was read the article
array:22 [ "pii" => "S2173574320301222" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.10.028" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1291" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2020;16:490-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2173574320301271" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.09.018" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1278" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2020;16:493-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "AA amyloidosis associated with morbid obesity (clinical case)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "493" "paginaFinal" => "496" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Amiloidosis AA asociada a la obesidad mórbida (caso clínico)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 534 "Ancho" => 1250 "Tamanyo" => 155130 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Renal biopsy: (a) Amyloid AA. (b) Congo-red.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nana Beridze Vaktangova, Vanesa García Moreira, Sandra García Castañón, Raúl Rodríguez Aguilar, Francisco Domínguez Iglesias" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Nana" "apellidos" => "Beridze Vaktangova" ] 1 => array:2 [ "nombre" => "Vanesa" "apellidos" => "García Moreira" ] 2 => array:2 [ "nombre" => "Sandra" "apellidos" => "García Castañón" ] 3 => array:2 [ "nombre" => "Raúl" "apellidos" => "Rodríguez Aguilar" ] 4 => array:2 [ "nombre" => "Francisco" "apellidos" => "Domínguez Iglesias" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301271?idApp=UINPBA00004M" "url" => "/21735743/0000001600000006/v1_202011251719/S2173574320301271/v1_202011251719/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574319301819" "issn" => "21735743" "doi" => "10.1016/j.reumae.2018.10.022" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1294" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2020;16:485-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Report</span>" "titulo" => "Radioisotope synoviorthesis in the control of refractory synovitis in Castilla-La Mancha. A 10-year experience" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "485" "paginaFinal" => "489" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La sinoviortesis radioisotópica en el control de la sinovitis refractaria en Castilla La-Mancha. Una experiencia de 10 años" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1163 "Ancho" => 1300 "Tamanyo" => 84139 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Scintigraphic imaging post intra-articular joint injection with Ytrium-90 of the knee in a 51-year-old male patient with rheumatoid arthritis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "David Castro Corredor, Wilson Rafael Martínez Bravo, Marco Aurelio Ramírez Huaranga, Javier José Mateos Rodríguez, Ana Isabel Rebollo Giménez, Joaquín Anino Fernández, María Dolores Mínguez Sánchez, Ángel Soriano Castrejón, José Luis Cuadra Díaz" "autores" => array:9 [ 0 => array:2 [ "nombre" => "David" "apellidos" => "Castro Corredor" ] 1 => array:2 [ "nombre" => "Wilson Rafael" "apellidos" => "Martínez Bravo" ] 2 => array:2 [ "nombre" => "Marco Aurelio" "apellidos" => "Ramírez Huaranga" ] 3 => array:2 [ "nombre" => "Javier José" "apellidos" => "Mateos Rodríguez" ] 4 => array:2 [ "nombre" => "Ana Isabel" "apellidos" => "Rebollo Giménez" ] 5 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Anino Fernández" ] 6 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Mínguez Sánchez" ] 7 => array:2 [ "nombre" => "Ángel" "apellidos" => "Soriano Castrejón" ] 8 => array:2 [ "nombre" => "José Luis" "apellidos" => "Cuadra Díaz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X18302389" "doi" => "10.1016/j.reuma.2018.10.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X18302389?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301819?idApp=UINPBA00004M" "url" => "/21735743/0000001600000006/v1_202011251719/S2173574319301819/v1_202011251719/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "The dilemma of chronic recurrent multifocal osteomyelitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "490" "paginaFinal" => "492" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Godwin Oligbu, Benjamin Jacobs, Tahir Khan" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Godwin" "apellidos" => "Oligbu" "email" => array:1 [ 0 => "godwin.oligbu@nhs.net" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Benjamin" "apellidos" => "Jacobs" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Tahir" "apellidos" => "Khan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Children and Adolescence Unit, Royal National Orthopaedic Hospital, Stanmore, UK" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, UK" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El dilema de la osteomielitis multifocal recurrente crónica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 709 "Ancho" => 1251 "Tamanyo" => 83695 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(a) X-ray of the right foot showing a focus of lucency in the distal metaphysis of the third metatarsal, extending to the growth plate with multi-lamellated periosteal reaction (b). MRI of the right ankle showing diffuse bone marrow oedema, fibular periosteal response, the localised medial fibular cortical defect and the tibiotalar joint effusion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic recurrent multifocal osteomyelitis (CRMO) is an idiopathic auto-inflammatory disorder of undefined origin affecting mainly children and young adolescent.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1,2</span></a> Although, recent findings suggest the possibility of an abnormal regulation of IL-1β axis been involved in the pathogenesis, this is yet to be fully elucidated.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is considered a rare disorder, but its incidence is probably underestimated, with some studies demonstrating that CRMO could be more common than previously reported,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> with a comparable incidence with bacterial osteomyelitis in a 10-year retrospective study involving 105 children in Germany.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This disease is generally benign but tends to follow a chronic or recurrent course, often the course is prolonged over several years with periodic exacerbations.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">7,8</span></a> It is generally regarded as benign, however complications have been reported in children and adolescence. These could be variable, from mild to debilitating asymmetries of limb length, vertebral collapse kyphosis, chronic spondylo-arthropathy, and stunting for early closure of the growth-cartilages.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> Therefore a correct and timely diagnosis is of utmost importance to reduce morbidity.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Here, we describe two cases of CRMO and demonstrate diagnostic features which help differentiate between bacteria osteomyelitis and CRMO.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Presentation</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 1</span><p id="par0025" class="elsevierStylePara elsevierViewall">11 year-old referred with 3 months history of persistent left foot pain, associated with swelling, redness and some difficulty in weight bearing. There was a preceding history of fall, 4 weeks prior to the onset of this pain from a height but no penetrating injury. Apart from tonsillectomy at the age of 6, the past medical history was unremarkable. She last travel to Asia 2 years before the onset of this symptoms, and has been appropriately immunised for age with no significant medical and family history.</p><p id="par0030" class="elsevierStylePara elsevierViewall">She examined well and appropriately grown for her age. She was unable to weight bear on her left foot, which was swollen, warm, and tender. The initial radiological investigations were reported as unremarkable with a normal metabolic bone profile. The inflammatory markers were persistently elevated with a peak Erythrocyte sedimentation rate (ESR) of 73<span class="elsevierStyleHsp" style=""></span>mm/h and C-reactive protein (CRP) of 15<span class="elsevierStyleHsp" style=""></span>mg/L (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Three weeks later, due to persistent pain, the X-ray was repeated (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a) and followed by CT and MRI showing hyperintensity within the third metatarsal shaft, circumferential cortical thickening and periostitis. No penumbra sign was seen to suggest an abscess. She had serial radiological investigations, follow-up and was regularly discussed at the regional sarcoma multidisciplinary team (MDT) meeting. Due to deteriorating lesion on the images, a biopsy was obtained and commenced on a 6 weeks course of antibiotics with no improvement. The microscopy, culture and sensitivity (MCS), mycobacterium tuberculosis (TB) culture and polymerase chain reaction (PCR) for staphylococcus, streptococcus and kingella kingae were all negative. There was no clinical or radiological response to antibiotics.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A whole body MRI allowed the diagnosis of CRMO. The patient received pamidronate infusion, with improvement in the leg lesion and reduction in pain. Her gait returned to normal, her pain settled and her radiographs showed remodelling of the metatarsal gradually over the following year.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case 2</span><p id="par0040" class="elsevierStylePara elsevierViewall">13 year-old previously fit and well male teenager was referred with 5 years of right ankle pain and swelling. There was no preceding history of trauma and no other constitutional symptoms. No associated pain or swelling in any other joints. Apart from hay fever, there was no significant past medical and family history of note. He was born at term with no developmental concern and fully immunise for age.</p><p id="par0045" class="elsevierStylePara elsevierViewall">He examined well with a weight of 70<span class="elsevierStyleHsp" style=""></span>kg, height 182<span class="elsevierStyleHsp" style=""></span>cm and BMI of 21.3. Apart from right ankle swelling and tenderness on palpation, the rest of the physical examination was unremarkable. The initial X-ray at the referring hospital was reported as normal. He had insufficient vitamin D of 38<span class="elsevierStyleHsp" style=""></span>nmol/L but the rest of the metabolic bone profile, including the renal functions, liver function and full blood counts were all normal. The ESR was slightly elevated at 16<span class="elsevierStyleHsp" style=""></span>mm/h with a normal CRP of 2<span class="elsevierStyleHsp" style=""></span>mg/L (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The X-ray and MRI series were subsequently reviewed at our MDT meeting and demonstrate diffuse bone marrow oedema, fibular periosteal response, localised medial fibular cortical defect and large tibiotalar joint effusion of the right distal fibula (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). Underwent joint aspirate, bone biopsy, debridement and sequestrectomy. The microscopy culture and sensitivity (MCS), polymerase chain reaction (PCR) for streptococcus, staphylococcus and kingella kingae, including culture for mycobacterium tuberculosis of the bone biopsy and joint fluid were all negative. The histopathology showed mild oedema and mild chronic inflammatory cellular infiltrate composed of lymphocytes and plasma cells. There is no evidence of granulomata or atypical cells to suggest malignancy. The base line immunological and auto-immune work up was also negative. He had a 6 week course of antibiotics due to worsening of the lesion with no improvement. The whole body MRI allowed for the diagnosis of CRMO. He received pamidronate infusion with significant improvement in the leg lesions and reduction in pain.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">This case series highlight CRMO as a well-known differential diagnosis of bacterial osteomyelitis and the clinical manifestations are highly variable.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> The clinical presentation of warmth and redness in the context of swelling and pain makes it difficult to exclude bacterial osteomyelitis. Although swelling is a less prominent feature of bacteria osteomyelitis, it is not uncommon for it to be complicated by septic arthritis of the preceding joints. The absence of fever has generally been used as a discriminatory symptoms/signs. However, few studies have observed a mild to moderate fever in children with CRMO.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">9,11</span></a> We did not observe extra-articular manifestation, which has been reported in 20% of children presenting with CRMO and particularly helpful in the diagnosis of CRMO, but the insidious onset of the symptoms and signs couple with the fact that both children appeared well was consistent with previous studies and is typical of CRMO.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Although, the lesion may affect any bone segment, the predilection for the lower extremities has been well documented, especially the metaphysis of long bone followed by clavicle, pelvis and spine in order of decreasing frequency.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">8,9</span></a> But these are not sufficient features to exclude bacterial osteomyelitis.</p><p id="par0060" class="elsevierStylePara elsevierViewall">A number of laboratory investigations have been used to help with the diagnosis of bacterial osteomyelitis, even though they generally lack specificity. The presence of inflammatory markers such as an increased C-reactive protein (CRP) level and increased erythrocyte sedimentation rate (ESR) may be used as an adjunct to the diagnosis and for monitoring clinical response to treatment in bacterial osteomyelitis was not useful in this case series as we observed both a significantly elevated ESR and CRP.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">12–14</span></a> Although, by contrast, in most cases, the presence of persistently normal CRP and ESR levels usually rules out osteomyelitis.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Additionally, this case demonstrates that MRI is a very sensitive method of investigation to substantiate suspected CRMO diagnosis. Both children examined using MRI had confirmed bone lesions. The typical MRI findings of bone cortical thickening, lytic lesions with sclerosis and bone oedema was seen.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> However, due to some atypical features of sequestra, consistent with possible chronic osteomyelitis, the children had a course of antibiotics. It is not unusual for CRMO to have been treated with course of antibiotics before the diagnosis is made due to the potential complication of delayed treatment. Nonetheless, a delay in diagnosing a non-bacterial osteomyelitis could also have a significant morbidity on children.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> CRMO is commoner in teenagers.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> Children presenting outside this age range should be thoroughly investigated for possible underlying malignancy, such as lymphoma in adult and leukaemia in younger ones.</p><p id="par0070" class="elsevierStylePara elsevierViewall">CRMO diagnosis can be almost definite if typical skin lesions accompany characteristic bone lesions on MRI.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> Notwithstanding, the ‘gold standard’ for the diagnosis of bacterial osteomyelitis or bone malignancy still remained the presence of positive bone cultures and histopathologic examination of the bone.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> However in children with unusual or persistent symptoms, and where the facilities are available a whole body MRI should be considered to detect clinically in apparent lesions of CRMO in other part of the body.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">CRMO continues to be a serious health problem worldwide, while representing an economic burden to any healthcare system. Missed and delayed diagnosis has a major impact on the quality of life of patients and is a substantial financial burden. A high index of suspicion and multidisciplinary approach involving radiologists, microbiologists with expertise in infectious diseases, orthopaedic surgeons and rheumatologist will reduce the diagnostic dilemma</p><p id="par0080" class="elsevierStylePara elsevierViewall">Although this diagnosis can often be challenging to the investigating physician, but it is important to realise that an early diagnosis will lead to a more favourable outcome.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Authors’ Contributions</span><p id="par0085" class="elsevierStylePara elsevierViewall">G.O. reviewed the literature, wrote the first draft, and coordinated the production of the manuscript B.J. and T.H. involved in the medical diagnosis, management and follow up of the patient. All authors read and approved the final manuscript.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Funding</span><p id="par0090" class="elsevierStylePara elsevierViewall">There is no institutional, financial or material support for publishing the manuscript.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare there are no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1420642" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1299096" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1420641" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1299097" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Case Presentation" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 2" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Authors’ Contributions" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-07-26" "fechaAceptado" => "2018-10-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1299096" "palabras" => array:4 [ 0 => "Chronic recurrent multifocal osteomyelitis" 1 => "Bone pain" 2 => "Children" 3 => "Osteomyelitis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1299097" "palabras" => array:4 [ 0 => "Osteomielitis multifocal recurrente crónica" 1 => "Dolor de huesos" 2 => "Niños" 3 => "Osteomielitis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic inflammatory disease that affects mainly children and young adults, resulting in significant morbidity especially if not diagnosed early. The clinical signs and symptoms are nonspecific, with a consequential delay in diagnosis. Radiological and histopathological criteria are important for its definition. Two cases of CRMO are reported, highlighting the diagnostic challenge and demonstrating the importance of timely investigations.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La osteomielitis multifocal recurrente crónica (CRMO) es una enfermedad inflamatoria idiopática rara que afecta a principalmente niños y adultos jóvenes, dando por resultado morbosidad significativa sobre todo si no se diagnostica a tiempo. Los signos y síntomas clínicos son inespecíficos, entorpecer y retrasar el diagnóstico. Las pruebas radiológicas e histopatológicas son esenciales para su definición. Se divulgan dos casos de CRMO, destacando el reto diagnóstico y demostrando la importancia de las investigaciones oportunas.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 709 "Ancho" => 1251 "Tamanyo" => 83695 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(a) X-ray of the right foot showing a focus of lucency in the distal metaphysis of the third metatarsal, extending to the growth plate with multi-lamellated periosteal reaction (b). MRI of the right ankle showing diffuse bone marrow oedema, fibular periosteal response, the localised medial fibular cortical defect and the tibiotalar joint effusion.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 1 \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">Case 2 \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">Range \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">ESR \t\t\t\t\t\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">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\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">1–20<span class="elsevierStyleHsp" style=""></span>mm/h \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">CRP \t\t\t\t\t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\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">0–5<span class="elsevierStyleHsp" style=""></span>mg/L \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">WBC \t\t\t\t\t\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">8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4–11<span class="elsevierStyleHsp" style=""></span>g/dl \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">Neutrophils \t\t\t\t\t\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">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5–8<span class="elsevierStyleHsp" style=""></span>g/dl \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">Calcium \t\t\t\t\t\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">2.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.59 \t\t\t\t\t\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">2.1–2.6<span class="elsevierStyleHsp" style=""></span>mmol/L \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">Phosphate \t\t\t\t\t\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">1.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.95 \t\t\t\t\t\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">0.81–1.94<span class="elsevierStyleHsp" style=""></span>mmol/L \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">ALP \t\t\t\t\t\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">266 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">137 \t\t\t\t\t\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">60–425<span class="elsevierStyleHsp" style=""></span>U/L \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">ALT \t\t\t\t\t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\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">0–36<span class="elsevierStyleHsp" style=""></span>U/L \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">Vitamin D \t\t\t\t\t\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">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\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<span class="elsevierStyleHsp" style=""></span>nmol/L \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">PTH \t\t\t\t\t\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">2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6–6.9<span class="elsevierStyleHsp" style=""></span>pmol/L \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2436698.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Laboratory Results of Case 1 and 2.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging of chronic recurrent multifocal osteomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Khanna" 1 => "T.S. Sato" 2 => "P. Ferguson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/rg.294085244" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2009" "volumen" => "29" "paginaInicial" => "1159" "paginaFinal" => "1177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19605663" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0095" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.M. Hedrich" 1 => "S.R. Hofmann" 2 => "J. Pablik" 3 => "H. MorBach" 4 => "H.J. Girschick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1546-0096-11-47" "Revista" => array:5 [ "tituloSerie" => "Pediatr Rheumatol Online J" "fecha" => "2013" "volumen" => "11" "paginaInicial" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24359092" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0100" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deregulation of the IL-1β axis in chronic recurrent multifocal osteomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Scianaro" 1 => "A. Insalaco" 2 => "L.B. Laudiero" 3 => "R. De Vito" 4 => "M. Pezzullo" 5 => "A. Teti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Pediatr Rheumatol Online J" "fecha" => "2014" "volumen" => "12" "paginaInicial" => "30" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0105" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New discoveries in CRMO: IL-1β, the neutrophil, and the microbiome implicated in disease pathogenesis in Pstpip2-deficient mice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.J. Ferguson" 1 => "R.M. Laxer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00281-015-0488-2" "Revista" => array:6 [ "tituloSerie" => "Semin Immunopathol" "fecha" => "2015" "volumen" => "37" "paginaInicial" => "407" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25894861" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0110" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic recurrent multifocal osteomyelitis in children: nine years’ experience at a statewide tertiary paediatric rheumatology referral centre" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Walsh" 1 => "P.J. Manners" 2 => "J. Vercoe" 3 => "D. Burgner" 4 => "K.J. Murray" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology" "fecha" => "2015" "volumen" => "54" "paginaInicial" => "1688" "paginaFinal" => "1691" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0115" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unexpectedly high incidences of chronic non-bacterial as compared to bacterial osteomyelitis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Schnabel" 1 => "U. Range" 2 => "G. Hahn" 3 => "T. Siepmann" 4 => "R. Berner" 5 => "C.M. Hedrich" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatol Int" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "1737" "paginaFinal" => "1745" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0120" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic recurrent multifocal osteomyelitis is a differential diagnosis of juvenile idiopathic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.P. Robertson" 1 => "P. Hickling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2001" "volumen" => "60" "paginaInicial" => "828" "paginaFinal" => "831" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0125" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic recurrent multifocal osteomyelitis: clinical outcomes after more than five years of follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. Huber" 1 => "P.Y. Lam" 2 => "C.M. Duffy" 3 => "R.S. Yeung" 4 => "M. Ditchfield" 5 => "D. Laxer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr" "fecha" => "2002" "volumen" => "141" "paginaInicial" => "198" "paginaFinal" => "203" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0130" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Jansson" 1 => "E.D. Renner" 2 => "J. Ramser" 3 => "A. Mayer" 4 => "M. Haban" 5 => "A. Meindl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/kel190" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "154" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16782988" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0135" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic non-bacterial osteomyelitis: pathophysiological concepts and current treatment strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.R. Hofmann" 1 => "A. Schnabel" 2 => "A. Rösen-Wolff" 3 => "H. Morbach" 4 => "H.J. Girschick" 5 => "C.M. Hedrich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.160256" "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2016" "volumen" => "43" "paginaInicial" => "1956" "paginaFinal" => "1964" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27585682" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0140" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A large national cohort of French patients with chronic recurrent multifocal osteitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Wipff" 1 => "F. Costantino" 2 => "I. Lemelle" 3 => "C. Pajot" 4 => "A. Duquesne" 5 => "M. Lorrot" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheumatol" "fecha" => "2015" "volumen" => "67" "paginaInicial" => "1128" "paginaFinal" => "1137" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0145" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotics for treating chronic osteomyelitis in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.O. Conterno" 1 => "M.D. Turchi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2013" "volumen" => "9" "paginaInicial" => "CD004439" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0150" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of osteomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Hatzenbuehler" 1 => "T.J. Pulling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Fam Phys" "fecha" => "2011" "volumen" => "84" "paginaInicial" => "1027" "paginaFinal" => "1033" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0155" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of bone infections in adults: the surgeon's and microbiologist's perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Mouzopoulos" 1 => "N.K. Kanakaris" 2 => "G. Kontakis" 3 => "O. Obakponovwe" 4 => "R. Townsend" 5 => "P.V. Giannoudis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0020-1383(11)70128-0" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2011" "volumen" => "42" "paginaInicial" => "S18" "paginaFinal" => "S23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22196905" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0160" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Fritz" 1 => "N. Tzaribatchev" 2 => "C.D. Claussen" 3 => "J.A. Carrino" 4 => "M.S. Horger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2523081335" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2009" "volumen" => "252" "paginaInicial" => "842" "paginaFinal" => "851" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19567645" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0165" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physeal involvement in chronic recurrent multifocal osteomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Manson" 1 => "D.M. Wilmot" 2 => "S. King" 3 => "R.M. Laxer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF02010639" "Revista" => array:6 [ "tituloSerie" => "Pediatr Radiol" "fecha" => "1989" "volumen" => "20" "paginaInicial" => "76" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2602021" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0170" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.J. Girschick" 1 => "C. Zimmer" 2 => "G. Klaus" 3 => "K. Darge" 4 => "A. Dick" 5 => "H. Morbach" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nat Clin Pr Rheumatol" "fecha" => "2007" "volumen" => "3" "paginaInicial" => "733" "paginaFinal" => "738" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001600000006/v1_202011251719/S2173574320301222/v1_202011251719/en/main.assets" "Apartado" => array:4 [ "identificador" => "43296" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001600000006/v1_202011251719/S2173574320301222/v1_202011251719/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301222?idApp=UINPBA00004M" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 9 | 9 | 18 |
2024 October | 60 | 30 | 90 |
2024 September | 70 | 9 | 79 |
2024 August | 103 | 29 | 132 |
2024 July | 131 | 27 | 158 |
2024 June | 109 | 38 | 147 |
2024 May | 132 | 34 | 166 |
2024 April | 95 | 33 | 128 |
2024 March | 98 | 36 | 134 |
2024 February | 75 | 20 | 95 |
2024 January | 80 | 20 | 100 |
2023 December | 54 | 34 | 88 |
2023 November | 84 | 26 | 110 |
2023 October | 91 | 26 | 117 |
2023 September | 103 | 36 | 139 |
2023 August | 124 | 22 | 146 |
2023 July | 60 | 20 | 80 |
2023 June | 54 | 24 | 78 |
2023 May | 71 | 28 | 99 |
2023 April | 76 | 13 | 89 |
2023 March | 76 | 35 | 111 |
2023 February | 65 | 38 | 103 |
2023 January | 51 | 28 | 79 |
2022 December | 85 | 38 | 123 |
2022 November | 73 | 32 | 105 |
2022 October | 107 | 35 | 142 |
2022 September | 79 | 37 | 116 |
2022 August | 56 | 44 | 100 |
2022 July | 65 | 57 | 122 |
2022 June | 64 | 49 | 113 |
2022 May | 48 | 41 | 89 |
2022 April | 84 | 52 | 136 |
2022 March | 87 | 64 | 151 |
2022 February | 113 | 40 | 153 |
2022 January | 93 | 53 | 146 |
2021 December | 79 | 54 | 133 |
2021 November | 85 | 42 | 127 |
2021 October | 63 | 58 | 121 |
2021 September | 54 | 48 | 102 |
2021 August | 28 | 23 | 51 |
2021 July | 28 | 17 | 45 |
2021 June | 25 | 27 | 52 |
2021 May | 21 | 41 | 62 |