was read the article
array:23 [ "pii" => "S2173574322001538" "issn" => "21735743" "doi" => "10.1016/j.reumae.2021.04.016" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1530" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2022;18:563-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S2173574321002203" "issn" => "21735743" "doi" => "10.1016/j.reumae.2021.08.002" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1566" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2022;18:564-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "How do Spanish Rheumatologists handle referral? Survey of knowledge and approach before and after a training workshop" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "564" "paginaFinal" => "566" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Cómo manejan la remisión los reumatólogos españoles? Encuesta de conocimientos y abordaje antes y después de un taller formativo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alejandro Balsa, Isidoro González-Álvaro, Raimon Sanmartí, Hector Corominas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Balsa" ] 1 => array:2 [ "nombre" => "Isidoro" "apellidos" => "González-Álvaro" ] 2 => array:2 [ "nombre" => "Raimon" "apellidos" => "Sanmartí" ] 3 => array:2 [ "nombre" => "Hector" "apellidos" => "Corominas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X21001911" "doi" => "10.1016/j.reuma.2021.08.002" "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/S1699258X21001911?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321002203?idApp=UINPBA00004M" "url" => "/21735743/0000001800000009/v2_202210290545/S2173574321002203/v2_202210290545/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173574322001526" "issn" => "21735743" "doi" => "10.1016/j.reumae.2021.04.015" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1536" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2022;18:561-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Outcomes of Pregnancy in Women With Idiopathic Inflammatory Myopathies in Africa" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "561" "paginaFinal" => "563" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mickael Essouma, Jean Jacques Noubiap" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Mickael" "apellidos" => "Essouma" ] 1 => array:2 [ "nombre" => "Jean Jacques" "apellidos" => "Noubiap" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574322001526?idApp=UINPBA00004M" "url" => "/21735743/0000001800000009/v2_202210290545/S2173574322001526/v2_202210290545/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The Value of a Negative Antinuclear Antibody (ANA) Test: An Often Forgotten Result" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "563" "paginaFinal" => "564" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Adrian Y.S. Lee" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Adrian Y.S." "apellidos" => "Lee" "email" => array:1 [ 0 => "adrian.lee1@health.nsw.gov.au" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "ICPMR & Department of Immunology, Westmead Hospital, Westmead, NSW, Australia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El valor de una prueba de anticuerpos antinucleares (ANA) negativa: un resultado a menudo olvidado" ] ] "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" => 1001 "Ancho" => 1255 "Tamanyo" => 287998 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Example cytoplasmic staining on the HEp-2 substrate. (A) F-actin staining suggesting the presence of smooth muscle antibodies found in autoimmune hepatitis and related disorders. (B) Coarse, granular cytoplasmic staining suggestive of anti-mitochondrial antibodies found in primary biliary cirrhosis. (C) Smooth, homogenous cytoplasmic staining suggestive of anti-ribosomal P antibodies found in systemic lupus erythematosus. (D) Large cytoplasmic dots staining suggestive of anti-GW bodies. All micrographs are taken at a magnification of 400×.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It is quite clear that medicine is biased towards positive results and the same applies to the practice of pathology.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> One of the ubiquitous tests in autoimmunity, the antinuclear antibody (ANA) suffers from this very same fate. A number of guidelines report on the clinical utility of a positive ANA and dissuade clinicians from requesting this test in the setting of low pre-test probability for an ANA-associated autoimmune disorder (AAD).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> This is certainly sound advice and prevents unnecessary investigations and healthcare expenditure. Yet, it is important to realise the clinical importance and pitfalls of a negative ANA results which sometimes becomes forgotten.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The internationally-accepted “gold standard” to measure ANA is via indirect immunofluorescence on HEp-2 cells.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> A negative ANA test on HEp-2 substrate usually means that there is no significant detection of IgG ANA (in the nucleus) at a specified dilution of serum – usually 1:80 to 1:160. There is a move to also classify positive cytoplasmic and mitotic staining of the HEp-2 substrate as ANA positive.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3,4</span></a> This may improve the sensitivity of detecting AADs and prompt appropriate further testing and follow-up (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The high sensitivity and negative predictive value (NPV) for systemic lupus erythematosus (SLE) makes the ANA test a good “rule out” test to essentially exclude this disorder if it is negative.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Indeed, the most recent European League Against Rheumatism/American College of Rheumatology guidelines for the diagnosis of SLE mandates a positive ANA (<span class="elsevierStyleUnderline">></span>1:80) on the HEp-2 substrate to be considered for this diagnosis.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Sensitivities for detecting other AADs is low-moderate at best; yet also demonstrates very high NPVs.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> Unless there has been a significant change in clinical picture or there is a suspicion of a laboratory issue, there is little value in repeating an ANA that is initially negative.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A pitfall is that ANA is a screening test and may, in rare instances, miss low-level specific autoantibodies/anti-extractable nuclear antigens (ENAs) if more sensitive assays are not performed,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> or miss anti-ENA that do not produce a characteristic ANA pattern e.g., anti-Ro52. Therefore, the substrate should be specified in the report since substrates such as the HEp-2000® (Immunoconcepts) which has transfected Ro60 increase the detection of anti-Ro60 and hence, a negative result makes the presence of anti-Ro60 less likely.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">If there is a high clinical suspicion for an AAD, the clinician should request further anti-ENA tests and the overall clinical picture and physician's interpretation of the patient should prevail. This is especially of importance since commercial HEp-2 substrates, whilst generally demonstrating excellent inter-assay and inter-laboratory agreement, display subtle staining differences that affect the microscopist's final interpretation.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> The significance of low levels of anti-ENA with negative ANA is not well established.</p><p id="par0030" class="elsevierStylePara elsevierViewall">To conclude, clinicians should be aware of the value, implications and pitfalls of a negative ANA result when considering AADs. They should also be aware of their laboratory's definitions of a “negative” ANA result, the substrate used and whether they report non-nuclear patterns which may have important implications for their patients. Importantly, the overall clinical picture of the patient should be taken into considerations when deciding on the relevancy of a negative ANA test.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">Nil.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1001 "Ancho" => 1255 "Tamanyo" => 287998 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Example cytoplasmic staining on the HEp-2 substrate. (A) F-actin staining suggesting the presence of smooth muscle antibodies found in autoimmune hepatitis and related disorders. (B) Coarse, granular cytoplasmic staining suggestive of anti-mitochondrial antibodies found in primary biliary cirrhosis. (C) Smooth, homogenous cytoplasmic staining suggestive of anti-ribosomal P antibodies found in systemic lupus erythematosus. (D) Large cytoplasmic dots staining suggestive of anti-GW bodies. All micrographs are taken at a magnification of 400×.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Publication bias in clinical trials of electronic health records" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.K. Vawdrey" 1 => "G. Hripcsak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jbi.2012.08.007" "Revista" => array:6 [ "tituloSerie" => "J Biomed Inform" "fecha" => "2013" "volumen" => "46" "paginaInicial" => "139" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22975314" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence-based guidelines for the use of immunologic tests: antinuclear antibody testing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.H. Solomon" 1 => "A.J. Kavanaugh" 2 => "P.H. Schur" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.10561" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2002" "volumen" => "47" "paginaInicial" => "434" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12209492" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Agmon-Levin" 1 => "J. Damoiseaux" 2 => "C. Kallenberg" 3 => "U. Sack" 4 => "T. Witte" 5 => "M. Herold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2013-203863" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2014" "volumen" => "73" "paginaInicial" => "17" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24126457" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Damoiseaux" 1 => "L.E.C. Andrade" 2 => "O.G. Carballo" 3 => "K. Conrad" 4 => "P.L.C. Francescantonio" 5 => "M.J. Fritzler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2019" "volumen" => "78" "paginaInicial" => "879" "paginaFinal" => "889" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of antinuclear antibodies for classifying systemic lupus erythematosus: a systematic literature review and meta-regression of diagnostic data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Leuchten" 1 => "A. Hoyer" 2 => "R. Brinks" 3 => "M. Schoels" 4 => "M. Schneider" 5 => "J. Smolen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2018" "volumen" => "70" "paginaInicial" => "428" "paginaFinal" => "438" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Aringer" 1 => "K. Costenbader" 2 => "D. Daikh" 3 => "R. Brinks" 4 => "M. Mosca" 5 => "R. Ramsey-Goldman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2018-214819" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2019" "volumen" => "78" "paginaInicial" => "1151" "paginaFinal" => "1159" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31383717" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antinuclear antibody testing: a study of clinical utility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.A. Slater" 1 => "R.B. Davis" 2 => "R.H. Shmerling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1996" "volumen" => "156" "paginaInicial" => "1421" "paginaFinal" => "1425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8678710" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The concordance of serial ANA tests in an Australian tertiary hospital pathology laboratory" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.Y.S. Lee" 1 => "A.R. Hudspeth" 2 => "S. Adelstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pathol.2016.06.003" "Revista" => array:6 [ "tituloSerie" => "Pathology" "fecha" => "2016" "volumen" => "48" "paginaInicial" => "597" "paginaFinal" => "601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27600602" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of a unique anti-Ro60 subset with restricted serological and molecular profiles" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.Y.S. Lee" 1 => "D. Beroukas" 2 => "L. Brown" 3 => "C. Lucchesi" 4 => "A. Kaur" 5 => "L. Gyedu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cei.13508" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Immunol" "fecha" => "2021" "volumen" => "203" "paginaInicial" => "13" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32852779" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utility of the HEp-2000 antinuclear antibody substrate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.Y.S. Lee" 1 => "D. Beroukas" 2 => "P.J. Roberts-Thomson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2019-215519" "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2020" "volumen" => "79" "paginaInicial" => "e67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31088792" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening for IgG antinuclear autoantibodies by HEp-2 indirect fluorescent antibody assays and the need for standardization" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.S. Copple" 1 => "S.R. Giles" 2 => "T.D. Jaskowski" 3 => "A.E. Gardiner" 4 => "A.M. Wilson" 5 => "H.R. Hill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1309/AJCPICNFG7UCES1S" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol" "fecha" => "2012" "volumen" => "137" "paginaInicial" => "825" "paginaFinal" => "830" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22523223" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001800000009/v2_202210290545/S2173574322001538/v2_202210290545/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001800000009/v2_202210290545/S2173574322001538/v2_202210290545/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574322001538?idApp=UINPBA00004M" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 47 | 15 | 62 |
2024 October | 434 | 49 | 483 |
2024 September | 633 | 43 | 676 |
2024 August | 815 | 50 | 865 |
2024 July | 978 | 40 | 1018 |
2024 June | 739 | 40 | 779 |
2024 May | 1021 | 51 | 1072 |
2024 April | 730 | 27 | 757 |
2024 March | 700 | 45 | 745 |
2024 February | 749 | 37 | 786 |
2024 January | 773 | 38 | 811 |
2023 December | 584 | 39 | 623 |
2023 November | 692 | 33 | 725 |
2023 October | 620 | 39 | 659 |
2023 September | 424 | 35 | 459 |
2023 August | 250 | 18 | 268 |
2023 July | 123 | 21 | 144 |
2023 June | 101 | 33 | 134 |
2023 May | 47 | 37 | 84 |
2023 March | 8 | 4 | 12 |