Brief Report
Achilles tendon rupture associated with the use of fluoroquinolones in patients over 60 years of age: Experience from a single tertiary centre
Rotura del tendón de Aquiles asociada al uso de fluoroquinolonas en pacientes mayores de 60 años: experiencia de un centro de tercer nivel
Read
3908
Timeswas read the article
1677
Total PDF
2231
Total HTML
Share statistics
array:24 [ "pii" => "S2173574320300046" "issn" => "21735743" "doi" => "10.1016/j.reumae.2019.08.001" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1364" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2021;17:141-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "formatos" => array:2 [ "HTML" => 1 "PDF" => 1 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X19301251" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2019.08.004" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1364" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2021;17:141-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3 "HTML" => 3 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>" "titulo" => "Rotura del tendón de Aquiles asociada al uso de fluoroquinolonas en pacientes mayores de 60 años: experiencia de un centro de tercer nivel" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "141" "paginaFinal" => "143" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Achilles Tendon Rupture Associated with the Use of Fluoroquinolones in Patients Over 60 Years of AGE: Experience From a Single Tertiary Centre" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andrea Briones-Figueroa, Walter Alberto Sifuentes-Giraldo, José Luis Morell-Hita, Mónica Vázquez-Díaz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Andrea" "apellidos" => "Briones-Figueroa" ] 1 => array:2 [ "nombre" => "Walter Alberto" "apellidos" => "Sifuentes-Giraldo" ] 2 => array:2 [ "nombre" => "José Luis" "apellidos" => "Morell-Hita" ] 3 => array:2 [ "nombre" => "Mónica" "apellidos" => "Vázquez-Díaz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574320300046" "doi" => "10.1016/j.reumae.2019.08.001" "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/S2173574320300046?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X19301251?idApp=UINPBA00004M" "url" => "/1699258X/0000001700000003/v1_202102180720/S1699258X19301251/v1_202102180720/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574321000356" "issn" => "21735743" "doi" => "10.1016/j.reumae.2019.05.004" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1346" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2021;17:144-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Subclinical interstitial lung disease in patients with systemic sclerosis. A pilot study on the role of ultrasound" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "144" "paginaFinal" => "149" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intersticiopatía pulmonar subclínica en pacientes con esclerosis sistémica. Estudio piloto sobre el papel del ultrasonido" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 679 "Ancho" => 1300 "Tamanyo" => 57220 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pulmonary US imaging in a healthy subject. Note that the pleura is a lineal and regular hyperechogenic band (arrow). There are no B lines B.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Samuel Reyes-Long, Marwin Gutierrez, Denise Clavijo-Cornejo, Alfonso Alfaro-Rodríguez, Karen González-Sámano, José Luis Cortes-Altamirano, Roberto Muñoz-Louis, Esteban Cruz-Arenas, Katia Camargo, Fernanda Gonzalez, Chiara Bertolazzi" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Samuel" "apellidos" => "Reyes-Long" ] 1 => array:2 [ "nombre" => "Marwin" "apellidos" => "Gutierrez" ] 2 => array:2 [ "nombre" => "Denise" "apellidos" => "Clavijo-Cornejo" ] 3 => array:2 [ "nombre" => "Alfonso" "apellidos" => "Alfaro-Rodríguez" ] 4 => array:2 [ "nombre" => "Karen" "apellidos" => "González-Sámano" ] 5 => array:2 [ "nombre" => "José Luis" "apellidos" => "Cortes-Altamirano" ] 6 => array:2 [ "nombre" => "Roberto" "apellidos" => "Muñoz-Louis" ] 7 => array:2 [ "nombre" => "Esteban" "apellidos" => "Cruz-Arenas" ] 8 => array:2 [ "nombre" => "Katia" "apellidos" => "Camargo" ] 9 => array:2 [ "nombre" => "Fernanda" "apellidos" => "Gonzalez" ] 10 => array:2 [ "nombre" => "Chiara" "apellidos" => "Bertolazzi" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X19301044" "doi" => "10.1016/j.reuma.2019.05.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X19301044?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321000356?idApp=UINPBA00004M" "url" => "/21735743/0000001700000003/v1_202103030852/S2173574321000356/v1_202103030852/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173574321000290" "issn" => "21735743" "doi" => "10.1016/j.reumae.2019.10.002" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1372" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2021;17:137-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Do humor styles predict clinical response to the MINDSET (MINDfulneSs & EducaTion) program? A pilot study in patients with fibromyalgia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "137" "paginaFinal" => "140" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Los estilos de humor predicen la respuesta clínica al programa MINDSET (MINDfulneSs & EducaTion)? Un estudio piloto en pacientes con fibromialgia" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Adrián Pérez-Aranda, Natalia Angarita-Osorio, Albert Feliu-Soler, Laura Andrés-Rodríguez, Xavier Borràs, Juan V. Luciano" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Adrián" "apellidos" => "Pérez-Aranda" ] 1 => array:2 [ "nombre" => "Natalia" "apellidos" => "Angarita-Osorio" ] 2 => array:2 [ "nombre" => "Albert" "apellidos" => "Feliu-Soler" ] 3 => array:2 [ "nombre" => "Laura" "apellidos" => "Andrés-Rodríguez" ] 4 => array:2 [ "nombre" => "Xavier" "apellidos" => "Borràs" ] 5 => array:2 [ "nombre" => "Juan V." "apellidos" => "Luciano" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321000290?idApp=UINPBA00004M" "url" => "/21735743/0000001700000003/v1_202103030852/S2173574321000290/v1_202103030852/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Report</span>" "titulo" => "Achilles tendon rupture associated with the use of fluoroquinolones in patients over 60 years of age: Experience from a single tertiary centre" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "141" "paginaFinal" => "143" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Andrea Briones-Figueroa, Walter Alberto Sifuentes-Giraldo, José Luis Morell-Hita, Mónica Vázquez-Díaz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Andrea" "apellidos" => "Briones-Figueroa" "email" => array:1 [ 0 => "andreabriones306@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" => "Walter Alberto" "apellidos" => "Sifuentes-Giraldo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José Luis" "apellidos" => "Morell-Hita" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Mónica" "apellidos" => "Vázquez-Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rotura del tendón de Aquiles asociada al uso de fluoroquinolonas en pacientes mayores de 60 años: experiencia de un centro de tercer nivel" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background and objective</span><p id="par0005" class="elsevierStylePara elsevierViewall">The Fluoroquinolones (FQ) are a group of broad-spectrum antibiotics, which have come into wider use due to their efficacy and suitable tolerability and safety profile. However, pharmacovigilance studies have associated the use of these drugs with adverse events in connection with alterations in the extracellular matrix collagen. Tendinopathy and tendon rupture have been reported, as well as retinal detachment and aortic aneurisms.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although the exact mechanism is unknown, the FQ may cause direct damage to cells in the connective tissue of the tendon, including alterations of fibroblast metabolism and phenomena of necrosis and apoptosis, as well as indirect damage due to the release of metalloproteases, nitric oxide and reactive forms of oxygen.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The Achilles tendon is the most frequent location of tendinopathy associated with FQ, and it is affected in up to 95% of cases. Although the risk of Achilles tendon rupture (ATR) associated with FQ is rare in a healthy young population, it triples in patients older than 60 years old or in the presence of other risk factors.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The aim of our study is to describe the epidemiological and clinical profile of patients diagnosed ATR after being treated with FQ, seen in a tertiary Madrid hospital.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A retrospective, observational and transversal study was performed, including patients diagnosed ATR (confirmed by imaging tests or surgical examination) and seen in our hospital in the period from 2000–2017. The clinical histories of the included patients were reviewed, obtaining their demographic data (age, sex, comorbidities and toxic habits) together with information on concomitant medication (glucocorticoids and statins), the mechanism that cause the rupture (spontaneous or traumatic), the type of rupture (partial or total), treatment and evolution of the same. Likewise, those patients who had received treatment with FQ prior to the ATR were identified, registering in these cases the time that transpired from starting to take FQ until the ATR, the type of FQ used, the duration of and the indication for the said treatment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The demographic and clinical variables were compared between the patients with and without previous treatment with FQ, using the χ<span class="elsevierStyleSup">2</span> and Mann–Whitney U tests to obtain the <span class="elsevierStyleItalic">P</span> value. A <span class="elsevierStyleItalic">P</span> value  < .05 was considered to indicate statistical significance.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">During the period studied a total of 44 patients with ATR were identified (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), of whom 18% (8/44) had been treated previously with FQ. In this latter group the average age at diagnosis of ATR was 77.37 ± 9.54 years old, and 6 of them were men (75%). In 4 cases there was a history of chronic treatment with concomitant glucocorticoids, although none of them had received statins when the ATR occurred. Regarding relevant comorbidities, 3 patients had previously been diagnosed with chronic obstructive pulmonary disease (COPD), one had recently been diagnosed with diffuse interstitial pulmonary disease (DIPD) and another patient had been subjected to renal transplant due to chronic terminal kidney disease secondary to nephroangioesclerosis.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Seven patients (87.5%) had been treated with levofloxacin and one with ciprofloxacin, all of them administered orally. In half of the cases the indication for treatment with FQ was acute bronchitis, while in the others it was for infectious exacerbations of their underlying respiratory disease (COPD/DIPD). The average duration of treatment with FQ was 6.16 ± 2.4 days, while the average time from starting to take this drug and the diagnosis of ATR was 19.25 ± 14.83 days. In 7 cases the rupture was spontaneous, while in one patient it was associated with low-intensity traumatism. The ATR was complete in 7 cases, and all of them required surgical repair (including the single case of partial rupture), without any subsequent recurrence.</p><p id="par0035" class="elsevierStylePara elsevierViewall">When the characteristics of the patients with ATR who had been treated with FQ are compared with those who had not, significant differences are found respecting a history of smoking (62.5% vs. 2.8%; <span class="elsevierStyleItalic">P</span> = .00), concomitant treatment with glucocorticoids (50% vs. 5.6%; <span class="elsevierStyleItalic">P</span> = .01) and spontaneous rupture (87.5% vs. 25.8%; <span class="elsevierStyleItalic">P</span> = .01) in the FQ group FQ (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion and conclusions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Based on previous population studies, it is estimated that patients under treatment with FQ are at 1.6–1.7 times more risk of tendinopathy than the general population, and the Achilles tendon is the most frequent location (rate of incidence adjusted for ATR 3.14).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> In the published cases and series of cases, the time from starting treatment with FQ until the appearance of ATR varies, with a median time of 6 days,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> although it has even been described as occurring from a few hours after starting to take the drug until 6 months after it had been withdrawn.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The risk of developing ATR is 3 times greater in the first 90 days after starting treatment with FQ.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In our series, the average time from starting to take the drug until the diagnosis of ATR was 19 days, and this is similar to the 16 day period found in the case-control by Corrao et al. in a Northern Italian population.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The risk factors that have been associated with developing ATR during treatment with FQ include being older than 60 years old, male, chronic treatment with glucocorticoids, chronic kidney disease and organ transplant (kidney, lung or heart).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Although the design of our study makes it impossible to establish causal relationships between the use of FQ and other risk factors and the development of ATR, or the possibility that the effect of FQ amplifies other possible risk factors, such as glucocorticoids or smoking, similar associations to those found in previous studies were observed. In our series, there were significantly more men in the group treated with FQ, and up to half of the cases received concomitant glucocorticoid treatment. This percentage is higher than those described in other series, in which the rate of treatment with these drugs ran from 15% to 20%.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,11</span></a> This is probably related to our higher number of patients with underlying respiratory disease and chronic inhaled or systemic corticoid therapy. Although organ transplant is a factor clearly associated with FQ connected ATR, only one case in our series had received a kidney transplant, and this type of transplant is the one for which this adverse event has been described the most often (incidence in the population who have received a kidney transplant: 12.2%–15,6%).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Statins have also been associated with the development of tendinopathy, and it has been argued that their concomitant use with FQ may amplify this risk.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> However, none of the cases in our series had received both drugs simultaneously, and the study of nested cases and controls in a British population by Morales et al. found no correlation between the concomitant use of statins and the development of ATR associated with FQ.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Other variables associated with the appearance of tendinopathy, the risk of which may increase with the use of FQ but which were not studied in our population are obesity, diabetes mellitus, dyslipidemia, hyperparathyroidism and underlying musculoskeletal disorders.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,12,14</span></a> On the other hand, we found a higher number of smokers among the patients who had received FQ, and this datum agrees with previous studies in which being a current smoker (but not an ex-smoker) is associated with an increase in ATR linked to these drugs.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although Seeger et al. found no difference in the risk of developing ATR associated with FQ when they compared different drugs in this family in a study of a North American population that included 947 cases of ATR and 18,940 controls,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> other studies, such as those by van der Linden et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and Hori et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> found a higher risk of ATR in patients who had taken ofloxacin in comparison with other types of FQ, and that this association was dose-dependent. Nevertheless, in the literature as well as in our series, the majority of cases occurred in patients treated with ciprofloxacin,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and in more recent publications those treated with levofloxacin.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This is probably due to the increasingly widespread use of the latter medication.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">FQ are usually prescribed to treat infections that affect the respiratory, genitourinary and gastrointestinal tracts, the first of which was the main cause of the indication for treatment with these drugs in our series. However, other alternative antibiotic treatments exist, and these could be considered for individuals at high risk of ATR, as this condition usually requires surgical treatment. This was evident in our study, in which surgery was necessary in 100% of the cases to repair the rupture, and this may be associated with a high level of morbidity and functional disability. It is therefore advisable to identify the presence of the said risk factors and ensure the early detection of tendinopathy symptoms in these patients.</p><p id="par0060" class="elsevierStylePara elsevierViewall">To conclude, the description of our series supports the emerging concern expressed by pharmacovigilance systems respecting adverse musculoskeletal reaction to the use of FQ, more specifically in terms of tendinopathy and ATR. An appropriate risk-benefit analysis should therefore be performed prior to using these drugs in patients over the age of 60 years old with concomitant risk factors, excluding them for cases of mild or self-limiting infections or when other alternative treatments are available.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1474285" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 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" => "xpalclavsec1342786" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1474284" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 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" => "xpalclavsec1342785" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background and objective" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion and conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-04" "fechaAceptado" => "2019-08-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1342786" "palabras" => array:5 [ 0 => "Achilles tendon rupture" 1 => "Tendinopathy" 2 => "Fluoroquinolones" 3 => "Levofloxacin" 4 => "Ciprofloxacin" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1342785" "palabras" => array:5 [ 0 => "Rotura del tendón de Aquiles" 1 => "Tendinopatía" 2 => "Fluoroquinolonas" 3 => "Levofloxacino" 4 => "Ciprofloxacino" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fluoroquinolones have been associated with increased risk of tendinopathy and Achilles tendon rupture (ATR), especially in patients over 60 years of age.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A retrospective study was carried out including patients over 60 years of age with ATR attended in our centre over the period 2000–2017.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We identified 44 patients with RTA, of whom 18% (8/44) had been previously treated with fluoroquinolones, with a mean age at diagnosis of ATR of 77.37 years and concomitant corticotherapy in 4 of them. In 7 patients, the rupture was spontaneous and all required surgical management. A significantly higher frequency of smoking, concomitant corticotherapy and spontaneous ruptures were found in the group treated with fluoroquinolones.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ATR is an adverse event that can occur in patients over 60 years of age treated with fluoroquinolones, so an adequate risk-benefit assessment should be carried out in this population, especially in the presence of associated risk factors.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 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" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las fluoroquinolonas han sido asociadas con aumento del riesgo de tendinopatía y rotura del tendón de Aquiles (RTA), especialmente en pacientes mayores de 60 años.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se llevó a cabo un estudio retrospectivo en el que se incluyó a los pacientes mayores de 60 años con RTA atendidos en nuestro centro durante el período 2000-2017.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se identificó a 44 pacientes con RTA, de los cuales 18% 8/44 habían sido tratados previamente con fluoroquinolonas, con una media de edad al diagnóstico de RTA de 77,37 años y corticoterapia concomitante en 4 de ellos. En 7 pacientes la rotura fue espontánea y todas requirieron tratamiento quirúrgico. Se encontró una frecuencia significativamente mayor de tabaquismo, corticoterapia concomitante y roturas espontáneas en el grupo tratado con fluoroquinolonas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La RTA es un evento adverso que puede ocurrir en pacientes mayores de 60 años tratados con fluoroquinolonas, por lo que debería realizarse una adecuada evaluación relación riesgo-beneficio en esta población, especialmente en presencia de factores de riesgo asociados.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Briones-Figueroa A, Sifuentes-Giraldo WA, Morell-Hita JL, Vázquez-Díaz M. Rotura del tendón de Aquiles asociada al uso de fluoroquinolonas en pacientes mayores de 60 años: experiencia de un centro de tercer nivel. Reumatol Clin. 2021;17:141–143.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "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">Variable \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">Previously treated with Fluoroquinolones (n = 8) \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 previous treatment with Fluoroquinolones (n = 36) \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"><span class="elsevierStyleItalic">P</span> 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"><span class="elsevierStyleItalic">Average age ± standard deviation (years)</span> \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">77.37 ± 9.54 \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">70.13 ± 8.3 \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">.48 \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 " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex</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>Male \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">6 (75%) \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">25 (69.4%) \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">.75 \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>Female \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 (25%) \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">11 (30.6%) \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"> \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>Smokers \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">5 (62.5%) \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 (2.8%) \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">.00 \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>Treatment with glucocorticoids \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">4 (50%) \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 (5.6%) \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">.01 \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>Treatment with statins \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">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (13.9%) \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">.26 \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 " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Type of rupture</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>Spontaneous \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 (87.5%) \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">8 (25.8%) \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">.01 \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>Traumatic \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 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (74.2%) \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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2536836.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of the characteristics of patients with ATR, with and without previous treatment with FQ.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Daneman" 1 => "H. Lu" 2 => "D. Redelmeier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjopen-2015-009907" "Revista" => array:4 [ "tituloSerie" => "BMJ Open" "fecha" => "2015" "volumen" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26610765" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluoroquinolone-associated tendinopathy: does levofloxacin pose the greatest risk?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Bidell" 1 => "T. Lodise" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pharmacotherapy" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "679" "paginaFinal" => "693" "itemHostRev" => array:3 [ "pii" => "S0022534708018351" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of ciprofloxacin on tendon, paratenon, and capsular fibroblast metabolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.J. Williams 3rd" 1 => "E. Attia" 2 => "T.L. Wickiewicz" 3 => "J.A. Hannafin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/03635465000280031401" "Revista" => array:7 [ "tituloSerie" => "Am J Sports Med" "fecha" => "2000" "volumen" => "28" "paginaInicial" => "364" "paginaFinal" => "369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10843129" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283806001850" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of levofloxacin on rabbit fibroblast-like synoviocytes in vitro" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Tan" 1 => "K. Lu" 2 => "Y. Deng" 3 => "H. Cao" 4 => "B. Chen" 5 => "H. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.taap.2012.10.003" "Revista" => array:6 [ "tituloSerie" => "Toxicol Appl Pharmacol" "fecha" => "2012" "volumen" => "265" "paginaInicial" => "175" "paginaFinal" => "180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23067722" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence of tendinitis provoked by fluoroquinolone treatment: a case-control study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Corrao" 1 => "A. Zambon" 2 => "L. Bertù" 3 => "A. Mauri" 4 => "V. Paleari" 5 => "C. Rossi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/00002018-200629100-00006" "Revista" => array:7 [ "tituloSerie" => "Drug Saf" "fecha" => "2006" "volumen" => "29" "paginaInicial" => "889" "paginaFinal" => "896" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16970512" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2405456917300330" "estado" => "S300" "issn" => "24054569" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relative and absolute risk of tendon rupture with fluoroquinolone and concomitant fluoroquinolone/corticosteroid therapy: population-based nested case-control study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.R. Morales" 1 => "J. Slattery" 2 => "A. Pacurariu" 3 => "L. Pinheiro" 4 => "P. McGettigan" 5 => "X. Kurz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40261-018-0729-y" "Revista" => array:6 [ "tituloSerie" => "Clin Drug Investig" "fecha" => "2019" "volumen" => "39" "paginaInicial" => "205" "paginaFinal" => "213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30465300" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of bilateral Achilles tendon rupture associated with ciprofloxacin: a review and case presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Akali" 1 => "N. Niranjan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bjps.2006.08.005" "Revista" => array:6 [ "tituloSerie" => "J Plast Reconstr Aesthet Surg" "fecha" => "2008" "volumen" => "61" "paginaInicial" => "830" "paginaFinal" => "834" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17409040" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral levofloxacin-induced Achilles tendon rupture: an uncommon case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.E. Fernández-Cuadros" 1 => "L.O. Casique-Bocanegra" 2 => "M.J. Albaladejo-Florín" 3 => "S. Gómez-Dueñas" 4 => "C. Ramos-Gonzalez" 5 => "O.S. Pérez-Moro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Clin Med Insights Arthritis Musculoskelet Disord" "fecha" => "2019" "volumen" => "12" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of fluoroquinolone and risk of Achilles tendon rupture: a population-based cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Sode" 1 => "N. Obel" 2 => "J. Hallas" 3 => "A. Lassen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00228-007-0265-9" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Pharmacol" "fecha" => "2007" "volumen" => "63" "paginaInicial" => "499" "paginaFinal" => "503" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17334751" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tendon injury and fluoroquinolone use: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Stephenson" 1 => "W. Wu" 2 => "D. Cortes" 3 => "P. Rochon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40264-013-0089-8" "Revista" => array:6 [ "tituloSerie" => "Drug Safety" "fecha" => "2013" "volumen" => "36" "paginaInicial" => "709" "paginaFinal" => "721" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23888427" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Van der Linden" 1 => "M.C. Sturkenboom" 2 => "R.M. Herings" 3 => "H.M. Leufkens" 4 => "S. Rowlands" 5 => "B.H. Stricker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinte.163.15.1801" "Revista" => array:7 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2003" "volumen" => "163" "paginaInicial" => "1801" "paginaFinal" => "1807" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12912715" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022534709008970" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluoroquinolones-induced tendinitis and tendon rupture in kidney transplant recipients: 2 cases and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Muzi" 1 => "G. Gravante" 2 => "E. Tati" 3 => "G. Tati" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.transproceed.2007.01.077" "Revista" => array:7 [ "tituloSerie" => "Transplant Proc" "fecha" => "2007" "volumen" => "39" "paginaInicial" => "1673" "paginaFinal" => "1675" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17580216" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022534709026536" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tendinopathy and tendon rupture associated with statins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.E. Deren" 1 => "S.A. Klinge" 2 => "N.H. Mukand" 3 => "J.A. Mukand" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "JBJS Rev" "fecha" => "2016" "volumen" => "4" "paginaInicial" => "e4" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Seeger" 1 => "W.A. West" 2 => "D. Fife" 3 => "G.J. Noel" 4 => "L.N. Johnson" 5 => "A.M. Walker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/pds.1214" "Revista" => array:6 [ "tituloSerie" => "Pharmacoepidemiol Drug Saf" "fecha" => "2006" "volumen" => "15" "paginaInicial" => "784" "paginaFinal" => "792" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16456878" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detection of fluoroquinolone-induced tendon disorders using a hospital database in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Hori" 1 => "K. Yamakawa" 2 => "N. Yoshida" 3 => "K. Ohnishi" 4 => "J. Kawakami" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/pds.3285" "Revista" => array:6 [ "tituloSerie" => "Pharmacoepidemiol Drug Saf" "fecha" => "2012" "volumen" => "21" "paginaInicial" => "886" "paginaFinal" => "889" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22532516" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001700000003/v1_202103030852/S2173574320300046/v1_202103030852/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/21735743/0000001700000003/v1_202103030852/S2173574320300046/v1_202103030852/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320300046?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 9 | 16 |
| 2024 October | 44 | 48 | 92 |
| 2024 September | 61 | 29 | 90 |
| 2024 August | 55 | 50 | 105 |
| 2024 July | 67 | 40 | 107 |
| 2024 June | 61 | 60 | 121 |
| 2024 May | 62 | 53 | 115 |
| 2024 April | 66 | 53 | 119 |
| 2024 March | 54 | 51 | 105 |
| 2024 February | 38 | 60 | 98 |
| 2024 January | 48 | 30 | 78 |
| 2023 December | 25 | 33 | 58 |
| 2023 November | 77 | 43 | 120 |
| 2023 October | 44 | 31 | 75 |
| 2023 September | 87 | 32 | 119 |
| 2023 August | 114 | 27 | 141 |
| 2023 July | 32 | 23 | 55 |
| 2023 June | 37 | 35 | 72 |
| 2023 May | 37 | 42 | 79 |
| 2023 April | 29 | 18 | 47 |
| 2023 March | 46 | 46 | 92 |
| 2023 February | 66 | 31 | 97 |
| 2023 January | 69 | 34 | 103 |
| 2022 December | 73 | 57 | 130 |
| 2022 November | 65 | 49 | 114 |
| 2022 October | 72 | 51 | 123 |
| 2022 September | 73 | 50 | 123 |
| 2022 August | 57 | 49 | 106 |
| 2022 July | 44 | 58 | 102 |
| 2022 June | 53 | 46 | 99 |
| 2022 May | 46 | 42 | 88 |
| 2022 April | 51 | 55 | 106 |
| 2022 March | 59 | 51 | 110 |
| 2022 February | 72 | 44 | 116 |
| 2022 January | 93 | 59 | 152 |
| 2021 December | 50 | 43 | 93 |
| 2021 November | 64 | 37 | 101 |
| 2021 October | 82 | 63 | 145 |
| 2021 September | 48 | 41 | 89 |
| 2021 August | 1 | 1 | 2 |
| 2021 June | 1 | 2 | 3 |
| 2020 January | 1 | 1 | 2 |
Show all
