Letter to the Editor
Valvulopathy in scleroderma is not always autoimmunity
Valvulopatía en la esclerodermia, no siempre es autoinmunidad
Read
2871
Timeswas read the article
1182
Total PDF
1689
Total HTML
Share statistics
array:24 [ "pii" => "S2173574320300010" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.12.012" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1314" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2021;17:56-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X19300087" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2018.12.003" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1314" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2021;17:56-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8 "HTML" => 8 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Valvulopatía en la esclerodermia, no siempre es autoinmunidad" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "56" "paginaFinal" => "57" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Valvulopathy in scleroderma is not always autoimmunity" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1590 "Ancho" => 1583 "Tamanyo" => 121418 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagen de PET-TC con 18F-FDG que muestra captación presacra con escasa avidez glucídica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lucía Suárez Pérez, Luis Caminal Montero, Luis Trapiella Martínez, Jessica Rugeles Niño" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Lucía" "apellidos" => "Suárez Pérez" ] 1 => array:2 [ "nombre" => "Luis" "apellidos" => "Caminal Montero" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Trapiella Martínez" ] 3 => array:2 [ "nombre" => "Jessica" "apellidos" => "Rugeles Niño" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574320300010" "doi" => "10.1016/j.reumae.2018.12.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320300010?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X19300087?idApp=UINPBA00004M" "url" => "/1699258X/0000001700000001/v1_202101090658/S1699258X19300087/v1_202101090658/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173574320301611" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.12.014" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1315" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2021;17:57-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Extension of the RENACER Study: 12-Month Efficacy, Safety and Certolizumab PEGol Survival in 501 Rheumatoid Arthritis Patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "57" "paginaFinal" => "58" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ampliación del estudio RENACER: eficacia, seguridad y supervivencia a 12 meses de 501 pacientes de artritis reumatoide tratados con Certolizumab PEGol" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1367 "Ancho" => 1622 "Tamanyo" => 57536 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparative cumulative survival between bio-naïve patients and patients that received previous biological therapy.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vicenç Torrente-Segarra, Manuel Fernández Prada, Rosa Expósito, Noemí Patricia Garrido Puñal, Amalia Sánchez-Andrade, José Ramón Lamúa-Riazuelo, Alejandro Olivé, Juan Víctor Tovar" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Vicenç" "apellidos" => "Torrente-Segarra" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Fernández Prada" ] 2 => array:2 [ "nombre" => "Rosa" "apellidos" => "Expósito" ] 3 => array:2 [ "nombre" => "Noemí Patricia" "apellidos" => "Garrido Puñal" ] 4 => array:2 [ "nombre" => "Amalia" "apellidos" => "Sánchez-Andrade" ] 5 => array:2 [ "nombre" => "José Ramón" "apellidos" => "Lamúa-Riazuelo" ] 6 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Olivé" ] 7 => array:2 [ "nombre" => "Juan Víctor" "apellidos" => "Tovar" ] 8 => array:1 [ "colaborador" => "on behalf of RENACER Study Group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301611?idApp=UINPBA00004M" "url" => "/21735743/0000001700000001/v1_202101140856/S2173574320301611/v1_202101140856/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173574320301623" "issn" => "21735743" "doi" => "10.1016/j.reumae.2019.01.004" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1318" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2021;17:55-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Revisiting the association between systemic lupus erythematosus and gout" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "55" "paginaFinal" => "56" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Revisitando la asociación entre lupus eritematoso sistémico y gota" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisca Aguiar, Iva Brito, Jean Sibilia" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Francisca" "apellidos" => "Aguiar" ] 1 => array:2 [ "nombre" => "Iva" "apellidos" => "Brito" ] 2 => array:2 [ "nombre" => "Jean" "apellidos" => "Sibilia" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301623?idApp=UINPBA00004M" "url" => "/21735743/0000001700000001/v1_202101140856/S2173574320301623/v1_202101140856/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Valvulopathy in scleroderma is not always autoimmunity" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "56" "paginaFinal" => "57" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lucía Suárez Pérez, Luis Caminal Montero, Luis Trapiella Martínez, Jessica Rugeles Niño" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Lucía" "apellidos" => "Suárez Pérez" "email" => array:1 [ 0 => "luciasuarezp27@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Luis" "apellidos" => "Caminal Montero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Luis" "apellidos" => "Trapiella Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Jessica" "apellidos" => "Rugeles Niño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Enfermedades Autoinmunes Sistémicas, Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario San Agustín, Avilés, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valvulopatía en la esclerodermia, no siempre es autoinmunidad" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1693 "Ancho" => 1667 "Tamanyo" => 151151 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET-CT scan image with 18F-FDG showing presacral capture with little glucidic avidity.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiac complications in scleroderma (SD) are associated with a poor prognosis. Up to 15% of patients, generally with limited forms and anticentromere antibodies, develop pulmonary hypertension (PHT). Early diagnosis improves the prognosis, so that routine transthoracic echocardiograms (TTE) are recommended.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Pericardial bleeding has also been described, as have valvulopathies, myocarditis and hypertrophy or myocardial fibrosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> We believe it is of interest to present the case of a patient with limited SD who developed mitral-aortic valvulopathy that was finally attributed to ergotamine toxicity.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 59 year-old woman diagnosed SD based on Reynaud’s phenomenon, characteristic capillaroscopy and anticentromere antibodies. At the moment of diagnosis TTE showed insignificant aortic and mitral insufficiency, normal systolic function and the absence of PHT data. 11 years later the valvulopathy had evolved to become severe mitral and tricuspid insufficiency, moderate aortic insufficiency and severe PHT (PSAP: 75 mmHg). Two mechanical prostheses were therefore implanted at mitral and aortic levels.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Two years later she visited due to general syndrome and dyspnoea. She was treated with Furosemide, Ranolazine, Acenocumarol, Spironolactone, Omeprazol and Bromazepam.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Physical examination only found distal metacarpophalangeal sclerodactila, with no scarring, ulcers or telangiectasias, and mild cutaneous sclerosis on the legs.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Relevant analytical data are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">A thoracic-abdominal CT scan showed an extensive area of retroperitoneal (RPF) and pelvic fibrosis with bilateral ureterohydronephrosis. Subsequently a PET-CT scan with <span class="elsevierStyleSup">18</span>F-FDG (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) confirmed the mass of soft tissues in front of the sacrococcygeal region, with low glucidic avidity (SUVmax: 2.16 g/ml).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Given these findings a double J catheter was implanted and the fibrotic retroperitoneal lesions were biopsied. In the valves resected 2 years previously and in the retroperitoneal lesions only areas of fibrosis with negative immunofluorescence for IgG4 were observed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient then remembered taking Hemicraneal® (paracetamol, caffeine and 2 mg ergotamine tartrate) almost every day for several years in suppository format for headaches, without medical prescription.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It was finally assumed that the RPF as well as the valvulopathy were side effects of the ergotamines.</p><p id="par0050" class="elsevierStylePara elsevierViewall">RPF is a fibroinflammatory disease that is now considered to be within the spectrum of diseases associated with IgG4, although it has also been associated with other systemic diseases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Differential diagnosis of this disease includes carcinoid tumours, actinomycosis, radiotherapy or abdominal surgery and Erdheim-Chester’s disease, although drugs also have to be considered. They include anti-migraine medication (metisergide and ergotamine), dopaminergic agonists used in Parkinson’s disease (pergolide and cabergoline), anorexigenic drugs (fenfluramine, dexfenfluramine and benfluorex) and anti-TNF<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> drugs. However, the list includes recreational drugs as well, such as 3,4-methylenodioxymethamphetamine, known as ecstasy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These drugs have strong affinity for the 5HT<span class="elsevierStyleInf">28</span> serotonin receptor that is found in valvular tissue, and they cause lesions similar to those observed in carcinoid tumours, with thickening and accumulation of collagen and the proliferation of myofibroblasts and smooth muscle cells.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Ergotamine is used as migraine prophylaxis. It is sold over the counter and its use is contraindicated in Raynaud as it causes vasospasm. The first case of valvulopathy due to ergotamines was described in 1974<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and, although its toxicity is well-known, it is rarely diagnosed. It is probably under-diagnosed as it is taken without supervision, and its toxicity appears after prolonged use.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Our patient, with limited SD, developed valvulopathy and RPF due to ergotamines. Although both toxicities are well-known, they are exceptional in the same patient. On the other hand, the association of SD and RPF, profibrotic diseases that may have similar physiopathological mechanisms, is exceptional.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> In spite of sophisticated current diagnostic procedures, our diagnosis is still based on directed anamnesis, which is often overlooked. In SD, as is the case for other systemic diseases,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> other processes and drugs which may simulate their clinical manifestations must always be taken into account.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financing</span><p id="par0065" class="elsevierStylePara elsevierViewall">This research received no specific grant from any agency in the public or private sector or those which are not-for-profit.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financing" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Suárez Pérez L, Caminal Montero L, Trapiella Martínez L, Rugeles Niño J. Valvulopatía en la esclerodermia, no siempre es autoinmunidad. Reumatol Clin. 2021;17:57–58.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1693 "Ancho" => 1667 "Tamanyo" => 151151 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET-CT scan image with 18F-FDG showing presacral capture with little glucidic avidity.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">ANA: antinuclear antibodies; ANCA: antineutrophile cytoplasm antibodies; Anti-DNA: anti-DNA antibodies; AST: aspartate aminotransferase; ENA: extractable nuclear antigens; AP: alkaline phosphatase; GGT: gamma glutamyl transpeptidase; PCR: polymerase chain reaction.</p>" "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">Biochemistry \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"> \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">Haemogram \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"> \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">Immunology \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"> \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">Creatinine \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">1.23 mg/dl \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">Haemoglobin \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">12.5 g/dl \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">ANA \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">Positive 1/1,280, centromere \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">AST \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">44 UI/l \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">Leukocytes \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">7,620 \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">Anti-DNA, ENA, ANCA \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">Negative \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">AP \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">716 UI/l \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">Platelets \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">13,700 \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">Anticardiolipin antibodies, anti-2-glycoprotein antibodies \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">Negative \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">GGT \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">290 UI/l \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">PCR \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">46 m/h \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">IgG4 \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">Normal (0.05) \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">PCR \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">2.54 mg/dl \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">– \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">– \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">Plasmablasts in peripheral blood \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">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2492046.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Analytical results.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.P. Denton" 1 => "D. Khanna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(17)30933-9" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2017" "volumen" => "390" "paginaInicial" => "1685" "paginaFinal" => "1699" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28413064" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus best practice pathway of the UK Systemic Sclerosis Study group: management of cardiac disease in systemic sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.A. Bissell" 1 => "M. Anderson" 2 => "M. Burgess" 3 => "K. Chakravarty" 4 => "G. Coghlan" 5 => "R.B. Dumitru" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2017" "volumen" => "56" "paginaInicial" => "912" "paginaFinal" => "921" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute cardiomyopathy as a clinical manifestation of systemic sclerosis [Article in Spanish]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Plasín" 1 => "E. Lluch" 2 => "R. Piulats" 3 => "J.C. Trullàs" 4 => "G. Espinosa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2011.01.024" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2011" "volumen" => "211" "paginaInicial" => "e51" "paginaFinal" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21536267" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic retroperitoneal fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Vaglio" 1 => "F. Maritati" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2015101110" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2016" "volumen" => "27" "paginaInicial" => "1880" "paginaFinal" => "1889" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26860343" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-induced valvular heart disease: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Andrejak" 1 => "C. Tribouilloy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acvd.2013.02.003" "Revista" => array:6 [ "tituloSerie" => "Arch Cardiovasc Dis" "fecha" => "2013" "volumen" => "106" "paginaInicial" => "333" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23769407" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-induced fibrotic valvular heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Bhattacharyya" 1 => "A.H. Schapira" 2 => "D.P. Mikhailidis" 3 => "J. Davar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)60252-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "374" "paginaInicial" => "577" "paginaFinal" => "585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19683643" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valvular heart disease associated with ergotamine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Martínez Quintana" 1 => "R. Llorens León" 2 => "E. Redondo Martínez" 3 => "V. Nieto Lago" 4 => "F. Jiménez Cabrera" 5 => "E. Gross Kastanovitz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2005" "volumen" => "58" "paginaInicial" => "97" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15680136" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retroperitoneal fibrosis and generalized scleroderma [Article in French]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Cochat" 1 => "S. Colon" 2 => "M. Laville" 3 => "P. Maillet" 4 => "N. Lefrançois" 5 => "J.F. Moskovtchenko" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nephrologie" "fecha" => "1985" "volumen" => "6" "paginaInicial" => "27" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4000379" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic sclerosis and collagenous colitis in a patient with retroperitoneal fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.U. Gerth" 1 => "P. Willeke" 2 => "C. Sunderkötter" 3 => "T. Spieker" 4 => "M. Köhler" 5 => "H. Pavenstädt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/03009742.2011.555926" "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "2011" "volumen" => "40" "paginaInicial" => "322" "paginaFinal" => "323" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21453186" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "All that glitters is not lupus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. López-Mato" 1 => "C. Zamora-Martínez" 2 => "S. Carbajal" 3 => "M. Estevez" 4 => "I. Rodriguez-Pinto" 5 => "R. Cervera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0961203317742713" "Revista" => array:2 [ "tituloSerie" => "Lupus" "fecha" => "2017" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001700000001/v1_202101140856/S2173574320300010/v1_202101140856/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001700000001/v1_202101140856/S2173574320300010/v1_202101140856/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320300010?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 27 | 10 | 37 |
| 2024 September | 46 | 27 | 73 |
| 2024 August | 70 | 42 | 112 |
| 2024 July | 45 | 32 | 77 |
| 2024 June | 53 | 28 | 81 |
| 2024 May | 55 | 20 | 75 |
| 2024 April | 45 | 21 | 66 |
| 2024 March | 46 | 39 | 85 |
| 2024 February | 56 | 30 | 86 |
| 2024 January | 39 | 25 | 64 |
| 2023 December | 26 | 25 | 51 |
| 2023 November | 51 | 27 | 78 |
| 2023 October | 29 | 29 | 58 |
| 2023 September | 72 | 27 | 99 |
| 2023 August | 42 | 14 | 56 |
| 2023 July | 33 | 17 | 50 |
| 2023 June | 33 | 24 | 57 |
| 2023 May | 33 | 39 | 72 |
| 2023 April | 18 | 14 | 32 |
| 2023 March | 39 | 25 | 64 |
| 2023 February | 40 | 28 | 68 |
| 2023 January | 38 | 9 | 47 |
| 2022 December | 48 | 28 | 76 |
| 2022 November | 54 | 31 | 85 |
| 2022 October | 67 | 30 | 97 |
| 2022 September | 42 | 20 | 62 |
| 2022 August | 39 | 38 | 77 |
| 2022 July | 39 | 34 | 73 |
| 2022 June | 33 | 39 | 72 |
| 2022 May | 36 | 42 | 78 |
| 2022 April | 41 | 38 | 79 |
| 2022 March | 40 | 36 | 76 |
| 2022 February | 45 | 32 | 77 |
| 2022 January | 48 | 36 | 84 |
| 2021 December | 33 | 39 | 72 |
| 2021 November | 40 | 33 | 73 |
| 2021 October | 48 | 49 | 97 |
| 2021 September | 32 | 42 | 74 |
| 2021 August | 33 | 31 | 64 |
| 2021 July | 31 | 29 | 60 |
Show all
