Gouty Involvement of Foot and Ankle: Beyond Flares

array:23 ["pii" => "S2173574320301817" "issn" => "21735743" "doi" => "10.1016/j.reumae.2019.12.004" "estado" => "S300" "fechaPublicacion" => "2021-02-01" "aid" => "1390" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 0 "subdocumento" => "rev" "cita" => "Reumatol Clin. 2021;17:106-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S2173574320300216" "issn" => "21735743" "doi" => "10.1016/j.reumae.2019.08.002" "estado" => "S300" "fechaPublicacion" => "2021-02-01" "aid" => "1361" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2021;17:113-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Case Report" "titulo" => "Cholinergic synovitis: Description of four cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "113" "paginaFinal" => "115" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sinovitis colinérgica: descripción de 4 casos" ] ] "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" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1086 "Ancho" => 1750 "Tamanyo" => 192272 ] ] "descripcion" => array:1 [ "en" => "(A) Dermographism observed in case 1. (B) Appearance of the knees 1h after physical activity in case 1. (C) Appearance of the hands in case 2 after isometric dumbbell exercises. (D) From left to right: basal situation of the pre-patellar recess of the patient of case 3, 1h after exercise and 3h later." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Guillén Astete, Miguel Zamorano Serrano, Mónica Luque Alarcón" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Guillén Astete" ] 1 => array:2 [ "nombre" => "Miguel" "apellidos" => "Zamorano Serrano" ] 2 => array:2 [ "nombre" => "Mónica" "apellidos" => "Luque Alarcón" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X19301226" "doi" => "10.1016/j.reuma.2019.08.002" "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/S1699258X19301226?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320300216?idApp=UINPBA00004M" "url" => "/21735743/0000001700000002/v1_202101301156/S2173574320300216/v1_202101301156/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S217357432100006X" "issn" => "21735743" "doi" => "10.1016/j.reumae.2019.04.003" "estado" => "S300" "fechaPublicacion" => "2021-02-01" "aid" => "1336" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Reumatol Clin. 2021;17:97-105" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Consensus statement" "titulo" => "Severe osteoporosis: Principles for pharmacological therapy in Mexico" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "105" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Osteoporosis severa: fundamentos para su terapia farmacológica en México" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Patricia Clark, Fernando Carlos Rivera, Lucía Méndez Sánchez, Carlos Fernando Mendoza Gutiérrez, Jessica Liliana Vargas Neri, Sandra Miriam Carrillo Vázquez, Daniel Xavier Xibillé Friedmann, Ariana Alvarado Ceballos, José Manuel Aguilera Zepeda, Víctor Mercado Cárdenas, Hilario Ávila Amengol" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Patricia" "apellidos" => "Clark" ] 1 => array:2 [ "nombre" => "Fernando Carlos" "apellidos" => "Rivera" ] 2 => array:2 [ "nombre" => "Lucía" "apellidos" => "Méndez Sánchez" ] 3 => array:2 [ "nombre" => "Carlos Fernando" "apellidos" => "Mendoza Gutiérrez" ] 4 => array:2 [ "nombre" => "Jessica Liliana" "apellidos" => "Vargas Neri" ] 5 => array:2 [ "nombre" => "Sandra Miriam" "apellidos" => "Carrillo Vázquez" ] 6 => array:2 [ "nombre" => "Daniel Xavier" "apellidos" => "Xibillé Friedmann" ] 7 => array:2 [ "nombre" => "Ariana" "apellidos" => "Alvarado Ceballos" ] 8 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Aguilera Zepeda" ] 9 => array:2 [ "nombre" => "Víctor" "apellidos" => "Mercado Cárdenas" ] 10 => array:2 [ "nombre" => "Hilario" "apellidos" => "Ávila Amengol" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X19300786" "doi" => "10.1016/j.reuma.2019.04.001" "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/S1699258X19300786?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357432100006X?idApp=UINPBA00004M" "url" => "/21735743/0000001700000002/v1_202101301156/S217357432100006X/v1_202101301156/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Review Article" "titulo" => "Gouty Involvement of Foot and Ankle: Beyond Flares" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "106" "paginaFinal" => "112" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José-Antonio Bernal, Jonatan García-Campos, Javier Marco-LLedó, Mariano Andrés" "autores" => array:4 [ 0 => array:4 [ "nombre" => "José-Antonio" "apellidos" => "Bernal" "email" => array:1 [ 0 => "Josantonio.bernal@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jonatan" "apellidos" => "García-Campos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Javier" "apellidos" => "Marco-LLedó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Mariano" "apellidos" => "Andrés" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Sección de Reumatología, Hospital Marina Baixa, Villajoyosa, Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Implicación de los tobillos y pies en gota: Algo más que ataques" ] ] "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" => 905 "Ancho" => 1605 "Tamanyo" => 189887 ] ] "descripcion" => array:1 [ "en" => "The figure depicts three different cases of foot involvement in tophaceous gout, shown by a clinical picture (left), plain radiography (center) and T1-weighted magnetic resonance (right)." ] ] ] "textoCompleto" => "IntroductionThe clinical presentations of any disease that occur more frequently are regarded as typical and prompt a straightforward diagnosis. Conversely, other presentations different to the classical may hamper reach the correct diagnosis and increase the possibility of misclassification. This situation occurs in gout, despite having an immediate and reliable technique – the synovial fluid analysis under the polarized microscope – that provides a diagnosis of certainty.<a class="elsevierStyleCrossRef" href="#bib0330">1</a> The hallmark picture is the acute inflammation of the big toe in a middle-aged man often suffering from renal and cardiovascular comorbidities. Besides the detection of subcutaneous tophi, this presentation poses the highest diagnostic utility compared to the microscopic evaluation.<a class="elsevierStyleCrossRef" href="#bib0335">2</a> However, in general terms, gout diagnoses solely based on clinical data misclassify up to one out of four patients.<a class="elsevierStyleCrossRef" href="#bib0340">3</a> Incorporating the routine microscopic analysis of every synovial fluid sample obtained in clinical practice is a crucial strategy to avoid misdiagnoses. Increasing the knowledge on the clinical spectrum of gout can be useful as well.The monosodium urate (MSU) crystals deposition occurs in the musculoskeletal (MSK) system, as is demonstrated by the overt manifestations (flares, tophi) suffered by gout patients. However, the deposition and clinical picture probably is more generalized.<a class="elsevierStyleCrossRef" href="#bib0345">4</a> Feet are major MSK sites of MSU crystal deposition, but there are other frequent locations such as knee, wrist, fingers or elbow bursae. In terms of gout flares, old series already reported that big toe and ankle/foot involvement affect to 76% and 50% of gout patients, respectively.<a class="elsevierStyleCrossRef" href="#bib0350">5</a> At the primary care level, 53% of gout flares affected the big toe, while other areas of foot and ankle comprised 18% of episodes. Beyond flares, nonspecific complains focused on feet and ankles are commonly stated by patients with gout in clinical practice, such as persistent walking pain, stiffness or numbness. Subcutaneous tophi are frequently found at Achilles tendon regions, ankle malleoli, lateral aspects of tarsi, over toes (especially the big toes) and even on the plantar surface.The predilection for feet and ankles of MSU crystals is also confirmed by ultrasound and dual-energy computed tomography (DECT), the imaging techniques that better ascertain the crystal deposition in gout, despite not being interchangeable.<a class="elsevierStyleCrossRef" href="#bib0355">6</a> By ultrasound, reported rates of deposits are 14.2–35.0% in first metatarsophalangeal (MTP) joint, 15.8% in the ankle and 1.6% in the midfoot.<a class="elsevierStyleCrossRefs" href="#bib0360">7,8</a> Using DECT, crystal deposits in 1st MTP, midfoot and ankle are seen in 12.1–57.4%, 0.8–7.5%, and 10.8–53.4% respectively.<a class="elsevierStyleCrossRefs" href="#bib0365">8–12</a> Prevalence rates vary according to several factors, such as age, disease duration, serum urate (SU) levels or use of urate-lowering agents. Interestingly, crystal deposits were strongly associated with the presence of joint damage such as erosions or joint space narrowing.<a class="elsevierStyleCrossRefs" href="#bib0360">7,9</a> Beside joints, imaging techniques also revealed tendon deposition of MSU crystals in feet, with a predominance for Achilles tendons – 26% by ultrasound,<a class="elsevierStyleCrossRef" href="#bib0390">13</a> 52% by DECT<a class="elsevierStyleCrossRef" href="#bib0395">14</a> – while other tendons, such as peroneal, extensor digitorum longus, extensor halluces longus, and tibialis anterior, are commonly affected (>10%).The reason for the predominant involvement of lower limbs, and notably foot and ankle, in gout, remains to be determined. Urate forms MSU crystals when its levels are persistently above the saturation point, that was determined at 6.8mg/dL with a normal body temperature of 37°C.<a class="elsevierStyleCrossRef" href="#bib0400">15</a> At lower values, the saturation level for urate also lowers. Interestingly, an old study proved that the temperature at the big toe is about 35°C,<a class="elsevierStyleCrossRef" href="#bib0405">16</a> thus theoretically facilitating the crystallization of urate.<a class="elsevierStyleCrossRef" href="#bib0410">17</a> Besides temperature and urate concentration, other determinants of the crystallization appear to be the proteins.<a class="elsevierStyleCrossRef" href="#bib0415">18</a> MSU crystals form through templated nucleation, a form of biomineralization that requires the presence of a complementary structure to facilitate a low-energy requiring crystallization. One of the potential protein candidates is the type II collagen, present at both joints and tendons: (i) fragments of proteins containing adhered and well-organized MSU crystals are occasionally seen in the synovial fluid from gout patients<a class="elsevierStyleCrossRef" href="#bib0420">19</a>; (ii) the crystal deposition is majoritary on the cartilage surfaces, as demonstrated by arthroscopy<a class="elsevierStyleCrossRef" href="#bib0425">20</a> and ultrasound<a class="elsevierStyleCrossRef" href="#bib0430">21</a>; and (iii) at tendons, crystals deposits are mostly seen in the enthesis,<a class="elsevierStyleCrossRef" href="#bib0395">14</a> an area of high mechanical stress for tendon fibers.<a class="elsevierStyleCrossRef" href="#bib0435">22</a> Lower limbs are the leading sites for developing osteoarthritis, as they are weight-bearing. Gout, both as MSU crystal deposition and clinical flares, has been associated with osteoarthritis in some reports,<a class="elsevierStyleCrossRefs" href="#bib0370">9,23</a> though not in others.<a class="elsevierStyleCrossRef" href="#bib0445">24</a> Joints affected with osteoarthritis developed cartilage fibrillation, likely facilitating the initial MSU crystal deposition. Afterwards, while hyperuricemia persists, the formation of further MSU crystals continues, now probably using another crystal as the template, as seen in the tophi.<a class="elsevierStyleCrossRef" href="#bib0415">18</a>MethodsFor this narrative review, an electronic search in MEDLINE, Cochrane, Embase and PEDro databases was performed. The search strategy, run at 2019 July 4th, with its used terms, can be found at the <a class="elsevierStyleCrossRef" href="#sec0070">Annexed 1</a>. Title and abstracts of retrieved articles were reviewed by all four authors to exclude papers unrelated to the topic of interest. Also, articles known by the authors and others obtained through reviewing the retrieved bibliography were included. The gout nomenclature recommended by the Gout and Crystal Arthritis Network (G-CAN)<a class="elsevierStyleCrossRef" href="#bib0450">25</a> was followed in the writing of this review.Clinical status of foot and ankle in patients with goutPain, impairment and loss of articular functionality and the decrease in muscular strength are the main signs and symptoms which affect feet in patients with gout.<a class="elsevierStyleCrossRef" href="#bib0455">26</a> These manifestations impact on their daily life activities, measured with HAQ-II; HAQ-II score are considerably reduced during a flare, but they remain low even after the disappearance of the acute symptomatology.<a class="elsevierStyleCrossRef" href="#bib0460">27</a>Pain, disability and impairmentPatients with a history of gout during the intercritical phase present higher levels of foot pain when compared with controls. Although a substantial improvement of pain is achieved through treatment, complete normalization is uncommon, suggesting that foot-related pain in such patients may be a persistent characteristic.<a class="elsevierStyleCrossRef" href="#bib0455">26</a> Pain is mostly located in the 1st MTP joint and the ankle. The presence of pain was reported to be associated with obesity, depression and the occurrence of oligoarticular flares.<a class="elsevierStyleCrossRef" href="#bib0465">28</a>Besides pain, other complaints are frequently referred. Impairment, disability and reduced levels of activity – measured respectively by the Leeds Foot Impact Scale and the Lower Limb Tasks Questionnaire – worsen during flares. Similar to pain, during the intercritical phase of gout, a significant improvement in these scores occurs without achieving a complete recovery. These results are similar to those found in other types of rheumatic diseases such as rheumatoid arthritis,<a class="elsevierStyleCrossRef" href="#bib0470">29</a> again suggesting the impact of persistent low-grade inflammation.TophiThe presence of tophi in gout indicates chronicity and a lack of effective treatment. They can be found in joints, cartilages, tendons, muscles and periarticular structures.<a class="elsevierStyleCrossRefs" href="#bib0475">30,31</a> As stated above, feet are preferred sites for tophi development [<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>], especially in the 1st MTP joints and ankles,<a class="elsevierStyleCrossRefs" href="#bib0460">27,32</a> although they may appear in other places of the body such as knees, upper limbs (olecranons, knuckles) or even ears. Presence of tophi in feet has been associated with a decrease in muscle strength<a class="elsevierStyleCrossRef" href="#bib0485">32</a> while some cases of pathological fractures directly related to tophi have been described.<a class="elsevierStyleCrossRef" href="#bib0490">33</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Although ulceration of tophi is not common, those located in the feet tend to ulcerate more frequently.<a class="elsevierStyleCrossRefs" href="#bib0460">27,34</a> Risk factors for ulceration include the number of tophi, their duration, and excessive use of glucocorticoids.<a class="elsevierStyleCrossRef" href="#bib0495">34</a> The presence of small ulcerated areas is common in gout, particularly in cases of chronic polyarticular involvement with tophi. The study by Rome et al.<a class="elsevierStyleCrossRef" href="#bib0460">27</a> performed on seven patients showed the presence of ulcerations on the dorsal side of the middle toes, likely related to unsuitable footwear. Ulcers in patients with gout tend to be highly exudative while carrying with a moderate amount of pain.<a class="elsevierStyleCrossRef" href="#bib0460">27</a> This situation can be worsened by the presence of comorbidities frequently associated with gout such as obesity, type 2 diabetes or peripheral arterial disease, which may delay healing and increase the risk of infection. Tophi ulceration, especially those located in the feet, must be distinguished from infected ulcers of diabetic patients given the frequent association between gout and diabetes.<a class="elsevierStyleCrossRef" href="#bib0480">31</a>Beside ulcers, other skin manifestations are usually present when gout affects superficial synovial structures and joints; this is the case of the podagra, in which peeling often occurs after intense swelling, erythema and edema of the affected joint. When the disease involves deeper joints such as the tibiotalar, dermatological alterations are unusual.Tendon involvementLower limbs tendons often show MSU crystals deposits at ultrasound and DECT studies.<a class="elsevierStyleCrossRefs" href="#bib0390">13,14</a> This involvement occurs mainly, but not exclusively, in tophaceous stages. However, the clinical consequences of the tendon deposition remain unclear. Tenosynovitis and paratenonitis are not frequent manifestations in gout, although there have been reported cases in the patellar, Achilles and peroneal tendons, nearly always associated with tophaceous infiltration.<a class="elsevierStyleCrossRef" href="#bib0500">35</a> Subclinical tenosynovitis of the posterior tibialis has also been observed in asymptomatic individuals with hyperuricemia.<a class="elsevierStyleCrossRef" href="#bib0505">36</a> Tearing of the tendon is also infrequent; however, there are reports of spontaneous tears of the anterior tibialis tendon secondary to a tophaceous gout without trauma and associated in most cases with a forced plantarflexion.<a class="elsevierStyleCrossRef" href="#bib0510">37</a>Limitation of movement, muscular strength and structural alterationsThe range of movement of subtalar joints, both inversion and eversion, as well as dorsiflexion of the 1st MTP joints seems significantly reduced in patients with gout.<a class="elsevierStyleCrossRef" href="#bib0515">38</a> This movement limitation of the joint in the absence of edema or other signs of arthritis suggests a state of subclinical inflammation. It is usually present in patients with intercritical gout. The subclinical inflammation has been proven by analysing the leukocyte count in joints containing MSU crystals.<a class="elsevierStyleCrossRef" href="#bib0520">39</a>Presence of tophi anywhere on foot or ankle is associated with reduced strength of plantarflexion and inversion-eversion of ankles. This association is stronger when the tophus is located in the Achilles tendon.<a class="elsevierStyleCrossRef" href="#bib0485">32</a>As for structural alterations of feet, people with gout are more likely to have hammertoes when compared to a group without gout.<a class="elsevierStyleCrossRef" href="#bib0515">38</a> However, Hallux Valgus is associated with age and gender, but not with the gout characteristics or associated comorbidities.<a class="elsevierStyleCrossRef" href="#bib0465">28</a>Gait characteristicsFew studies analyzed the gait characteristics of gouty patients.<a class="elsevierStyleCrossRefs" href="#bib0470">29,40–45</a> However, difficulty in walking during a flare has been considered one of its main discriminatory characteristics. The retrieved studies have focused on the analysis of space-time parameters (STP)<a class="elsevierStyleCrossRefs" href="#bib0470">29,40–42,44</a> and the study of plantar pressures.<a class="elsevierStyleCrossRefs" href="#bib0470">29,40,42,44</a>The study of STPs consists of analysing the different phenomena observed throughout a gait cycle related to space (step length, stride length and others) and time (such as step time or swing time of the lower limb). Its study has been an area of interest for the different types of inflammatory arthritis, although most studies have been focused on rheumatoid arthritis.<a class="elsevierStyleCrossRef" href="#bib0525">40</a> Concerning gout, statistically significant changes have been found in some of the STPs in patients with gout<a class="elsevierStyleCrossRefs" href="#bib0470">29,40,42,43</a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>). The identified changes vary depending on the reviewed study. In general, patients with gout walk at gait velocity and reduced cadence, as well as with an increase in step time and in the stance phase time. Reports on gait patterns of participants either with and without footwear, as well as those walking at a self-selected<a class="elsevierStyleCrossRefs" href="#bib0470">29,41–43</a> or fast speed,<a class="elsevierStyleCrossRef" href="#bib0530">41</a>indicate that swing time only increases during fast gait patterns. An only study, which analyzed the walking STPs of patients with gout on footwear in contrast with healthy subjects, has found a significant decrease in the stride and step lengths, and an increase in the stance time with double leg support.<a class="elsevierStyleCrossRef" href="#bib0470">29</a> Equally, when comparing the STPs of patients using footwear which is considered appropriate versus those of patients using their footwear, there is a significant increase in gait velocity, step length and stride length.<a class="elsevierStyleCrossRef" href="#bib0545">44</a> These effects have also been found when comparing the patients’ footwear with that footwear considered deficient, which leads the authors to question whether these findings might be due to other factors.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Patients with gout also present changes in their peak plantar pressures (PPP) and their pressure-time integrals (PTI).<a class="elsevierStyleCrossRefs" href="#bib0470">29,40,42</a> Although the reviewed studies establish different plantar pressure areas, a statistically significant decrease of PPP has been found in the hallux<a class="elsevierStyleCrossRefs" href="#bib0470">29,42</a> and the heel<a class="elsevierStyleCrossRef" href="#bib0535">42</a> compared to healthy control groups. Furthermore, a significant increase in PTI values of the midfoot has been noted, being these values lower in the hallux. It has also been observed that PPPs decrease significantly in the third and fifth metatarsal bone when using footwear considered better than the patient's footwear.<a class="elsevierStyleCrossRef" href="#bib0545">44</a> The use of suitable footwear also obtains a significant decrease in PTIs in the lateral and middle side of the heel and the third and fifth metatarsal bone, as well as a significant increase below the midfoot in contrast with use of the patient's footwear.Reviewed studies show changes in space-time parameters and plantar pressures during gait in patients with gout in contrast with healthy control groups<a class="elsevierStyleCrossRefs" href="#bib0470">29,40–42</a> or with the type of footwear used.<a class="elsevierStyleCrossRef" href="#bib0545">44</a> These changes have been linked to a strategy to reduce or prevent pain during walking, which may affect daily life activities. However, despite the correlation among space-time parameters and total scores of Manchester Foot Pain and Disability Index, and the results associated with functional limitation, physical appearance and work/free time, the control over pain is not associated with gait characteristics.<a class="elsevierStyleCrossRef" href="#bib0530">41</a> Nevertheless, it is worth noting that these results were obtained when participants with gout were not experiencing symptoms. For this reason, these adaptations may be explained through an acquired strategy, as a measure to avoid a flare, or as a secondary adaptation to walking as a means of reducing pain.FootwearPatients with gout present problems when it comes to finding footwear that fits the appropriate shape and with which they feel comfortable, especially during a flare.<a class="elsevierStyleCrossRef" href="#bib0555">46</a> Several studies have identified which characteristics the patients value in footwear<a class="elsevierStyleCrossRefs" href="#bib0555">46–48</a>; being the most relevant comfort, fit and support. A series of deficiencies associated with footwear has been recognized for consideration at the time of acquiring new footwear. Some of these characteristics are found in the everyday footwear of this group.<a class="elsevierStyleCrossRefs" href="#bib0555">46–49</a> Inadequate width and length, high rigidity, weight, cushioning and deficient motion control, lack of fastening elements, lack of heel counter stiffness and high cost are some of them.Similarly, patients have stated their inability to find footwear that meets an appropriate balance between comfort and appearance in formal or work environments.<a class="elsevierStyleCrossRefs" href="#bib0555">46,48</a> They also indicate a lack of confidence when it comes to knowing what footwear they should buy based on previous negative experiences. Patients who use deficient footwear present a higher impairment and limited activity than those who use suitable footwear.<a class="elsevierStyleCrossRef" href="#bib0560">47</a>Specific management of foot and ankle in goutAfter the review of the literature, a few papers were retrieved in relationship with specific treatment of gout in foot and ankle, most of them related to surgical procedures. In 2018, the American College of Foot and Ankle Surgeons, together with the American Association of Nurse Practitioners, performed a consensus about etiology, diagnosis and treatment of gouty arthritis affecting foot and ankle.<a class="elsevierStyleCrossRef" href="#bib0575">50</a> In this consensus, the experts agreed that nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line therapy for a flare. From the authors’ point of view, NSAIDs are many times contraindicated or not appropriate, while colchicine and corticosteroids (oral or intraarticular) are also effective and safe options. At this consensus, it was also settled the need of urate-lowering therapies, such as allopurinol, to reach the SU target below 6mg/dL. It is also important to mention that the 2016 EULAR treatment guidelines recommend a lower target – <5mg/dL – in severe gout (defined as tophi, chronic arthropathy or with frequent flares) to enhance crystal dissolution.<a class="elsevierStyleCrossRef" href="#bib0580">51</a>Regarding pharmacological treatment, no references dealing with specific management of gout in foot and ankle were found. Nevertheless, it seems reasonable that the treatment would not be different from the ordinary gout patient. Gout must be understood as an MSU crystal deposition disease secondary to hyperuricemia. These MSU crystals are recognized by the innate immune system, causing inflammation.<a class="elsevierStyleCrossRef" href="#bib0585">52</a> The treatment aims to dissolve the MSU crystal storage by achieving a persistent normalization of SU levels. Until MSU crystals are entirely removed, it is also mandatory the flare prophylaxis and, in advance cases, the control of persistent clinical inflammation.Most of the articles found in the review regarding the targeted management of foot and ankle involvement deal with surgical techniques for cases of tophaceous gout. Interventions can be divided into five types: arthroscopic cleaning, joint replacement, arthrodesis, surgical debridement and graft techniques. In 2016, a systematic review of surgical procedures could not reach a specific recommendation due to the limited good quality studies.<a class="elsevierStyleCrossRef" href="#bib0590">53</a> In addition, a Cochrane review concluded more randomized-controlled trial data for surgical interventions of tophi is needed before drawing firm conclusions.<a class="elsevierStyleCrossRef" href="#bib0595">54</a> One paper assessed the arthroscopic removal of MSU crystals from 1st MTP joints, comparing outcomes against “anti-gout therapy” in 28 patients.<a class="elsevierStyleCrossRef" href="#bib0600">55</a> After more than two years, functional scores and number of attacks significantly favored the surgical group; furthermore, the final SU levels were also lower. Surprisingly, no patient in the control group showed SU levels under 6mg/dL, and the authors did not provide the mean dose of urate-lowering therapy in both groups. Concerning joint replacement, one article reports 16 patients with gout undergoing total ankle arthroplasty, with good results in terms of pain and disability.<a class="elsevierStyleCrossRef" href="#bib0605">56</a> These outcomes were also shown in patients in whom an arthrodesis was performed after tophi excision compared with the excision alone. In fact, in this work, the authors noted that osteoarthritis progressed more frequently in patients without arthrodesis and those with intraarticular tophi.<a class="elsevierStyleCrossRef" href="#bib0610">57</a> Surgical debridement is the classic technique for tophi removal,<a class="elsevierStyleCrossRef" href="#bib0615">58</a> despite being supported only by two relatively recent articles. In the first one, a surgical debridement with a free flap reconstruction in six patients is described with favorable results.<a class="elsevierStyleCrossRef" href="#bib0620">59</a> In the other paper, Lee et al.<a class="elsevierStyleCrossRef" href="#bib0625">60</a> described an intralesional shaving technique focused on reducing the burden of MSU. More recently, a modified bone graft technique called Masquelet's technique was used in situations with significant bone losses, as sometimes occurs in tophaceous gout, with successful results.<a class="elsevierStyleCrossRef" href="#bib0630">61</a>The prescription of footwear considered appropriate is controversial. It produces improvements in pain and foot disability in the short term (2 months),<a class="elsevierStyleCrossRefs" href="#bib0635">62,63</a> but eventually, this effect disappears. However, improvements in comfort and fit using suitable footwear tend to persist in time.<a class="elsevierStyleCrossRef" href="#bib0635">62</a> All the studies related to footwear were performed in New Zealand, a fact that needs to be taking into account as could affect data extrapolation.In the authors’ opinion, the timing and indications for surgical procedures in case of gouty involvement remain to be determined. What is mandatory is to optimize the urate-lowering therapy, because gout is too often poorly managed,<a class="elsevierStyleCrossRef" href="#bib0645">64</a> even by rheumatologists, as it has been demonstrated that only 66% of treated patients reached the targeted SU level.<a class="elsevierStyleCrossRef" href="#bib0650">65</a> Footwear interventions could improve patients’ foot comfortability. Probably in severe gout with considerable structural damage, surgical procedures could be an option, always together with urate-lowering therapies.ConclusionThe result of the present review highlights that the foot and ankle involvement in gout overtakes the classical picture of recurrent episodes of acute arthritis. Patients affected with gout, even in a non-tophaceous stage, deal with persistent pain and gait impairment. Their ranges of movement at lower limbs are limited, and the choice of footwear may be troublesome for these subjects, especially when tophi are present, all resulting in an impaired quality of life. Focused attention and management appear convenient, where close collaborations between rheumatologists and podiatrists can be constructive. Gout is a curable disease as MSU crystals dissolve when SU levels are persistently normalized; however, the specific effect on these foot and ankle manifestations remains to be determined.FundingThe present work received no funding.Conflict of interestMA declares speaking fees and research grants from Grunenthal, Menarini, Astra-Zeneca and Horizon. The rest of the authors declares no conflicts of interest in the making of the present manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1457064" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1328172" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1457063" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1328171" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical status of foot and ankle in patients with gout" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Pain, disability and impairment" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Tophi" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Tendon involvement" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Limitation of movement, muscular strength and structural alterations" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Gait characteristics" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Footwear" ] ] ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Specific management of foot and ankle in gout" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack509787" "titulo" => "Acknowledgement" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-09-18" "fechaAceptado" => "2019-12-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1328172" "palabras" => array:5 [ 0 => "Gout" 1 => "Tophi" 2 => "Foot" 3 => "Footwear" 4 => "Gait" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1328171" "palabras" => array:5 [ 0 => "Gota" 1 => "Tofos" 2 => "Pie" 3 => "Calzado" 4 => "Marcha" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The foot and ankle are common locations of deposition of monosodium urate (MSU) crystals, as indicated by the clinical manifestations presented by patients with gout, which are not limited to the acute inflammation of the big toe. We present a narrative literature review aimed to update the gout involvement of foot and ankle and how it affects the quality of life. Cumulative reports indicate that gout, even at the non-tophaceous stage, could cause pain, gait impairment and limit the mobility at lower limbs. These patients may present difficulties in some activities of daily living such as choosing footwear, thus leading to an impaired quality of life. Gout is a curable disease by dissolving MSU crystals but remains unclear how this could modify some of these foot and ankle manifestations, especially when structural damage has already occurred. Furthermore, a collaboration between rheumatologists and podiatrists seems helpful to understand, relieve these symptoms and improve the quality of life in gouty patients." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El pie y el tobillo son lugares comunes de depósito de cristales de urato monosódico (UMS), como indican las manifestaciones clínicas que presentan los pacientes con gota, que no se limitan a la inflamación aguda del primer dedo del pie. Presentamos una revisión narrativa de la literatura con el objetivo de actualizar la implicación de la gota en pie y tobillo y cómo afecta a la calidad de vida. En la literatura se describe que la gota, incluso en la etapa no tofácea, podría causar dolor, deterioro de la marcha y limitaciones de la movilidad en las extremidades inferiores. Estos pacientes pueden presentar dificultades en algunas actividades de la vida diaria, como la elección de calzado, lo cual implica una calidad de vida deteriorada. La gota es una enfermedad curable si se disuelven los cristales de UMS, pero resulta incierto cómo esto podría modificar algunas de estas manifestaciones en pie y el tobillo, especialmente cuando el daño estructural ya ha ocurrido. Además, una colaboración entre reumatólogos y podólogos sería de utilidad para comprender y aliviar estos síntomas así como mejorar la calidad de vida de los pacientes con gota." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>" "etiqueta" => "Annexed 1" "titulo" => "Search strategy" "identificador" => "sec0070" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 905 "Ancho" => 1605 "Tamanyo" => 189887 ] ] "descripcion" => array:1 [ "en" => "The figure depicts three different cases of foot involvement in tophaceous gout, shown by a clinical picture (left), plain radiography (center) and T1-weighted magnetic resonance (right)." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "↑: increased; ↓: decreased; NE: not evaluated; NSSD: not statistically significant differences." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference \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">Gait analysis \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">Disease duration, years, mean \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">Tophaceous gout (%) \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">Ancestry \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">Velocity \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">Cadence \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">Step length \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">Stride length \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">Support base \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">Step time \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">Swing time \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">Stance time \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">Single leg support time \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">Double leg support time \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">Rome<a class="elsevierStyleCrossRef" href="#bib0470">29</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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ShoedSelf-selected walking speed \t\t\t\t\t\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">22.4 \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">52% \t\t\t\t\t\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">European 56%Asian 20%Māori 20%Pacific 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">↓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\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">NSSD \t\t\t\t\t\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">NSSD \t\t\t\t\t\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">NSSD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stewart<a class="elsevierStyleCrossRef" href="#bib0530">41</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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BarefootSelf-selected walking speed \t\t\t\t\t\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 \t\t\t\t\t\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% \t\t\t\t\t\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">European 60%Asian 20%Pacific 15%Māori 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">↓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSSD \t\t\t\t\t\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">NSSD \t\t\t\t\t\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">NE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSSD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NE \t\t\t\t\t\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">NE \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">Stewart<a class="elsevierStyleCrossRef" href="#bib0530">41</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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BarefootFast walking speed \t\t\t\t\t\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 \t\t\t\t\t\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% \t\t\t\t\t\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">European 60%Asian 20%Pacific 15%Māori 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">↓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSSD \t\t\t\t\t\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">NSSD \t\t\t\t\t\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">NE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \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">Stewart<a class="elsevierStyleCrossRef" href="#bib0535">42</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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BarefootSelf-selected walking speed \t\t\t\t\t\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 \t\t\t\t\t\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">71% \t\t\t\t\t\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">European 58%Asian 17%Pacific 21%Māori 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">↓ \t\t\t\t\t\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">NSSD \t\t\t\t\t\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">NSSD \t\t\t\t\t\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">NSSD \t\t\t\t\t\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">NSSD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSSD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSSD \t\t\t\t\t\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">NSSD \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">Burke<a class="elsevierStyleCrossRef" href="#bib0540">43</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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ShoedSelf-selected walking speed \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\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">Caucasian 70.1%African American 29.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\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">NE \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2506350.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Changes in spatiotemporal parameters seen in patients with gout." ] ] 2 => array:5 [ "identificador" => "tbl0005" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "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=""><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">(“Gout”[Mesh] OR “Arthritis, Gouty”[Mesh] OR gout[Title/Abstract] OR gouty[Title/Abstract] OR toph*[Title/Abstract] OR tophi[Title/Abstract] OR tophaceous[Title/Abstract] OR podagra[Title/Abstract]) \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">AND \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">(“Foot”[Mesh] OR Foot*[Title/Abstract] OR Footwear*[Title/Abstract] OR Feet*[Title/Abstract] OR Shoe*[Title/Abstract] OR “Foot Orthoses”[Mesh] OR Orthos*[Title/Abstract] OR “Lower Extremity”[Mesh:NoExp] OR “Lower Extremity”[Title/Abstract] OR Gait[Title/Abstract]) \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">NOT (“Clinical Conference”[Publication Type] OR “Congress”[Publication Type] OR “Consensus Development Conference”[Publication Type] OR “Editorial”[Publication Type] OR “Published Erratum”[Publication Type] OR “Letter”[Publication Type] OR “Comment”[Publication Type] OR mice[Title/Abstract] OR mouse[Title/Abstract]) \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">NOT (“Animals”[Mesh] NOT (“Animals”[Mesh] AND “Humans”[Mesh])) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2506351.png" ] ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:65 [ 0 => array:3 [ "identificador" => "bib0330" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Richette" 1 => "M. Doherty" 2 => "E. Pascual" 3 => "V. Barskova" 4 => "F. Becce" 5 => "J. Castaneda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2019-215315" "Revista" => array:2 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2019" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0335" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic value of clinical, laboratory, and imaging findings in patients with a clinical suspicion of gout: a systematic literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Sivera" 1 => "M. Andrès" 2 => "L. Falzon" 3 => "D.M.F.M. van der Heijde" 4 => "L. Carmona" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.140456" "Revista" => array:7 [ "tituloSerie" => "J Rheumatol Suppl" "fecha" => "2014" "volumen" => "92" "paginaInicial" => "3" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25180122" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0210569119302347" "estado" => "S300" "issn" => "02105691" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0340" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Malik" 1 => "H.R. Schumacher" 2 => "J.E. Dinnella" 3 => "G.M. Clayburne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RHU.0b013e318194579" "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "22" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19125136" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0345" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.J. Forbess" 1 => "T.R. Fields" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2012.03.007" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2012" "volumen" => "42" "paginaInicial" => "146" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22522111" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0350" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical survey of 354 patients with gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Grahame" 1 => "J.T. Scott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.29.5.461" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "1970" "volumen" => "29" "paginaInicial" => "461" "paginaFinal" => "468" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5476673" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0355" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonography and dual-energy computed tomography provide different quantification of urate burden in gout: results from a cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Pascart" 1 => "A. Grandjean" 2 => "L. Norberciak" 3 => "V. Ducoulombier" 4 => "M. Motte" 5 => "H. Luraschi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13075-017-1381-2" "Revista" => array:6 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2017" "volumen" => "19" "paginaInicial" => "171" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28732526" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0210569118300159" "estado" => "S300" "issn" => "02105691" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0360" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Wright" 1 => "E. Filippucci" 2 => "C. McVeigh" 3 => "A. Grey" 4 => "M. McCarron" 5 => "W. Grassi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2006.062802" "Revista" => array:7 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "859" "paginaFinal" => "864" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17185326" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1525861015001498" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0365" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detection of uric acid crystal deposition by ultrasonography and dual-energy computed tomography: a cross-sectional study in patients with clinically diagnosed gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y. Wang" 1 => "X. Deng" 2 => "Y. Xu" 3 => "L. Ji" 4 => "Z. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MD.0000000000012834" "Revista" => array:4 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "2018" "volumen" => "97" "paginaInicial" => "e12834" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0370" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between structural joint damage and urate deposition in gout: a plain radiography and dual-energy CT study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Dalbeth" 1 => "O. Aati" 2 => "R. Kalluru" 3 => "G.D. Gamble" 4 => "A. Horne" 5 => "A.J. Doyle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2013-204273" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2015" "volumen" => "74" "paginaInicial" => "1030" "paginaFinal" => "1036" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24521739" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0375" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The distribution of urate deposition within the extremities in gout: a review of 148 dual-energy CT cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.I. Mallinson" 1 => "A.C. Reagan" 2 => "T. Coupal" 3 => "P.L. Munk" 4 => "H. Ouellette" 5 => "S. Nicolaou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00256-013-1771-8" "Revista" => array:6 [ "tituloSerie" => "Skeletal Radiol" "fecha" => "2014" "volumen" => "43" "paginaInicial" => "277" "paginaFinal" => "281" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24337414" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0380" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Features of urate deposition in patients with gouty arthritis of the foot using dual-energy computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Sun" 1 => "L. Ma" 2 => "Y. Zhou" 3 => "H. Chen" 4 => "Y. Ding" 5 => "J. Zhou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1756-185X. 12194" "Revista" => array:6 [ "tituloSerie" => "Int J Rheum Dis" "fecha" => "2015" "volumen" => "18" "paginaInicial" => "560" "paginaFinal" => "567" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24238356" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0385" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dual-energy computed tomography has limited diagnostic sensitivity for short-term gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Jia" 1 => "J. Zhu" 2 => "W. Huang" 3 => "X. Chen" 4 => "J. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-017-3753-z" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2018" "volumen" => "37" "paginaInicial" => "773" "paginaFinal" => "777" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28803339" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0390" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tendon involvement in patients with gout: an ultrasound study of prevalence" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Ventura-Ríos" 1 => "G. Sánchez-Bringas" 2 => "C. Pineda" 3 => "C. Hernández-Díaz" 4 => "A. Reginato" 5 => "M. Alva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-016-3309-7" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "2039" "paginaFinal" => "2044" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27236513" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0395" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tendon involvement in the feet of patients with gout: a dual-energy CT study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Dalbeth" 1 => "R. Kalluru" 2 => "O. Aati" 3 => "A. Horne" 4 => "A.J. Doyle" 5 => "F.M. McQueen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2012-202786" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2013" "volumen" => "72" "paginaInicial" => "1545" "paginaFinal" => "1548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23334212" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0400" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The influence of temperature on the solubility of monosodium urate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.N. Loeb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.1780150209" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1972" "volumen" => "15" "paginaInicial" => "189" "paginaFinal" => "192" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5027604" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0405" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Joint temperature measurement in the evaluation of anti-arthritic agents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.L. Hollander" 1 => "E.K. Stoner" 2 => "E.M. Brown" 3 => "P. DeMOOR" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1172/JCI102483" "Revista" => array:6 [ "tituloSerie" => "J Clin Invest" "fecha" => "1951" "volumen" => "30" "paginaInicial" => "701" "paginaFinal" => "706" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14850549" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0410" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperuricemia starts at 360 micromoles (6mg/dL)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Bardin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jbspin.2015.01.002" "Revista" => array:6 [ "tituloSerie" => "J Bone Spine" "fecha" => "2015" "volumen" => "82" "paginaInicial" => "141" "paginaFinal" => "143" "itemHostRev" => array:3 [ "pii" => "S1130634308728083" "estado" => "S300" "issn" => "11306343" ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0415" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms of crystal formation in gout-a structural approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Pascual" 1 => "L. Addadi" 2 => "M. Andrés" 3 => "F. Sivera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrrheum.2015" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Rheumatol" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "725" "paginaFinal" => "730" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26369610" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0420" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Orderly arrayed deposit of urate crystals in gout suggest epitaxial formation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Pascual" 1 => "S. Ordóñez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.57.4.255" "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "1998" "volumen" => "57" "paginaInicial" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9709186" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0425" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tophaceous gout in a patient with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.L. Baker" 1 => "J.S. Stroup" 2 => "C.A. Gilstrap" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Osteopath Assoc" "fecha" => "2007" "volumen" => "107" "paginaInicial" => "554" "paginaFinal" => "556" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18178765" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0430" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of the value of ultrasound and magnetic resonance musculoskeletal imaging in the evaluation of response to treatment of gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Villaverde" 1 => "M.P. Rosario" 2 => "E. Loza" 3 => "F. Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2013.07.011" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2014" "volumen" => "10" "paginaInicial" => "160" "paginaFinal" => "163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24296268" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0435" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Entheses: tendon and ligament attachment sites" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Benjamin" 1 => "D. McGonagle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0838.2009.00906.x" "Revista" => array:5 [ "tituloSerie" => "Scand J Med Sci Sports" "fecha" => "2009" "volumen" => "19" "paginaInicial" => "520" "paginaFinal" => "527" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0440" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are joints affected by gout also affected by osteoarthritis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Roddy" 1 => "W. Zhang" 2 => "M. Doherty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2006.063768" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "1374" "paginaFinal" => "1377" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17284542" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0445" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between gout and radiographic hand, knee and foot osteoarthritis: a cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Bevis" 1 => "M. Marshall" 2 => "T. Rathod" 3 => "E. Roddy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12891-016-1032-9" "Revista" => array:5 [ "tituloSerie" => "BMC Musculoskelet Disord" "fecha" => "2016" "volumen" => "17" "paginaInicial" => "169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27085669" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0450" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gout hyperuricemia, and crystal-associated disease network consensus statement regarding labels and definitions for disease elements in gout" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Bursill" 1 => "W.J. Taylor" 2 => "R. Terkeltaub" 3 => "M. Kuwabara" 4 => "T.R. Merriman" 5 => "R. Grainger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/acr.23607" "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2019" "volumen" => "71" "paginaInicial" => "427" "paginaFinal" => "434" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0455" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foot pain, impairment, and disability in patients with acute gout flares: a prospective observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Rome" 1 => "M. Frecklington" 2 => "P. McNair" 3 => "P. Gow" 4 => "N. Dalbeth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/acr.20670" "Revista" => array:6 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "384" "paginaFinal" => "388" "itemHostRev" => array:3 [ "pii" => "S1368764617300432" "estado" => "S300" "issn" => "13687646" ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0460" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics of foot ulceration in people with chronic gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Rome" 1 => "K. Erikson" 2 => "C. Otene" 3 => "H. Sahid" 4 => "K. Sangster" 5 => "P. Gow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/iwj.12262" "Revista" => array:6 [ "tituloSerie" => "Int Wound J" "fecha" => "2016" "volumen" => "13" "paginaInicial" => "209" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24674139" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0465" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foot problems in people with gout in primary care: baseline findings from a prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Roddy" 1 => "S. Muller" 2 => "K. Rome" 3 => "P. Chandratre" 4 => "S.L. Hider" 5 => "J. Richardson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13047-015-0090-9" "Revista" => array:4 [ "tituloSerie" => "J Foot Ankle Res" "fecha" => "2015" "volumen" => "8" "paginaInicial" => "31" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0470" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional and biomechanical characteristics of foot disease in chronic gout: a case–control study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Rome" 1 => "D. Survepalli" 2 => "A. Sanders" 3 => "M. Lobo" 4 => "F.M. McQueen" 5 => "P. McNair" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinbiomech.2010.09.006" "Revista" => array:5 [ "tituloSerie" => "Clin Biomech Bristol Avon" "fecha" => "2011" "volumen" => "26" "paginaInicial" => "90" "paginaFinal" => "94" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0475" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unusual localisation of tophaceous gout. A report of four cases and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Reber" 1 => "X. Crevoisier" 2 => "B. Noesberger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/bf00439058" "Revista" => array:6 [ "tituloSerie" => "Arch Orthop Trauma Surg" "fecha" => "1996" "volumen" => "115" "paginaInicial" => "297" "paginaFinal" => "299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8836466" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0480" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ulcerated gout masquerading as a non healing diabetic foot ulcer: a case series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Crasto" 1 => "R. Jogia" 2 => "S. Jackson" 3 => "K. Nisal" 4 => "K. Higgins" 5 => "M.-F. Kong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.15277/bjdvd.2014.004" "Revista" => array:6 [ "tituloSerie" => "Br J Diabetes Vasc Dis" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "21" "paginaFinal" => "25" "itemHostRev" => array:3 [ "pii" => "S1130239914000303" "estado" => "S300" "issn" => "11302399" ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0485" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinically-evident tophi are associated with reduced muscle force in the foot and ankle in people with gout: a cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Stewart" 1 => "N. Dalbeth" 2 => "S. Otter" 3 => "P. Gow" 4 => "S. Kumar" 5 => "K. Rome" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13047-017-0207-4" "Revista" => array:5 [ "tituloSerie" => "J Foot Ankle Res" "fecha" => "2017" "volumen" => "10" "paginaInicial" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28649283" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0490" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tophaceous gout: an unusual cause of multiple fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Nguyen" 1 => "H.-K. Ea" 2 => "E. Palazzo" 3 => "F. Lioté" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/03009740903061428" "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "2010" "volumen" => "39" "paginaInicial" => "93" "paginaFinal" => "96" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20132078" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0495" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics and risk factors of ulceration over tophi in patients with gout" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Huang" 1 => "X. Liu" 2 => "Y. Liu" 3 => "G. Li" 4 => "X. Pan" 5 => "Z. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1756-185X. 13581" "Revista" => array:6 [ "tituloSerie" => "Int J Rheum Dis" "fecha" => "2019" "volumen" => "22" "paginaInicial" => "1052" "paginaFinal" => "1057" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31119888" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0500" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tibialis posterior tenosynovitis: a unique musculoskeletal manifestation of gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Shupper" 1 => "T.P. Stitik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PHM.0000000000000774" "Revista" => array:6 [ "tituloSerie" => "Am J Phys Med Rehabil" "fecha" => "2018" "volumen" => "97" "paginaInicial" => "143" "paginaFinal" => "146" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28632507" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0505" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Pineda" 1 => "L.M. Amezcua-Guerra" 2 => "C. Solano" 3 => "P. Rodriguez-Henriquez" 4 => "C. Hernandez-Diaz" 5 => "A. Vargas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/ar3223" "Revista" => array:4 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2011" "volumen" => "13" "paginaInicial" => "R4" ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0510" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tibialis anterior tendon rupture in gout – case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.T.J. Jerome" 1 => "M. Varghese" 2 => "B. Sankaran" 3 => "S. Thomas" 4 => "S.K. Thirumagal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.fas.2007.12.001" "Revista" => array:6 [ "tituloSerie" => "Foot Ankle Surg" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "166" "paginaFinal" => "169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19083637" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0515" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foot structure, pain and functional ability in people with gout in primary care: cross-sectional findings from the clinical assessment study of the foot" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.R. Petty" 1 => "T. Rathod-Mistry" 2 => "H.B. Menz" 3 => "E. Roddy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13047-019-0317-2" "Revista" => array:4 [ "tituloSerie" => "J Foot Ankle Res" "fecha" => "2019" "volumen" => "12" "paginaInicial" => "8" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0520" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistence of monosodium urate crystals and low-grade inflammation in the synovial fluid of patients with untreated gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Pascual" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.1780340203" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1991" "volumen" => "34" "paginaInicial" => "141" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1994910" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0525" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gait characteristics associated with the foot and ankle in inflammatory arthritis: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Carroll" 1 => "P. Parmar" 2 => "N. Dalbeth" 3 => "M. Boocock" 4 => "K. Rome" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12891-015-0596-0" "Revista" => array:4 [ "tituloSerie" => "BMC Musculoskelet Disord" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "134" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0530" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: a two-arm cross sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Stewart" 1 => "T. Morpeth" 2 => "N. Dalbeth" 3 => "A.C. Vandal" 4 => "M. Carroll" 5 => "L. Davidtz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaitpost.2015" "Revista" => array:6 [ "tituloSerie" => "Gait Posture" "fecha" => "2016" "volumen" => "44" "paginaInicial" => "18" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27004627" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0535" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spatiotemporal gait parameters and plantar pressure distribution during barefoot walking in people with gout and asymptomatic hyperuricemia: comparison with healthy individuals with normal serum urate concentrations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Stewart" 1 => "N. Dalbeth" 2 => "A.C. Vandal" 3 => "K. Rome" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13047-016-0147-4" "Revista" => array:5 [ "tituloSerie" => "J Foot Ankle Res" "fecha" => "2016" "volumen" => "9" "paginaInicial" => "15" "itemHostRev" => array:3 [ "pii" => "S0210569117303613" "estado" => "S300" "issn" => "02105691" ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0540" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physical function hyperuricemia, and gout in older adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.T. Burke" 1 => "A. Köttgen" 2 => "A. Law" 3 => "B.G. Windham" 4 => "D. Segev" 5 => "A.N. Baer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/acr.22648" "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2015" "volumen" => "67" "paginaInicial" => "1730" "paginaFinal" => "1738" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0545" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of good and poor walking shoe characteristics on plantar pressure and gait in people with gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Stewart" 1 => "N. Dalbeth" 2 => "P. McNair" 3 => "P. Parmar" 4 => "P. Gow" 5 => "K. Rome" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinbiomech.2014.09.009" "Revista" => array:5 [ "tituloSerie" => "Clin Biomech Bristol Avon" "fecha" => "2014" "volumen" => "29" "paginaInicial" => "1158" "paginaFinal" => "1163" ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0550" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between tissue stress during gait in healthy volunteers and patterns of urate deposition and bone erosion in gout: a biomechanical computational modelling study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Dalbeth" 1 => "M. Deacon" 2 => "G.D. Gamble" 3 => "K. Mithraratne" 4 => "J. Fernandez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/rmdopen-2015-000101" "Revista" => array:4 [ "tituloSerie" => "RMD Open" "fecha" => "2015" "volumen" => "1" "paginaInicial" => "e000101" ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0555" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Experience of finding footwear and factors contributing to footwear choice in people with gout: a mixed methods study using a web-based survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Brenton-Rule" 1 => "N. Dalbeth" 2 => "N.L. Edwards" 3 => "K. Rome" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13047-018-0313-y" "Revista" => array:6 [ "tituloSerie" => "J Foot Ankle Res" "fecha" => "2019" "volumen" => "12" "paginaInicial" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30636975" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0210569118302213" "estado" => "S300" "issn" => "02105691" ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0560" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Footwear characteristics and factors influencing footwear choice in patients with gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Rome" 1 => "M. Frecklington" 2 => "P. Mcnair" 3 => "P. Gow" 4 => "N. Dalbeth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/acr.20582" "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2011" "volumen" => "63" "paginaInicial" => "1599" "paginaFinal" => "1604" ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0565" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The footwear experiences of people with gout: a qualitative study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Frecklington" 1 => "A. Williams" 2 => "N. Dalbeth" 3 => "P. McNair" 4 => "P. Gow" 5 => "K. Rome" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13047-019-0349-7" "Revista" => array:5 [ "tituloSerie" => "J Foot Ankle Res" "fecha" => "2019" "volumen" => "12" "paginaInicial" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31338128" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0570" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Footwear interventions for foot pain, function, impairment and disability for people with foot and ankle arthritis: a literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Frecklington" 1 => "N. Dalbeth" 2 => "P. McNair" 3 => "P. Gow" 4 => "A. Williams" 5 => "M. Carroll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2017.10.017" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2018" "volumen" => "47" "paginaInicial" => "814" "paginaFinal" => "824" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29174793" "web" => "Medline" ] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0575" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons® and the American Association of Nurse Practitioners®: Etiology, Diagnosis, and Treatment Consensus for Gouty Arthritis of the Foot and Ankle" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Mirmiran" 1 => "T. Bush" 2 => "M.M. Cerra" 3 => "S. Grambart" 4 => "E. Kauschinger" 5 => "M. Younger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jfas.2018.08.018" "Revista" => array:6 [ "tituloSerie" => "J Foot Ankle Surg" "fecha" => "2018" "volumen" => "57" "paginaInicial" => "1207" "paginaFinal" => "1217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30368431" "web" => "Medline" ] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0580" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 updated EULAR evidence-based recommendations for the management of gout" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Richette" 1 => "M. Doherty" 2 => "E. Pascual" 3 => "V. Barskova" 4 => "F. Becce" 5 => "J. Castañeda-Sanabria" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2016-209707" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2017" "volumen" => "76" "paginaInicial" => "29" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27457514" "web" => "Medline" ] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0585" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural adjuvants: endogenous activators of dendritic cells" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Gallucci" 1 => "M. Lolkema" 2 => "P. Matzinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/15200" "Revista" => array:6 [ "tituloSerie" => "Nat Med" "fecha" => "1999" "volumen" => "5" "paginaInicial" => "1249" "paginaFinal" => "1255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10545990" "web" => "Medline" ] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0590" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical management of gout in the foot and ankle: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Poratt" 1 => "K. Rome" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7547/14-128" "Revista" => array:5 [ "tituloSerie" => "J Am Podiatr Med Assoc" "fecha" => "2016" "volumen" => "106" "paginaInicial" => "182" "paginaFinal" => "188" ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0595" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions for tophi in gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.K. Sriranganathan" 1 => "O. Vinik" 2 => "C. Bombardier" 3 => "C.J. Edwards" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD010069.pub2" "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2014" "paginaInicial" => "CD010069" ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0600" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Wang" 1 => "S. Lien" 2 => "G. Huang" 3 => "R. Pan" 4 => "H. Shen" 5 => "C. Kuo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arthro.2008.09.002" "Revista" => array:6 [ "tituloSerie" => "Arthroscopy" "fecha" => "2009" "volumen" => "25" "paginaInicial" => "153" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19171274" "web" => "Medline" ] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0605" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Total ankle replacement in patients with gouty arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Barg" 1 => "M. Knupp" 2 => "A.L. Kapron" 3 => "B. Hintermann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.J.00957" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2011" "volumen" => "93" "paginaInicial" => "357" "paginaFinal" => "366" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21325587" "web" => "Medline" ] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0610" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First metatarsophalangeal joint arthrodesis for the treatment of tophaceous gouty arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y.S. Kim" 1 => "E.H. Park" 2 => "H.J. Lee" 3 => "Y.G. Koh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3928/01477447-20140124-15" "Revista" => array:6 [ "tituloSerie" => "Orthopedics" "fecha" => "2014" "volumen" => "37" "paginaInicial" => "e141" "paginaFinal" => "e147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24679199" "web" => "Medline" ] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0615" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgery of tophaceous gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.A. Cassagrande" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0049-0172(72)90005-4" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "1972" "volumen" => "1" "paginaInicial" => "262" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5083718" "web" => "Medline" ] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0620" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Free-flap resurfacing of tissue defects in the foot due to large gouty tophi" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.T. Lin" 1 => "S.C. Chang" 2 => "T.M. Chen" 3 => "N.T. Dai" 4 => "J.P. Fu" 5 => "S.C. Deng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/micr.20949" "Revista" => array:6 [ "tituloSerie" => "Microsurgery" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "610" "paginaFinal" => "615" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22009664" "web" => "Medline" ] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0625" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Timing of intra-lesion shaving for surgical treatment of chronic tophus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.S. Lee" 1 => "M.C. Chen" 2 => "Y.H. Chou" 3 => "S.D. Lin" 4 => "C.S. Lai" 5 => "Y.C. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bjps.2013.03.041" "Revista" => array:5 [ "tituloSerie" => "J Plast Reconstr Aesthetic Surg" "fecha" => "2013" "volumen" => "66" "paginaInicial" => "1131" "paginaFinal" => "1137" ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0630" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of Masquelet's technique for treating the first metatarsophalangeal joint in cases of gout combined with a massive bone defect" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Liu" 1 => "R.-K. Huang" 2 => "M. Xie" 3 => "H. Pan" 4 => "J.-J. Zhao" 5 => "B. Lei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.fas.2017.01.009" "Revista" => array:6 [ "tituloSerie" => "Foot Ankle Surg" "fecha" => "2018" "volumen" => "24" "paginaInicial" => "159" "paginaFinal" => "163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29409218" "web" => "Medline" ] ] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0635" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of a footwear intervention on foot pain and disability in people with gout: a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Frecklington" 1 => "N. Dalbeth" 2 => "P. McNair" 3 => "T. Morpeth" 4 => "A.C. Vandal" 5 => "P. Gow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13075-019-1886-y" "Revista" => array:5 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2019" "volumen" => "21" "paginaInicial" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31018869" "web" => "Medline" ] ] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0640" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of commercially available footwear on foot pain and disability in people with gout: a pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Rome" 1 => "S. Stewart" 2 => "A.C. Vandal" 3 => "P. Gow" 4 => "P. McNair" 5 => "N. Dalbeth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2474-14-278" "Revista" => array:5 [ "tituloSerie" => "BMC Musculoskelet Disord" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24063678" "web" => "Medline" ] ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0645" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gout: why is this curable disease so seldom cured?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Doherty" 1 => "T.L. Jansen" 2 => "G. Nuki" 3 => "E. Pascual" 4 => "F. Perez-Ruiz" 5 => "L. Punzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2012-201687" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2012 Nov" "volumen" => "71" "paginaInicial" => "1765" "paginaFinal" => "1770" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22863577" "web" => "Medline" ] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0650" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvement in diagnosis and treat-to-target management of hyperuricemia in gout: results from the GEMA-2 transversal study on practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Perez Ruiz" 1 => "C.A. Sanchez-Piedra" 2 => "J.T. Sanchez-Costa" 3 => "M. Andrés" 4 => "C. Diaz-Torne" 5 => "M. Jimenez-Palop" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40744-017-0091-1" "Revista" => array:6 [ "tituloSerie" => "Rheumatol Ther" "fecha" => "2018" "volumen" => "5" "paginaInicial" => "243" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29204859" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack509787" "titulo" => "Acknowledgement" "texto" => "The authors want to thank Mercedes Guerra from Sociedad Española de Reumatología for the assistance with the search strategy." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001700000002/v1_202101301156/S2173574320301817/v1_202101301156/en/main.assets" "Apartado" => array:4 [ "identificador" => "8383" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001700000002/v1_202101301156/S2173574320301817/v1_202101301156/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301817?idApp=UINPBA00004M"]

Statistics

Review Article

Gouty Involvement of Foot and Ankle: Beyond Flares

Implicación de los tobillos y pies en gota: Algo más que ataques

José-Antonio Bernala,

Corresponding author

Josantonio.bernal@gmail.com

Corresponding author.

, Jonatan García-Camposb, Javier Marco-LLedób, Mariano Andrésc,d

a Sección de Reumatología, Hospital Marina Baixa, Villajoyosa, Alicante, Spain

b Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández, Alicante, Spain

c Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain

d Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain

Read

11015

Times
was read the article

1465

Total PDF

9550

Total HTML

Share statistics

 array:23 [
  "pii" => "S2173574320301817"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2019.12.004"
  "estado" => "S300"
  "fechaPublicacion" => "2021-02-01"
  "aid" => "1390"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "rev"
  "cita" => "Reumatol Clin. 2021;17:106-12"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574320300216"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2019.08.002"
    "estado" => "S300"
    "fechaPublicacion" => "2021-02-01"
    "aid" => "1361"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2021;17:113-5"
    "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" => "Cholinergic synovitis&#58; Description of four cases"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "113"
          "paginaFinal" => "115"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Sinovitis colin&#233;rgica&#58; descripci&#243;n de 4 casos"
        ]
      ]
      "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" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1086
              "Ancho" => 1750
              "Tamanyo" => 192272
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Dermographism observed in case 1&#46; &#40;B&#41; Appearance of the knees 1<span class="elsevierStyleHsp" style=""></span>h after physical activity in case 1&#46; &#40;C&#41; Appearance of the hands in case 2 after isometric dumbbell exercises&#46; &#40;D&#41; From left to right&#58; basal situation of the pre-patellar recess of the patient of case 3&#44; 1<span class="elsevierStyleHsp" style=""></span>h after exercise and 3<span class="elsevierStyleHsp" style=""></span>h later&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Carlos Guill&#233;n Astete, Miguel Zamorano Serrano, M&#243;nica Luque Alarc&#243;n"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Guill&#233;n Astete"
            ]
            1 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Zamorano Serrano"
            ]
            2 => array:2 [
              "nombre" => "M&#243;nica"
              "apellidos" => "Luque Alarc&#243;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X19301226"
        "doi" => "10.1016/j.reuma.2019.08.002"
        "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/S1699258X19301226?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320300216?idApp=UINPBA00004M"
    "url" => "/21735743/0000001700000002/v1_202101301156/S2173574320300216/v1_202101301156/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S217357432100006X"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2019.04.003"
    "estado" => "S300"
    "fechaPublicacion" => "2021-02-01"
    "aid" => "1336"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "pgl"
    "cita" => "Reumatol Clin. 2021;17:97-105"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Consensus statement</span>"
      "titulo" => "Severe osteoporosis&#58; Principles for pharmacological therapy in Mexico"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "97"
          "paginaFinal" => "105"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Osteoporosis severa&#58; fundamentos para su terapia farmacol&#243;gica en M&#233;xico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Patricia Clark, Fernando Carlos Rivera, Luc&#237;a M&#233;ndez S&#225;nchez, Carlos Fernando Mendoza Guti&#233;rrez, Jessica Liliana Vargas Neri, Sandra Miriam Carrillo V&#225;zquez, Daniel Xavier Xibill&#233; Friedmann, Ariana Alvarado Ceballos, Jos&#233; Manuel Aguilera Zepeda, V&#237;ctor Mercado C&#225;rdenas, Hilario &#193;vila Amengol"
          "autores" => array:11 [
            0 => array:2 [
              "nombre" => "Patricia"
              "apellidos" => "Clark"
            ]
            1 => array:2 [
              "nombre" => "Fernando Carlos"
              "apellidos" => "Rivera"
            ]
            2 => array:2 [
              "nombre" => "Luc&#237;a"
              "apellidos" => "M&#233;ndez S&#225;nchez"
            ]
            3 => array:2 [
              "nombre" => "Carlos Fernando"
              "apellidos" => "Mendoza Guti&#233;rrez"
            ]
            4 => array:2 [
              "nombre" => "Jessica Liliana"
              "apellidos" => "Vargas Neri"
            ]
            5 => array:2 [
              "nombre" => "Sandra Miriam"
              "apellidos" => "Carrillo V&#225;zquez"
            ]
            6 => array:2 [
              "nombre" => "Daniel Xavier"
              "apellidos" => "Xibill&#233; Friedmann"
            ]
            7 => array:2 [
              "nombre" => "Ariana"
              "apellidos" => "Alvarado Ceballos"
            ]
            8 => array:2 [
              "nombre" => "Jos&#233; Manuel"
              "apellidos" => "Aguilera Zepeda"
            ]
            9 => array:2 [
              "nombre" => "V&#237;ctor"
              "apellidos" => "Mercado C&#225;rdenas"
            ]
            10 => array:2 [
              "nombre" => "Hilario"
              "apellidos" => "&#193;vila Amengol"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X19300786"
        "doi" => "10.1016/j.reuma.2019.04.001"
        "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/S1699258X19300786?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357432100006X?idApp=UINPBA00004M"
    "url" => "/21735743/0000001700000002/v1_202101301156/S217357432100006X/v1_202101301156/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>"
    "titulo" => "Gouty Involvement of Foot and Ankle&#58; Beyond Flares"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "106"
        "paginaFinal" => "112"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Jos&#233;-Antonio Bernal, Jonatan Garc&#237;a-Campos, Javier Marco-LLed&#243;, Mariano Andr&#233;s"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Jos&#233;-Antonio"
            "apellidos" => "Bernal"
            "email" => array:1 [
              0 => "Josantonio.bernal@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jonatan"
            "apellidos" => "Garc&#237;a-Campos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Javier"
            "apellidos" => "Marco-LLed&#243;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Mariano"
            "apellidos" => "Andr&#233;s"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Secci&#243;n de Reumatolog&#237;a&#44; Hospital Marina Baixa&#44; Villajoyosa&#44; Alicante&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departamento de Ciencias del Comportamiento y Salud&#44; Universidad Miguel Hern&#225;ndez&#44; Alicante&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Secci&#243;n de Reumatolog&#237;a&#44; Hospital General Universitario de Alicante&#44; Instituto de Investigaci&#243;n Sanitaria y Biom&#233;dica de Alicante&#44; Alicante&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Departamento de Medicina Cl&#237;nica&#44; Universidad Miguel Hern&#225;ndez&#44; Alicante&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Implicaci&#243;n de los tobillos y pies en gota&#58; Algo m&#225;s que ataques"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 905
            "Ancho" => 1605
            "Tamanyo" => 189887
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The figure depicts three different cases of foot involvement in tophaceous gout&#44; shown by a clinical picture &#40;left&#41;&#44; plain radiography &#40;center&#41; and T1-weighted magnetic resonance &#40;right&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The clinical presentations of any disease that occur more frequently are regarded as typical and prompt a straightforward diagnosis&#46; Conversely&#44; other presentations different to the classical may hamper reach the correct diagnosis and increase the possibility of misclassification&#46; This situation occurs in gout&#44; despite having an immediate and reliable technique &#8211; the synovial fluid analysis under the polarized microscope &#8211; that provides a diagnosis of certainty&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">1</span></a> The hallmark picture is the acute inflammation of the big toe in a middle-aged man often suffering from renal and cardiovascular comorbidities&#46; Besides the detection of subcutaneous tophi&#44; this presentation poses the highest diagnostic utility compared to the microscopic evaluation&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">2</span></a> However&#44; in general terms&#44; gout diagnoses solely based on clinical data misclassify up to one out of four patients&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">3</span></a> Incorporating the routine microscopic analysis of every synovial fluid sample obtained in clinical practice is a crucial strategy to avoid misdiagnoses&#46; Increasing the knowledge on the clinical spectrum of gout can be useful as well&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The monosodium urate &#40;MSU&#41; crystals deposition occurs in the musculoskeletal &#40;MSK&#41; system&#44; as is demonstrated by the overt manifestations &#40;flares&#44; tophi&#41; suffered by gout patients&#46; However&#44; the deposition and clinical picture probably is more generalized&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">4</span></a> Feet are major MSK sites of MSU crystal deposition&#44; but there are other frequent locations such as knee&#44; wrist&#44; fingers or elbow bursae&#46; In terms of gout flares&#44; old series already reported that big toe and ankle&#47;foot involvement affect to 76&#37; and 50&#37; of gout patients&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">5</span></a> At the primary care level&#44; 53&#37; of gout flares affected the big toe&#44; while other areas of foot and ankle comprised 18&#37; of episodes&#46; Beyond flares&#44; nonspecific complains focused on feet and ankles are commonly stated by patients with gout in clinical practice&#44; such as persistent walking pain&#44; stiffness or numbness&#46; Subcutaneous tophi are frequently found at Achilles tendon regions&#44; ankle malleoli&#44; lateral aspects of tarsi&#44; over toes &#40;especially the big toes&#41; and even on the plantar surface&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The predilection for feet and ankles of MSU crystals is also confirmed by ultrasound and dual-energy computed tomography &#40;DECT&#41;&#44; the imaging techniques that better ascertain the crystal deposition in gout&#44; despite not being interchangeable&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">6</span></a> By ultrasound&#44; reported rates of deposits are 14&#46;2&#8211;35&#46;0&#37; in first metatarsophalangeal &#40;MTP&#41; joint&#44; 15&#46;8&#37; in the ankle and 1&#46;6&#37; in the midfoot&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">7&#44;8</span></a> Using DECT&#44; crystal deposits in 1st MTP&#44; midfoot and ankle are seen in 12&#46;1&#8211;57&#46;4&#37;&#44; 0&#46;8&#8211;7&#46;5&#37;&#44; and 10&#46;8&#8211;53&#46;4&#37; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">8&#8211;12</span></a> Prevalence rates vary according to several factors&#44; such as age&#44; disease duration&#44; serum urate &#40;SU&#41; levels or use of urate-lowering agents&#46; Interestingly&#44; crystal deposits were strongly associated with the presence of joint damage such as erosions or joint space narrowing&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">7&#44;9</span></a> Beside joints&#44; imaging techniques also revealed tendon deposition of MSU crystals in feet&#44; with a predominance for Achilles tendons &#8211; 26&#37; by ultrasound&#44;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">13</span></a> 52&#37; by DECT<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">14</span></a> &#8211; while other tendons&#44; such as peroneal&#44; extensor digitorum longus&#44; extensor halluces longus&#44; and tibialis anterior&#44; are commonly affected &#40;&#62;10&#37;&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The reason for the predominant involvement of lower limbs&#44; and notably foot and ankle&#44; in gout&#44; remains to be determined&#46; Urate forms MSU crystals when its levels are persistently above the saturation point&#44; that was determined at 6&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dL with a normal body temperature of 37<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">15</span></a> At lower values&#44; the saturation level for urate also lowers&#46; Interestingly&#44; an old study proved that the temperature at the big toe is about 35<span class="elsevierStyleHsp" style=""></span>&#176;C&#44;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">16</span></a> thus theoretically facilitating the crystallization of urate&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">17</span></a> Besides temperature and urate concentration&#44; other determinants of the crystallization appear to be the proteins&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">18</span></a> MSU crystals form through templated nucleation&#44; a form of biomineralization that requires the presence of a complementary structure to facilitate a low-energy requiring crystallization&#46; One of the potential protein candidates is the type II collagen&#44; present at both joints and tendons&#58; &#40;i&#41; fragments of proteins containing adhered and well-organized MSU crystals are occasionally seen in the synovial fluid from gout patients<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">19</span></a>&#59; &#40;ii&#41; the crystal deposition is majoritary on the cartilage surfaces&#44; as demonstrated by arthroscopy<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">20</span></a> and ultrasound<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">21</span></a>&#59; and &#40;iii&#41; at tendons&#44; crystals deposits are mostly seen in the enthesis&#44;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">14</span></a> an area of high mechanical stress for tendon fibers&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">22</span></a> Lower limbs are the leading sites for developing osteoarthritis&#44; as they are weight-bearing&#46; Gout&#44; both as MSU crystal deposition and clinical flares&#44; has been associated with osteoarthritis in some reports&#44;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">9&#44;23</span></a> though not in others&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">24</span></a> Joints affected with osteoarthritis developed cartilage fibrillation&#44; likely facilitating the initial MSU crystal deposition&#46; Afterwards&#44; while hyperuricemia persists&#44; the formation of further MSU crystals continues&#44; now probably using another crystal as the template&#44; as seen in the tophi&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">For this narrative review&#44; an electronic search in MEDLINE&#44; Cochrane&#44; Embase and PEDro databases was performed&#46; The search strategy&#44; run at 2019 July 4th&#44; with its used terms&#44; can be found at the <a class="elsevierStyleCrossRef" href="#sec0070">Annexed 1</a>&#46; Title and abstracts of retrieved articles were reviewed by all four authors to exclude papers unrelated to the topic of interest&#46; Also&#44; articles known by the authors and others obtained through reviewing the retrieved bibliography were included&#46; The gout nomenclature recommended by the Gout and Crystal Arthritis Network &#40;G-CAN&#41;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">25</span></a> was followed in the writing of this review&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Clinical status of foot and ankle in patients with gout</span><p id="par0030" class="elsevierStylePara elsevierViewall">Pain&#44; impairment and loss of articular functionality and the decrease in muscular strength are the main signs and symptoms which affect feet in patients with gout&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">26</span></a> These manifestations impact on their daily life activities&#44; measured with HAQ-II&#59; HAQ-II score are considerably reduced during a flare&#44; but they remain low even after the disappearance of the acute symptomatology&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pain&#44; disability and impairment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patients with a history of gout during the intercritical phase present higher levels of foot pain when compared with controls&#46; Although a substantial improvement of pain is achieved through treatment&#44; complete normalization is uncommon&#44; suggesting that foot-related pain in such patients may be a persistent characteristic&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">26</span></a> Pain is mostly located in the 1<span class="elsevierStyleSup">st</span> MTP joint and the ankle&#46; The presence of pain was reported to be associated with obesity&#44; depression and the occurrence of oligoarticular flares&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">28</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Besides pain&#44; other complaints are frequently referred&#46; Impairment&#44; disability and reduced levels of activity &#8211; measured respectively by the <span class="elsevierStyleItalic">Leeds Foot Impact Scale</span> and the <span class="elsevierStyleItalic">Lower Limb Tasks Questionnaire</span> &#8211; worsen during flares&#46; Similar to pain&#44; during the intercritical phase of gout&#44; a significant improvement in these scores occurs without achieving a complete recovery&#46; These results are similar to those found in other types of rheumatic diseases such as rheumatoid arthritis&#44;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">29</span></a> again suggesting the impact of persistent low-grade inflammation&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Tophi</span><p id="par0045" class="elsevierStylePara elsevierViewall">The presence of tophi in gout indicates chronicity and a lack of effective treatment&#46; They can be found in joints&#44; cartilages&#44; tendons&#44; muscles and periarticular structures&#46;<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">30&#44;31</span></a> As stated above&#44; feet are preferred sites for tophi development &#91;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#93;&#44; especially in the 1st MTP joints and ankles&#44;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">27&#44;32</span></a> although they may appear in other places of the body such as knees&#44; upper limbs &#40;olecranons&#44; knuckles&#41; or even ears&#46; Presence of tophi in feet has been associated with a decrease in muscle strength<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">32</span></a> while some cases of pathological fractures directly related to tophi have been described&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">33</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Although ulceration of tophi is not common&#44; those located in the feet tend to ulcerate more frequently&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">27&#44;34</span></a> Risk factors for ulceration include the number of tophi&#44; their duration&#44; and excessive use of glucocorticoids&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">34</span></a> The presence of small ulcerated areas is common in gout&#44; particularly in cases of chronic polyarticular involvement with tophi&#46; The study by Rome et al&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">27</span></a> performed on seven patients showed the presence of ulcerations on the dorsal side of the middle toes&#44; likely related to unsuitable footwear&#46; Ulcers in patients with gout tend to be highly exudative while carrying with a moderate amount of pain&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">27</span></a> This situation can be worsened by the presence of comorbidities frequently associated with gout such as obesity&#44; type 2 diabetes or peripheral arterial disease&#44; which may delay healing and increase the risk of infection&#46; Tophi ulceration&#44; especially those located in the feet&#44; must be distinguished from infected ulcers of diabetic patients given the frequent association between gout and diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">31</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Beside ulcers&#44; other skin manifestations are usually present when gout affects superficial synovial structures and joints&#59; this is the case of the podagra&#44; in which peeling often occurs after intense swelling&#44; erythema and edema of the affected joint&#46; When the disease involves deeper joints such as the tibiotalar&#44; dermatological alterations are unusual&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Tendon involvement</span><p id="par0060" class="elsevierStylePara elsevierViewall">Lower limbs tendons often show MSU crystals deposits at ultrasound and DECT studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">13&#44;14</span></a> This involvement occurs mainly&#44; but not exclusively&#44; in tophaceous stages&#46; However&#44; the clinical consequences of the tendon deposition remain unclear&#46; Tenosynovitis and paratenonitis are not frequent manifestations in gout&#44; although there have been reported cases in the patellar&#44; Achilles and peroneal tendons&#44; nearly always associated with tophaceous infiltration&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">35</span></a> Subclinical tenosynovitis of the posterior tibialis has also been observed in asymptomatic individuals with hyperuricemia&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">36</span></a> Tearing of the tendon is also infrequent&#59; however&#44; there are reports of spontaneous tears of the anterior tibialis tendon secondary to a tophaceous gout without trauma and associated in most cases with a forced plantarflexion&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">37</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Limitation of movement&#44; muscular strength and structural alterations</span><p id="par0065" class="elsevierStylePara elsevierViewall">The range of movement of subtalar joints&#44; both inversion and eversion&#44; as well as dorsiflexion of the 1st MTP joints seems significantly reduced in patients with gout&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">38</span></a> This movement limitation of the joint in the absence of edema or other signs of arthritis suggests a state of subclinical inflammation&#46; It is usually present in patients with intercritical gout&#46; The subclinical inflammation has been proven by analysing the leukocyte count in joints containing MSU crystals&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">39</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Presence of tophi anywhere on foot or ankle is associated with reduced strength of plantarflexion and inversion-eversion of ankles&#46; This association is stronger when the tophus is located in the Achilles tendon&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">32</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">As for structural alterations of feet&#44; people with gout are more likely to have hammertoes when compared to a group without gout&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">38</span></a> However&#44; Hallux Valgus is associated with age and gender&#44; but not with the gout characteristics or associated comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Gait characteristics</span><p id="par0080" class="elsevierStylePara elsevierViewall">Few studies analyzed the gait characteristics of gouty patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">29&#44;40&#8211;45</span></a> However&#44; difficulty in walking during a flare has been considered one of its main discriminatory characteristics&#46; The retrieved studies have focused on the analysis of space-time parameters &#40;STP&#41;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">29&#44;40&#8211;42&#44;44</span></a> and the study of plantar pressures&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">29&#44;40&#44;42&#44;44</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The study of STPs consists of analysing the different phenomena observed throughout a gait cycle related to space &#40;step length&#44; stride length and others&#41; and time &#40;such as step time or swing time of the lower limb&#41;&#46; Its study has been an area of interest for the different types of inflammatory arthritis&#44; although most studies have been focused on rheumatoid arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">40</span></a> Concerning gout&#44; statistically significant changes have been found in some of the STPs in patients with gout<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">29&#44;40&#44;42&#44;43</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46; The identified changes vary depending on the reviewed study&#46; In general&#44; patients with gout walk at gait velocity and reduced cadence&#44; as well as with an increase in step time and in the stance phase time&#46; Reports on gait patterns of participants either with and without footwear&#44; as well as those walking at a self-selected<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">29&#44;41&#8211;43</span></a> or fast speed&#44;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">41</span></a>indicate that swing time only increases during fast gait patterns&#46; An only study&#44; which analyzed the walking STPs of patients with gout on footwear in contrast with healthy subjects&#44; has found a significant decrease in the stride and step lengths&#44; and an increase in the stance time with double leg support&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">29</span></a> Equally&#44; when comparing the STPs of patients using footwear which is considered appropriate versus those of patients using their footwear&#44; there is a significant increase in gait velocity&#44; step length and stride length&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">44</span></a> These effects have also been found when comparing the patients&#8217; footwear with that footwear considered deficient&#44; which leads the authors to question whether these findings might be due to other factors&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Patients with gout also present changes in their peak plantar pressures &#40;PPP&#41; and their pressure-time integrals &#40;PTI&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">29&#44;40&#44;42</span></a> Although the reviewed studies establish different plantar pressure areas&#44; a statistically significant decrease of PPP has been found in the hallux<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">29&#44;42</span></a> and the heel<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">42</span></a> compared to healthy control groups&#46; Furthermore&#44; a significant increase in PTI values of the midfoot has been noted&#44; being these values lower in the hallux&#46; It has also been observed that PPPs decrease significantly in the third and fifth metatarsal bone when using footwear considered better than the patient&#39;s footwear&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">44</span></a> The use of suitable footwear also obtains a significant decrease in PTIs in the lateral and middle side of the heel and the third and fifth metatarsal bone&#44; as well as a significant increase below the midfoot in contrast with use of the patient&#39;s footwear&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Reviewed studies show changes in space-time parameters and plantar pressures during gait in patients with gout in contrast with healthy control groups<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">29&#44;40&#8211;42</span></a> or with the type of footwear used&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">44</span></a> These changes have been linked to a strategy to reduce or prevent pain during walking&#44; which may affect daily life activities&#46; However&#44; despite the correlation among space-time parameters and total scores of <span class="elsevierStyleItalic">Manchester Foot Pain and Disability Index&#44;</span> and the results associated with functional limitation&#44; physical appearance and work&#47;free time&#44; the control over pain is not associated with gait characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">41</span></a> Nevertheless&#44; it is worth noting that these results were obtained when participants with gout were not experiencing symptoms&#46; For this reason&#44; these adaptations may be explained through an acquired strategy&#44; as a measure to avoid a flare&#44; or as a secondary adaptation to walking as a means of reducing pain&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Footwear</span><p id="par0100" class="elsevierStylePara elsevierViewall">Patients with gout present problems when it comes to finding footwear that fits the appropriate shape and with which they feel comfortable&#44; especially during a flare&#46;<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">46</span></a> Several studies have identified which characteristics the patients value in footwear<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">46&#8211;48</span></a>&#59; being the most relevant comfort&#44; fit and support&#46; A series of deficiencies associated with footwear has been recognized for consideration at the time of acquiring new footwear&#46; Some of these characteristics are found in the everyday footwear of this group&#46;<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">46&#8211;49</span></a> Inadequate width and length&#44; high rigidity&#44; weight&#44; cushioning and deficient motion control&#44; lack of fastening elements&#44; lack of heel counter stiffness and high cost are some of them&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Similarly&#44; patients have stated their inability to find footwear that meets an appropriate balance between comfort and appearance in formal or work environments&#46;<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">46&#44;48</span></a> They also indicate a lack of confidence when it comes to knowing what footwear they should buy based on previous negative experiences&#46; Patients who use deficient footwear present a higher impairment and limited activity than those who use suitable footwear&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">47</span></a></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Specific management of foot and ankle in gout</span><p id="par0110" class="elsevierStylePara elsevierViewall">After the review of the literature&#44; a few papers were retrieved in relationship with specific treatment of gout in foot and ankle&#44; most of them related to surgical procedures&#46; In 2018&#44; the American College of Foot and Ankle Surgeons&#44; together with the American Association of Nurse Practitioners&#44; performed a consensus about etiology&#44; diagnosis and treatment of gouty arthritis affecting foot and ankle&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">50</span></a> In this consensus&#44; the experts agreed that nonsteroidal anti-inflammatory drugs &#40;NSAIDs&#41; are the first-line therapy for a flare&#46; From the authors&#8217; point of view&#44; NSAIDs are many times contraindicated or not appropriate&#44; while colchicine and corticosteroids &#40;oral or intraarticular&#41; are also effective and safe options&#46; At this consensus&#44; it was also settled the need of urate-lowering therapies&#44; such as allopurinol&#44; to reach the SU target below 6<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; It is also important to mention that the 2016 EULAR treatment guidelines recommend a lower target &#8211; &#60;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#8211; in severe gout &#40;defined as tophi&#44; chronic arthropathy or with frequent flares&#41; to enhance crystal dissolution&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">51</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding pharmacological treatment&#44; no references dealing with specific management of gout in foot and ankle were found&#46; Nevertheless&#44; it seems reasonable that the treatment would not be different from the ordinary gout patient&#46; Gout must be understood as an MSU crystal deposition disease secondary to hyperuricemia&#46; These MSU crystals are recognized by the innate immune system&#44; causing inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">52</span></a> The treatment aims to dissolve the MSU crystal storage by achieving a persistent normalization of SU levels&#46; Until MSU crystals are entirely removed&#44; it is also mandatory the flare prophylaxis and&#44; in advance cases&#44; the control of persistent clinical inflammation&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Most of the articles found in the review regarding the targeted management of foot and ankle involvement deal with surgical techniques for cases of tophaceous gout&#46; Interventions can be divided into five types&#58; arthroscopic cleaning&#44; joint replacement&#44; arthrodesis&#44; surgical debridement and graft techniques&#46; In 2016&#44; a systematic review of surgical procedures could not reach a specific recommendation due to the limited good quality studies&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">53</span></a> In addition&#44; a Cochrane review concluded more randomized-controlled trial data for surgical interventions of tophi is needed before drawing firm conclusions&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">54</span></a> One paper assessed the arthroscopic removal of MSU crystals from 1st MTP joints&#44; comparing outcomes against &#8220;anti-gout therapy&#8221; in 28 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">55</span></a> After more than two years&#44; functional scores and number of attacks significantly favored the surgical group&#59; furthermore&#44; the final SU levels were also lower&#46; Surprisingly&#44; no patient in the control group showed SU levels under 6<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; and the authors did not provide the mean dose of urate-lowering therapy in both groups&#46; Concerning joint replacement&#44; one article reports 16 patients with gout undergoing total ankle arthroplasty&#44; with good results in terms of pain and disability&#46;<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">56</span></a> These outcomes were also shown in patients in whom an arthrodesis was performed after tophi excision compared with the excision alone&#46; In fact&#44; in this work&#44; the authors noted that osteoarthritis progressed more frequently in patients without arthrodesis and those with intraarticular tophi&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">57</span></a> Surgical debridement is the classic technique for tophi removal&#44;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">58</span></a> despite being supported only by two relatively recent articles&#46; In the first one&#44; a surgical debridement with a free flap reconstruction in six patients is described with favorable results&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">59</span></a> In the other paper&#44; Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">60</span></a> described an intralesional shaving technique focused on reducing the burden of MSU&#46; More recently&#44; a modified bone graft technique called Masquelet&#39;s technique was used in situations with significant bone losses&#44; as sometimes occurs in tophaceous gout&#44; with successful results&#46;<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">61</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The prescription of footwear considered appropriate is controversial&#46; It produces improvements in pain and foot disability in the short term &#40;2 months&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0635"><span class="elsevierStyleSup">62&#44;63</span></a> but eventually&#44; this effect disappears&#46; However&#44; improvements in comfort and fit using suitable footwear tend to persist in time&#46;<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">62</span></a> All the studies related to footwear were performed in New Zealand&#44; a fact that needs to be taking into account as could affect data extrapolation&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In the authors&#8217; opinion&#44; the timing and indications for surgical procedures in case of gouty involvement remain to be determined&#46; What is mandatory is to optimize the urate-lowering therapy&#44; because gout is too often poorly managed&#44;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">64</span></a> even by rheumatologists&#44; as it has been demonstrated that only 66&#37; of treated patients reached the targeted SU level&#46;<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">65</span></a> Footwear interventions could improve patients&#8217; foot comfortability&#46; Probably in severe gout with considerable structural damage&#44; surgical procedures could be an option&#44; always together with urate-lowering therapies&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclusion</span><p id="par0135" class="elsevierStylePara elsevierViewall">The result of the present review highlights that the foot and ankle involvement in gout overtakes the classical picture of recurrent episodes of acute arthritis&#46; Patients affected with gout&#44; even in a non-tophaceous stage&#44; deal with persistent pain and gait impairment&#46; Their ranges of movement at lower limbs are limited&#44; and the choice of footwear may be troublesome for these subjects&#44; especially when tophi are present&#44; all resulting in an impaired quality of life&#46; Focused attention and management appear convenient&#44; where close collaborations between rheumatologists and podiatrists can be constructive&#46; Gout is a curable disease as MSU crystals dissolve when SU levels are persistently normalized&#59; however&#44; the specific effect on these foot and ankle manifestations remains to be determined&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">The present work received no funding&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">MA declares speaking fees and research grants from Grunenthal&#44; Menarini&#44; Astra-Zeneca and Horizon&#46; The rest of the authors declares no conflicts of interest in the making of the present manuscript&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1457064"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1328172"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1457063"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1328171"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:7 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Clinical status of foot and ankle in patients with gout"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Pain&#44; disability and impairment"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Tophi"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Tendon involvement"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Limitation of movement&#44; muscular strength and structural alterations"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Gait characteristics"
            ]
            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Footwear"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Specific management of foot and ankle in gout"
        ]
        7 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conclusion"
        ]
        8 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Funding"
        ]
        9 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflict of interest"
        ]
        10 => array:2 [
          "identificador" => "xack509787"
          "titulo" => "Acknowledgement"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-09-18"
    "fechaAceptado" => "2019-12-19"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1328172"
          "palabras" => array:5 [
            0 => "Gout"
            1 => "Tophi"
            2 => "Foot"
            3 => "Footwear"
            4 => "Gait"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1328171"
          "palabras" => array:5 [
            0 => "Gota"
            1 => "Tofos"
            2 => "Pie"
            3 => "Calzado"
            4 => "Marcha"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The foot and ankle are common locations of deposition of monosodium urate &#40;MSU&#41; crystals&#44; as indicated by the clinical manifestations presented by patients with gout&#44; which are not limited to the acute inflammation of the big toe&#46; We present a narrative literature review aimed to update the gout involvement of foot and ankle and how it affects the quality of life&#46; Cumulative reports indicate that gout&#44; even at the non-tophaceous stage&#44; could cause pain&#44; gait impairment and limit the mobility at lower limbs&#46; These patients may present difficulties in some activities of daily living such as choosing footwear&#44; thus leading to an impaired quality of life&#46; Gout is a curable disease by dissolving MSU crystals but remains unclear how this could modify some of these foot and ankle manifestations&#44; especially when structural damage has already occurred&#46; Furthermore&#44; a collaboration between rheumatologists and podiatrists seems helpful to understand&#44; relieve these symptoms and improve the quality of life in gouty patients&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El pie y el tobillo son lugares comunes de dep&#243;sito de cristales de urato monos&#243;dico &#40;UMS&#41;&#44; como indican las manifestaciones cl&#237;nicas que presentan los pacientes con gota&#44; que no se limitan a la inflamaci&#243;n aguda del primer dedo del pie&#46; Presentamos una revisi&#243;n narrativa de la literatura con el objetivo de actualizar la implicaci&#243;n de la gota en pie y tobillo y c&#243;mo afecta a la calidad de vida&#46; En la literatura se describe que la gota&#44; incluso en la etapa no tof&#225;cea&#44; podr&#237;a causar dolor&#44; deterioro de la marcha y limitaciones de la movilidad en las extremidades inferiores&#46; Estos pacientes pueden presentar dificultades en algunas actividades de la vida diaria&#44; como la elecci&#243;n de calzado&#44; lo cual implica una calidad de vida deteriorada&#46; La gota es una enfermedad curable si se disuelven los cristales de UMS&#44; pero resulta incierto c&#243;mo esto podr&#237;a modificar algunas de estas manifestaciones en pie y el tobillo&#44; especialmente cuando el da&#241;o estructural ya ha ocurrido&#46; Adem&#225;s&#44; una colaboraci&#243;n entre reumat&#243;logos y pod&#243;logos ser&#237;a de utilidad para comprender y aliviar estos s&#237;ntomas as&#237; como mejorar la calidad de vida de los pacientes con gota&#46;</p></span>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0155" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p>"
            "etiqueta" => "Annexed 1"
            "titulo" => "Search strategy"
            "identificador" => "sec0070"
          ]
        ]
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 905
            "Ancho" => 1605
            "Tamanyo" => 189887
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The figure depicts three different cases of foot involvement in tophaceous gout&#44; shown by a clinical picture &#40;left&#41;&#44; plain radiography &#40;center&#41; and T1-weighted magnetic resonance &#40;right&#41;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#8593;&#58; increased&#59; &#8595;&#58; decreased&#59; NE&#58; not evaluated&#59; NSSD&#58; not statistically significant differences&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&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">Gait analysis&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">Disease duration&#44; years&#44; mean&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">Tophaceous gout &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ancestry&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">Velocity&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">Cadence&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">Step length&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">Stride length&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">Support base&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">Step time&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">Swing time&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">Stance time&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">Single leg support time&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">Double leg support time&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">Rome</span><a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">29</span></a>&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">ShoedSelf-selected walking speed&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">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">52&#37;&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">European 56&#37;Asian 20&#37;M&#257;ori 20&#37;Pacific 4&#37;&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">&#8595;&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">&#8595;&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">&#8595;&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">&#8595;&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">NE&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">NE&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">NSSD&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">NSSD&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">NSSD&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">&#8593;&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">Stewart</span><a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">41</span></a>&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">BarefootSelf-selected walking speed&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&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">60&#37;&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">European 60&#37;Asian 20&#37;Pacific 15&#37;M&#257;ori 5&#37;&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">&#8595;&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">&#8595;&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">NSSD&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">NSSD&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">NE&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">&#8593;&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">NSSD&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">&#8593;&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">NE&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">NE&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">Stewart</span><a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">41</span></a>&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">BarefootFast walking speed&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&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">60&#37;&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">European 60&#37;Asian 20&#37;Pacific 15&#37;M&#257;ori 5&#37;&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">&#8595;&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">&#8595;&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">NSSD&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">NSSD&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">NE&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">&#8593;&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">&#8593;&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">&#8593;&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">NE&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">NE&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">Stewart</span><a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">42</span></a>&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">BarefootSelf-selected walking speed&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&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">71&#37;&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">European 58&#37;Asian 17&#37;Pacific 21&#37;M&#257;ori 4&#37;&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">&#8595;&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">NSSD&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">NSSD&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">NSSD&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">NSSD&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">&#8593;&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">NSSD&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">&#8593;&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">NSSD&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">NSSD&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">Burke</span><a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">43</span></a>&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">ShoedSelf-selected walking speed&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">NE&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">NE&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">Caucasian 70&#46;1&#37;African American 29&#46;9&#37;&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">&#8595;&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">NE&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">NE&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">NE&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">NE&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">NE&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">NE&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">NE&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">NE&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">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2506350.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Changes in spatiotemporal parameters seen in patients with gout&#46;</p>"
        ]
      ]
      2 => array:5 [
        "identificador" => "tbl0005"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "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=""><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">&#40;&#8220;Gout&#8221;&#91;Mesh&#93; OR &#8220;Arthritis&#44; Gouty&#8221;&#91;Mesh&#93; OR gout&#91;Title&#47;Abstract&#93; OR gouty&#91;Title&#47;Abstract&#93; OR toph&#42;&#91;Title&#47;Abstract&#93; OR tophi&#91;Title&#47;Abstract&#93; OR tophaceous&#91;Title&#47;Abstract&#93; OR podagra&#91;Title&#47;Abstract&#93;&#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">AND&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">&#40;&#8220;Foot&#8221;&#91;Mesh&#93; OR Foot&#42;&#91;Title&#47;Abstract&#93; OR Footwear&#42;&#91;Title&#47;Abstract&#93; OR Feet&#42;&#91;Title&#47;Abstract&#93; OR Shoe&#42;&#91;Title&#47;Abstract&#93; OR &#8220;Foot Orthoses&#8221;&#91;Mesh&#93; OR Orthos&#42;&#91;Title&#47;Abstract&#93; OR &#8220;Lower Extremity&#8221;&#91;Mesh&#58;NoExp&#93; OR &#8220;Lower Extremity&#8221;&#91;Title&#47;Abstract&#93; OR Gait&#91;Title&#47;Abstract&#93;&#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">NOT &#40;&#8220;Clinical Conference&#8221;&#91;Publication Type&#93; OR &#8220;Congress&#8221;&#91;Publication Type&#93; OR &#8220;Consensus Development Conference&#8221;&#91;Publication Type&#93; OR &#8220;Editorial&#8221;&#91;Publication Type&#93; OR &#8220;Published Erratum&#8221;&#91;Publication Type&#93; OR &#8220;Letter&#8221;&#91;Publication Type&#93; OR &#8220;Comment&#8221;&#91;Publication Type&#93; OR mice&#91;Title&#47;Abstract&#93; OR mouse&#91;Title&#47;Abstract&#93;&#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">NOT &#40;&#8220;Animals&#8221;&#91;Mesh&#93; NOT &#40;&#8220;Animals&#8221;&#91;Mesh&#93; AND &#8220;Humans&#8221;&#91;Mesh&#93;&#41;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2506351.png"
              ]
            ]
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:65 [
            0 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Richette"
                            1 => "M&#46; Doherty"
                            2 => "E&#46; Pascual"
                            3 => "V&#46; Barskova"
                            4 => "F&#46; Becce"
                            5 => "J&#46; Castaneda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2019-215315"
                      "Revista" => array:2 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2019"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic value of clinical&#44; laboratory&#44; and imaging findings in patients with a clinical suspicion of gout&#58; a systematic literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; Sivera"
                            1 => "M&#46; Andr&#232;s"
                            2 => "L&#46; Falzon"
                            3 => "D&#46;M&#46;F&#46;M&#46; van der Heijde"
                            4 => "L&#46; Carmona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3899/jrheum.140456"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Rheumatol Suppl"
                        "fecha" => "2014"
                        "volumen" => "92"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25180122"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0210569119302347"
                          "estado" => "S300"
                          "issn" => "02105691"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical diagnostic criteria for gout&#58; comparison with the gold standard of synovial fluid crystal analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Malik"
                            1 => "H&#46;R&#46; Schumacher"
                            2 => "J&#46;E&#46; Dinnella"
                            3 => "G&#46;M&#46; Clayburne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RHU.0b013e318194579"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Rheumatol"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "22"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19125136"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The broad spectrum of urate crystal deposition&#58; unusual presentations of gouty tophi"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;J&#46; Forbess"
                            1 => "T&#46;R&#46; Fields"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2012.03.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2012"
                        "volumen" => "42"
                        "paginaInicial" => "146"
                        "paginaFinal" => "154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22522111"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical survey of 354 patients with gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Grahame"
                            1 => "J&#46;T&#46; Scott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.29.5.461"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "1970"
                        "volumen" => "29"
                        "paginaInicial" => "461"
                        "paginaFinal" => "468"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5476673"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonography and dual-energy computed tomography provide different quantification of urate burden in gout&#58; results from a cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Pascart"
                            1 => "A&#46; Grandjean"
                            2 => "L&#46; Norberciak"
                            3 => "V&#46; Ducoulombier"
                            4 => "M&#46; Motte"
                            5 => "H&#46; Luraschi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13075-017-1381-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2017"
                        "volumen" => "19"
                        "paginaInicial" => "171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28732526"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0210569118300159"
                          "estado" => "S300"
                          "issn" => "02105691"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-resolution ultrasonography of the first metatarsal phalangeal joint in gout&#58; a controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Wright"
                            1 => "E&#46; Filippucci"
                            2 => "C&#46; McVeigh"
                            3 => "A&#46; Grey"
                            4 => "M&#46; McCarron"
                            5 => "W&#46; Grassi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2006.062802"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2007"
                        "volumen" => "66"
                        "paginaInicial" => "859"
                        "paginaFinal" => "864"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17185326"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1525861015001498"
                          "estado" => "S300"
                          "issn" => "15258610"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection of uric acid crystal deposition by ultrasonography and dual-energy computed tomography&#58; a cross-sectional study in patients with clinically diagnosed gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Wang"
                            1 => "X&#46; Deng"
                            2 => "Y&#46; Xu"
                            3 => "L&#46; Ji"
                            4 => "Z&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MD.0000000000012834"
                      "Revista" => array:4 [
                        "tituloSerie" => "Medicine &#40;Baltimore&#41;"
                        "fecha" => "2018"
                        "volumen" => "97"
                        "paginaInicial" => "e12834"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between structural joint damage and urate deposition in gout&#58; a plain radiography and dual-energy CT study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Dalbeth"
                            1 => "O&#46; Aati"
                            2 => "R&#46; Kalluru"
                            3 => "G&#46;D&#46; Gamble"
                            4 => "A&#46; Horne"
                            5 => "A&#46;J&#46; Doyle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2013-204273"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2015"
                        "volumen" => "74"
                        "paginaInicial" => "1030"
                        "paginaFinal" => "1036"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24521739"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The distribution of urate deposition within the extremities in gout&#58; a review of 148 dual-energy CT cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46;I&#46; Mallinson"
                            1 => "A&#46;C&#46; Reagan"
                            2 => "T&#46; Coupal"
                            3 => "P&#46;L&#46; Munk"
                            4 => "H&#46; Ouellette"
                            5 => "S&#46; Nicolaou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00256-013-1771-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Skeletal Radiol"
                        "fecha" => "2014"
                        "volumen" => "43"
                        "paginaInicial" => "277"
                        "paginaFinal" => "281"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24337414"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Features of urate deposition in patients with gouty arthritis of the foot using dual-energy computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Sun"
                            1 => "L&#46; Ma"
                            2 => "Y&#46; Zhou"
                            3 => "H&#46; Chen"
                            4 => "Y&#46; Ding"
                            5 => "J&#46; Zhou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1756-185X. 12194"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Rheum Dis"
                        "fecha" => "2015"
                        "volumen" => "18"
                        "paginaInicial" => "560"
                        "paginaFinal" => "567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24238356"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dual-energy computed tomography has limited diagnostic sensitivity for short-term gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Jia"
                            1 => "J&#46; Zhu"
                            2 => "W&#46; Huang"
                            3 => "X&#46; Chen"
                            4 => "J&#46; Li"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-017-3753-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2018"
                        "volumen" => "37"
                        "paginaInicial" => "773"
                        "paginaFinal" => "777"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28803339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tendon involvement in patients with gout&#58; an ultrasound study of prevalence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Ventura-R&#237;os"
                            1 => "G&#46; S&#225;nchez-Bringas"
                            2 => "C&#46; Pineda"
                            3 => "C&#46; Hern&#225;ndez-D&#237;az"
                            4 => "A&#46; Reginato"
                            5 => "M&#46; Alva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-016-3309-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "2039"
                        "paginaFinal" => "2044"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27236513"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tendon involvement in the feet of patients with gout&#58; a dual-energy CT study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Dalbeth"
                            1 => "R&#46; Kalluru"
                            2 => "O&#46; Aati"
                            3 => "A&#46; Horne"
                            4 => "A&#46;J&#46; Doyle"
                            5 => "F&#46;M&#46; McQueen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2012-202786"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2013"
                        "volumen" => "72"
                        "paginaInicial" => "1545"
                        "paginaFinal" => "1548"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23334212"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The influence of temperature on the solubility of monosodium urate"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;N&#46; Loeb"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.1780150209"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "1972"
                        "volumen" => "15"
                        "paginaInicial" => "189"
                        "paginaFinal" => "192"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5027604"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Joint temperature measurement in the evaluation of anti-arthritic agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; Hollander"
                            1 => "E&#46;K&#46; Stoner"
                            2 => "E&#46;M&#46; Brown"
                            3 => "P&#46; DeMOOR"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1172/JCI102483"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Invest"
                        "fecha" => "1951"
                        "volumen" => "30"
                        "paginaInicial" => "701"
                        "paginaFinal" => "706"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14850549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyperuricemia starts at 360 micromoles &#40;6<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Bardin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jbspin.2015.01.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Spine"
                        "fecha" => "2015"
                        "volumen" => "82"
                        "paginaInicial" => "141"
                        "paginaFinal" => "143"
                        "itemHostRev" => array:3 [
                          "pii" => "S1130634308728083"
                          "estado" => "S300"
                          "issn" => "11306343"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanisms of crystal formation in gout-a structural approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Pascual"
                            1 => "L&#46; Addadi"
                            2 => "M&#46; Andr&#233;s"
                            3 => "F&#46; Sivera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrrheum.2015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Rheumatol"
                        "fecha" => "2015"
                        "volumen" => "11"
                        "paginaInicial" => "725"
                        "paginaFinal" => "730"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26369610"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Orderly arrayed deposit of urate crystals in gout suggest epitaxial formation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Pascual"
                            1 => "S&#46; Ord&#243;&#241;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.57.4.255"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "1998"
                        "volumen" => "57"
                        "paginaInicial" => "255"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9709186"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tophaceous gout in a patient with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;L&#46; Baker"
                            1 => "J&#46;S&#46; Stroup"
                            2 => "C&#46;A&#46; Gilstrap"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Osteopath Assoc"
                        "fecha" => "2007"
                        "volumen" => "107"
                        "paginaInicial" => "554"
                        "paginaFinal" => "556"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18178765"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review of the value of ultrasound and magnetic resonance musculoskeletal imaging in the evaluation of response to treatment of gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Villaverde"
                            1 => "M&#46;P&#46; Rosario"
                            2 => "E&#46; Loza"
                            3 => "F&#46; P&#233;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.reuma.2013.07.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reumatol Clin"
                        "fecha" => "2014"
                        "volumen" => "10"
                        "paginaInicial" => "160"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24296268"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Entheses&#58; tendon and ligament attachment sites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Benjamin"
                            1 => "D&#46; McGonagle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0838.2009.00906.x"
                      "Revista" => array:5 [
                        "tituloSerie" => "Scand J Med Sci Sports"
                        "fecha" => "2009"
                        "volumen" => "19"
                        "paginaInicial" => "520"
                        "paginaFinal" => "527"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are joints affected by gout also affected by osteoarthritis&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Roddy"
                            1 => "W&#46; Zhang"
                            2 => "M&#46; Doherty"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2006.063768"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2007"
                        "volumen" => "66"
                        "paginaInicial" => "1374"
                        "paginaFinal" => "1377"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17284542"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The association between gout and radiographic hand&#44; knee and foot osteoarthritis&#58; a cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Bevis"
                            1 => "M&#46; Marshall"
                            2 => "T&#46; Rathod"
                            3 => "E&#46; Roddy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12891-016-1032-9"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Musculoskelet Disord"
                        "fecha" => "2016"
                        "volumen" => "17"
                        "paginaInicial" => "169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27085669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gout hyperuricemia&#44; and crystal-associated disease network consensus statement regarding labels and definitions for disease elements in gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Bursill"
                            1 => "W&#46;J&#46; Taylor"
                            2 => "R&#46; Terkeltaub"
                            3 => "M&#46; Kuwabara"
                            4 => "T&#46;R&#46; Merriman"
                            5 => "R&#46; Grainger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.23607"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2019"
                        "volumen" => "71"
                        "paginaInicial" => "427"
                        "paginaFinal" => "434"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foot pain&#44; impairment&#44; and disability in patients with acute gout flares&#58; a prospective observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Rome"
                            1 => "M&#46; Frecklington"
                            2 => "P&#46; McNair"
                            3 => "P&#46; Gow"
                            4 => "N&#46; Dalbeth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.20670"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2012"
                        "volumen" => "64"
                        "paginaInicial" => "384"
                        "paginaFinal" => "388"
                        "itemHostRev" => array:3 [
                          "pii" => "S1368764617300432"
                          "estado" => "S300"
                          "issn" => "13687646"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics of foot ulceration in people with chronic gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Rome"
                            1 => "K&#46; Erikson"
                            2 => "C&#46; Otene"
                            3 => "H&#46; Sahid"
                            4 => "K&#46; Sangster"
                            5 => "P&#46; Gow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/iwj.12262"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Wound J"
                        "fecha" => "2016"
                        "volumen" => "13"
                        "paginaInicial" => "209"
                        "paginaFinal" => "215"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24674139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foot problems in people with gout in primary care&#58; baseline findings from a prospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Roddy"
                            1 => "S&#46; Muller"
                            2 => "K&#46; Rome"
                            3 => "P&#46; Chandratre"
                            4 => "S&#46;L&#46; Hider"
                            5 => "J&#46; Richardson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13047-015-0090-9"
                      "Revista" => array:4 [
                        "tituloSerie" => "J Foot Ankle Res"
                        "fecha" => "2015"
                        "volumen" => "8"
                        "paginaInicial" => "31"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional and biomechanical characteristics of foot disease in chronic gout&#58; a case&#8211;control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Rome"
                            1 => "D&#46; Survepalli"
                            2 => "A&#46; Sanders"
                            3 => "M&#46; Lobo"
                            4 => "F&#46;M&#46; McQueen"
                            5 => "P&#46; McNair"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clinbiomech.2010.09.006"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Biomech Bristol Avon"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "90"
                        "paginaFinal" => "94"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unusual localisation of tophaceous gout&#46; A report of four cases and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Reber"
                            1 => "X&#46; Crevoisier"
                            2 => "B&#46; Noesberger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/bf00439058"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Orthop Trauma Surg"
                        "fecha" => "1996"
                        "volumen" => "115"
                        "paginaInicial" => "297"
                        "paginaFinal" => "299"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8836466"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ulcerated gout masquerading as a non healing diabetic foot ulcer&#58; a case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "W&#46; Crasto"
                            1 => "R&#46; Jogia"
                            2 => "S&#46; Jackson"
                            3 => "K&#46; Nisal"
                            4 => "K&#46; Higgins"
                            5 => "M&#46;-F&#46; Kong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15277/bjdvd.2014.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Diabetes Vasc Dis"
                        "fecha" => "2014"
                        "volumen" => "14"
                        "paginaInicial" => "21"
                        "paginaFinal" => "25"
                        "itemHostRev" => array:3 [
                          "pii" => "S1130239914000303"
                          "estado" => "S300"
                          "issn" => "11302399"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinically-evident tophi are associated with reduced muscle force in the foot and ankle in people with gout&#58; a cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Stewart"
                            1 => "N&#46; Dalbeth"
                            2 => "S&#46; Otter"
                            3 => "P&#46; Gow"
                            4 => "S&#46; Kumar"
                            5 => "K&#46; Rome"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13047-017-0207-4"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Foot Ankle Res"
                        "fecha" => "2017"
                        "volumen" => "10"
                        "paginaInicial" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28649283"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tophaceous gout&#58; an unusual cause of multiple fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Nguyen"
                            1 => "H&#46;-K&#46; Ea"
                            2 => "E&#46; Palazzo"
                            3 => "F&#46; Liot&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/03009740903061428"
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Rheumatol"
                        "fecha" => "2010"
                        "volumen" => "39"
                        "paginaInicial" => "93"
                        "paginaFinal" => "96"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20132078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and risk factors of ulceration over tophi in patients with gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Huang"
                            1 => "X&#46; Liu"
                            2 => "Y&#46; Liu"
                            3 => "G&#46; Li"
                            4 => "X&#46; Pan"
                            5 => "Z&#46; Huang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1756-185X. 13581"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Rheum Dis"
                        "fecha" => "2019"
                        "volumen" => "22"
                        "paginaInicial" => "1052"
                        "paginaFinal" => "1057"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31119888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tibialis posterior tenosynovitis&#58; a unique musculoskeletal manifestation of gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Shupper"
                            1 => "T&#46;P&#46; Stitik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PHM.0000000000000774"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Phys Med Rehabil"
                        "fecha" => "2018"
                        "volumen" => "97"
                        "paginaInicial" => "143"
                        "paginaFinal" => "146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28632507"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia&#58; an ultrasound controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Pineda"
                            1 => "L&#46;M&#46; Amezcua-Guerra"
                            2 => "C&#46; Solano"
                            3 => "P&#46; Rodriguez-Henriquez"
                            4 => "C&#46; Hernandez-Diaz"
                            5 => "A&#46; Vargas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/ar3223"
                      "Revista" => array:4 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2011"
                        "volumen" => "13"
                        "paginaInicial" => "R4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tibialis anterior tendon rupture in gout &#8211; case report and literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;T&#46;J&#46; Jerome"
                            1 => "M&#46; Varghese"
                            2 => "B&#46; Sankaran"
                            3 => "S&#46; Thomas"
                            4 => "S&#46;K&#46; Thirumagal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fas.2007.12.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Surg"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "166"
                        "paginaFinal" => "169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19083637"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foot structure&#44; pain and functional ability in people with gout in primary care&#58; cross-sectional findings from the clinical assessment study of the foot"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;R&#46; Petty"
                            1 => "T&#46; Rathod-Mistry"
                            2 => "H&#46;B&#46; Menz"
                            3 => "E&#46; Roddy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13047-019-0317-2"
                      "Revista" => array:4 [
                        "tituloSerie" => "J Foot Ankle Res"
                        "fecha" => "2019"
                        "volumen" => "12"
                        "paginaInicial" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Persistence of monosodium urate crystals and low-grade inflammation in the synovial fluid of patients with untreated gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Pascual"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.1780340203"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "1991"
                        "volumen" => "34"
                        "paginaInicial" => "141"
                        "paginaFinal" => "145"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1994910"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0525"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gait characteristics associated with the foot and ankle in inflammatory arthritis&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Carroll"
                            1 => "P&#46; Parmar"
                            2 => "N&#46; Dalbeth"
                            3 => "M&#46; Boocock"
                            4 => "K&#46; Rome"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12891-015-0596-0"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Musculoskelet Disord"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "paginaInicial" => "134"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout&#58; a two-arm cross sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Stewart"
                            1 => "T&#46; Morpeth"
                            2 => "N&#46; Dalbeth"
                            3 => "A&#46;C&#46; Vandal"
                            4 => "M&#46; Carroll"
                            5 => "L&#46; Davidtz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.gaitpost.2015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gait Posture"
                        "fecha" => "2016"
                        "volumen" => "44"
                        "paginaInicial" => "18"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27004627"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spatiotemporal gait parameters and plantar pressure distribution during barefoot walking in people with gout and asymptomatic hyperuricemia&#58; comparison with healthy individuals with normal serum urate concentrations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Stewart"
                            1 => "N&#46; Dalbeth"
                            2 => "A&#46;C&#46; Vandal"
                            3 => "K&#46; Rome"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13047-016-0147-4"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Foot Ankle Res"
                        "fecha" => "2016"
                        "volumen" => "9"
                        "paginaInicial" => "15"
                        "itemHostRev" => array:3 [
                          "pii" => "S0210569117303613"
                          "estado" => "S300"
                          "issn" => "02105691"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical function hyperuricemia&#44; and gout in older adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;T&#46; Burke"
                            1 => "A&#46; K&#246;ttgen"
                            2 => "A&#46; Law"
                            3 => "B&#46;G&#46; Windham"
                            4 => "D&#46; Segev"
                            5 => "A&#46;N&#46; Baer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.22648"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2015"
                        "volumen" => "67"
                        "paginaInicial" => "1730"
                        "paginaFinal" => "1738"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0545"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of good and poor walking shoe characteristics on plantar pressure and gait in people with gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Stewart"
                            1 => "N&#46; Dalbeth"
                            2 => "P&#46; McNair"
                            3 => "P&#46; Parmar"
                            4 => "P&#46; Gow"
                            5 => "K&#46; Rome"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clinbiomech.2014.09.009"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Biomech Bristol Avon"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "paginaInicial" => "1158"
                        "paginaFinal" => "1163"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0550"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between tissue stress during gait in healthy volunteers and patterns of urate deposition and bone erosion in gout&#58; a biomechanical computational modelling study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Dalbeth"
                            1 => "M&#46; Deacon"
                            2 => "G&#46;D&#46; Gamble"
                            3 => "K&#46; Mithraratne"
                            4 => "J&#46; Fernandez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/rmdopen-2015-000101"
                      "Revista" => array:4 [
                        "tituloSerie" => "RMD Open"
                        "fecha" => "2015"
                        "volumen" => "1"
                        "paginaInicial" => "e000101"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0555"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Experience of finding footwear and factors contributing to footwear choice in people with gout&#58; a mixed methods study using a web-based survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Brenton-Rule"
                            1 => "N&#46; Dalbeth"
                            2 => "N&#46;L&#46; Edwards"
                            3 => "K&#46; Rome"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13047-018-0313-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Foot Ankle Res"
                        "fecha" => "2019"
                        "volumen" => "12"
                        "paginaInicial" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30636975"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0210569118302213"
                          "estado" => "S300"
                          "issn" => "02105691"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0560"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Footwear characteristics and factors influencing footwear choice in patients with gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Rome"
                            1 => "M&#46; Frecklington"
                            2 => "P&#46; Mcnair"
                            3 => "P&#46; Gow"
                            4 => "N&#46; Dalbeth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.20582"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2011"
                        "volumen" => "63"
                        "paginaInicial" => "1599"
                        "paginaFinal" => "1604"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0565"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The footwear experiences of people with gout&#58; a qualitative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Frecklington"
                            1 => "A&#46; Williams"
                            2 => "N&#46; Dalbeth"
                            3 => "P&#46; McNair"
                            4 => "P&#46; Gow"
                            5 => "K&#46; Rome"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13047-019-0349-7"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Foot Ankle Res"
                        "fecha" => "2019"
                        "volumen" => "12"
                        "paginaInicial" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31338128"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0570"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Footwear interventions for foot pain&#44; function&#44; impairment and disability for people with foot and ankle arthritis&#58; a literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Frecklington"
                            1 => "N&#46; Dalbeth"
                            2 => "P&#46; McNair"
                            3 => "P&#46; Gow"
                            4 => "A&#46; Williams"
                            5 => "M&#46; Carroll"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2017.10.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2018"
                        "volumen" => "47"
                        "paginaInicial" => "814"
                        "paginaFinal" => "824"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29174793"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0575"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons&#174; and the American Association of Nurse Practitioners&#174;&#58; Etiology&#44; Diagnosis&#44; and Treatment Consensus for Gouty Arthritis of the Foot and Ankle"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Mirmiran"
                            1 => "T&#46; Bush"
                            2 => "M&#46;M&#46; Cerra"
                            3 => "S&#46; Grambart"
                            4 => "E&#46; Kauschinger"
                            5 => "M&#46; Younger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.jfas.2018.08.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Foot Ankle Surg"
                        "fecha" => "2018"
                        "volumen" => "57"
                        "paginaInicial" => "1207"
                        "paginaFinal" => "1217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30368431"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0580"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2016 updated EULAR evidence-based recommendations for the management of gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Richette"
                            1 => "M&#46; Doherty"
                            2 => "E&#46; Pascual"
                            3 => "V&#46; Barskova"
                            4 => "F&#46; Becce"
                            5 => "J&#46; Casta&#241;eda-Sanabria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2016-209707"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2017"
                        "volumen" => "76"
                        "paginaInicial" => "29"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27457514"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0585"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural adjuvants&#58; endogenous activators of dendritic cells"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Gallucci"
                            1 => "M&#46; Lolkema"
                            2 => "P&#46; Matzinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/15200"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Med"
                        "fecha" => "1999"
                        "volumen" => "5"
                        "paginaInicial" => "1249"
                        "paginaFinal" => "1255"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10545990"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0590"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management of gout in the foot and ankle&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Poratt"
                            1 => "K&#46; Rome"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7547/14-128"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Podiatr Med Assoc"
                        "fecha" => "2016"
                        "volumen" => "106"
                        "paginaInicial" => "182"
                        "paginaFinal" => "188"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0595"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interventions for tophi in gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;K&#46; Sriranganathan"
                            1 => "O&#46; Vinik"
                            2 => "C&#46; Bombardier"
                            3 => "C&#46;J&#46; Edwards"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD010069.pub2"
                      "Revista" => array:3 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2014"
                        "paginaInicial" => "CD010069"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0600"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Wang"
                            1 => "S&#46; Lien"
                            2 => "G&#46; Huang"
                            3 => "R&#46; Pan"
                            4 => "H&#46; Shen"
                            5 => "C&#46; Kuo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arthro.2008.09.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthroscopy"
                        "fecha" => "2009"
                        "volumen" => "25"
                        "paginaInicial" => "153"
                        "paginaFinal" => "158"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19171274"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0605"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total ankle replacement in patients with gouty arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Barg"
                            1 => "M&#46; Knupp"
                            2 => "A&#46;L&#46; Kapron"
                            3 => "B&#46; Hintermann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2106/JBJS.J.00957"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2011"
                        "volumen" => "93"
                        "paginaInicial" => "357"
                        "paginaFinal" => "366"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21325587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0610"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "First metatarsophalangeal joint arthrodesis for the treatment of tophaceous gouty arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46;S&#46; Kim"
                            1 => "E&#46;H&#46; Park"
                            2 => "H&#46;J&#46; Lee"
                            3 => "Y&#46;G&#46; Koh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3928/01477447-20140124-15"
                      "Revista" => array:6 [
                        "tituloSerie" => "Orthopedics"
                        "fecha" => "2014"
                        "volumen" => "37"
                        "paginaInicial" => "e141"
                        "paginaFinal" => "e147"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24679199"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0615"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgery of tophaceous gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;A&#46; Cassagrande"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0049-0172(72)90005-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "1972"
                        "volumen" => "1"
                        "paginaInicial" => "262"
                        "paginaFinal" => "273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5083718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0620"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Free-flap resurfacing of tissue defects in the foot due to large gouty tophi"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;T&#46; Lin"
                            1 => "S&#46;C&#46; Chang"
                            2 => "T&#46;M&#46; Chen"
                            3 => "N&#46;T&#46; Dai"
                            4 => "J&#46;P&#46; Fu"
                            5 => "S&#46;C&#46; Deng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/micr.20949"
                      "Revista" => array:6 [
                        "tituloSerie" => "Microsurgery"
                        "fecha" => "2011"
                        "volumen" => "31"
                        "paginaInicial" => "610"
                        "paginaFinal" => "615"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22009664"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0625"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Timing of intra-lesion shaving for surgical treatment of chronic tophus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;S&#46; Lee"
                            1 => "M&#46;C&#46; Chen"
                            2 => "Y&#46;H&#46; Chou"
                            3 => "S&#46;D&#46; Lin"
                            4 => "C&#46;S&#46; Lai"
                            5 => "Y&#46;C&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjps.2013.03.041"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Plast Reconstr Aesthetic Surg"
                        "fecha" => "2013"
                        "volumen" => "66"
                        "paginaInicial" => "1131"
                        "paginaFinal" => "1137"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0630"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of Masquelet&#39;s technique for treating the first metatarsophalangeal joint in cases of gout combined with a massive bone defect"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Liu"
                            1 => "R&#46;-K&#46; Huang"
                            2 => "M&#46; Xie"
                            3 => "H&#46; Pan"
                            4 => "J&#46;-J&#46; Zhao"
                            5 => "B&#46; Lei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fas.2017.01.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Surg"
                        "fecha" => "2018"
                        "volumen" => "24"
                        "paginaInicial" => "159"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29409218"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0635"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of a footwear intervention on foot pain and disability in people with gout&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Frecklington"
                            1 => "N&#46; Dalbeth"
                            2 => "P&#46; McNair"
                            3 => "T&#46; Morpeth"
                            4 => "A&#46;C&#46; Vandal"
                            5 => "P&#46; Gow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13075-019-1886-y"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2019"
                        "volumen" => "21"
                        "paginaInicial" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31018869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0640"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of commercially available footwear on foot pain and disability in people with gout&#58; a pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Rome"
                            1 => "S&#46; Stewart"
                            2 => "A&#46;C&#46; Vandal"
                            3 => "P&#46; Gow"
                            4 => "P&#46; McNair"
                            5 => "N&#46; Dalbeth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2474-14-278"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Musculoskelet Disord"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "278"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24063678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0645"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gout&#58; why is this curable disease so seldom cured&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Doherty"
                            1 => "T&#46;L&#46; Jansen"
                            2 => "G&#46; Nuki"
                            3 => "E&#46; Pascual"
                            4 => "F&#46; Perez-Ruiz"
                            5 => "L&#46; Punzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2012-201687"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2012 Nov"
                        "volumen" => "71"
                        "paginaInicial" => "1765"
                        "paginaFinal" => "1770"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22863577"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0650"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improvement in diagnosis and treat-to-target management of hyperuricemia in gout&#58; results from the GEMA-2 transversal study on practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Perez Ruiz"
                            1 => "C&#46;A&#46; Sanchez-Piedra"
                            2 => "J&#46;T&#46; Sanchez-Costa"
                            3 => "M&#46; Andr&#233;s"
                            4 => "C&#46; Diaz-Torne"
                            5 => "M&#46; Jimenez-Palop"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40744-017-0091-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatol Ther"
                        "fecha" => "2018"
                        "volumen" => "5"
                        "paginaInicial" => "243"
                        "paginaFinal" => "253"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29204859"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack509787"
        "titulo" => "Acknowledgement"
        "texto" => "<p id="par0150" class="elsevierStylePara elsevierViewall">The authors want to thank Mercedes Guerra from Sociedad Espa&#241;ola de Reumatolog&#237;a for the assistance with the search strategy&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001700000002/v1_202101301156/S2173574320301817/v1_202101301156/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "8383"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Review Article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001700000002/v1_202101301156/S2173574320301817/v1_202101301156/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301817?idApp=UINPBA00004M"
]

Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2019.12.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	150	60	210
2024 September	195	37	232
2024 August	297	49	346
2024 July	337	38	375
2024 June	261	39	300
2024 May	345	40	385
2024 April	281	22	303
2024 March	245	40	285
2024 February	255	35	290
2024 January	267	27	294
2023 December	284	38	322
2023 November	372	43	415
2023 October	440	52	492
2023 September	547	52	599
2023 August	643	36	679
2023 July	285	30	315
2023 June	329	26	355
2023 May	313	31	344
2023 April	251	15	266
2023 March	350	43	393
2023 February	290	30	320
2023 January	302	38	340
2022 December	307	31	338
2022 November	375	40	415
2022 October	390	42	432
2022 September	309	43	352
2022 August	254	44	298
2022 July	189	51	240
2022 June	179	28	207
2022 May	120	36	156
2022 April	99	45	144
2022 March	63	45	108
2022 February	44	32	76
2022 January	33	33	66
2021 December	31	32	63
2021 November	36	39	75
2021 October	40	47	87
2021 September	28	32	60
2021 August	13	22	35
2021 February	1	2	3

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter