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exposure to sunlight&#44; age&#44; ethnic group&#44; body mass index &#40;BMI&#41;&#44; the use of medication &#40;steroids and immunosuppressant drugs&#41;&#44; as well as dietary supplements&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Vitamin D has recently been described as having non-classical actions&#44; indicating that it not only regulates calcium and phosphorus metabolism&#44; but that it is also plays immunological and anti-inflammatory roles by adjusting the growth and differentiation of macrophages&#44; dendrite cells and T- and B-lymphocytes&#46; In turn&#44; it also promotes the inhibition of tumour necrosis factor &#945; and the generation of anti-inflammatory factors &#40;IL-4 and IL-10&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This anti-inflammatory activity has led to research into its role in the regulation of the inflammatory disease progression&#46; It has been shown that the direct and indirect immunomodulating actions of the molecule affect innate and adaptive immune responses&#46; It may also have anti-inflammatory effects through regulation of the biosynthesis of pro-inflammatory molecules in the prostaglandin cascade through the active cells nuclear kappa factor light chain amplifier&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a systemic chronic inflammatory autoimmune disease that is characterised by synovitis&#46; Although its aetiology and pathogenesis have yet to be clearly described&#44; many associated factors are known to intervene&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> It has been said that reduced levels of 25&#40;OH&#41;D may be associated with a higher risk of developing RA&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Its role in the physiopathology of RA and the relationship between vitamin D deficiency and disease activity has been discussed by medical professionals and researchers&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Nevertheless&#44; 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analytical and retrospective study took place in the outpatient section of the rheumatology department of Hospital Luis Vernaza and the Centro de Reumatolog&#237;a y Rehabilitaci&#243;n&#46; This study was approved by the teaching and medical research department and the Scientific Committees of both health centres&#59; no informed consent was requested because of the nature of the study&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Individuals aged from 18 to 75 years old were included&#44; diagnosed RA according to 2010 American College of Rheumatology&#47;European League Against Rheumatism &#40;EULAR&#41; classification criteria&#44; and patients who had been examined for 25&#40;OH&#41;D in the previous 3 months&#46; Patients with a diagnosis of another inflammatory or connective tissue disease were excluded&#44; as were those with kidney failure&#44; poor intestinal absorption&#44; hyperthyroidism&#44; pregnancy&#44; breast feeding or neoplasia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Information was extracted directly from virtual clinical histories corresponding to 2016&#8211;2017&#46; Demographic data of sex and age were recorded&#44; together with years of evolution&#44; laboratory tests and treatment&#46; C reactive protein was standardised over the erythrocyte sedimentation volume as the acute phase reagent&#44; as it has proven to be the most consistent&#46; A value of &#8805;5&#8239;mg&#47;l was considered positive&#46; The analogue visual pain score was also recorded on a numerical scale from 0&#8722;100&#8239;mm for the overall evaluation of each patient&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Disease activity was calculated using the data obtained with an activity score index taken from a count of 28 joints &#40;the Disease Activity Score &#40;DAS28&#41;&#41;&#46; According to the results of this the patients were classified in 4 categories&#58; high disease activity &#40;DAS28&#58; &#62;5&#46;1&#41;&#44; moderate disease activity &#40;DAS28&#58; 3&#46;21&#8211;5&#46;1&#41;&#44; low disease activity &#40;DAS28&#58; &#8804;3&#46;2&#41; and remission &#40;DAS28&#58; &#60;2&#46;6&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">To determine serum levels of 25&#40;OH&#41;D immunoanalysis was performed in both centres using electrochemiluminiscence &#40;Cobas&#44; Basel&#44; Switzerland&#41; in ng&#47;ml units&#46; The vitamin D level was considered normal at a serum level of o &#8805;30&#8239;ng&#47;ml&#44; insufficient at from &#8804;30&#8722;10&#8239;ng&#47;ml and deficient at levels lower than 10&#8239;ng&#47;ml&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Version 21 of the IBM SPSS &#40;2012&#41; program was used for all of the statistical analysis&#46; Qualitative variables were expressed as frequencies and percentages&#44; and their distribution between groups was compared using the chi&#46;-squared test or Fisher&#8217;s test&#44; depending on which was appropriate&#46; Quantitative variables were expressed as averages with their standard deviations&#44; and they were compared between groups using the t-test for independent samples or the Mann-Whitney test&#44; depending on which was appropriate according to the distribution of variables as a function of the dependent variable&#46; Spearman&#8217;s &#961; coefficient was used to establish correlations between disease activity &#40;DAS28&#41; and serum levels of vitamin D&#46; A <span class="elsevierStyleItalic">P</span> value of &#60;&#46;05 was set as the limit of statistical significance for all of the analyses&#44; with a confidence interval of 95&#37;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">A total of 306 clinical histories were reviewed of patients with a diagnosis of RA&#44; of which 135 were excluded due to a lack of 25&#40;OH&#41;D test results&#59; there were insufficient data for 46 individuals and 25 fulfilled other exclusion criteria&#46; A total of 100 clinical histories from both medical centres that fulfilled the inclusion criteria were therefore studied&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">91&#37; of the patients were women&#44; and the average age of the group was 54&#46;6&#8239;&#177;&#8239;13 years old&#46; The average time over which the disease had evolved was 9&#46;1&#8239;&#177;&#8239;9 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The average number of inflamed joints was 2&#46;5&#8239;&#177;&#8239;3 and the average number of painful joints was 2&#46;3&#8239;&#177;&#8239;3&#46; The average score on the analogue patient pain scale was 30&#46;65&#8239;&#177;&#8239;20&#46;8&#46; RF was positive in 86&#37; of the patients and anti-CCP antibody was positive in 72&#37;&#46; Acute phase reactant CRP&#8239;&#8805;&#8239;5&#8239;mg&#47;l was found in 57&#37; of the population&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">According to disease activity&#44; the average score obtained in the basal DAS28-RCP was 3&#46;1&#8239;&#177;&#8239;1&#46;36&#46; Respecting the EULAR disease activity classification&#44; 42&#37; of patients were in remission&#44; 10&#37; had low level activity&#44; 32&#37; had a moderate level of activity and 16&#37; had a high level of activity&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The average concentration of 25&#40;OH&#41;D in the basal determination was 32&#46;9&#8239;&#177;&#8239;11&#46;5&#8239;ng&#47;ml&#46; In terms of the cut-off points of vitamin D serum levels in the basal determination&#44; 55&#37; of patients had optimum levels&#44; 45&#37; had insufficient levels and no deficient values were found&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">64&#37; of the 100 patients in the study were taking oral calcium supplements with vitamin D3&#59; the average dose of calcium in its elemental calcium equivalent was 250&#46;43&#8239;&#177;&#8239;58&#46;25&#8239;mg &#40;1&#46;1&#8239;g citrate&#44; 0&#46;6&#8239;g carbonate&#41;&#44; while the average dose of vitamin D3 was 505&#46;40&#8239;&#177;&#8239;469&#46;00 UI&#46; 77&#37; of the study participants were being treated with corticoids at an average dose of 5&#46;1&#8239;mg &#40;1&#46;25&#8211;25&#41; of prednisone&#46; All of the patients had been treated with disease-modifying drugs during an average of 9&#46;1&#8239;&#177;&#8239;9 years&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">When the levels of 25&#40;OH&#41;D were evaluated according to disease activity as measured by DAS28-CRP&#44; an average of 30&#46;4&#8239;&#177;&#8239;10&#46;7&#8239;ng&#47;ml was found for low activity&#44; 31&#46;9&#8239;&#177;&#8239;10&#46;7&#8239;ng&#47;ml for moderate activity and 31&#46;8&#8239;&#177;&#8239;12&#46;1&#8239;ng&#47;ml for a high level of activity&#44; although no statistically significant differences were found between them &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;28&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Spearman&#8217;s &#961; coefficient showed no relationship at all between both variables &#40;&#961; 0&#46;60&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Insufficient levels of 25&#40;OH&#41;D were not significantly associated with a high level of disease activity&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The relationships between 25&#40;OH&#41;D and sociodemographic&#44; clinical&#44; analytical and treatment variables were also examined &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Univariate analysis showed no significant relationship between serum vitamin D levels and the characteristics of these patients&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">When 25&#40;OH&#41;D levels were compared according to whether or not patients were taking a supplement of the same&#44; there was no statistically significant difference between the patients taking supplements and those who were not &#40;32&#46;75&#8239;ng&#47;ml vs&#46; 33&#46;19&#8239;ng&#47;ml&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;96&#41;&#46; Likewise&#44; there was no significant difference between the DAS28-RCP scores of the patients who were taking vitamin D3 supplements and those who were not &#40;3&#46;25 vs&#46; 3&#46;08&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;54&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study did not prove that there is a significant relationship between disease activity measured by DAS28-RCP and serum levels of 25&#40;OH&#41;D&#46; The average level of vitamin D was 32&#46;9&#8239;&#177;&#8239;11&#46;5&#8239;ng&#47;ml&#44; and almost half of the patients &#40;45&#37;&#41; had 25&#40;OH&#41;D insufficiency in spite of taking vitamin D3 supplements&#46; However&#44; the other half &#40;55&#37;&#41; had normal levels and no vitamin D deficiency was detected&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Ecuador is located on the equator&#44; at a latitude of &#8722;0&#46;95&#44; with solar radiation of 10&#8211;11&#8239;UV&#44;15 so that the skin synthesises vitamin D during the whole year&#46; In spite of this&#44; the Ecuadorian population in general has been show to have a high prevalence of sub-optimum vitamin D levels&#46; A study of the prevalence of vitamin D insufficiency and deficiency in adults over the age of 60 years old on the coast and in the mountains of Ecuador&#44; with 2&#44;375 participants&#44; found that incidences of 67&#46;8&#37; and 21&#46;6&#37;&#44; respectively&#46; Low levels were particularly more common in older women&#44; natives and those living in the Andes Mountains&#46; Nevertheless&#44; when only those living on the coast of the country are analysed&#44; the region where our study took place&#44; significantly lower incidences of 25&#40;OH&#41;D insufficiency &#40;44&#37;&#8211;50&#37;&#41; and deficiency &#40;10&#37;&#8211;14&#37;&#41; were found&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> These findings may be largely due to the latitude&#44; greater exposure to sunlight and the type of clothing worn in the region&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A recent retrospective study in the city of Guayaquil&#44; Ecuador&#44; of 269 patients with joint pain in their first appointment with the rheumatology department&#44; found an average vitamin D level of 27&#46;29&#8239;&#177;&#8239;10&#46;12&#8239;ng&#47;dl&#46; 30&#37; of these patients had normal levels&#44; 69&#37; had insufficient levels &#40;29&#8722;10&#8239;ng&#47;dl&#41; and only 1&#37; had deficient levels &#40;&#60;10&#8239;ng&#47;dl&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Another study by the same author on the prevalence of vitamin D in patients with rheumatic diseases in Ecuador&#44; showed that 41&#46;2&#37; had levels above 30&#8239;ng&#47;ml&#44; while levels in the remaining 58&#46;8&#37; were below this range&#46; More particularly&#44; patients with RA had an average of 30&#46;2&#8239;&#177;&#8239;18&#46;2&#8239;ng&#47;ml of vitamin D in serum&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Our population of patients reflects characteristics that are typical of a group with RA&#46; The majority are women &#40;91&#37;&#41;&#44; with an average age of 54&#46;6 years old and an average duration of the disease of 9&#46;1 years&#46; All of them are receiving treatment and are in follow-up by the rheumatology department&#46; This study did not reveal any significant relationship between disease activity and 25&#40;OH&#41;D serum levels&#46; Even so&#44; it is important to consider that a large proportion of the population studied are in remission or with low disease activity&#44; so it is possible that this lack of correlation could not be extrapolated to a population with a high level of RA activity&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The findings of this study are similar to those described by several authors&#46; A study of 116 patients with RA&#44; 93 women and 23 men&#44; concluded that serum levels of 25&#40;OH&#41;D did not correlate significantly&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A transversal study with 239 patients in Thailand with RA did not show any relationship between serum levels of 25&#40;OH&#41;D and the number of painful and inflamed joints&#44; the DAS28 score&#44; HAQ and seropositivity for RF and anti-CCP&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The TOMORROW study in Japan&#44; with 186 patients with RA&#44; who were not treated with vitamin D supplements&#44; did not show any significant correlation between disease activity and the level of 25&#40;OH&#41;D in serum&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> A Latin American study in Argentina found an average of 20&#46;4&#8239;&#177;&#8239;0&#44;9&#8239;ng&#47;ml vitamin D in 34 women with RA&#46; Although there was no lineal correlation with DAS28&#44; patients with moderate to high levels of activity had lower levels of vitamin D than those patients with low levels of disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Nevertheless&#44; other reports do correlate lower vitamin D levels with more severe clinical manifestations of RA&#44; the disease activity index and other rheumatic diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> An exhaustive meta-analysis published in 2016 with a total of 24 reports with 3&#44;489 patients showed an inverse relationship between disease activity and serum levels of vitamin D&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Additionally&#44; they remark that this correlation was more significant in developing countries&#46; The COMORA study&#44; with 1&#44;412 patients with RA in 15 countries&#44; found an average vitamin D level of 27&#46;3&#8239;&#177;&#8239;15&#46;1&#8239;ng&#47;ml&#44; insufficiency in 54&#46;6&#37; of cases and deficiency in 8&#46;5&#37;&#46; Low levels of vitamin D are associated with age&#44; BMI&#44; educational level&#44; disease activity&#44; corticoid dose and comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The association between vitamin D levels and disease activity is still controversial&#44; and this may be because 25&#40;OH&#41;D levels are easily modified by factors such as geographical region&#44; age&#44; the use of sunblock&#44; dress&#44; glucocorticoids&#44; antimaleria drugs and the immunosuppressant drugs used to treat RA&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">On the other hand&#44; this study analysed possible risk factors associated with vitamin D levels in patients with RA&#44; although no association was found in univariate analysis&#46; Although it is true that no association with any variable was found here&#44; other studies have associated reduced levels of vitamin D with sex&#44; BMI and chronic pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Although the recommendation to take vitamin D3 supplements for chronic users of glucocorticoids has been widely accepted&#44; the contribution of the latter to the deficiency and its possible association with the disease is controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> It has been suggested that as vitamin D is a secosteroid&#44; it may reduce the immune response in a similar way to steroids&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Some studies have shown that taking vitamin D supplements modulates the production of proinflammatory cytokines&#44; so that it may even have a cardioprotector effect&#46; It also improves the regulation of vitamin D receptors<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and reduces the development of RA as well as other autoimmune diseases<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and cancer&#46; Vitamin D has also been described as effective in the prevention of falls&#46; The dose and duration of vitamin D3 supplements are not very clear&#44; and cholecalciferol supplements are indicated at doses from 400 UI to 2&#44;000 UI&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;13</span></a> The risk of systemic toxicity due to calcium&#47;phosphorus metabolism is rare&#44; and it occurs at doses above 50&#44;000 UI&#47;day&#44; causing hypercalcaemia and hyperphosphatemia&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">As this study compared serum levels of 25&#40;OH&#41;D in patients who were and were not taking vitamin D3 supplements&#44; no statistically significant difference was found&#46; A placebo controlled randomised and double blind study with high doses of vitamin D found no benefit in terms of disease activity or the general health of patients with RA&#59; however&#44; it concludes that the sample size was very small&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> On the other hand&#44; Varenna et al&#46; in their study concluded that vitamin D deficiency is common in patients with RA&#44; even when they receive a suitable dose in supplements&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">On the other hand&#44; the use of calcium supplements has been shown to have cardiovascular side effects&#44; although this finding is still controversial&#46; A correct evaluation of the risk-benefit of adding calcium to the diet is required&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">This study has certain limitations&#46; Chiefly&#44; as it is retrospective&#44; the presence of incomplete clinical histories and&#44; moreover&#44; the lack of vitamin D evaluation in all of the patients made it impossible to include them in the analysis&#44; reducing the sample size and making the study deficient in comparison with previous ones&#46; Secondly&#44; the study participants were patients during check-ups and treatment&#44; so that a large proportion of them had disease activity that was classified as low level or in remission&#44; so that it is impossible to compare the results with those of patients with a high level of RA activity&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Our findings are highly relevant for the field under study&#44; as no biological measure has been proven to be sufficient to measure disease activity&#44; so that new biomarkers are needed to function as reliable and objective indicators&#46; This study was performed in patients with RA in everyday clinical practice&#46; The association between vitamin D and disease activity was made using a widely used index that is simple to apply&#44; the DAS28-RCP&#46; Additionally&#44; this study covered the greatest number of patients with these characteristics of all the studies carried out in this country&#46; This paper may therefore have implications for subsequent studies to be used in decision-making regarding the treatment of patients with RA&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Vitamin D&#44; due to its link with autoimmunity and its immunoregulating effects&#44; may be one of the environmental factors that&#44; among others&#44; participate in the pathogenesis of RA&#46; However&#44; it is hard to establish a strong association between vitamin D deficiency and disease activity&#46; Multiple factors such as age&#44; geography&#44; medication&#44; the use of sunblock products and photosensitivity are associated with variations in serum levels of vitamin D&#59; these factors may be linked to the inconsistent findings of previous studies&#46; Even so&#44; the future of vitamin D in autoimmune diseases continues to evolve due to increasing interest in its possible influence on the activity&#44; severity and development of immune diseases&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">To conclude&#44; this study showed no significant correlation between disease activity measured by DAS28-RCP and the serum level of vitamin D&#46; Additionally&#44; there was no significant difference between serum level of 25&#40;OH&#41;D in patients who were taking vitamin D supplements and those who were not&#46; Nor was it possible to associate other variables which determine vitamin D levels&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">More studies are needed to explain how vitamin D influences RA&#46; This will require larger scale evaluation and even the follow-up of these patients&#44; to determine how any possible association behaves&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To determine whether there is an association between serum vitamin D levels and the Disease Activity Index in patients with rheumatoid arthritis &#40;RA&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An analytical&#44; retrospective&#44; cross-sectional study was performed at the Hospital Luis Vernaza &#40;HLV&#41; and Center for Rheumatology and Rehabilitation &#40;CERER&#41;&#46; We included 18 to 75-year-old patients with a diagnosis of RA according to the 2010 classification criteria&#44; and with a 25-hydroxyvitamin D &#40;25 &#91;OH&#93; D&#41; test within the last 3 months&#46; The activity of the disease was assessed with the 28-joint Disease Activity Score &#40;DAS 28&#41; and C-reactive protein &#40;CRP&#41; as an acute-phase reactant&#46; Spearman&#39;s <span class="elsevierStyleItalic">rank</span> correlation coefficient was used to establish association between the variables&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A total of 100 RA patients were studied&#46; The mean vitamin D levels were 32&#46;9&#8239;&#177;&#8239;11&#46;5&#8239;ng&#47;mL&#46; In all&#44; 45&#37; showed insufficient 25 &#40;OH&#41; D and 55&#37; had normal levels&#59; no deficient vitamin D values were found&#46; According to the DAS28-CRP&#44; patients with low&#44; moderate and high activity had an average vitamin D level of 30&#46;4&#8239;&#177;&#8239;10&#46;7&#44; 31&#46;9&#8239;&#177;&#8239;10&#46;7&#44; and 31&#46;8&#8239;&#177;&#8239;12&#46;1&#8239;ng&#47;mL&#44; respectively&#46; There were no significant correlations between the disease activity and the serum vitamin D level &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;60&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">In our group of RA patients&#44; there was no statistically significant correlation between the levels of vitamin D and the activity of the disease&#44; nor were other determining variables associated with vitamin D levels</p></span>"
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            "titulo" => "Conclusion"
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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="spar0065" class="elsevierStyleSimplePara elsevierViewall">Determinar si existe asociaci&#243;n entre los niveles s&#233;ricos de vitamina D y el &#237;ndice de actividad de la enfermedad en pacientes con artritis reumatoide &#40;AR&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal&#44; anal&#237;tico&#44; retrospectivo realizado en el Hospital Luis Vernaza &#40;HLV&#41; y Centro de Reumatolog&#237;a y Rehabilitaci&#243;n &#40;CERER&#41;&#46; Se incluyeron pacientes entre 18 a 75 a&#241;os con diagn&#243;stico de AR seg&#250;n los criterios de clasificaci&#243;n 2010&#44; y examen 25-hidroxivitamina D en los &#250;ltimos 3 meses&#46; La actividad de la enfermedad se evalu&#243; con el DAS 28 &#40;28-joint Desease Activity Score&#41; y el PCR &#40;prote&#237;na C reactiva&#41; como reactante de fase aguda&#46; Para establecer asociaci&#243;n entre las variables se realiz&#243; por el coeficiente de correlaci&#243;n de Spearman&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron un total de 100 pacientes con AR&#46; La media de vitamina D fue de 32&#44;9&#8239;&#177;&#8239;11&#44;5&#8239;ng&#47;ml&#44; el 45&#37; present&#243; insuficiencia de 25&#40;OH&#41;D y el 55&#37; niveles normales&#59; no se hallaron valores deficientes de vitamina D&#46; De acuerdo al DAS28-PCR&#44; los pacientes en baja&#44; moderada&#44; y alta actividad tuvieron una media de vitamina D de 30&#44;4&#8239;&#177;&#8239;10&#44;7&#44; 31&#44;9&#8239;&#177;&#8239;10&#44;7&#44; y 31&#44;8&#8239;&#177;&#8239;12&#44;1&#8239;ng&#47;ml respectivamente&#46; La actividad de la enfermedad y el nivel s&#233;rico de vitamina D no se correlacionaron significativamente &#40;&#961; 0&#44;60&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">En nuestro grupo de pacientes con artritis reumatoide&#44; no hubo correlaci&#243;n estad&#237;sticamente significativa entre los niveles de vitamina D y la actividad de la enfermedad&#44; tampoco se asociaron otras variables determinantes a los niveles de vitamina D&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Metodolog&#237;a"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; de la Torre Lossa P&#44; Moreno &#193;lvarez M&#44; Gonz&#225;lez Guzm&#225;n MC&#44; L&#243;pez Mart&#237;nez R&#44; R&#237;os Acosta C&#46; La vitamina D no es &#250;til como biomarcador para la actividad de laenfermedad en artritis reumatoide&#46; Reumatol Clin&#46; 2020&#59;16&#58;110&#8211;115&#46;</p>"
      ]
    ]
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      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1646
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
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            "rol" => "short"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scatter diagram of serum vitamin D and disease activity measured by DAS28-RCP&#46; The correlation coefficients were calculated using Spearman&#8217;s p range&#46; The line of fit with the CI of 95&#37; of the average is shown&#46;</p>"
        ]
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; BMI&#58; body mass index&#59; DAS28&#58; Disease Activity Score&#59; AVS&#58; analogue visual scale&#59; RCP&#58; reactive C protein&#59; Vit&#46; D&#58; vitamin D&#59; DMAD&#58; disease modifying anti-rheumatic drugs&#46;</p>"
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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">&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">N&#8239;&#61;&#8239;100&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">Age &#40;years&#41;&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;6&#8239;&#177;&#8239;13&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="elsevierStyleItalic">Female sex&#44; n &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91 &#40;91&#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="elsevierStyleItalic">BMI&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;4&#8239;&#177;&#8239;4&#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"><span class="elsevierStyleItalic">Years of evolution&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1&#8239;&#177;&#8239;9&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="elsevierStyleItalic">Inflamed joints&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5&#8239;&#177;&#8239;3&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="elsevierStyleItalic">Painful joints&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&#8239;&#177;&#8239;3&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="elsevierStyleItalic">DAS28-RCP&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&#8239;&#177;&#8239;1&#46;36&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="2" 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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DAS28-RCP&#44; n &#40;&#37;&#41;</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>Remission&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">42 &#40;42&#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>Low&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">10 &#40;10&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;32&#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>High&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&#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="2" 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-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">AVS pct 0&#8722;100&#8239;mm&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;65&#8239;&#177;&#8239;20&#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"><span class="elsevierStyleItalic">Rheumatoid factor &#62; 14 U&#47;ml&#44; n &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;85&#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="elsevierStyleItalic">Antipeptide cyclical citrulinate ab &#62; 25 U&#47;ml&#44; n &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;72&#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="elsevierStyleItalic">RCP &#40;&#8805; 5&#8239;mg&#47;l&#41;&#44; &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;57&#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="elsevierStyleItalic">Vit&#46; D &#40;ng&#47;ml&#41;&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;9&#8239;&#177;&#8239;11&#46;5&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="2" 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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vit D levels &#40;ng&#47;ml&#41;&#44; n &#40;&#37;&#41;</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>Deficiency &#40;&#60; 10&#8239;ng&#47;ml&#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">0&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>Insufficiency &#40;10&#8722;30&#8239;ng&#47;ml&#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;45&#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>Normal &#40;&#62; 30&#8239;ng&#47;ml&#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">55 &#40;55&#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="2" 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-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">Calcium&#8239;&#43;&#8239;vit&#46; D supplements</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#37;&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="elsevierStyleItalic">Corticoids 5&#46;1&#8239;mg &#40;1&#46;25&#8211;25&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#37;&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="elsevierStyleItalic">DMAD</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="left" valign="\n
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                  \t\t\t\t">80&#37;&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Methotrexate</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59&#37;&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="elsevierStyleItalic">Biological agents</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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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">&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">&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DAS28 activity</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" 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</th></tr><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">&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">Remission&#44; n&#8239;&#61;&#8239;43&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">Low&#44; n&#8239;&#61;&#8239;10&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">Moderate&#44; n&#8239;&#61;&#8239;32&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">High&#44; n&#8239;&#61;&#8239;16&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">Vit&#46; D &#40;ng&#47;ml&#41;&#44; average&#8239;&#177;&#8239;SD&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">34&#46;8&#8239;&#177;&#8239;12&#46;2&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">30&#46;4&#8239;&#177;&#8239;10&#46;7&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">31&#46;9&#8239;&#177;&#8239;10&#46;7&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">31&#46;8&#8239;&#177;&#8239;12&#46;1&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">&#46;28&nbsp;\t\t\t\t\t\t\n
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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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total series&#44; N&#8239;&#61;&#8239;100</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> Value</th></tr><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">Normal &#40;n&#8239;&#61;&#8239;55&#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">Insufficient &#40;n&#8239;&#61;&#8239;45&#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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#40;years&#41;&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#8239;&#177;&#8239;12&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">53&#8239;&#177;&#8239;14&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">&#46;18&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="elsevierStyleItalic">Female sex&#44; n &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;90&#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">41 &#40;91&#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;00&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="elsevierStyleItalic">BMI&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;6&#8239;&#177;&#8239;4&#46;7&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;3&#8239;&#177;&#8239;4&#46;9&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">&#46;12&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="elsevierStyleItalic">Years of evolution&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8239;&#177;&#8239;8&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&#8239;&#177;&#8239;10&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">&#46;20&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="elsevierStyleItalic">Inflamed joints&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8239;&#177;&#8239;3&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">3&#8239;&#177;&#8239;3&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">&#46;16&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="elsevierStyleItalic">Painful joints&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8239;&#177;&#8239;3&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">3&#8239;&#177;&#8239;3&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">&#46;27&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="elsevierStyleItalic">DAS28-RCP activity&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8239;&#177;&#8239;1&#46;3&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">3&#46;3&#8239;&#177;&#8239;1&#46;4&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">&#46;35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#8239;&#177;&#8239;30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40&#8239;&#177;&#8239;30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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Vitamin D is not useful as a biomarker for disease activity in rheumatoid arthritis
La vitamina D no es útil como biomarcador para la actividad de la enfermedad en artritis reumatoide
Paola de la Torre Lossaa,
Corresponding author
lp_delatorre@hotmail.com

Corresponding author.
, Mario Moreno Álvarezb, María del Carmen González Guzmánb, Rafael López Martínezb, Carlos Ríos Acostac
a Universidad Espíritu Santo, Samborondón, Ecuador
b Servicio de Reumatología, Hospital Luis Vernaza, Guayaquil, Ecuador
c Centro de Reumatología y Rehabilitación, Guayaquil, Ecuador
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        "titulo" => "La vitamina D no es &#250;til como biomarcador para la actividad de la enfermedad en artritis reumatoide"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scatter diagram of serum vitamin D and disease activity measured by DAS28-RCP&#46; The correlation coefficients were calculated using Spearman&#8217;s p range&#46; The line of fit with the CI of 95&#37; of the average is shown&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vitamin D is an essential steroid prohormone that chiefly participates in physiological processes that regulate phosphorus and calcium metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A deficiency in this vitamin has now been linked to several diseases&#44; such as cardiovascular diseases&#44; inflammatory diseases and mortality rates in the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Vitamin D is measured by determining 25-hydroxyvitamin D &#40;25&#91;OH&#93;D&#41; in the blood&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The concentration of the same in serum depends on several factors&#58; exposure to sunlight&#44; age&#44; ethnic group&#44; body mass index &#40;BMI&#41;&#44; the use of medication &#40;steroids and immunosuppressant drugs&#41;&#44; as well as dietary supplements&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Vitamin D has recently been described as having non-classical actions&#44; indicating that it not only regulates calcium and phosphorus metabolism&#44; but that it is also plays immunological and anti-inflammatory roles by adjusting the growth and differentiation of macrophages&#44; dendrite cells and T- and B-lymphocytes&#46; In turn&#44; it also promotes the inhibition of tumour necrosis factor &#945; and the generation of anti-inflammatory factors &#40;IL-4 and IL-10&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This anti-inflammatory activity has led to research into its role in the regulation of the inflammatory disease progression&#46; It has been shown that the direct and indirect immunomodulating actions of the molecule affect innate and adaptive immune responses&#46; It may also have anti-inflammatory effects through regulation of the biosynthesis of pro-inflammatory molecules in the prostaglandin cascade through the active cells nuclear kappa factor light chain amplifier&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a systemic chronic inflammatory autoimmune disease that is characterised by synovitis&#46; Although its aetiology and pathogenesis have yet to be clearly described&#44; many associated factors are known to intervene&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> It has been said that reduced levels of 25&#40;OH&#41;D may be associated with a higher risk of developing RA&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Its role in the physiopathology of RA and the relationship between vitamin D deficiency and disease activity has been discussed by medical professionals and researchers&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Nevertheless&#44; some studies have not shown any significant relationship between serum levels of 25&#40;OH&#41;D and RA activity or the development of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In Ecuador&#44; only one study has been published recently on vitamin D levels in rheumatic patients&#46; 58&#46;8&#37; of the patients in this study had insufficient levels of vitamin D&#44; although these serum levels were not correlated with disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of this study is to determine whether there is an association between serum levels of vitamin D and the disease activity index in our patients with RA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">This transversal&#44; analytical and retrospective study took place in the outpatient section of the rheumatology department of Hospital Luis Vernaza and the Centro de Reumatolog&#237;a y Rehabilitaci&#243;n&#46; This study was approved by the teaching and medical research department and the Scientific Committees of both health centres&#59; no informed consent was requested because of the nature of the study&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Individuals aged from 18 to 75 years old were included&#44; diagnosed RA according to 2010 American College of Rheumatology&#47;European League Against Rheumatism &#40;EULAR&#41; classification criteria&#44; and patients who had been examined for 25&#40;OH&#41;D in the previous 3 months&#46; Patients with a diagnosis of another inflammatory or connective tissue disease were excluded&#44; as were those with kidney failure&#44; poor intestinal absorption&#44; hyperthyroidism&#44; pregnancy&#44; breast feeding or neoplasia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Information was extracted directly from virtual clinical histories corresponding to 2016&#8211;2017&#46; Demographic data of sex and age were recorded&#44; together with years of evolution&#44; laboratory tests and treatment&#46; C reactive protein was standardised over the erythrocyte sedimentation volume as the acute phase reagent&#44; as it has proven to be the most consistent&#46; A value of &#8805;5&#8239;mg&#47;l was considered positive&#46; The analogue visual pain score was also recorded on a numerical scale from 0&#8722;100&#8239;mm for the overall evaluation of each patient&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Disease activity was calculated using the data obtained with an activity score index taken from a count of 28 joints &#40;the Disease Activity Score &#40;DAS28&#41;&#41;&#46; According to the results of this the patients were classified in 4 categories&#58; high disease activity &#40;DAS28&#58; &#62;5&#46;1&#41;&#44; moderate disease activity &#40;DAS28&#58; 3&#46;21&#8211;5&#46;1&#41;&#44; low disease activity &#40;DAS28&#58; &#8804;3&#46;2&#41; and remission &#40;DAS28&#58; &#60;2&#46;6&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">To determine serum levels of 25&#40;OH&#41;D immunoanalysis was performed in both centres using electrochemiluminiscence &#40;Cobas&#44; Basel&#44; Switzerland&#41; in ng&#47;ml units&#46; The vitamin D level was considered normal at a serum level of o &#8805;30&#8239;ng&#47;ml&#44; insufficient at from &#8804;30&#8722;10&#8239;ng&#47;ml and deficient at levels lower than 10&#8239;ng&#47;ml&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Version 21 of the IBM SPSS &#40;2012&#41; program was used for all of the statistical analysis&#46; Qualitative variables were expressed as frequencies and percentages&#44; and their distribution between groups was compared using the chi&#46;-squared test or Fisher&#8217;s test&#44; depending on which was appropriate&#46; Quantitative variables were expressed as averages with their standard deviations&#44; and they were compared between groups using the t-test for independent samples or the Mann-Whitney test&#44; depending on which was appropriate according to the distribution of variables as a function of the dependent variable&#46; Spearman&#8217;s &#961; coefficient was used to establish correlations between disease activity &#40;DAS28&#41; and serum levels of vitamin D&#46; A <span class="elsevierStyleItalic">P</span> value of &#60;&#46;05 was set as the limit of statistical significance for all of the analyses&#44; with a confidence interval of 95&#37;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">A total of 306 clinical histories were reviewed of patients with a diagnosis of RA&#44; of which 135 were excluded due to a lack of 25&#40;OH&#41;D test results&#59; there were insufficient data for 46 individuals and 25 fulfilled other exclusion criteria&#46; A total of 100 clinical histories from both medical centres that fulfilled the inclusion criteria were therefore studied&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">91&#37; of the patients were women&#44; and the average age of the group was 54&#46;6&#8239;&#177;&#8239;13 years old&#46; The average time over which the disease had evolved was 9&#46;1&#8239;&#177;&#8239;9 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The average number of inflamed joints was 2&#46;5&#8239;&#177;&#8239;3 and the average number of painful joints was 2&#46;3&#8239;&#177;&#8239;3&#46; The average score on the analogue patient pain scale was 30&#46;65&#8239;&#177;&#8239;20&#46;8&#46; RF was positive in 86&#37; of the patients and anti-CCP antibody was positive in 72&#37;&#46; Acute phase reactant CRP&#8239;&#8805;&#8239;5&#8239;mg&#47;l was found in 57&#37; of the population&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">According to disease activity&#44; the average score obtained in the basal DAS28-RCP was 3&#46;1&#8239;&#177;&#8239;1&#46;36&#46; Respecting the EULAR disease activity classification&#44; 42&#37; of patients were in remission&#44; 10&#37; had low level activity&#44; 32&#37; had a moderate level of activity and 16&#37; had a high level of activity&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The average concentration of 25&#40;OH&#41;D in the basal determination was 32&#46;9&#8239;&#177;&#8239;11&#46;5&#8239;ng&#47;ml&#46; In terms of the cut-off points of vitamin D serum levels in the basal determination&#44; 55&#37; of patients had optimum levels&#44; 45&#37; had insufficient levels and no deficient values were found&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">64&#37; of the 100 patients in the study were taking oral calcium supplements with vitamin D3&#59; the average dose of calcium in its elemental calcium equivalent was 250&#46;43&#8239;&#177;&#8239;58&#46;25&#8239;mg &#40;1&#46;1&#8239;g citrate&#44; 0&#46;6&#8239;g carbonate&#41;&#44; while the average dose of vitamin D3 was 505&#46;40&#8239;&#177;&#8239;469&#46;00 UI&#46; 77&#37; of the study participants were being treated with corticoids at an average dose of 5&#46;1&#8239;mg &#40;1&#46;25&#8211;25&#41; of prednisone&#46; All of the patients had been treated with disease-modifying drugs during an average of 9&#46;1&#8239;&#177;&#8239;9 years&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">When the levels of 25&#40;OH&#41;D were evaluated according to disease activity as measured by DAS28-CRP&#44; an average of 30&#46;4&#8239;&#177;&#8239;10&#46;7&#8239;ng&#47;ml was found for low activity&#44; 31&#46;9&#8239;&#177;&#8239;10&#46;7&#8239;ng&#47;ml for moderate activity and 31&#46;8&#8239;&#177;&#8239;12&#46;1&#8239;ng&#47;ml for a high level of activity&#44; although no statistically significant differences were found between them &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;28&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Spearman&#8217;s &#961; coefficient showed no relationship at all between both variables &#40;&#961; 0&#46;60&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Insufficient levels of 25&#40;OH&#41;D were not significantly associated with a high level of disease activity&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The relationships between 25&#40;OH&#41;D and sociodemographic&#44; clinical&#44; analytical and treatment variables were also examined &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Univariate analysis showed no significant relationship between serum vitamin D levels and the characteristics of these patients&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">When 25&#40;OH&#41;D levels were compared according to whether or not patients were taking a supplement of the same&#44; there was no statistically significant difference between the patients taking supplements and those who were not &#40;32&#46;75&#8239;ng&#47;ml vs&#46; 33&#46;19&#8239;ng&#47;ml&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;96&#41;&#46; Likewise&#44; there was no significant difference between the DAS28-RCP scores of the patients who were taking vitamin D3 supplements and those who were not &#40;3&#46;25 vs&#46; 3&#46;08&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;54&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study did not prove that there is a significant relationship between disease activity measured by DAS28-RCP and serum levels of 25&#40;OH&#41;D&#46; The average level of vitamin D was 32&#46;9&#8239;&#177;&#8239;11&#46;5&#8239;ng&#47;ml&#44; and almost half of the patients &#40;45&#37;&#41; had 25&#40;OH&#41;D insufficiency in spite of taking vitamin D3 supplements&#46; However&#44; the other half &#40;55&#37;&#41; had normal levels and no vitamin D deficiency was detected&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Ecuador is located on the equator&#44; at a latitude of &#8722;0&#46;95&#44; with solar radiation of 10&#8211;11&#8239;UV&#44;15 so that the skin synthesises vitamin D during the whole year&#46; In spite of this&#44; the Ecuadorian population in general has been show to have a high prevalence of sub-optimum vitamin D levels&#46; A study of the prevalence of vitamin D insufficiency and deficiency in adults over the age of 60 years old on the coast and in the mountains of Ecuador&#44; with 2&#44;375 participants&#44; found that incidences of 67&#46;8&#37; and 21&#46;6&#37;&#44; respectively&#46; Low levels were particularly more common in older women&#44; natives and those living in the Andes Mountains&#46; Nevertheless&#44; when only those living on the coast of the country are analysed&#44; the region where our study took place&#44; significantly lower incidences of 25&#40;OH&#41;D insufficiency &#40;44&#37;&#8211;50&#37;&#41; and deficiency &#40;10&#37;&#8211;14&#37;&#41; were found&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> These findings may be largely due to the latitude&#44; greater exposure to sunlight and the type of clothing worn in the region&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A recent retrospective study in the city of Guayaquil&#44; Ecuador&#44; of 269 patients with joint pain in their first appointment with the rheumatology department&#44; found an average vitamin D level of 27&#46;29&#8239;&#177;&#8239;10&#46;12&#8239;ng&#47;dl&#46; 30&#37; of these patients had normal levels&#44; 69&#37; had insufficient levels &#40;29&#8722;10&#8239;ng&#47;dl&#41; and only 1&#37; had deficient levels &#40;&#60;10&#8239;ng&#47;dl&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Another study by the same author on the prevalence of vitamin D in patients with rheumatic diseases in Ecuador&#44; showed that 41&#46;2&#37; had levels above 30&#8239;ng&#47;ml&#44; while levels in the remaining 58&#46;8&#37; were below this range&#46; More particularly&#44; patients with RA had an average of 30&#46;2&#8239;&#177;&#8239;18&#46;2&#8239;ng&#47;ml of vitamin D in serum&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Our population of patients reflects characteristics that are typical of a group with RA&#46; The majority are women &#40;91&#37;&#41;&#44; with an average age of 54&#46;6 years old and an average duration of the disease of 9&#46;1 years&#46; All of them are receiving treatment and are in follow-up by the rheumatology department&#46; This study did not reveal any significant relationship between disease activity and 25&#40;OH&#41;D serum levels&#46; Even so&#44; it is important to consider that a large proportion of the population studied are in remission or with low disease activity&#44; so it is possible that this lack of correlation could not be extrapolated to a population with a high level of RA activity&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The findings of this study are similar to those described by several authors&#46; A study of 116 patients with RA&#44; 93 women and 23 men&#44; concluded that serum levels of 25&#40;OH&#41;D did not correlate significantly&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A transversal study with 239 patients in Thailand with RA did not show any relationship between serum levels of 25&#40;OH&#41;D and the number of painful and inflamed joints&#44; the DAS28 score&#44; HAQ and seropositivity for RF and anti-CCP&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The TOMORROW study in Japan&#44; with 186 patients with RA&#44; who were not treated with vitamin D supplements&#44; did not show any significant correlation between disease activity and the level of 25&#40;OH&#41;D in serum&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> A Latin American study in Argentina found an average of 20&#46;4&#8239;&#177;&#8239;0&#44;9&#8239;ng&#47;ml vitamin D in 34 women with RA&#46; Although there was no lineal correlation with DAS28&#44; patients with moderate to high levels of activity had lower levels of vitamin D than those patients with low levels of disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Nevertheless&#44; other reports do correlate lower vitamin D levels with more severe clinical manifestations of RA&#44; the disease activity index and other rheumatic diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> An exhaustive meta-analysis published in 2016 with a total of 24 reports with 3&#44;489 patients showed an inverse relationship between disease activity and serum levels of vitamin D&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Additionally&#44; they remark that this correlation was more significant in developing countries&#46; The COMORA study&#44; with 1&#44;412 patients with RA in 15 countries&#44; found an average vitamin D level of 27&#46;3&#8239;&#177;&#8239;15&#46;1&#8239;ng&#47;ml&#44; insufficiency in 54&#46;6&#37; of cases and deficiency in 8&#46;5&#37;&#46; Low levels of vitamin D are associated with age&#44; BMI&#44; educational level&#44; disease activity&#44; corticoid dose and comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The association between vitamin D levels and disease activity is still controversial&#44; and this may be because 25&#40;OH&#41;D levels are easily modified by factors such as geographical region&#44; age&#44; the use of sunblock&#44; dress&#44; glucocorticoids&#44; antimaleria drugs and the immunosuppressant drugs used to treat RA&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">On the other hand&#44; this study analysed possible risk factors associated with vitamin D levels in patients with RA&#44; although no association was found in univariate analysis&#46; Although it is true that no association with any variable was found here&#44; other studies have associated reduced levels of vitamin D with sex&#44; BMI and chronic pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Although the recommendation to take vitamin D3 supplements for chronic users of glucocorticoids has been widely accepted&#44; the contribution of the latter to the deficiency and its possible association with the disease is controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> It has been suggested that as vitamin D is a secosteroid&#44; it may reduce the immune response in a similar way to steroids&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Some studies have shown that taking vitamin D supplements modulates the production of proinflammatory cytokines&#44; so that it may even have a cardioprotector effect&#46; It also improves the regulation of vitamin D receptors<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and reduces the development of RA as well as other autoimmune diseases<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and cancer&#46; Vitamin D has also been described as effective in the prevention of falls&#46; The dose and duration of vitamin D3 supplements are not very clear&#44; and cholecalciferol supplements are indicated at doses from 400 UI to 2&#44;000 UI&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;13</span></a> The risk of systemic toxicity due to calcium&#47;phosphorus metabolism is rare&#44; and it occurs at doses above 50&#44;000 UI&#47;day&#44; causing hypercalcaemia and hyperphosphatemia&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">As this study compared serum levels of 25&#40;OH&#41;D in patients who were and were not taking vitamin D3 supplements&#44; no statistically significant difference was found&#46; A placebo controlled randomised and double blind study with high doses of vitamin D found no benefit in terms of disease activity or the general health of patients with RA&#59; however&#44; it concludes that the sample size was very small&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> On the other hand&#44; Varenna et al&#46; in their study concluded that vitamin D deficiency is common in patients with RA&#44; even when they receive a suitable dose in supplements&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">On the other hand&#44; the use of calcium supplements has been shown to have cardiovascular side effects&#44; although this finding is still controversial&#46; A correct evaluation of the risk-benefit of adding calcium to the diet is required&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">This study has certain limitations&#46; Chiefly&#44; as it is retrospective&#44; the presence of incomplete clinical histories and&#44; moreover&#44; the lack of vitamin D evaluation in all of the patients made it impossible to include them in the analysis&#44; reducing the sample size and making the study deficient in comparison with previous ones&#46; Secondly&#44; the study participants were patients during check-ups and treatment&#44; so that a large proportion of them had disease activity that was classified as low level or in remission&#44; so that it is impossible to compare the results with those of patients with a high level of RA activity&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Our findings are highly relevant for the field under study&#44; as no biological measure has been proven to be sufficient to measure disease activity&#44; so that new biomarkers are needed to function as reliable and objective indicators&#46; This study was performed in patients with RA in everyday clinical practice&#46; The association between vitamin D and disease activity was made using a widely used index that is simple to apply&#44; the DAS28-RCP&#46; Additionally&#44; this study covered the greatest number of patients with these characteristics of all the studies carried out in this country&#46; This paper may therefore have implications for subsequent studies to be used in decision-making regarding the treatment of patients with RA&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Vitamin D&#44; due to its link with autoimmunity and its immunoregulating effects&#44; may be one of the environmental factors that&#44; among others&#44; participate in the pathogenesis of RA&#46; However&#44; it is hard to establish a strong association between vitamin D deficiency and disease activity&#46; Multiple factors such as age&#44; geography&#44; medication&#44; the use of sunblock products and photosensitivity are associated with variations in serum levels of vitamin D&#59; these factors may be linked to the inconsistent findings of previous studies&#46; Even so&#44; the future of vitamin D in autoimmune diseases continues to evolve due to increasing interest in its possible influence on the activity&#44; severity and development of immune diseases&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">To conclude&#44; this study showed no significant correlation between disease activity measured by DAS28-RCP and the serum level of vitamin D&#46; Additionally&#44; there was no significant difference between serum level of 25&#40;OH&#41;D in patients who were taking vitamin D supplements and those who were not&#46; Nor was it possible to associate other variables which determine vitamin D levels&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">More studies are needed to explain how vitamin D influences RA&#46; This will require larger scale evaluation and even the follow-up of these patients&#44; to determine how any possible association behaves&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "titulo" => "Abstract"
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          "titulo" => "Resumen"
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              "titulo" => "Metodolog&#237;a"
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          "titulo" => "Palabras claves"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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    "fechaRecibido" => "2017-11-22"
    "fechaAceptado" => "2018-02-22"
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          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Vitamin D"
            1 => "Rheumatoid arthritis"
            2 => "Disease activity"
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          "clase" => "keyword"
          "titulo" => "Palabras claves"
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          "palabras" => array:3 [
            0 => "Vitamina D"
            1 => "Artritis reumatoide"
            2 => "Actividad de la enfermedad"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To determine whether there is an association between serum vitamin D levels and the Disease Activity Index in patients with rheumatoid arthritis &#40;RA&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An analytical&#44; retrospective&#44; cross-sectional study was performed at the Hospital Luis Vernaza &#40;HLV&#41; and Center for Rheumatology and Rehabilitation &#40;CERER&#41;&#46; We included 18 to 75-year-old patients with a diagnosis of RA according to the 2010 classification criteria&#44; and with a 25-hydroxyvitamin D &#40;25 &#91;OH&#93; D&#41; test within the last 3 months&#46; The activity of the disease was assessed with the 28-joint Disease Activity Score &#40;DAS 28&#41; and C-reactive protein &#40;CRP&#41; as an acute-phase reactant&#46; Spearman&#39;s <span class="elsevierStyleItalic">rank</span> correlation coefficient was used to establish association between the variables&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A total of 100 RA patients were studied&#46; The mean vitamin D levels were 32&#46;9&#8239;&#177;&#8239;11&#46;5&#8239;ng&#47;mL&#46; In all&#44; 45&#37; showed insufficient 25 &#40;OH&#41; D and 55&#37; had normal levels&#59; no deficient vitamin D values were found&#46; According to the DAS28-CRP&#44; patients with low&#44; moderate and high activity had an average vitamin D level of 30&#46;4&#8239;&#177;&#8239;10&#46;7&#44; 31&#46;9&#8239;&#177;&#8239;10&#46;7&#44; and 31&#46;8&#8239;&#177;&#8239;12&#46;1&#8239;ng&#47;mL&#44; respectively&#46; There were no significant correlations between the disease activity and the serum vitamin D level &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;60&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">In our group of RA patients&#44; there was no statistically significant correlation between the levels of vitamin D and the activity of the disease&#44; nor were other determining variables associated with vitamin D levels</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
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            "titulo" => "Results"
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            "titulo" => "Conclusion"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Determinar si existe asociaci&#243;n entre los niveles s&#233;ricos de vitamina D y el &#237;ndice de actividad de la enfermedad en pacientes con artritis reumatoide &#40;AR&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal&#44; anal&#237;tico&#44; retrospectivo realizado en el Hospital Luis Vernaza &#40;HLV&#41; y Centro de Reumatolog&#237;a y Rehabilitaci&#243;n &#40;CERER&#41;&#46; Se incluyeron pacientes entre 18 a 75 a&#241;os con diagn&#243;stico de AR seg&#250;n los criterios de clasificaci&#243;n 2010&#44; y examen 25-hidroxivitamina D en los &#250;ltimos 3 meses&#46; La actividad de la enfermedad se evalu&#243; con el DAS 28 &#40;28-joint Desease Activity Score&#41; y el PCR &#40;prote&#237;na C reactiva&#41; como reactante de fase aguda&#46; Para establecer asociaci&#243;n entre las variables se realiz&#243; por el coeficiente de correlaci&#243;n de Spearman&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron un total de 100 pacientes con AR&#46; La media de vitamina D fue de 32&#44;9&#8239;&#177;&#8239;11&#44;5&#8239;ng&#47;ml&#44; el 45&#37; present&#243; insuficiencia de 25&#40;OH&#41;D y el 55&#37; niveles normales&#59; no se hallaron valores deficientes de vitamina D&#46; De acuerdo al DAS28-PCR&#44; los pacientes en baja&#44; moderada&#44; y alta actividad tuvieron una media de vitamina D de 30&#44;4&#8239;&#177;&#8239;10&#44;7&#44; 31&#44;9&#8239;&#177;&#8239;10&#44;7&#44; y 31&#44;8&#8239;&#177;&#8239;12&#44;1&#8239;ng&#47;ml respectivamente&#46; La actividad de la enfermedad y el nivel s&#233;rico de vitamina D no se correlacionaron significativamente &#40;&#961; 0&#44;60&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">En nuestro grupo de pacientes con artritis reumatoide&#44; no hubo correlaci&#243;n estad&#237;sticamente significativa entre los niveles de vitamina D y la actividad de la enfermedad&#44; tampoco se asociaron otras variables determinantes a los niveles de vitamina D&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; de la Torre Lossa P&#44; Moreno &#193;lvarez M&#44; Gonz&#225;lez Guzm&#225;n MC&#44; L&#243;pez Mart&#237;nez R&#44; R&#237;os Acosta C&#46; La vitamina D no es &#250;til como biomarcador para la actividad de laenfermedad en artritis reumatoide&#46; Reumatol Clin&#46; 2020&#59;16&#58;110&#8211;115&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scatter diagram of serum vitamin D and disease activity measured by DAS28-RCP&#46; The correlation coefficients were calculated using Spearman&#8217;s p range&#46; The line of fit with the CI of 95&#37; of the average is shown&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; BMI&#58; body mass index&#59; DAS28&#58; Disease Activity Score&#59; AVS&#58; analogue visual scale&#59; RCP&#58; reactive C protein&#59; Vit&#46; D&#58; vitamin D&#59; DMAD&#58; disease modifying anti-rheumatic drugs&#46;</p>"
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                  \t\t\t\t  " colspan="2" 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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DAS28-RCP&#44; n &#40;&#37;&#41;</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>Remission&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">42 &#40;42&#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>Low&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">10 &#40;10&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;32&#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>High&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&#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="2" 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-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">AVS pct 0&#8722;100&#8239;mm&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;65&#8239;&#177;&#8239;20&#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"><span class="elsevierStyleItalic">Rheumatoid factor &#62; 14 U&#47;ml&#44; n &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;85&#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="elsevierStyleItalic">Antipeptide cyclical citrulinate ab &#62; 25 U&#47;ml&#44; n &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;72&#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="elsevierStyleItalic">RCP &#40;&#8805; 5&#8239;mg&#47;l&#41;&#44; &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;57&#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="elsevierStyleItalic">Vit&#46; D &#40;ng&#47;ml&#41;&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;9&#8239;&#177;&#8239;11&#46;5&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="2" 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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vit D levels &#40;ng&#47;ml&#41;&#44; n &#40;&#37;&#41;</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>Deficiency &#40;&#60; 10&#8239;ng&#47;ml&#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">0&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>Insufficiency &#40;10&#8722;30&#8239;ng&#47;ml&#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;45&#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>Normal &#40;&#62; 30&#8239;ng&#47;ml&#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">55 &#40;55&#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="2" 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-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">Calcium&#8239;&#43;&#8239;vit&#46; D supplements</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#37;&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="elsevierStyleItalic">Corticoids 5&#46;1&#8239;mg &#40;1&#46;25&#8211;25&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#37;&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="elsevierStyleItalic">DMAD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#37;&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="elsevierStyleItalic">Methotrexate</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#37;&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="elsevierStyleItalic">Biological agents</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">DAS28&#58; Disease Activity Score&#59; Vit&#46; D&#58; vitamin D&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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">&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DAS28 activity</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" 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</th></tr><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">&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">Remission&#44; n&#8239;&#61;&#8239;43&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">Low&#44; n&#8239;&#61;&#8239;10&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">Moderate&#44; n&#8239;&#61;&#8239;32&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">High&#44; n&#8239;&#61;&#8239;16&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">Vit&#46; D &#40;ng&#47;ml&#41;&#44; average&#8239;&#177;&#8239;SD&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">34&#46;8&#8239;&#177;&#8239;12&#46;2&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">30&#46;4&#8239;&#177;&#8239;10&#46;7&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">31&#46;9&#8239;&#177;&#8239;10&#46;7&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">31&#46;8&#8239;&#177;&#8239;12&#46;1&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">&#46;28&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">DAS28&#58; Disease Activity Score&#59; SD&#58; standard deviation&#59; AVS&#58; analogue visual scale&#59; DMAD&#58; disease modifying anti-rheumatic drugs&#59; BMI&#58; body mass index&#59; RCP&#58; reactive C protein&#46;</p>"
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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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total series&#44; N&#8239;&#61;&#8239;100</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serum levels of vitamin D</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" 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</th></tr><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">Normal &#40;n&#8239;&#61;&#8239;55&#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">Insufficient &#40;n&#8239;&#61;&#8239;45&#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">Age &#40;years&#41;&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#8239;&#177;&#8239;12&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">53&#8239;&#177;&#8239;14&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">&#46;18&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="elsevierStyleItalic">Female sex&#44; n &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;90&#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">41 &#40;91&#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;00&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="elsevierStyleItalic">BMI&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;6&#8239;&#177;&#8239;4&#46;7&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;3&#8239;&#177;&#8239;4&#46;9&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">&#46;12&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="elsevierStyleItalic">Years of evolution&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8239;&#177;&#8239;8&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&#8239;&#177;&#8239;10&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">&#46;20&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="elsevierStyleItalic">Inflamed joints&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8239;&#177;&#8239;3&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">3&#8239;&#177;&#8239;3&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">&#46;16&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="elsevierStyleItalic">Painful joints&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8239;&#177;&#8239;3&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">3&#8239;&#177;&#8239;3&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">&#46;27&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="elsevierStyleItalic">DAS28-RCP activity&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8239;&#177;&#8239;1&#46;3&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">3&#46;3&#8239;&#177;&#8239;1&#46;4&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">&#46;35&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="4" 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-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">DAS28-RCP activity&#44; n &#40;&#37;&#41;</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>Remission&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">26 &#40;48&#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">14 &#40;32&#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">&#46;44&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>Low&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">5 &#40;9&#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">5 &#40;11&#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">&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;28&#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">17 &#40;39&#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">&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>High&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;15&#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;18&#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">&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="4" 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-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">AVS 0&#8722;100&#8239;mm&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#8239;&#177;&#8239;30&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">40&#8239;&#177;&#8239;30&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">&#46;29&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="elsevierStyleItalic">RCP &#40;&#8805;5&#8239;mg&#47;L&#41;&#44; average&#8239;&#177;&#8239;SD</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46; 5&#8239;&#177;&#8239;15&#46;8&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">13&#46;8&#8239;&#177;&#8239;22&#46;4&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">&#46;78&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="elsevierStyleItalic">Calcium&#8239;&#43;&#8239;vitamin D supplements&#44; n &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;66&#46;7&#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">34 &#40;61&#46;8&#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">&#46;62&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="elsevierStyleItalic">Corticoids&#44; n &#40;&#37;&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;73&#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">37 &#40;82&#46;2&#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">&#46;26&nbsp;\t\t\t\t\t\t\n
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Idiomas
Reumatología Clínica (English Edition)
es en

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

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