#40;SD-OCT&#41;showed&#58; multilobulated serous detachments affecting the macular and peripapillary area&#44; septation of the detachments was observed together with increased choroid thickness &#40;734<span class="elsevierStyleHsp" style=""></span>&#956;&#44; <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Autofluorescence revealed hypoautofluorescence with a hyperautofluorescent halo surrounding the detachments&#44; and fluorescein angiography showed the typical &#8220;starry sky&#8221; image with multiple leakage sites&#44; and diffusion in the late stages&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnostic criteria for Vogt&#8211;Koyanagi&#8211;Harada disease</span><p id="par0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">No history of perforating trauma or prior surgeries&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">No evidence of previous eye disease&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Bilateral eye involvement &#40;A or B&#44; according to the stage of the disease&#41;&#58;</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">A&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Early manifestations&#58;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Presence of diffuse choroiditis &#40;focal areas of subretinal fluid or bullous serous retinal detachment&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">If the lesions are not that evident&#44; there should be&#58; areas of delayed choroidal filling &#40;FAG&#41;&#44; placoid areas of hyperfluorescence&#44; and optic nerve staining&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Diffuse thickening with no posterior scleritis &#40;ultrasound&#41;&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">B&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Late manifestations&#58;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">History of previous manifestations&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Ocular depigmentation&#58; Sugiura sign or sunset glow fundus&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Others such as numerous chorioretinal scars&#44; recurring or chronic anterior uveitis&#46;</p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">4&#46;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Neurological and or auditory findings&#58;</p></li></ul></p><p id="par0120" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Meningismus&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Tinnitus and&#47;or hearing loss&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Pleocytosis in cerebrospinal fluid&#46;</p></li></ul></p><p id="par0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">5&#46;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Dermatological findings&#44; after uveitis&#58;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Alopecia&#44; vitiligo&#44; poliosis&#46;</p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall">VKH syndrome is defined as&#58;</p><p id="par0165" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Complete&#44; when the patient meets criteria 1 to 5&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Incomplete&#44; when the patient meets criteria 1 to 3&#44; plus the 4th or 5th criteria&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Probable&#44; when only ocular criteria 1 to 3 are present&#46;</p></li></ul></p><p id="par0185" class="elsevierStylePara elsevierViewall">Therefore&#44; our patient fully met the clinical criteria established by the American Uveitis Society &#40;AUS&#41;&#44; published in 2001&#44; in sections 1&#44; 2&#44; 3A&#44; 4&#58; pleocytes in CSF&#44; and 5 alopecia&#46; Finally&#44; a diagnosis of complete acute uveitic stage VKH was made&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">CSF showed the presence of pleocytosis&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Microbiological study discounted acute or latent tuberculosis infection&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">QuantiFERON&#174;-TB gold&#58; negative&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">CSF culture at 45 days&#58; culture negative for mycobacteria&#44; negative for bacteria&#44; and negative for mycosis&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Serology for hepatitis C virus&#44; hepatitis C&#44; HIV and syphilis was negative&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">There is currently no consensus as to the therapeutic regimen for patients with VKH disease&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Treatment was started with 3 1<span class="elsevierStyleHsp" style=""></span>g boluses of methylprednisolone and improved VA was achieved&#58; &#46;7 in both eyes&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">In relation to the pharmacological management of our patient&#44; it is important to highlight her history of an associated metabolic syndrome manifested by chronic hypertension&#44; type 2 diabetes mellitus treated with oral antidiabetic agents&#44; obesity and dyslipidaemia&#46; After induction treatment with intravenous boluses of corticosteroids&#44; the patient suffered metabolic decompensation complicated by sustained hyperglycaemia and hypertensive crisis&#44; therefore we decided to start early treatment with an oral immunosuppressant as a steroid saver&#44; which would also ensure induction initiated with corticosteroids to serve as bridge therapy until starting biological therapy&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">We studied the different treatment options and straight away discounted methotrexate due to a fatty liver and hypertransaminasaemia&#44; and known prior intolerance&#46; We ruled out cyclosporine due to its potential nephrotoxic effect&#44; and the coexistence of kidney failure risk factors &#40;chronic hypertension and diabetes mellitus&#41;&#46; A major limitation to treatment in our case was the patient&#39;s obesity&#46; Therefore&#44; given our experience with the drug we decided to start mycophenolate mofetil as a steroid saver until we could establish biological therapy as the definitive treatment&#44; in this case adalimumab&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The patient was monitored using SD-OCT &#40;Heidelberg&#41; obtaining sequential images that showed a reduction in the serous detachments&#44; persistent impairment of the external retina&#44; and residual perimacular hyperautofluorescence&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0240" class="elsevierStylePara elsevierViewall">Diagnosis of VKH disease is clinical&#46; The characteristic eye involvement is non-infectious granulomatous panuveitis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The presence of neurological manifestations makes an urgent differential diagnosis necessary given the possibility of infection of the CSF&#46; Therefore&#44; detailed medical history and a complete examination are compulsory&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">RA associated with VKH disease is extremely rare&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The most common eye involvement in RA is keratoconjunctivitis sicca&#44; which is present in 25&#37; of patients&#46; In contrast&#44; bilateral panuveitis is unusual&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">By means of CT and MRI we ruled out the presence of space-occupying&#44; vascular or inflammatory lesions&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">By testing the CSF&#44; we found the presence of pleocytosis&#44; and the microbiological study discounted acute or latent tuberculosis infection&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Given the patient&#39;s history of RA&#44; ocular ultrasound ruled out posterior scleritis&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Eventually we made a diagnosis of complete VKH in the acute uveitic phase&#46; Our patient fully met the clinical criteria of the AUS&#44; published in 2001&#44; in sections 1&#44; 2&#44; 3A&#44; 4&#58; pleocytosis in CSF&#44; and 5&#58; alopecia&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Our patient responded favourably to systemic corticosteroids&#44; however&#44; due to her prior metabolic syndrome and to prevent complications associated with prolonged steroid use&#44; administration of immunosuppressant treatment was necessary from the start of the disease&#46; To achieve complete remission&#44; mycophenolate mofetil was prescribed as bridge therapy until starting a TNF inhibitor&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#8211;6</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="par0275" class="elsevierStylePara elsevierViewall">Diagnosis of VKH disease is challenging&#44; and differential diagnosis is compulsory&#46; A multidisciplinary approach to autoimmune diseases enables diagnosis and prompt treatment&#44; improves the prognosis of these diseases&#44; and significantly reduces sequelae to the vital organs&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interests</span><p id="par0280" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:6 [
        0 => array:3 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0010"
              "titulo" => "Objective"
            ]
          ]
        ]
        1 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Case report"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Diagnostic criteria for Vogt&#8211;Koyanagi&#8211;Harada disease"
            ]
          ]
        ]
        2 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        3 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conclusion"
        ]
        4 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflict of interests"
        ]
        5 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-08-17"
    "fechaAceptado" => "2018-01-04"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Paz-Solarte JA&#44; Hern&#225;ndez-Garfella M&#44; Rueda-Cid A&#44; Campos-Fern&#225;ndez C&#44; Calvo-Catala J&#46; Rara asociaci&#243;n entre la enfermedad de Vogt-Koyanagi-Harada y la artritis reumatoide&#46; Reporte de un caso cl&#237;nico de la consulta multidisciplinar de uve&#237;tis&#46; Reumatol Clin&#46; 2020&#59;16&#58;59&#8211;61&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1255
            "Ancho" => 2335
            "Tamanyo" => 330662
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right eye&#58; &#40;A&#41; On diagnosis&#46; &#40;B&#41; Seven days after diagnosis&#46; Serous detachment<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>450 &#40;grey arrow&#41; septated &#40;asterisk&#41;&#46; Hyperreflective points &#40;white arrow&#41;&#46; Retinal pigment epithelial folds &#40;tip of the black arrow&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1253
            "Ancho" => 2335
            "Tamanyo" => 194131
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Left eye&#58; &#40;A&#41; On diagnosis&#46; &#40;B&#41; Seven days after diagnosis&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changing patterns of intraocular inflammatory disease in Japan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Wakabayashi"
                            1 => "Y&#46; Morimura"
                            2 => "Y&#46; Miyamoto"
                            3 => "A&#46;A&#46; Okada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1076/ocii.11.4.277.18260"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ocul Immunol Inflamm"
                        "fecha" => "2003"
                        "volumen" => "11"
                        "paginaInicial" => "277"
                        "paginaFinal" => "286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14704899"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vogt&#8211;Koyanagi&#8211;Harada disease associated with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Ali Tufan"
                            1 => "A&#46; Akbal"
                            2 => "S&#46; Arikan"
                            3 => "B&#46; Gencer"
                            4 => "S&#46; Kara"
                            5 => "A&#46; Tufan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Turk J Rheumatol"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "212"
                        "paginaFinal" => "215"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of ocular complications in rheumatoid arthritis and the relation of keratoconjunctivitis sicca with its systemic activity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Matsuo"
                            1 => "R&#46; Kono"
                            2 => "N&#46; Matsuo"
                            3 => "K&#46; Ezawa"
                            4 => "M&#46; Natsumeda"
                            5 => "K&#46; Soda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/03009749709115829"
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Rheumatol"
                        "fecha" => "1997"
                        "volumen" => "26"
                        "paginaInicial" => "113"
                        "paginaFinal" => "116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9137326"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunomodulatory therapy for Vogt&#8211;Koyanagi&#8211;Harada patients as first-line therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Paredes"
                            1 => "M&#46; Ahmed"
                            2 => "C&#46;S&#46; Foster"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ocul Immunol Inflamm"
                        "fecha" => "2006"
                        "volumen" => "14"
                        "paginaInicial" => "87"
                        "paginaFinal" => "90"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful use of infliximab therapy in sight-threatening corticosteroid-resistant Vogt&#8211;Koyanagi&#8211;Harada disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Zmuda"
                            1 => "K&#46;P&#46; Tiev"
                            2 => "J&#46; Knoeri"
                            3 => "E&#46; Heron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/09273948.2013.775312"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ocul Immunol Inflamm"
                        "fecha" => "2013"
                        "volumen" => "21"
                        "paginaInicial" => "310"
                        "paginaFinal" => "316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23617262"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adalimumab therapy for Vogt&#8211;Koyanagi&#8211;Harada syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Diaz Llopis"
                            1 => "L&#46; Amselem"
                            2 => "F&#46;J&#46; Romero"
                            3 => "S&#46; Garcia-Delpech"
                            4 => "M&#46;L&#46; Hernandez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4321/s0365-66912007000300003"
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Soc Esp Oftalmol"
                        "fecha" => "2007"
                        "volumen" => "82"
                        "paginaInicial" => "131"
                        "paginaFinal" => "132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17357888"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0030666515000870"
                          "estado" => "S300"
                          "issn" => "00306665"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001600000001/v2_202002132029/S2173574319300607/v2_202002132029/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5795"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Images in Clinical Rheumatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001600000001/v2_202002132029/S2173574319300607/v2_202002132029/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300607?idApp=UINPBA00004M"
]
Article information
ISSN: 21735743
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 October 43 18 61
2024 September 83 24 107
2024 August 94 42 136
2024 July 111 29 140
2024 June 177 28 205
2024 May 99 55 154
2024 April 80 23 103
2024 March 85 27 112
2024 February 91 34 125
2024 January 76 29 105
2023 December 81 19 100
2023 November 100 18 118
2023 October 96 29 125
2023 September 106 32 138
2023 August 98 12 110
2023 July 89 17 106
2023 June 88 17 105
2023 May 95 22 117
2023 April 79 6 85
2023 March 150 28 178
2023 February 90 22 112
2023 January 112 12 124
2022 December 116 27 143
2022 November 102 29 131
2022 October 97 25 122
2022 September 84 30 114
2022 August 78 32 110
2022 July 76 32 108
2022 June 99 37 136
2022 May 87 31 118
2022 April 95 38 133
2022 March 107 41 148
2022 February 79 24 103
2022 January 89 30 119
2021 December 82 43 125
2021 November 70 36 106
2021 October 118 47 165
2021 September 69 42 111
2021 August 56 35 91
2021 July 52 36 88
2021 June 58 39 97
2021 May 63 42 105
2021 April 179 107 286
2021 March 87 20 107
2021 February 70 17 87
2021 January 78 19 97
2020 December 53 20 73
2020 November 48 15 63
2020 October 25 13 38
2020 September 40 29 69
2020 August 22 18 40
2020 July 26 10 36
Show all

Follow this link to access the full text of the article

Idiomas
Reumatología Clínica (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?