Subclinical synovitis and tenosynovitis by ultrasonography (US) 7 score in patients with rheumatoid arthritis treated with synthetic drugs, in clinical remission by DAS28

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arthritis treated with synthetic drugs, in clinical remission by DAS28" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e5" "paginaFinal" => "e9" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lucio Ventura-Ríos, Guadalupe Sánchez Bringas, Cristina Hernández-Díaz, Esteban Cruz-Arenas, Rubén Burgos-Vargas" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Lucio" "apellidos" => "Ventura-Ríos" "email" => array:1 [ 0 => "venturarioslucio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Guadalupe" "apellidos" => "Sánchez Bringas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Cristina" "apellidos" => "Hernández-Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => 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"aff0015" ] 3 => array:3 [ "entidad" => "Director de Investigación, Hospital General de México “Eduardo Liceaga”, México City, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sinovitis y tenosinovitis subclínica evaluada por índice ultrasonográfico 7 en pacientes con artritis reumatoide tratados con fármacos sintéticos en remisión clínica por DAS-28" ] ] "textoCompleto" => "IntroductionThe aim of treatment in rheumatoid arthritis (RA) is to suppress the disease activity and induce remission as quickly and for as long as possible, to prevent joint damage and loss of function.<a class="elsevierStyleCrossRef" href="#bib0150">1</a> The assessment of disease activity relies on composite indexes that include clinical findings. However, several reports have shown that a high percentage of patients categorized on remission by clinical methods may develop radiographic progression (irreversible structural damage) throughout follow up because of subclinical synovitis that is not detectable with simple X-ray.<a class="elsevierStyleCrossRef" href="#bib0155">2</a> Magnetic Resonance Imaging (MRI) is perhaps the best tool to assess subclinical synovitis and early loss of the articular cartilage and erosions development, but its high cost and sometimes the need for enhancing medium to evaluate synovitis among others limit its accessibility.<a class="elsevierStyleCrossRef" href="#bib0160">3</a>In this context, US is a highly useful technique low cost, multiplanar, and non-invasive technique that does no produce any radiation, does not require contrast medium, and can be repeated as many times as necessary. Grayscale (GS) and power Doppler (PD) may show subclinical synovitis in patients with RA in remission achieved by the use of synthetic or biologic disease-modifying antirheumatic drugs (DMARDs).<a class="elsevierStyleCrossRef" href="#bib0165">4</a> GS synovitis suggest the development or worsening of bone erosions<a class="elsevierStyleCrossRef" href="#bib0170">5</a> and the presence of PD signal increases at least >1 the probability of flare up in clinical remission.<a class="elsevierStyleCrossRef" href="#bib0175">6</a>US is superior to clinical examination in detecting joint inflammation in undifferentiated arthritis, and in established RA.<a class="elsevierStyleCrossRef" href="#bib0180">7</a> Joint exploration by US has been used to reclassify patients who clinically have fewer inflamed joints by showing synovitis in those which are apparently normal.<a class="elsevierStyleCrossRef" href="#bib0180">7</a> Also, it has validity comparable to MRI with contrast medium and arthroscopy to detect synovitis, and is superior to simple X-ray to detect erosions.<a class="elsevierStyleCrossRef" href="#bib0185">8</a> There are different scales to evaluate joint inflammation. Today, it has been shown that the US 7 scale is equally sensitive as the 78-joint scale to evaluate changes in grayscale and PD.<a class="elsevierStyleCrossRef" href="#bib0190">9</a>The importance of proper monitoring of the disease is that timely modifications of treatment can be made, which may really change the course of the disease, by preventing structural damage and permanent disability.<a class="elsevierStyleCrossRef" href="#bib0195">10</a> It is therefore that the objective of this investigation was to evaluate the presence of inflammatory activity, by means of the US 7 scale, in patients with RA treated with synthetic DMARDs who were clinically in remission according to the DAS28 score.Material and methodsWe conducted a prospective, cross-sectional, observational phase IV study between March, 2013, and June, 2014 in three centers in México City. Ninety-four patients over 18 years of age with RA<a class="elsevierStyleCrossRef" href="#bib0200">11</a> receiving treatment with synthetic DMARDs (methotrexate, hydroxychloroquine, chloroquine, leflunomide, sulfasalazine) (either as monotherapy or combined therapy), without corticosteroid and treatment without modifications in clinical remission by DAS28 score (<2.6) at least for 6 months before they were included in the study. Only subjects whose treatment remained stable for 6 months before entering the study were included. We excluded patients who had received glucocorticoid infiltration during 6 months prior to inclusion in the study. All patients agreed to participate in the study and signed an informed consent form. Patients currently or past treated with anti-TNFs such as infliximab, adalimumab, certolizumab pegol and golimumab, or with circulating receptor fusion proteins like etanercept, were not included in the study. The National Bioethics Committee for clinical research approved the protocol.The sample included 100 patients of whom 94 patients completed the two visits planned for the study. At visit 1 (days −10 to 0), informed consent was presented to patients and signed by those who accepted their participation; then, inclusion and exclusion criteria were checked; and data on clinical evaluation and therapeutic history was collected. One experimented rheumatologist conducted clinical evaluation. At visit 2 (days 1–7), patients were sent to only one of the centers to underwent the US 7 scale (grayscale and PD) joint evaluation<a class="elsevierStyleCrossRef" href="#bib0190">9</a> performed by a rheumatologist, who was blinded to clinical findings. The average time for each evaluation was 15min.US studies were carried out with a Esaote MyLab 25® US equipment (Biomedica, Genoa, Italy) equipped with a 10–18MHz linear transducer; PD was adjusted according to the following parameters: frequency, 8.0, PRF, 0.500, wall filter, 3, gain between 50 and 70. PD gain was set to a level below its appearance from cortical bone.<a class="elsevierStyleCrossRef" href="#bib0205">12</a> The US 7 scale included the wrist, 2nd, and 3rd metacarpophalangeal (MCP) joints, 2nd and 3rd proximal interphalangeal (PIP) joints, and 2nd and 5th metatarsophalangeal (MTP) joints on the clinically dominant side,<a class="elsevierStyleCrossRef" href="#bib0190">9</a> according to EULAR US guidelines.<a class="elsevierStyleCrossRef" href="#bib0210">13</a>OMERACT definitions were used to describe synovitis, tenosynovitis, and erosions. Synovitis is seen as effusion defined as abnormal, hypoechoic or anechoic, compressible, displaceable intraarticular material, without PD signal, and synovial hypertrophy as abnormal hypoechoic, poorly compressible intra-articular tissue that may exhibit PD signal.<a class="elsevierStyleCrossRef" href="#bib0215">14</a> Tenosynovitis: abnormal, hypoechoic or anechoic (relative to tendon fibers) tendon sheath widening which can be related both to the presence of abnormal tenosynovial fluid and/or hypertrophy<a class="elsevierStyleCrossRef" href="#bib0220">15</a> thickened, hypoechoic or anechoic tissue with or without fluid in the tendon sheath. Erosion: an intraarticular discontinuity of the bone surface visible in 2 perpendicular planes.<a class="elsevierStyleCrossRef" href="#bib0220">15</a> Also, the presence of paratenonitis, was evaluated, and defined as a hypoechoic halo around the tendon with or without the presence of PD.<a class="elsevierStyleCrossRef" href="#bib0190">9</a> Tenosynovitis or paratenonitis, and erosions were reported as present or absent (1 or 0).Grayscale synovitis was evaluated semi-quantitatively: 0 absent, 1 mild, 2 moderate, and 3 severe. Grade 1 describes a hypoechoic or anechoic area which does not extend beyond the joint capsule interline; in grade 2, the joint capsule is raised parallel to the articular area; and grade 3 shows notable widening of the joint capsule.<a class="elsevierStyleCrossRef" href="#bib0190">9</a> The presence of PD was graduated as follows: grade 0 without intra-articular signal; grade 1, up to 3 signals in the joint area; grade 2, more than 3 signals in less than 50% of the intraarticular area; grade 3, more than 50% of the intraarticular area.<a class="elsevierStyleCrossRef" href="#bib0225">16</a> US evaluation was performed only by one ultrasonographer. Intra and inter-reading exercise were done by 2 ultrasonographers.Statistical analysisMedian, standard deviation (SD), and percentages were used to describe patients’ clinical characteristics and US findings. Intra and Inter-reader reliability were calculated by the Cohen's kappa coefficient. Kappa values were assigned the following designations: below 0.20 as poor, 0.21–0.40 as fair, 0.41–0.60 as moderate, 0.61–0.80 as good, and 0.81–1 as excellent. The analyses were performed using the SPSS ver. 21.0 statistical computer software (SPSS, Inc., Chicago, IL, USA).ResultsClinical and demographic data are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Ninety-four patients were included; six were excluded for failing to meet the criterion of DAS28 below 2.6. As expected, most patients were women. Disease duration was 27.5+31.8 months and DAS28 was 1.9+0.66.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the prevalence of elementary lesions in all joints evaluated. In grayscale we observed a high prevalence of synovitis in 94% (88 patients), although in almost 90% changes were mild and moderate in only 12.5%; there were no severe lesions found in the study. Only 12 (13%) of the 94 patients had PD signal and in all it was mild. Tenosynovitis was observed in 9 (9.6%) in grayscale and with PD only 2 (2.1%). Paratenonitis was not observed in any case. Erosions were found in 34 (36%) patients.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the frequency of elementary lesions by US grayscale in most affected regions. The prevalence was high in metatarsal joints, followed by MCP and carpal joints (88.6%, 60.8%, and 51.5% respectively). On the other hand, tenosynovitis was more common in hand flexors in MCP joints than in the carpus (8.2% vs. 1%). Erosions were more common in metatarsal heads than in metacarpal joints (29.9% vs. 16.5%).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> presents the distribution of elementary lesions with PD signal. The highest prevalence was in MCP joints, then in wrists, and the lowest in MTP joints (8.2%, 5.1%, and 1.0% respectively). In only 1% of patients, PD was observed in tenosynovitis of finger flexors at the metacarpal level and 1% in carpus. None of the erosions showed PD signal.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The intra and inter-reading kappa value were respectively 0.77, p<0.003 (CI 95%, 0.34–0.81) and 0.81, p<0.0001 (CI 95%, 0.27–0.83).DiscussionIn this study the prevalence of subclinical synovitis, in grayscale was high and low by PD, similar as shown by a systematic review of the literature, where percentages ranging from 73% to 95% and from 8.5% to 62%.<a class="elsevierStyleCrossRef" href="#bib0180">7</a> Thus, in turn, corroborates the discrepancy between the criterion of clinical remission used and US findings. Some studies have reported that, regardless of the specific criteria of remission used, when evaluated by US, synovitis active is detected in 60–80% of patients.<a class="elsevierStyleCrossRef" href="#bib0230">17</a> The use of US to monitor patients in clinical remission can help to predict those likely to suffer flare-up or structural damage.<a class="elsevierStyleCrossRefs" href="#bib0230">17,18</a> Because some studies have demonstrated high percentage of synovial hypertrophy on US in patients considered to be in remission, this state should be defined only in the absence of synovitis by this technique.<a class="elsevierStyleCrossRef" href="#bib0240">19</a>The sites of greatest prevalence of synovitis are the carpal and the MCP joints.<a class="elsevierStyleCrossRef" href="#bib0215">14</a> However, in our study, we observed more synovitis in the metatarsal joints, which correlates with reports indicating that the feet are affected in around 90% of patients during the course of the disease, 91% in women and 85% in men.<a class="elsevierStyleCrossRef" href="#bib0245">20</a> Additionally, this is the region that conditions the highest rates of disability,<a class="elsevierStyleCrossRef" href="#bib0250">21</a> which underscores the importance of including such joints in scanning for synovitis. In relation to PD, multiple studies have reported that a signal was present in around 50% of patients in clinical remission in MCP and carpal joints of the dominant hand. Our findings are some similar, since we detected a lower percentage of activity, perhaps of the longer remission time in our group.<a class="elsevierStyleCrossRefs" href="#bib0225">16,22</a>The prevalence of tenosynovitis in long term RA ranges from 5% to 55%.<a class="elsevierStyleCrossRef" href="#bib0260">23</a> We found tenosynovitis in less than 10% of patients, predominantly in the third flexor of the dominant hand. This finding may be related to biomechanical factors due to the high range of movement of that tendon compared with others.<a class="elsevierStyleCrossRef" href="#bib0260">23</a> Tenosynovitis may be very important for monitoring RA, because could conditioned tendon damage and consequently disability.<a class="elsevierStyleCrossRef" href="#bib0265">24</a> Lillegraven et al. have demonstrated that tenosynovitis assessed by US predicts the development of erosive joint damage in a cohort of early RA patients.<a class="elsevierStyleCrossRef" href="#bib0270">25</a> Two studies have shown that tenosynovitis is not present in true remission, suggesting the high value of its assessment by US.<a class="elsevierStyleCrossRefs" href="#bib0275">26,27</a> Furthermore, damaged tendon as assessed by US correlates very well with bone structural damage assessed by X-ray.<a class="elsevierStyleCrossRef" href="#bib0280">27</a> Today, however, there is neither established scale nor which tendons should be included in US evaluation for monitoring.<a class="elsevierStyleCrossRef" href="#bib0265">24</a>Bone erosions including in this score pertain to the realm of structural damage. In this study, around 30% had erosions in the MTP joints and 16% in the MCP joints. For patients with established diagnosis of RA, perhaps bone erosions have not great value, and may be more useful in patients with suspected early-stage RA. However, some data suggest that bone erosions may sensitive to change.<a class="elsevierStyleCrossRef" href="#bib0285">28</a>To the best of our knowledge, this is the first study that applied US 7 scale to detect any residual inflammatory activity in clinical remission, in joint and tendon level with vantage of consuming less time than more extended count joint and had been used to evaluate response to treatment.<a class="elsevierStyleCrossRef" href="#bib0290">29</a>LimitationsWe considered another method, such as magnetic resonance imaging (MRI) was needed to compare the findings, but MRI is not a feasible technique to evaluate multiple joints at the same time. Additionally, control group was absence.ConclusionsThe prevalence of synovitis and tenosynovitis assessed by US 7 score is low in patients with rheumatoid arthritis in clinical remission by DAS28 during long time of disease remission. The US 7 score is useful because add additional value to detect tenosynovitis that appear other instruments to measure real remission state.FundingThe present work was supported by unrestricted AbbVie grants.Conflicts of interestThe authors declare have not conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres1258206" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1165539" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1258205" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1165540" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Limitations" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 13 => array:2 [ "identificador" => "xack431396" "titulo" => "Acknowledgements" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-27" "fechaAceptado" => "2017-10-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1165539" "palabras" => array:4 [ 0 => "Rheumatoid arthritis" 1 => "Remission" 2 => "Ultrasonography" 3 => "Disease-modifying antirheumatic drugs" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1165540" "palabras" => array:4 [ 0 => "Artritis reumatoide" 1 => "Remisión" 2 => "Ultrasonografía" 3 => "Fármacos antirreumáticos modificadores de la enfermedad sintética" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo identify synovitis and tenosynovitis active by using the Ultrasound 7 (US 7) scoring system in patients with rheumatoid arthritis (RA) in clinical remission induced by synthetic disease-modifying antirheumatic drugs (DMARDs). MethodsThis is a multicentric, cross-sectional, observational study including 94 RA patients >18 years old who were in remission as defined by the 28-joints disease activity score (DAS28) <2.6 induced by synthetic DMARD during at least 6 months. Patients with a previous or current history of biologic DMARD treatment were not included in the study. Demographic and clinical data were collected by the local rheumatologist; the US evaluation was performed by a calibrated rheumatologist, who intended to detect grayscale synovitis and power Doppler (PD) using the 7-joint scale. Intra and inter-reader exercises of images between 2 ultrasonographers were realized. ResultsPatients’ mean age was 49.1±13.7 years; 83% were women. The mean disease duration was 8±7 years and remission lasted for 27.5±31.8 months. The mean DAS28 score was 1.9±0.66. Grayscale synovitis was present in 94% of cases; it was mild in 87.5% and moderate in 12.5%. Only 12.8% of the patients had PD. The metatarsophalangeal, metacarpophalangeal, and carpal joints of the dominant hand were the joints more frequently affected by synovitis. Tenosynovitis by grayscale was observed in 9 patients (9.6%). The intra and inter-reading kappa value were 0.77, p<0.003 (CI 95%, 0.34–0.81) and 0.81, p<0.0001 (CI 95%, 0.27–0.83) respectively. ConclusionsLow percentage of synovitis and tenosynovitis active were founded according to PD US by 7 score in RA patients under synthetic DMARDs during long remission. This score has benefit because evaluate tenosynovitis, another element of subclinical disease activity." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoIdentificar la sinovitis y tenosinovitis activa mediante el uso de ultrasonido en un índice de 7 articulaciones (US7) en pacientes con artritis reumatoide (AR) en remisión clínica inducida por fármacos antirreumáticos modificadores de la enfermedad sintética (DMARD). MétodosSe trata de un estudio observacional multicéntrico, transversal, que incluyó a 94 pacientes con AR mayores de 18 años que estaban en «remisión de acuerdo a DAS-28<2,6 inducida por DMARD sintético durante al menos 6 meses». Los pacientes con antecedentes previos o actuales de tratamiento biológico no fueron incluidos en el estudio. Los datos demográficos y clínicos fueron recogidos por el reumatólogo tratante; la evaluación de US fue realizada por un reumatólogo experimentado, para detectar sinovitis en escala de grises y power Doppler (PD) utilizando la escala de 7 articulaciones. Se realizaron ejercicios intra e inter-lector de imágenes entre 2 ultrasonografistas. ResultadosLa edad media de los pacientes fue de 49,1±13,7 años; el 83% eran mujeres. La duración media de la enfermedad fue de 8±7 años y la remisión duró 27,5±31,8 meses. La media de DAS-28 fue de 1,9±0,66. La sinovitis en escala de grises estuvo presente en el 94% de los casos; fue leve en el 87,5% y moderada en el 12,5%. Solo el 12,8% de los pacientes tenían PD. Las articulaciones metatarsofalángicas, metacarpofalángicas y carpales de la mano dominante fueron las articulaciones más frecuentemente afectadas por la sinovitis. La tenosinovitis en escala de grises se observó en 9 pacientes (9,6%). El valor de kappa intra e inter-lector fue 0,77, p<0,003 (CI 95%: 0,34-0,81) y 0,81, p<0,0001 (CI 95%: 0,27-0,83), respectivamente. ConclusionesSe observó un bajo porcentaje de sinovitis y tenosinovitis activa de acuerdo a PD por US7 en pacientes con AR tratados con DMARD sintéticos. Esta escala tiene ventaja porque evalúa tenosinovitis, otro elemento de la actividad inflamatoria subclínica." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n=94 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age, years (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.1±13.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex female/male, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (88)/11 (12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AR seropositive, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 (80.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AR erosive, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (47.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean disease duration, years (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8±7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean duration of disease remission by DAS28 in months (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.5±31.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean DAS28 score (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9±0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean CPR, mg/dL (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.02±1.76 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean ESR, mm (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.1±9.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean Pain Visual Analogue Scale (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.7+13.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2151622.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No. (%) of patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Methotrexate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 (92.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sulfasalazine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (28.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leflunomide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (14.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydroxychloroquine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (14.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with methotrexate plus another DMARD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (44.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2151624.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical and demographic data for patients." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NA=not applicable." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="6" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage of patients with elementary lesions observed by ultrasound</th></tr><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Disease activity \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grayscale (n=94)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Power Doppler (n=94)</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Synovitisn (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tenosynovitisn (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Erosionn (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Synovitisn (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tenosynovitisn (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 (94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (9.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (88.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">NA</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">NA</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2151623.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of elementary lesions in all joints evaluated by US 7 score." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NA=not applicable." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anatomical region \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Synovitis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tenosynovitis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Erosions \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carpal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 (51.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metacarpophalangeal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 (60.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (8.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (16.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metatarsophalangeal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86 (88.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (29.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2151625.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Frequency of elementary lesions by US grayscale in most affected regions." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anatomical regions \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Synovitis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tenosynovitis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Erosions \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carpal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (5.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metacarpophalangeal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (8.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metatarsophalangeal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2151621.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Frequency of elementary lesions with PD signal in most affected regions." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.M. Verstappen" 1 => "J.W. Jacobs" 2 => "M.J. Van der Veen" 3 => "A.H.M. Heurkens" 4 => "Y. Schenk" 5 => "E.J. Borg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2007.071092" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "1443" "paginaFinal" => "1449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17519278" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0155" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MRI in early rheumatoid arthritis: synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Bøyesen" 1 => "E.A. Haavardsholm" 2 => "M. Østergaard" 3 => "D. Van der Heijde" 4 => "S. Sesseng" 5 => "T.K. Kvien" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "428" "paginaFinal" => "433" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0160" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MRI and musculoskeletal ultrasonography as diagnostic tools in early arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Keen" 1 => "A. Brown" 2 => "R. Wakefield" 3 => "P. Conhagan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheum Dis Clin N Am" "fecha" => "2005" "volumen" => "31" "paginaInicial" => "699" "paginaFinal" => "714" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0165" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disease remission state in patients treated with the combination of tumor necrosis factor blockade and methotrexate or with disease-modifying antirheumatic drugs: a clinical and imaging comparative study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Saleem" 1 => "A.K. Brown" 2 => "H. Keen" 3 => "S. Nizam" 4 => "J. Freeston" 5 => "Z. Karim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.24596" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2009" "volumen" => "60" "paginaInicial" => "1915" "paginaFinal" => "1922" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19565512" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0170" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can flare be predicted in DMARD treated RA patients in remission, and is it important? A cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Saleem" 1 => "A.K. Brown" 2 => "M. Quinn" 3 => "Z. Karim" 4 => "E.M. Hensor" 5 => "P. Conaghan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2011-200548" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2012" "volumen" => "71" "paginaInicial" => "1316" "paginaFinal" => "1321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22294638" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0175" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Power Doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Foltz" 1 => "F. Gandjbakhch" 2 => "F. Etchepare" 3 => "C. Rosenberg" 4 => "M.L. Tanguy" 5 => "S. Rozenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.33312" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "67" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21904998" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0180" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis – a systematic review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.F. Ten Cate" 1 => "J.J. Luime" 2 => "N. Swen" 3 => "A.H. Gerards" 4 => "M.H. De Jager" 5 => "N.M. Basoski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "R4" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0185" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.K. Brown" 1 => "M.A. Quinn" 2 => "Z. Karim" 3 => "P.G. Conaghan" 4 => "C.G. Peterfy" 5 => "E. Hensor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.22190" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2006" "volumen" => "54" "paginaInicial" => "3761" "paginaFinal" => "3773" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17133543" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0190" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Backhaus" 1 => "S. Ohrndorf" 2 => "H. Kellner" 3 => "J. Strunk" 4 => "M. Backhaus" 5 => "W. Hartung" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2009" "volumen" => "61" "paginaInicial" => "1194" "paginaFinal" => "1201" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0195" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.B. Hammer" 1 => "T.K. Kvien" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2011" "volumen" => "27" "paginaInicial" => "R78" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0200" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disease flare in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I.M. Markusse" 1 => "L. Dirven" 2 => "A.H. Gerards" 3 => "J.H. van Groenendael" 4 => "H.K. Ronday" 5 => "P.J. Kerstens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13075-015-0730-2" "Revista" => array:5 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "232" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26321751" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0205" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of a short four-joint ultrasound test for gout diagnosis: a pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Peiteado" 1 => "E. de Miguel" 2 => "A. Villalba" 3 => "M.C. Ordonez" 4 => "C. Castillo" 5 => "E. Martin Mola" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "830" "paginaFinal" => "837" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0210" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for musculoskeletal ultrasound in rheumatology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Backhaus" 1 => "G.R. Burmester" 2 => "T. Gerber" 3 => "W. Grassi" 4 => "K.P. Machold" 5 => "W.A. Swen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.60.7.641" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2001" "volumen" => "60" "paginaInicial" => "641" "paginaFinal" => "649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11406516" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0215" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Musculoskeletal ultrasound including definitions for ultrasonographic pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Wakefield" 1 => "P. Balint" 2 => "M. Skudlarek" 3 => "E. Filippuci" 4 => "M. Backhaus" 5 => "M.A. D’Agostino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheum" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "2485" "paginaFinal" => "2487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16331793" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0220" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Naredo" 1 => "M.A. DAgostino" 2 => "R.J. Wakefield" 3 => "I. Möller" 4 => "P.V. Balint" 5 => "E. Filippucci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2012-202092" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2013" "volumen" => "72" "paginaInicial" => "1328" "paginaFinal" => "1334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22984169" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0225" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrast-enhanced power Doppler ultrasonography of the metacarpophalangeal joints in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Szkudlarek" 1 => "M. Court-Payen" 2 => "C. Strandberg" 3 => "M. Klarlund" 4 => "T. Klausen" 5 => "M. Ostergaard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00330-002-1459-2" "Revista" => array:5 [ "tituloSerie" => "Eur Radiol" "fecha" => "2003" "volumen" => "13" "paginaInicial" => "163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12541125" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0230" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonographic predictors for the development of joint damage in rheumatoid arthritis patients: a single joint prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Macchioni" 1 => "M. Magnani" 2 => "R. Mulé" 3 => "S. Galletti" 4 => "M. Catanoso" 5 => "E. Pignotti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Rheum" "fecha" => "2013" "volumen" => "31" "paginaInicial" => "8" "paginaFinal" => "17" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0235" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.C. Arnett" 1 => "S.M. Edworthy" 2 => "D.A. Bloch" 3 => "D.J. McShane" 4 => "J.F. Fries" 5 => "N.S. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.1780310302" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1998" "volumen" => "31" "paginaInicial" => "315" "paginaFinal" => "324" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3358796" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0240" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. D’Agostino" 1 => "L. Terslev" 2 => "R. Wakefield" 3 => "M. Ostergaard" 4 => "P. Balint" 5 => "E. Naredo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2016" "paginaInicial" => "1" "paginaFinal" => "7" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0245" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Saleem" 1 => "A.K. Brown" 2 => "H. Keen" 3 => "S. Nizam" 4 => "J. Freeston" 5 => "R. Wakefield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2010.134445" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "792" "paginaFinal" => "798" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21242236" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0250" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The foot: still the most important reason for walking incapacity in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Grondal" 1 => "B. Tengstrand" 2 => "B. Nordmark" 3 => "P. Wretenburg" 4 => "A. Stark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/17453670710015067" "Revista" => array:6 [ "tituloSerie" => "Acta Orthop" "fecha" => "2008" "volumen" => "79" "paginaInicial" => "257" "paginaFinal" => "261" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18484253" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0255" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of US to show subclinical joint abnormalities in asymptomatic feet of RA patients compared to healthy controls" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Sant’Ana Petterle" 1 => "J. Natour" 2 => "K. Rodriguez da Luz" 3 => "F. Soares Machado" 4 => "M.F. dos Santos" 5 => "A. da Rocha Correa Fernandes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Rheum" "fecha" => "2013" "volumen" => "31" "paginaInicial" => "904" "paginaFinal" => "912" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0260" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Kawashiri" 1 => "T. Suzuki" 2 => "Y. Nakashima" 3 => "Y. Horai" 4 => "A. Okada" 5 => "N. Iwamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/ket405" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2014" "volumen" => "53" "paginaInicial" => "562" "paginaFinal" => "569" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24319104" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0265" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Hamamouchi" 1 => "R. Bahiri" 2 => "N. Srifi" 3 => "S. Aktaou" 4 => "Abouqal" 5 => "N. Hajjaj-Hassouni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMC Musculoskelet Dis" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "91" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0270" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Lillegraven" 1 => "P. Bøyesen" 2 => "H.B. Hammer" 3 => "M. Østergaard" 4 => "T. Uhlig" 5 => "S. Sesseng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2011.151316" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "2049" "paginaFinal" => "2050" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21515919" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0275" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Vlad" 1 => "F. Berghea" 2 => "M. Micu" 3 => "L. Varzaru" 4 => "M. Bojinca" 5 => "M. 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"vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574319301352/v1_201910260908/en/main.assets" "Apartado" => array:4 [ "identificador" => "43294" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000005/v1_201910260908/S2173574319301352/v1_201910260908/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301352?idApp=UINPBA00004M"]

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Original Article

Subclinical synovitis and tenosynovitis by ultrasonography (US) 7 score in patients with rheumatoid arthritis treated with synthetic drugs, in clinical remission by DAS28

Sinovitis y tenosinovitis subclínica evaluada por índice ultrasonográfico 7 en pacientes con artritis reumatoide tratados con fármacos sintéticos en remisión clínica por DAS-28

Lucio Ventura-Ríosa,

Corresponding author

venturarioslucio@gmail.com

Corresponding author.

, Guadalupe Sánchez Bringasb, Cristina Hernández-Díaza, Esteban Cruz-Arenasc, Rubén Burgos-Vargasd

a Laboratorio de ultrasonido musculoesquelético y articular, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México City, Mexico

b Jefa de Departamento de Embriología, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico

c Unidad de Vigilancia Epidemiológica Hospitalaria-Investigación Sociomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México City, Mexico

d Director de Investigación, Hospital General de México “Eduardo Liceaga”, México City, Mexico

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is perhaps the best tool to assess subclinical synovitis and early loss of the articular cartilage and erosions development&#44; but its high cost and sometimes the need for enhancing medium to evaluate synovitis among others limit its accessibility&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this context&#44; US is a highly useful technique low cost&#44; multiplanar&#44; and non-invasive technique that does no produce any radiation&#44; does not require contrast medium&#44; and can be repeated as many times as necessary&#46; Grayscale &#40;GS&#41; and power Doppler &#40;PD&#41; may show subclinical synovitis in patients with RA in remission achieved by the use of synthetic or biologic disease-modifying antirheumatic drugs &#40;DMARDs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> GS synovitis suggest the development or worsening of bone erosions<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> and the presence of PD signal increases at least &#62;1 the probability of flare up in clinical remission&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">US is superior to clinical examination in detecting joint inflammation in undifferentiated arthritis&#44; and in established RA&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Joint exploration by US has been used to reclassify patients who clinically have fewer inflamed joints by showing synovitis in those which are apparently normal&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Also&#44; it has validity comparable to MRI with contrast medium and arthroscopy to detect synovitis&#44; and is superior to simple X-ray to detect erosions&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> There are different scales to evaluate joint inflammation&#46; Today&#44; it has been shown that the US 7 scale is equally sensitive as the 78-joint scale to evaluate changes in grayscale and PD&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The importance of proper monitoring of the disease is that timely modifications of treatment can be made&#44; which may really change the course of the disease&#44; by preventing structural damage and permanent disability&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> It is therefore that the objective of this investigation was to evaluate the presence of inflammatory activity&#44; by means of the US 7 scale&#44; in patients with RA treated with synthetic DMARDs who were clinically in remission according to the DAS28 score&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a prospective&#44; cross-sectional&#44; observational phase IV study between March&#44; 2013&#44; and June&#44; 2014 in three centers in M&#233;xico City&#46; Ninety-four patients over 18 years of age with RA<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> receiving treatment with synthetic DMARDs &#40;methotrexate&#44; hydroxychloroquine&#44; chloroquine&#44; leflunomide&#44; sulfasalazine&#41; &#40;either as monotherapy or combined therapy&#41;&#44; without corticosteroid and treatment without modifications in clinical remission by DAS28 score &#40;&#60;2&#46;6&#41; at least for 6 months before they were included in the study&#46; Only subjects whose treatment remained stable for 6 months before entering the study were included&#46; We excluded patients who had received glucocorticoid infiltration during 6 months prior to inclusion in the study&#46; All patients agreed to participate in the study and signed an informed consent form&#46; Patients currently or past treated with anti-TNFs such as infliximab&#44; adalimumab&#44; certolizumab pegol and golimumab&#44; or with circulating receptor fusion proteins like etanercept&#44; were not included in the study&#46; The National Bioethics Committee for clinical research approved the protocol&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The sample included 100 patients of whom 94 patients completed the two visits planned for the study&#46; At visit 1 &#40;days &#8722;10 to 0&#41;&#44; informed consent was presented to patients and signed by those who accepted their participation&#59; then&#44; inclusion and exclusion criteria were checked&#59; and data on clinical evaluation and therapeutic history was collected&#46; One experimented rheumatologist conducted clinical evaluation&#46; At visit 2 &#40;days 1&#8211;7&#41;&#44; patients were sent to only one of the centers to underwent the US 7 scale &#40;grayscale and PD&#41; joint evaluation<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> performed by a rheumatologist&#44; who was blinded to clinical findings&#46; The average time for each evaluation was 15<span class="elsevierStyleHsp" style=""></span>min&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">US studies were carried out with a Esaote MyLab 25&#174; US equipment &#40;Biomedica&#44; Genoa&#44; Italy&#41; equipped with a 10&#8211;18<span class="elsevierStyleHsp" style=""></span>MHz linear transducer&#59; PD was adjusted according to the following parameters&#58; frequency&#44; 8&#46;0&#44; PRF&#44; 0&#46;500&#44; wall filter&#44; 3&#44; gain between 50 and 70&#46; PD gain was set to a level below its appearance from cortical bone&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a> The US 7 scale included the wrist&#44; 2nd&#44; and 3rd metacarpophalangeal &#40;MCP&#41; joints&#44; 2nd and 3rd proximal interphalangeal &#40;PIP&#41; joints&#44; and 2nd and 5th metatarsophalangeal &#40;MTP&#41; joints on the clinically dominant side&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> according to EULAR US guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">OMERACT definitions were used to describe synovitis&#44; tenosynovitis&#44; and erosions&#46; Synovitis is seen as effusion defined as abnormal&#44; hypoechoic or anechoic&#44; compressible&#44; displaceable intraarticular material&#44; without PD signal&#44; and synovial hypertrophy as abnormal hypoechoic&#44; poorly compressible intra-articular tissue that may exhibit PD signal&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Tenosynovitis&#58; abnormal&#44; hypoechoic or anechoic &#40;relative to tendon fibers&#41; tendon sheath widening which can be related both to the presence of abnormal tenosynovial fluid and&#47;or hypertrophy<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> thickened&#44; hypoechoic or anechoic tissue with or without fluid in the tendon sheath&#46; Erosion&#58; an intraarticular discontinuity of the bone surface visible in 2 perpendicular planes&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> Also&#44; the presence of paratenonitis&#44; was evaluated&#44; and defined as a hypoechoic halo around the tendon with or without the presence of PD&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> Tenosynovitis or paratenonitis&#44; and erosions were reported as present or absent &#40;1 or 0&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Grayscale synovitis was evaluated semi-quantitatively&#58; 0 absent&#44; 1 mild&#44; 2 moderate&#44; and 3 severe&#46; Grade 1 describes a hypoechoic or anechoic area which does not extend beyond the joint capsule interline&#59; in grade 2&#44; the joint capsule is raised parallel to the articular area&#59; and grade 3 shows notable widening of the joint capsule&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> The presence of PD was graduated as follows&#58; grade 0 without intra-articular signal&#59; grade 1&#44; up to 3 signals in the joint area&#59; grade 2&#44; more than 3 signals in less than 50&#37; of the intraarticular area&#59; grade 3&#44; more than 50&#37; of the intraarticular area&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> US evaluation was performed only by one ultrasonographer&#46; Intra and inter-reading exercise were done by 2 ultrasonographers&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Median&#44; standard deviation &#40;SD&#41;&#44; and percentages were used to describe patients&#8217; clinical characteristics and US findings&#46; Intra and Inter-reader reliability were calculated by the Cohen&#39;s kappa coefficient&#46; Kappa values were assigned the following designations&#58; below 0&#46;20 as poor&#44; 0&#46;21&#8211;0&#46;40 as fair&#44; 0&#46;41&#8211;0&#46;60 as moderate&#44; 0&#46;61&#8211;0&#46;80 as good&#44; and 0&#46;81&#8211;1 as excellent&#46; The analyses were performed using the SPSS ver&#46; 21&#46;0 statistical computer software &#40;SPSS&#44; Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Clinical and demographic data are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Ninety-four patients were included&#59; six were excluded for failing to meet the criterion of DAS28 below 2&#46;6&#46; As expected&#44; most patients were women&#46; Disease duration was 27&#46;5<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>31&#46;8 months and DAS28 was 1&#46;9<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;66&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the prevalence of elementary lesions in all joints evaluated&#46; In grayscale we observed a high prevalence of synovitis in 94&#37; &#40;88 patients&#41;&#44; although in almost 90&#37; changes were mild and moderate in only 12&#46;5&#37;&#59; there were no severe lesions found in the study&#46; Only 12 &#40;13&#37;&#41; of the 94 patients had PD signal and in all it was mild&#46; Tenosynovitis was observed in 9 &#40;9&#46;6&#37;&#41; in grayscale and with PD only 2 &#40;2&#46;1&#37;&#41;&#46; Paratenonitis was not observed in any case&#46; Erosions were found in 34 &#40;36&#37;&#41; patients&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the frequency of elementary lesions by US grayscale in most affected regions&#46; The prevalence was high in metatarsal joints&#44; followed by MCP and carpal joints &#40;88&#46;6&#37;&#44; 60&#46;8&#37;&#44; and 51&#46;5&#37; respectively&#41;&#46; On the other hand&#44; tenosynovitis was more common in hand flexors in MCP joints than in the carpus &#40;8&#46;2&#37; vs&#46; 1&#37;&#41;&#46; Erosions were more common in metatarsal heads than in metacarpal joints &#40;29&#46;9&#37; vs&#46; 16&#46;5&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> presents the distribution of elementary lesions with PD signal&#46; The highest prevalence was in MCP joints&#44; then in wrists&#44; and the lowest in MTP joints &#40;8&#46;2&#37;&#44; 5&#46;1&#37;&#44; and 1&#46;0&#37; respectively&#41;&#46; In only 1&#37; of patients&#44; PD was observed in tenosynovitis of finger flexors at the metacarpal level and 1&#37; in carpus&#46; None of the erosions showed PD signal&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The intra and inter-reading kappa value were respectively 0&#46;77&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;003 &#40;CI 95&#37;&#44; 0&#46;34&#8211;0&#46;81&#41; and 0&#46;81&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 &#40;CI 95&#37;&#44; 0&#46;27&#8211;0&#46;83&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this study the prevalence of subclinical synovitis&#44; in grayscale was high and low by PD&#44; similar as shown by a systematic review of the literature&#44; where percentages ranging from 73&#37; to 95&#37; and from 8&#46;5&#37; to 62&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Thus&#44; in turn&#44; corroborates the discrepancy between the criterion of clinical remission used and US findings&#46; Some studies have reported that&#44; regardless of the specific criteria of remission used&#44; when evaluated by US&#44; synovitis active is detected in 60&#8211;80&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> The use of US to monitor patients in clinical remission can help to predict those likely to suffer flare-up or structural damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;18</span></a> Because some studies have demonstrated high percentage of synovial hypertrophy on US in patients considered to be in remission&#44; this state should be defined only in the absence of synovitis by this technique&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The sites of greatest prevalence of synovitis are the carpal and the MCP joints&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> However&#44; in our study&#44; we observed more synovitis in the metatarsal joints&#44; which correlates with reports indicating that the feet are affected in around 90&#37; of patients during the course of the disease&#44; 91&#37; in women and 85&#37; in men&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> Additionally&#44; this is the region that conditions the highest rates of disability&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> which underscores the importance of including such joints in scanning for synovitis&#46; In relation to PD&#44; multiple studies have reported that a signal was present in around 50&#37; of patients in clinical remission in MCP and carpal joints of the dominant hand&#46; Our findings are some similar&#44; since we detected a lower percentage of activity&#44; perhaps of the longer remission time in our group&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#44;22</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The prevalence of tenosynovitis in long term RA ranges from 5&#37; to 55&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> We found tenosynovitis in less than 10&#37; of patients&#44; predominantly in the third flexor of the dominant hand&#46; This finding may be related to biomechanical factors due to the high range of movement of that tendon compared with others&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Tenosynovitis may be very important for monitoring RA&#44; because could conditioned tendon damage and consequently disability&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> Lillegraven et al&#46; have demonstrated that tenosynovitis assessed by US predicts the development of erosive joint damage in a cohort of early RA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> Two studies have shown that tenosynovitis is not present in true remission&#44; suggesting the high value of its assessment by US&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">26&#44;27</span></a> Furthermore&#44; damaged tendon as assessed by US correlates very well with bone structural damage assessed by X-ray&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> Today&#44; however&#44; there is neither established scale nor which tendons should be included in US evaluation for monitoring&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Bone erosions including in this score pertain to the realm of structural damage&#46; In this study&#44; around 30&#37; had erosions in the MTP joints and 16&#37; in the MCP joints&#46; For patients with established diagnosis of RA&#44; perhaps bone erosions have not great value&#44; and may be more useful in patients with suspected early-stage RA&#46; However&#44; some data suggest that bone erosions may sensitive to change&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this is the first study that applied US 7 scale to detect any residual inflammatory activity in clinical remission&#44; in joint and tendon level with vantage of consuming less time than more extended count joint and had been used to evaluate response to treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">We considered another method&#44; such as magnetic resonance imaging &#40;MRI&#41; was needed to compare the findings&#44; but MRI is not a feasible technique to evaluate multiple joints at the same time&#46; Additionally&#44; control group was absence&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">The prevalence of synovitis and tenosynovitis assessed by US 7 score is low in patients with rheumatoid arthritis in clinical remission by DAS28 during long time of disease remission&#46; The US 7 score <span class="elsevierStyleUnderline">i</span>s useful because add additional value to detect tenosynovitis that appear other instruments to measure real remission state&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">The present work was supported by unrestricted <span class="elsevierStyleGrantSponsor" id="gs1">AbbVie</span> grants&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare have not conflict of interest&#46;</p></span></span>"
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            1 => "Remission"
            2 => "Ultrasonography"
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            0 => "Artritis reumatoide"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To identify synovitis and tenosynovitis active by using the Ultrasound 7 &#40;US 7&#41; scoring system in patients with rheumatoid arthritis &#40;RA&#41; in clinical remission induced by synthetic disease-modifying antirheumatic drugs &#40;DMARDs&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is a multicentric&#44; cross-sectional&#44; observational study including 94 RA patients &#62;18 years old who were in remission as defined by the 28-joints disease activity score &#40;DAS28&#41; &#60;2&#46;6 induced by synthetic DMARD during at least 6 months&#46; Patients with a previous or current history of biologic DMARD treatment were not included in the study&#46; Demographic and clinical data were collected by the local rheumatologist&#59; the US evaluation was performed by a calibrated rheumatologist&#44; who intended to detect grayscale synovitis and power Doppler &#40;PD&#41; using the 7-joint scale&#46; Intra and inter-reader exercises of images between 2 ultrasonographers were realized&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients&#8217; mean age was 49&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;7 years&#59; 83&#37; were women&#46; The mean disease duration was 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7 years and remission lasted for 27&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;8 months&#46; The mean DAS28 score was 1&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;66&#46; Grayscale synovitis was present in 94&#37; of cases&#59; it was mild in 87&#46;5&#37; and moderate in 12&#46;5&#37;&#46; Only 12&#46;8&#37; of the patients had PD&#46; The metatarsophalangeal&#44; metacarpophalangeal&#44; and carpal joints of the dominant hand were the joints more frequently affected by synovitis&#46; Tenosynovitis by grayscale was observed in 9 patients &#40;9&#46;6&#37;&#41;&#46; The intra and inter-reading kappa value were 0&#46;77&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;003 &#40;CI 95&#37;&#44; 0&#46;34&#8211;0&#46;81&#41; and 0&#46;81&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 &#40;CI 95&#37;&#44; 0&#46;27&#8211;0&#46;83&#41; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Low percentage of synovitis and tenosynovitis active were founded according to PD US by 7 score in RA patients under synthetic DMARDs during long remission&#46; This score has benefit because evaluate tenosynovitis&#44; another element of subclinical disease activity&#46;</p></span>"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Identificar la sinovitis y tenosinovitis activa mediante el uso de ultrasonido en un &#237;ndice de 7 articulaciones &#40;US7&#41; en pacientes con artritis reumatoide &#40;AR&#41; en remisi&#243;n cl&#237;nica inducida por f&#225;rmacos antirreum&#225;ticos modificadores de la enfermedad sint&#233;tica &#40;DMARD&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio observacional multic&#233;ntrico&#44; transversal&#44; que incluy&#243; a 94 pacientes con AR mayores de 18 a&#241;os que estaban en &#171;remisi&#243;n de acuerdo a DAS-28<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#44;6 inducida por DMARD sint&#233;tico durante al menos 6 meses&#187;&#46; Los pacientes con antecedentes previos o actuales de tratamiento biol&#243;gico no fueron incluidos en el estudio&#46; Los datos demogr&#225;ficos y cl&#237;nicos fueron recogidos por el reumat&#243;logo tratante&#59; la evaluaci&#243;n de US fue realizada por un reumat&#243;logo experimentado&#44; para detectar sinovitis en escala de grises y power Doppler &#40;PD&#41; utilizando la escala de 7 articulaciones&#46; Se realizaron ejercicios intra e inter-lector de im&#225;genes entre 2 ultrasonografistas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media de los pacientes fue de 49&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;7 a&#241;os&#59; el 83&#37; eran mujeres&#46; La duraci&#243;n media de la enfermedad fue de 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7 a&#241;os y la remisi&#243;n dur&#243; 27&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#44;8 meses&#46; La media de DAS-28 fue de 1&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;66&#46; La sinovitis en escala de grises estuvo presente en el 94&#37; de los casos&#59; fue leve en el 87&#44;5&#37; y moderada en el 12&#44;5&#37;&#46; Solo el 12&#44;8&#37; de los pacientes ten&#237;an PD&#46; Las articulaciones metatarsofal&#225;ngicas&#44; metacarpofal&#225;ngicas y carpales de la mano dominante fueron las articulaciones m&#225;s frecuentemente afectadas por la sinovitis&#46; La tenosinovitis en escala de grises se observ&#243; en 9 pacientes &#40;9&#44;6&#37;&#41;&#46; El valor de kappa intra e inter-lector fue 0&#44;77&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;003 &#40;CI 95&#37;&#58; 0&#44;34-0&#44;81&#41; y 0&#44;81&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001 &#40;CI 95&#37;&#58; 0&#44;27-0&#44;83&#41;&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se observ&#243; un bajo porcentaje de sinovitis y tenosinovitis activa de acuerdo a PD por US7 en pacientes con AR tratados con DMARD sint&#233;ticos&#46; Esta escala tiene ventaja porque eval&#250;a tenosinovitis&#44; otro elemento de la actividad inflamatoria subcl&#237;nica&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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        "tabla" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean age&#44; years &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex female&#47;male&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;88&#41;&#47;11 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AR seropositive&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;80&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AR erosive&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;47&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean disease duration&#44; years &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean duration of disease remission by DAS28 in months &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean DAS28 score &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean CPR&#44; mg&#47;dL &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean ESR&#44; mm &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean Pain Visual Analogue Scale &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;7<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>13&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41; of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methotrexate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;92&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sulfasalazine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;28&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leflunomide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hydroxychloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients with methotrexate plus another DMARD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;44&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical and demographic data for patients&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">NA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>not applicable&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="6" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage of patients with elementary lesions observed by ultrasound</th></tr><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Disease activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grayscale &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Power Doppler &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Synovitis<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tenosynovitis<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Erosion<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Synovitis<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tenosynovitis<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Present</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grade</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;88&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">NA</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">NA</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anatomical region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Synovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Erosions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carpal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;51&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metacarpophalangeal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;60&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;8&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;16&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metatarsophalangeal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;88&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;29&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Synovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Erosions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carpal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metacarpophalangeal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;8&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metatarsophalangeal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => "xTab2151621.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Frequency of elementary lesions with PD signal in most affected regions&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive treatment with methotrexate in early rheumatoid arthritis&#58; aiming for remission&#46; Computer Assisted Management in Early Rheumatoid Arthritis &#40;CAMERA&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Verstappen"
                            1 => "J&#46;W&#46; Jacobs"
                            2 => "M&#46;J&#46; Van der Veen"
                            3 => "A&#46;H&#46;M&#46; Heurkens"
                            4 => "Y&#46; Schenk"
                            5 => "E&#46;J&#46; Borg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2007.071092"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2007"
                        "volumen" => "66"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17519278"
                            "web" => "Medline"
                          ]
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            1 => array:3 [
              "identificador" => "bib0155"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MRI in early rheumatoid arthritis&#58; synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; B&#248;yesen"
                            1 => "E&#46;A&#46; Haavardsholm"
                            2 => "M&#46; &#216;stergaard"
                            3 => "D&#46; Van der Heijde"
                            4 => "S&#46; Sesseng"
                            5 => "T&#46;K&#46; Kvien"
                          ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Rheum Dis"
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                        "paginaInicial" => "428"
                        "paginaFinal" => "433"
                      ]
                    ]
                  ]
                ]
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            2 => array:3 [
              "identificador" => "bib0160"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MRI and musculoskeletal ultrasonography as diagnostic tools in early arthritis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Keen"
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                            2 => "R&#46; Wakefield"
                            3 => "P&#46; Conhagan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheum Dis Clin N Am"
                        "fecha" => "2005"
                        "volumen" => "31"
                        "paginaInicial" => "699"
                        "paginaFinal" => "714"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0165"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disease remission state in patients treated with the combination of tumor necrosis factor blockade and methotrexate or with disease-modifying antirheumatic drugs&#58; a clinical and imaging comparative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Saleem"
                            1 => "A&#46;K&#46; Brown"
                            2 => "H&#46; Keen"
                            3 => "S&#46; Nizam"
                            4 => "J&#46; Freeston"
                            5 => "Z&#46; Karim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.24596"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2009"
                        "volumen" => "60"
                        "paginaInicial" => "1915"
                        "paginaFinal" => "1922"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19565512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Can flare be predicted in DMARD treated RA patients in remission&#44; and is it important&#63; A cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Saleem"
                            1 => "A&#46;K&#46; Brown"
                            2 => "M&#46; Quinn"
                            3 => "Z&#46; Karim"
                            4 => "E&#46;M&#46; Hensor"
                            5 => "P&#46; Conaghan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2011-200548"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2012"
                        "volumen" => "71"
                        "paginaInicial" => "1316"
                        "paginaFinal" => "1321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22294638"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0175"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Power Doppler ultrasound&#44; but not low-field magnetic resonance imaging&#44; predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Foltz"
                            1 => "F&#46; Gandjbakhch"
                            2 => "F&#46; Etchepare"
                            3 => "C&#46; Rosenberg"
                            4 => "M&#46;L&#46; Tanguy"
                            5 => "S&#46; Rozenberg"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.33312"
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                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2012"
                        "volumen" => "64"
                        "paginaInicial" => "67"
                        "paginaFinal" => "76"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21904998"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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              "identificador" => "bib0180"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis &#8211; a systematic review of the literature"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;F&#46; Ten Cate"
                            1 => "J&#46;J&#46; Luime"
                            2 => "N&#46; Swen"
                            3 => "A&#46;H&#46; Gerards"
                            4 => "M&#46;H&#46; De Jager"
                            5 => "N&#46;M&#46; Basoski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2013"
                        "volumen" => "15"
                        "paginaInicial" => "R4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "8"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;K&#46; Brown"
                            1 => "M&#46;A&#46; Quinn"
                            2 => "Z&#46; Karim"
                            3 => "P&#46;G&#46; Conaghan"
                            4 => "C&#46;G&#46; Peterfy"
                            5 => "E&#46; Hensor"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.22190"
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                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2006"
                        "volumen" => "54"
                        "paginaInicial" => "3761"
                        "paginaFinal" => "3773"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17133543"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice&#58; a pilot project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Backhaus"
                            1 => "S&#46; Ohrndorf"
                            2 => "H&#46; Kellner"
                            3 => "J&#46; Strunk"
                            4 => "M&#46; Backhaus"
                            5 => "W&#46; Hartung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2009"
                        "volumen" => "61"
                        "paginaInicial" => "1194"
                        "paginaFinal" => "1201"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0195"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparisons of 7- to 78-joint ultrasonography scores&#58; all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;B&#46; Hammer"
                            1 => "T&#46;K&#46; Kvien"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2011"
                        "volumen" => "27"
                        "paginaInicial" => "R78"
                      ]
                    ]
                  ]
                ]
              ]
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            10 => array:3 [
              "identificador" => "bib0200"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Disease flare in rheumatoid arthritis are associated with joint damage progression and disability&#58; 10-year results from the BeSt study"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46;M&#46; Markusse"
                            1 => "L&#46; Dirven"
                            2 => "A&#46;H&#46; Gerards"
                            3 => "J&#46;H&#46; van Groenendael"
                            4 => "H&#46;K&#46; Ronday"
                            5 => "P&#46;J&#46; Kerstens"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13075-015-0730-2"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2015"
                        "volumen" => "17"
                        "paginaInicial" => "232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26321751"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0205"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Value of a short four-joint ultrasound test for gout diagnosis&#58; a pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Peiteado"
                            1 => "E&#46; de Miguel"
                            2 => "A&#46; Villalba"
                            3 => "M&#46;C&#46; Ordonez"
                            4 => "C&#46; Castillo"
                            5 => "E&#46; Martin Mola"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Exp Rheumatol"
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                        "volumen" => "30"
                        "paginaInicial" => "830"
                        "paginaFinal" => "837"
                      ]
                    ]
                  ]
                ]
              ]
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            12 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for musculoskeletal ultrasound in rheumatology"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Backhaus"
                            1 => "G&#46;R&#46; Burmester"
                            2 => "T&#46; Gerber"
                            3 => "W&#46; Grassi"
                            4 => "K&#46;P&#46; Machold"
                            5 => "W&#46;A&#46; Swen"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.60.7.641"
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                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2001"
                        "volumen" => "60"
                        "paginaInicial" => "641"
                        "paginaFinal" => "649"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11406516"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0215"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Musculoskeletal ultrasound including definitions for ultrasonographic pathology"
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                        0 => array:2 [
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                          "autores" => array:6 [
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                            5 => "M&#46;A&#46; D&#8217;Agostino"
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                        "tituloSerie" => "J Rheum"
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                        "paginaInicial" => "2485"
                        "paginaFinal" => "2487"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16331793"
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                ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis"
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                            3 => "I&#46; M&#246;ller"
                            4 => "P&#46;V&#46; Balint"
                            5 => "E&#46; Filippucci"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2013"
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                        "paginaInicial" => "1328"
                        "paginaFinal" => "1334"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22984169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0225"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contrast-enhanced power Doppler ultrasonography of the metacarpophalangeal joints in rheumatoid arthritis"
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                            3 => "M&#46; Klarlund"
                            4 => "T&#46; Klausen"
                            5 => "M&#46; Ostergaard"
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                    0 => array:2 [
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                        "tituloSerie" => "Eur Radiol"
                        "fecha" => "2003"
                        "volumen" => "13"
                        "paginaInicial" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12541125"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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              "identificador" => "bib0230"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonographic predictors for the development of joint damage in rheumatoid arthritis patients&#58; a single joint prospective study"
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                          "etal" => true
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                            3 => "S&#46; Galletti"
                            4 => "M&#46; Catanoso"
                            5 => "E&#46; Pignotti"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Exp Rheum"
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                        "volumen" => "31"
                        "paginaInicial" => "8"
                        "paginaFinal" => "17"
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0235"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;C&#46; Arnett"
                            1 => "S&#46;M&#46; Edworthy"
                            2 => "D&#46;A&#46; Bloch"
                            3 => "D&#46;J&#46; McShane"
                            4 => "J&#46;F&#46; Fries"
                            5 => "N&#46;S&#46; Cooper"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "1998"
                        "volumen" => "31"
                        "paginaInicial" => "315"
                        "paginaFinal" => "324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3358796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0240"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis&#58; from diagnosis to remission"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            3 => "M&#46; Ostergaard"
                            4 => "P&#46; Balint"
                            5 => "E&#46; Naredo"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Ann Rheum Dis"
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                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0245"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Should imaging be a component of rheumatoid arthritis remission criteria&#63; A comparison between traditional and modified composite remission scores and imaging assessments"
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                        0 => array:2 [
                          "etal" => true
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                            2 => "H&#46; Keen"
                            3 => "S&#46; Nizam"
                            4 => "J&#46; Freeston"
                            5 => "R&#46; Wakefield"
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                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1136/ard.2010.134445"
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                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "792"
                        "paginaFinal" => "798"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21242236"
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                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The foot&#58; still the most important reason for walking incapacity in rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Grondal"
                            1 => "B&#46; Tengstrand"
                            2 => "B&#46; Nordmark"
                            3 => "P&#46; Wretenburg"
                            4 => "A&#46; Stark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/17453670710015067"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Orthop"
                        "fecha" => "2008"
                        "volumen" => "79"
                        "paginaInicial" => "257"
                        "paginaFinal" => "261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18484253"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of US to show subclinical joint abnormalities in asymptomatic feet of RA patients compared to healthy controls"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Sant&#8217;Ana Petterle"
                            1 => "J&#46; Natour"
                            2 => "K&#46; Rodriguez da Luz"
                            3 => "F&#46; Soares Machado"
                            4 => "M&#46;F&#46; dos Santos"
                            5 => "A&#46; da Rocha Correa Fernandes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Exp Rheum"
                        "fecha" => "2013"
                        "volumen" => "31"
                        "paginaInicial" => "904"
                        "paginaFinal" => "912"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis&#58; power Doppler subclinical synovitis is associated with bone erosion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "T&#46; Suzuki"
                            2 => "Y&#46; Nakashima"
                            3 => "Y&#46; Horai"
                            4 => "A&#46; Okada"
                            5 => "N&#46; Iwamoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/ket405"
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                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2014"
                        "volumen" => "53"
                        "paginaInicial" => "562"
                        "paginaFinal" => "569"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24319104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "24"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Hamamouchi"
                            1 => "R&#46; Bahiri"
                            2 => "N&#46; Srifi"
                            3 => "S&#46; Aktaou"
                            4 => "Abouqal"
                            5 => "N&#46; Hajjaj-Hassouni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Musculoskelet Dis"
                        "fecha" => "2011"
                        "volumen" => "12"
                        "paginaInicial" => "91"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
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              "etiqueta" => "25"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Lillegraven"
                            1 => "P&#46; B&#248;yesen"
                            2 => "H&#46;B&#46; Hammer"
                            3 => "M&#46; &#216;stergaard"
                            4 => "T&#46; Uhlig"
                            5 => "S&#46; Sesseng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2011.151316"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "2049"
                        "paginaFinal" => "2050"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21515919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0275"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Vlad"
                            1 => "F&#46; Berghea"
                            2 => "M&#46; Micu"
                            3 => "L&#46; Varzaru"
                            4 => "M&#46; Bojinca"
                            5 => "M&#46; Milicescu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.11152/mu.2013.2066.173.viv"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Ultrason"
                        "fecha" => "2015"
                        "volumen" => "17"
                        "paginaInicial" => "352"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26343085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Structural damage in rheumatoid arthritis&#58; comparison between tendon damage evaluated by ultrasound and radiographic damage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Janta"
                            1 => "D&#46; Stanciu"
                            2 => "M&#46; Hinojosa"
                            3 => "J&#46;C&#46; Nieto-Gonz&#225;lez"
                            4 => "L&#46; Valor"
                            5 => "N&#46; Bello"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/kew020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2016"
                        "volumen" => "55"
                        "paginaInicial" => "1042"
                        "paginaFinal" => "1046"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26945055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0285"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound joint inflammation in rheumatoid arthritis in clinical remission&#58; how many and which joints should be assessed&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Naredo"
                            1 => "L&#46; Valor"
                            2 => "I&#46; De la Torre"
                            3 => "L&#46; Mart&#237;nez-Estupi&#241;&#225;n"
                            4 => "J&#46;C&#46; Nieto"
                            5 => "J&#46;G&#46; Ovalles-Bonilla"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2013"
                        "volumen" => "65"
                        "paginaInicial" => "512"
                        "paginaFinal" => "517"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound 7 versus ultrasound 12 in monitoring the response to infliximab in patients with rheumatoid arthritis"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "X&#46; Leng"
                            1 => "W&#46; Xiao"
                            2 => "Z&#46; Xu"
                            3 => "X&#46; Zhu"
                            4 => "Y&#46; Liu"
                            5 => "D&#46; Zhao"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Rheum"
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                        "paginaInicial" => "587"
                        "paginaFinal" => "594"
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2017.10.008

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Year/Month	Html	Pdf	Total

2024 November	3	4	7
2024 October	34	20	54
2024 September	36	14	50
2024 August	49	39	88
2024 July	45	23	68
2024 June	40	23	63
2024 May	62	29	91
2024 April	48	23	71
2024 March	32	35	67
2024 February	21	33	54
2024 January	38	30	68
2023 December	37	28	65
2023 November	30	33	63
2023 October	12	26	38
2023 September	101	34	135
2023 August	136	16	152
2023 July	20	26	46
2023 June	28	20	48
2023 May	38	21	59
2023 April	27	9	36
2023 March	55	16	71
2023 February	47	21	68
2023 January	22	18	40
2022 December	69	22	91
2022 November	34	35	69
2022 October	86	35	121
2022 September	25	29	54
2022 August	21	36	57
2022 July	39	38	77
2022 June	26	30	56
2022 May	29	44	73
2022 April	34	36	70
2022 March	33	40	73
2022 February	48	30	78
2022 January	53	39	92
2021 December	39	36	75
2021 November	54	39	93
2021 October	69	49	118
2021 September	62	40	102
2021 August	37	33	70
2021 July	20	24	44
2021 June	28	23	51
2021 May	34	39	73
2021 April	92	74	166
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2021 February	38	16	54
2021 January	32	12	44
2020 December	30	18	48
2020 November	30	10	40
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2020 August	61	25	86
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