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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Idiopathic Inflammatory Myopathies &#40;IIM&#41; are heterogeneous and often result in morbidity and at times even mortality&#46; The various subsets of IIM&#44; namely polymyositis &#40;PM&#41;&#44; dermatomyositis &#40;DM&#41;&#44; overlap myositis &#40;OM&#41;&#44; and anti-synthetase syndrome &#40;ASS&#41; have varied pathogenic origins with common involvement of the muscle and often the pulmonary tissue&#46; While innate immune activation in response to environmental influences is usually the first breach in tolerance that initiates autoimmunity&#44; consistent adaptive immune activation is essential for a sustained inflammatory response in autoimmune diseases including IIM&#46; Recent literature suggests pathogenic origins of certain subsets of IIM such as ASSD in the lung&#44; particularly in smokers with the ancestral haplotype&#44; which later triggers systemic autoimmunity&#46; The presence of tertiary lymphoid organogenesis &#40;TLO&#41; has been demonstrated in the lungs and muscle tissues of patients with DM and ASSD respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#8211;3</span></a> Furthermore&#44; the oligoclonal expansion of T cells suggests common antigenic drivers of autoimmunity&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> To the same effect&#44; maternal microchimeric antigens are known to persist in muscle tissue of male children with jDM&#44; as a reminder of antigenic drivers&#46;<span class="elsevierStyleSup">5</span> Thus&#44; it seems plausible that the various T helper &#40;Th&#41; cell subsets in the peripheral blood may be reflective of the ongoing events and mechanisms of autoimmunity in the various subsets of IIM&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Inflammation in the lung may be granulomatous&#44; as seen in sarcoidosis&#44; wherein a Th1 response is dominant and central to Interferon-gamma &#40;IFN-&#947;&#41; production and Th cell and macrophage activation&#46; Th subset plasticity occurs along a continuum&#44; with a variable switch of Th1 subsets to Th17 phenotype in the appropriate milieu&#46; The Th17&#46;1 cells are plastic variants demonstrating fluidic shifts in an inflamed microenvironment&#46; Understanding the Th1 and Th17 balance assumes a larger role in the era of precision medicine wherein biotherapeutics with specific targets are available&#46; Since the Th cell subsets are well characterized in sarcoidosis&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;7</span></a> and lung inflammation and consequent Interstitial Lung Disease &#40;ILD&#41; in IIM continues to be a challenge&#44; exploring the T helper subset profiles of these individuals in comparison with ILD in sarcoidosis may provide greater insight&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Previously proportions of various T cell subsets have lent researchers a greater understanding of the pathogenesis in other autoantibody-driven diseases&#44; such as lupus&#44; rheumatoid arthritis&#44; and ANCA associated vasculitis&#46; The utility of T helper subsets as biomarkers has also been explored&#46; There is a dearth of biomarkers in IIM to identify ongoing inflammation in the muscle and distinguish it from inactivity or damage&#46; Since myositis is an autoantibody-mediated disease and TLO is reported in the diseased muscles we had previously focussed on B cell associated biomarkers&#46; We now looked for peripheral blood T helper subset profiling as a reflection of ongoing muscle inflammation&#46; We further compare the T helper subset ratios in various clinical and antibody defined subsets of IIM and compare and contrast the picture in myositis ILD with that in sarcoidosis&#44; where the disease is less heterogeneous&#44; and pathogenesis is better understood&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Fifty-six patients with probable or possible IIM by 2017 ACR-EULAR classification criteria<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> were prospectively evaluated with the assessment of clinical features and laboratory data &#40;including autoantibodies&#41; in an institutional review board certified study &#91;2017-41-IP-76&#93;&#46; They were screened to identify cases without active ongoing infection&#44; pregnancy&#44; acute renal dysfunction&#44; or chronic kidney disease&#46; Those with metabolic&#44; degenerative&#44; inherited&#44; or other forms of myopathies were excluded &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Further sub Classification into Polymyositis &#40;PM&#41;&#44; DM&#44; Juvenile IIM &#40;JIIM&#41;&#44; Overlap Myositis &#40;OM &#8211; in association with another CTD&#41; was done&#46; Those with two or more rashes suggestive of DM but without gottron&#39;s or heliotrope rashes were also classified as DM&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> Twenty-one healthy controls and 18 patients with sarcoidosis were included as diseased controls for comparison&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Clinical details</span><p id="par0025" class="elsevierStylePara elsevierViewall">A standardized case record form &#40;CRF&#41; was used to record clinical and laboratory variables&#46; Clinical data and sera of patients and healthy controls were retrieved from the database and biobank respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">10&#8211;12</span></a> Case details were supplanted with standard outcome measures as described by the International Myositis Assessment &#38; Clinical Studies Group &#40;IMACS&#41;&#46; Active disease was defined by Myositis Disease Activity Assessment Tool &#40;MDAAT&#41; score of greater than or equal to one&#46; STROBE&#39;s checklist was followed for reporting results&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Controls</span><p id="par0030" class="elsevierStylePara elsevierViewall">Healthy controls&#58; Twenty-one healthy adults without any comorbidities were included as healthy controls &#40;HC&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Disease controls&#58; Eighteen patients of sarcoidosis with a male to female ratio of 1&#46;4&#58;1 were included as disease controls &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Laboratory assays</span><p id="par0040" class="elsevierStylePara elsevierViewall">Sera from all the patients were tested for Myositis Specific&#47;Myositis Associated Antibodies &#40;MSA&#47;MAA&#41; by the Line immunoassay &#40;G4 panel&#44; Euro-Immune&#44; Lubeck&#44; Germany&#41; and Anti-Nuclear antibodies &#40;ANA&#41; using the immunofluorescence assay &#40;IFA&#44; Nova-lite&#44; Inova&#44; CA&#44; USA&#41; according to the manufacturer&#39;s instructions&#46; A cut-off of &#43;&#43; was taken as positive for the former and 1&#58;80 dilution was used for the analysis of ANA&#46; Samples were diluted to 1 in 100 for the latter&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">T-cell staining</span><p id="par0045" class="elsevierStylePara elsevierViewall">Fresh venous peripheral blood samples were collected from the study patients and controls by venipuncture using sterile lithium heparin-treated tubes&#46; The blood samples were diluted in a ratio of 1&#58;1 with incomplete RPMI-1640 culture media &#40;Sigma&#8211;Aldrich&#44; St&#46; Louis&#41; and stimulated with phorbol 12-myristate 13-acetate &#40;PMA&#44; 20<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#59; Sigma&#8211;Aldrich&#44; St&#46; Louis&#41;&#44; ionomycin &#40;1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#59; Sigma&#8211;Aldrich&#44; St&#46; Louis&#41; and monensin &#40;2<span class="elsevierStyleHsp" style=""></span>&#956;M&#59; bd biosciences&#44; San Diego&#44; Ca&#41; for 5<span class="elsevierStyleHsp" style=""></span>h at 37<span class="elsevierStyleHsp" style=""></span>&#176;C in culture incubator&#46; The surface staining was performed using an appropriate surface markers CD4&#43;IFN-&#947;&#43;&#44; CD4&#43; IL-17&#43;&#44; CD4&#43;IFN-&#947;&#43;IL-17&#43;&#44; and CD4&#43;CD25&#43; FOXP3&#43; for Th1&#44; th17&#44; Th17&#46; 1 and Treg cells shown in <a class="elsevierStyleCrossRef" href="#sec0085">Supplementary Table I</a> and <a class="elsevierStyleCrossRef" href="#sec0085">Supplementary Fig&#46; 4</a>&#46; After that&#44; red blood cells were lysed using BD FACS&#8482; lysing solution buffer&#46; Cells were washed with 1X PBS&#44; fixed and permeabilized using BD Cytofix&#47;Cytoperm&#8482; &#40;BD Pharmingen&#41; followed by washing with cytoperm wash buffer as per the provided instructions&#46; The stained cells were acquired on the BD Facs Canto II Flowcytometry machine&#46; All the results were analyzed using BD Facs diva software version &#40;6&#46;1&#46;3&#41;&#44; considering at least 10&#44;000<span class="elsevierStyleHsp" style=""></span>cells for the lymphocyte gate&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Data were represented as median<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>IQR or &#37;&#46; Unpaired t tests or Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> tests were used for intergroup comparisons&#46; Kruskal&#8211;allis test was used for multi-group comparisons&#46; <span class="elsevierStyleItalic">p</span>-Values of &#60;0&#46;05 were considered statistically significant&#46; GraphPad Prism software&#44; version 8&#46;2&#46;1 was used for statistical analysis&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Baseline characteristic</span><p id="par0055" class="elsevierStylePara elsevierViewall">56 patients with IIM &#91;31 DM &#40;55&#46;35&#37;&#41;&#44; 17 PM &#40;30&#46;35&#37;&#41;&#44; 5 OM &#40;8&#46;93&#37;&#41;&#44; 3 JDM &#40;5&#46;35&#37;&#41;&#93; of median age 36 &#40;25&#8211;45&#41; years &#40;4&#46;1&#58;1 F&#58;M&#41; and disease duration of 3&#40;2&#8211;8&#41; years were studied&#46; Twenty-one HC &#40;14 Male and 7 Female&#41; with median age 32 &#40;24&#46;5&#8211;41&#41; and 18 patients with sarcoidosis of median age 42 &#40;33&#46;75&#8211;53&#46;75&#41; &#123;ILD &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; or without ILD &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&#125; were included as controls &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Th subsets in IIM versus healthy controls</span><p id="par0060" class="elsevierStylePara elsevierViewall">All Th subsets were elevated in IIM than HC &#91;Th1 &#40;49&#46;65&#37; vs 14&#46;32&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#59; Th17 &#40;4&#46;4&#37; vs&#46; 1&#46;7&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#59; Th17&#46;1 &#40;2&#46;2&#37; vs&#46; 0&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0002&#41;&#59; Treg &#40;6&#46;2&#37; vs&#46; 3&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#93; &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Th subsets in various subsets of IIM</span><p id="par0065" class="elsevierStylePara elsevierViewall">All Th subsets were elevated in the three subtypes of IIM&#8211;DM&#44; PM and OM than HC &#91;Th1 &#40;55&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#59; 49&#46;15&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#59; 45&#46;35&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41;&#59; Th17 &#40;4&#46;0&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#59; 4&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#59; 5&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; Th17&#46;1 &#40;1&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0078&#59; 2&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#59; 2&#46;7&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0019&#59;&#41; and Treg cells &#40;6&#46;1&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0012&#59; 6&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#59; 7&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#44; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#93; respectively except in JDM&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">No difference was observed in the Th subsets after subcategorization based on MSAs &#40;ARS&#44; Mi-2&#44; SAE-1&#44; NXP-2&#44; MAA&#44; Negative&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0085">Supplementary Fig&#46; 1I</a>&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Th subsets in IIM versus sarcoidosis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Th1 and Treg were significantly elevated in Sarcoidosis as compared with IIM&#46; However&#44; Th17 population was lower in sarcoidosis compared to IIM&#46; &#91;Th1&#40;69&#46;1&#37; vs 49&#46;65&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#93;&#44; &#91;Treg &#40;12&#46;05&#37; vs 6&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#93;&#44; &#91;Th17 &#40;2&#46;49&#37; vs 4&#46;4&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#93; respectively&#46; Similarly&#44; the distribution of the Th subsets was similar in the subpopulation with ILD between both the groups&#91;Th1 &#40;68&#46;15&#37; vs 50&#46;40&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0265&#41;&#44; Treg &#40;15&#46;61&#37; vs 7&#46;1&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0168&#41;&#44; Th17 &#40;2&#46;35&#37; vs 5&#46;25&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0046&#41;&#93; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">T helper subsets based on clinical manifestation and disease activity</span><p id="par0080" class="elsevierStylePara elsevierViewall">There was no significant difference in between the various phenotypic subsets &#40;arthritis present vs&#46; absent&#44; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>b&#41; and active vs&#46; inactive disease groups &#40;<a class="elsevierStyleCrossRef" href="#sec0085">Supplementary Figs&#46; II and III</a>&#41;&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The peripheral blood T cell signature is heterogeneous in patients with IIM&#46; We evaluated the T cell profile in IIM and compared it with those of HC and sarcoidosis &#8211; a multisystem disease with chronic lung involvement akin to IIM with a well characterized pathogenesis&#46; We observed an elevated peripheral blood Th1&#44; Th17&#44; Th17&#46;1&#44; and Treg population in IIM as compared to HC irrespective of the subtype of IIM&#44; MSA specificity&#44; and disease activity&#46; Patients with IIM exhibited a stronger Th17 and lower Th1 and Treg signature as compared with sarcoidosis&#46; Patients with OM showed a dominant Th17&#46;1 signature&#44; possibly suggesting the dominance of a plastic phenotype of Th cells&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The autoimmune basis of IIM is substantiated with CD4 and CD8 T cell infiltration in muscle biopsy specimens&#46; In recent years&#44; the discovery of MSA and MAA further supports a direct role of B cells in the pathogenesis of IIM&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a> B cell and autoantibody production&#44; in turn&#44; require help from T cells&#46; The known susceptibility of IIM to certain HLAs &#40;predominantly HLA-DR&#41; and demonstration of restricted TCR repertoire in muscle tissues&#44; point towards an indisputable role of T cells in the pathogenesis of IIM&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">IFN-&#947;&#44; the signature cytokine produced by Th1 cells is elevated in PM&#47;DM muscle biopsy samples&#46; Furthermore&#44; IFN-&#947; cytokine levels along with Tumor Necrosis Factor alpha &#40;TNF-&#945;&#41; are elevated in muscle specimens from Inclusion Body Myositis &#40;IBM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Th1 response through IFN-&#947; activates proinflammatory M1 macrophages resulting in further inflammation and tissue damage&#46; Traditionally&#44; the Th1 response was considered to be the predominant inflammatory phenotype responsible for the pathogenesis in IIM until the discovery of Th17 cells&#46; Analysis of the peripheral blood for Th1 cells has shown a lower frequency in active DM as compared to HC with elevated Th2&#47;Th1 ratios in DM<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;16</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; However&#44; a clear Th1 predominant pattern is seen in the peripheral blood in patients with IBM&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> Although we observed elevated Th1 levels in IIM as compared to HC&#44; the levels were lower when compared with patients with Sarcoidosis&#46; This can be explained by the heterogeneity of the subtypes of IIM&#44; the differences in duration of disease and the possible influence of treatment&#46; Moreover&#44; the Th cell subsets cannot be strictly defined at all times given considerable plasticity based on the inflammatory milieu&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Since the discovery of Th17 cells&#44; their role has been explored in the pathogenesis of various autoimmune rheumatic diseases&#44; and myositis is no exception&#46; An increased expression of IL-17 and IL-23 mRNA in muscle specimens from patients with IIM compared to HC suggests activation of the IL-17&#47;IL-23 pathway&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> IL-17 along with IL-1 stimulated IL-6 production regulates the survival and differentiation of B cells&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> IL-17 induced Nuclear factor kappa B expression in myoblasts enhances inflammatory injury&#44; inhibits myocyte differentiation&#44; and myocyte migration through induction of TNF-like weak inducer of apoptosis &#40;TWEAK&#41;&#46; A predominant Th17 mediated inflammation is proposed in a subcategory of patients responding to IVIG&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> Moreover&#44; IL-17 may play an important role in TLO genesis and sustenance&#46; Elevated IL-17A has been found in patients with ASSD and Connective tissue disease associated ILD as compared to HC&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">20&#44;21</span></a> Thus&#44; IL-17 plays a central role in enhancing inflammation&#44; induction of antibodies&#44; and impairing muscle regeneration which is characteristic of the pathogenesis of IIM&#46; In our present work&#44; we observed increased Th17 numbers in the peripheral blood as compared to HC as previously depicted in the work by Ortega and Wilkinson et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">22&#44;23</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Th cells exhibit considerable plasticity and in presence of IL-12 and IL-23 without Transforming Growth Factor &#40;TGF-&#946;&#41;&#44; Th17 cells can evolve into IFN producing Th17&#46;1 cells&#46; The role of Th17&#46;1 cells is explored in cancer biology&#44; inflammatory bowel disease&#44; and rheumatoid arthritis and defined phenotypically as an aggressive phenotype that exhibits resistance to glucocorticoids by expression of P-glycoprotein&#47;multidrug resistance&#46; Ours was a novel attempt at characterizing Th17&#46;1 signature in the peripheral blood in patients with IIM and it was significantly elevated as compared to HC&#46; Further&#44; DM and OM had a trend towards greater Th17 and Th17&#46;1 signature as compared to PM in the peripheral blood&#46; This can be explained based on a greater extent of systemic inflammation and multiorgan involvement in the latter two&#46; Although this seems to be a plausible explanation&#44; the findings need to be verified in a larger cohort&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A tilted balance between pro-inflammatory Th1&#44; Th17&#44; and Treg in favour of the former has been seen in most autoimmune diseases&#46; Most studies show lower peripheral blood Treg cells in IIM as compared to HC&#46; However&#44; the frequency of Treg is comparable between IIM and HC in muscle biopsy specimens&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> The lower numbers in the peripheral blood in patients with IIM could indicate sequestration to sites of inflammation in the affected muscles and other organs&#46; But conversely&#44; we demonstrated higher peripheral blood Treg frequency IIM than HC as in the study by Wilkinson et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">22&#44;28&#44;30</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Sarcoidosis was traditionally believed to be a Th1 mediated disease with IFN-&#947; playing a central role in the granulomatous inflammation&#46; Th2 mediated inflammation dominates the chronic phase of the disease with established fibrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;7&#44;24</span></a> However&#44; recent studies have identified increased Th17 fractions in the bronchoalveolar fluid as well as the peripheral blood&#44; with a correlation of Th17&#46;1 cells with the Scadding stage&#44; arthritis&#44; and relapsing disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">25&#44;26</span></a> A recent study identified Th17&#46;1 cells as the predominant IFN-&#947; producing cells in the BAL fluid in patients with Sarcoidosis challenging the Th1 paradigm&#46; An exaggerated Th1 profile was seen in Sarcoidosis as compared to IIM&#44; with lower Th17 levels and similarly elevated Th17&#46;1 values in peripheral blood&#46; This difference may account for the characteristic IFN-&#947; driven granulomatous inflammation characteristic of Sarcoidosis steered by either Th1&#44; or Th17&#46;1 cells&#44; depending on the phase of the disease&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The discovery of MSA in IIM with some showing a correlation with disease activity throws light on the significant role of B cells in the immunopathogenesis&#44; and interaction between Th17 and B cell is reciprocatory&#46; Th17 predominant inflammation in IIM enhances proliferation of B cells with subsequent autoantibody production possibly through IL-6 production&#46; And&#44; B-1 cells can in turn induce Th17 cell differentiation from na&#239;ve Th cells&#46; This interaction is further supported by Th17 predominant inflammation in a subcategory of patients with IIM responding to IVIG&#46; TLO is reported in new onset JDM with a poor response to standard therapy and a greater need for treatment with cyclosporine&#44; IVIG&#44; or Rituximab in those with well-defined follicular structures in the inflamed muscles&#46; TLO is observed in Rheumatoid arthritis &#40;in the synovium&#41; and Sjogren&#39;s Syndrome &#40;in the salivary glands&#41; and represents an extra nodal site of immune activation with greater Dendritic cell-T-B cell interaction&#46; It also bypasses the immune regulation that normally occurs in regional lymph nodes&#46; We did not find any influence of MSA specificity on the T cell profile possibly due to a smaller sample size as positivity is expected in around 60&#37; of patients&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Drugs targeting the IL-23-IL-17 axis are being considered to be potentially useful and clinical case reports of IL-6 inhibition in IIM are described&#46; A clinical trial of Ustekinumab in PM&#47;DM is underway and is in the stage of recruitment&#46; The interplay between B cells and Th17 cells&#44; with the known role of Th17 cells in the establishment and maintenance of TLO further supports the possibility of exploring Th17 inhibition in IIM in addition to B cell targeting therapy&#46; Similarly&#44; a Th1 predominant inflammation in the acute phase of Sarcoidosis with the chronic fibrotic stage induced by Th17 cells is proposed&#46; Another evolving concept is the activation of a metabolic checkpoint kinase mechanistic target of rapamycin complex 1 &#40;mTORC1&#41; that drives the proliferation of macrophages and granuloma formation&#46; Both these newer targets are being explored in Sarcoidosis with an ongoing trial of Ustekinumab and case reports of sirolimus use in chronic Sarcoidosis&#46; The current observations of a Th17 paradigm in IIM open the case for exploring these pathways therapeutically in the disease&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Other than T and B cells&#44; role of the innate immune system has been also implicated in various subtypes of myositis&#46; Increased NK cell infiltration secondary to downregulation of NKp30 in muscle and lung in ASSD and decreased functioning in JDM has been demonstrated&#46; NKG2D and NKp46 correlated with lung involvement and its severity in ASSD and DM in a recent study&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> The role of Innate lymphoid cells have been studied extensively in other autoimmune inflammatory diseases like rheumatoid arthritis&#44; Systemic Lupus Erythematosus and Spondyloarthritis but their role in IIM is yet to be explored&#46; IL-23 independent IL-17 producing cells like ILC-3 and NKT cells could be important players in IIM&#46; Future projects integrating biomarkers of innate and adaptive immune systems will be able to shed light better on the differential role of these in IIM and its subtypes&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The distinct strengths of our paper include attempts at characterization of Th17&#46;1 cells in the peripheral blood in IIM and comparing the T cell profile with Sarcoidosis&#44; another multisystem disease with an established T cell mediated pathogenesis&#46; The drawbacks include a cross-sectional evaluation of the T cell profile&#46; T helper subsets are known to undergo fluidic shifts depending on the stage of the disease and activity&#46; Therefore&#44; a timed follow-up evaluation with an analysis of disease activity may provide greater insight into the changing T cell profile relevant to the pathogenesis of IIM&#46; Furthermore&#44; validating the findings in a larger subset may provide greater insight into the pathogenetically distinct subtypes of IIM&#46; To further explore the role of T cells in TLO&#44; evaluation of muscle and lung tissue for T cell subsets will be of relevance in the future&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; Th axis was skewed towards a Th1&#44; Th17&#44; and Th17&#46;1 profile in IIM compared to HC with a greater Th17 and lower Th1 fractions as compared with Sarcoidosis&#46; It explains the diverse organ involvement seen across both the disease with the difference plausibly explaining the type of inflammation seen in the underlying involved organs&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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              "titulo" => "Conclusi&#243;n"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Clinical details"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Controls"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Laboratory assays"
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              "identificador" => "sec0030"
              "titulo" => "T-cell staining"
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              "titulo" => "Statistical analysis"
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            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Baseline characteristic"
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            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Th subsets in IIM versus healthy controls"
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              "identificador" => "sec0055"
              "titulo" => "Th subsets in various subsets of IIM"
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              "identificador" => "sec0060"
              "titulo" => "Th subsets in IIM versus sarcoidosis"
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              "identificador" => "sec0065"
              "titulo" => "T helper subsets based on clinical manifestation and disease activity"
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          "titulo" => "Discussion"
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          "titulo" => "References"
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    "fechaRecibido" => "2021-09-02"
    "fechaAceptado" => "2022-03-10"
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            0 => "Th17 cells"
            1 => "Myositis"
            2 => "Sarcoidosis"
            3 => "Biomarkers"
            4 => "Muscles"
            5 => "Lung diseases"
            6 => "Interstitial"
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          "palabras" => array:7 [
            0 => "C&#233;lulas Th17"
            1 => "Miositis"
            2 => "Sarcoidosis"
            3 => "Biomarcadores"
            4 => "M&#250;sculos"
            5 => "Enfermedades pulmonares"
            6 => "Intersticiales"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">There is a dearth of biomarkers in Idiopathic Inflammatory Myopathies &#40;IIM&#41; to recognize ongoing muscle inflammation and distinguish damage from activity&#46; Since IIM is an autoantibody-mediated disease with tertiary lymphoid organogenesis reported in the diseased muscles&#44; we aimed to study the peripheral blood T helper &#40;Th&#41; subset profiling as a plausible reflection of ongoing muscle inflammation&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fifty-six patients of IIM were compared with 21 healthy controls &#40;HC&#41; and 18 patients with sarcoidosis&#46; Th1&#44; Th17&#44; Th17&#46;1&#44; and Treg cells were identified after stimulation assays &#40;BD Biosciences&#41;&#46; Myositis autoantibodies were tested by line immunoassay &#40;Euroimmune&#44; Germany&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All Th subsets were elevated in IIM as compared with HC&#46; As compared to HC&#44; PM had elevated Th1 and Treg while Th17 and Th17&#46;1 populations were higher in OM&#46; Patients with sarcoidosis had higher Th1 and Treg but lower Th17 population as compared to IIM &#123;Th1&#40;69&#46;1&#37; vs 49&#46;65&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; &#123;Treg &#40;12&#46;05&#37; vs 6&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; &#123;Th17 &#40;2&#46;49&#37; vs 4&#46;4&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#125;&#46; Similar results were obtained when sarcoidosis ILD was compared with IIM ILD with a higher Th1 and Treg population but lower Th17 population in the former&#46; No difference in T cell profile was observed after stratification for MSA positivity&#44; type of MSA&#44; clinical features of IIM and disease activity&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Th subsets in IIM are distinct from sarcoidosis and HC with a TH17 predominant paradigm&#44; creating a case of exploring Th17 pathway and IL-17 blockers for the treatment of IIM&#46; However&#44; cell profiling cannot distinguish active from inactive disease limiting its predictive potential as a biomarker of activity in IIM&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Hay una escasez de biomarcadores en las miopat&#237;as inflamatorias idiop&#225;ticas &#40;MII&#41; para reconocer la inflamaci&#243;n muscular en curso y distinguir el da&#241;o de la actividad&#46; Dado que la MII es una enfermedad mediada por autoanticuerpos con organog&#233;nesis linfoide terciaria informada en los m&#250;sculos enfermos&#44; nuestro objetivo fue estudiar el perfil del subconjunto de linfocitos T <span class="elsevierStyleItalic">helpers</span> &#40;Th&#41; de sangre perif&#233;rica como un reflejo plausible de la inflamaci&#243;n muscular en curso&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se compararon 56 pacientes de MII con 21 controles sanos &#40;CS&#41; y 18 pacientes con sarcoidosis&#46; Las c&#233;lulas Th1&#44; Th17&#44; Th17&#46;1 y Treg se identificaron despu&#233;s de los ensayos de estimulaci&#243;n &#40;BD Biosciences&#41;&#46; Los autoanticuerpos de miositis se analizaron mediante inmunoan&#225;lisis en l&#237;nea &#40;Euroimmune&#44; Alemania&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Todos los subconjuntos de Th estaban elevados en las MII en comparaci&#243;n con los CS&#46; En comparaci&#243;n con los CS&#44; PM ten&#237;a Th1 y Treg elevados&#44; mientras que las poblaciones de Th17 y Th17&#46;1 eran m&#225;s altas en OM&#46; Los pacientes con sarcoidosis ten&#237;an una poblaci&#243;n Th1 y Treg m&#225;s alta pero una poblaci&#243;n Th17 m&#225;s baja en comparaci&#243;n con MII &#123;Th1 &#40;69&#44;1&#37; frente a 49&#44;65&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; &#123;Treg &#40;12&#44;05&#37; frente a 6&#44;2&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; &#123;Th17 &#40;2&#44;49&#37; frente a 4&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#125;&#46; Se obtuvieron resultados similares cuando se compar&#243; la EPI de sarcoidosis con la EPI de las MII con una mayor poblaci&#243;n Th1 y Treg pero menor poblaci&#243;n Th17 en la primera&#46; No se observaron diferencias en el perfil de c&#233;lulas T despu&#233;s de la estratificaci&#243;n por positividad de MSA&#44; tipo de MSA&#44; caracter&#237;sticas cl&#237;nicas de las MII y actividad de la enfermedad&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los subconjuntos de Th en las MII son distintos de la sarcoidosis y los CS con un paradigma predominante TH17&#44; lo que crea un caso de exploraci&#243;n de la v&#237;a Th17 y los bloqueadores de IL-17 para el tratamiento de las MII&#46; Sin embargo&#44; el perfil celular no puede distinguir la enfermedad activa de la inactiva&#44; lo que limita su potencial predictivo como biomarcador de actividad en las MII&#46;</p></span>"
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            "titulo" => "Resultados"
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            "apendice" => "<p id="par0155" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0085"
          ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Methodology &#40;a&#41; and MSA profile &#40;b&#41;&#46;</p>"
        ]
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        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Representative dot plot depicting T helper subsets in Idiopathic Inflammatory Myopathy &#40;IIM&#41; as compared with healthy controls &#40;a&#41; Th1 &#40;b&#41; Th17 &#40;c&#41; Th17&#46;1 &#40;d&#41; T reg&#46; Statistical test used is Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46;</p>"
        ]
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        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Representative dot plot comparing percentage of T cell subsets in various subsets of myositis &#40;Dermatomyositis &#8211; DM&#44; Polymyositis &#8211; PM&#44; Overlap Myositis &#8211; OM&#44; juvenile dermatomyositis &#8211; JDM with healthy controls &#40;HC&#41;&#46; &#40;a&#41; Th1 &#40;b&#41; Th17 &#40;c&#41; Th17&#46;1 &#40;d&#41; T reg&#46; Statistical test used is Kruskal&#8211;Wallis test&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Representative dot plot depicting that T helper subsets in Idiopathic Inflammatory Myopathy &#40;IIM&#41; vs sarcoidosis &#40;a&#41; Th1 &#40;b&#41; Th17 &#40;c&#41; T reg and in those with Interstitial Lung Disease &#40;ILD&#41; within IIM and sarcoidosis&#46; &#40;d&#41; Th1 &#40;e&#41; Th17 &#40;f&#41; T reg&#46; Statistical test used is Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46;</p>"
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        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#42;<span class="elsevierStyleItalic">Abbreviations</span>&#58; ARS&#44; antibodies to amino acyl t RNA synthetase&#44; NXP&#44; nuclear matrix protein&#59; ILD&#44; Interstitial Lung Disease&#59; SAE-1-Anti&#44; small ubiquitin-like modifier-1 activating enzyme&#59; MDA&#44; melanoma differentiation-associated protein&#59; dsDNA-Anti&#44; double standard DNA antibody&#59; Ku-anti&#44; Ku antibodies&#59; Mi-2&#44; antibodies to nucleosome remodeling deacetylase &#40;NuRD&#41; complex&#59; PM&#44; polymyositis&#59; DM&#44; dermatomyositis&#59; OM&#44; overlap myositis&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#35;</span>Of the 14 cases&#44; all had chronic ILD except one which had a rapidly progressive ILD&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Demographic details &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37; or median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>OM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;8&#46;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>JDM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Disease course</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monocyclic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;14&#46;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Polycyclic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;17&#46;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic continuous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;79&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Undefined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clinical profile</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Myositis&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">4 &#40;15&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ILD&#35;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rash&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 &#40;39&#46;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;44&#46;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;23&#46;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Disease duration &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;3 &#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Disease activity</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Active&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;53&#46;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inactive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;46&#46;43&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Antinuclear antibodies</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Positive</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nuclear</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Speckled&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">21 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Homogenous&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nucleolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>NXP2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;8&#46;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#46;79&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;35&#46;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of patients with inflammatory myositis&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">IIM&#44; idiopathic Inflammatory m&#47;myopathy&#59; HC&#44; healthy control&#59; M&#44; male&#59; F&#44; female&#59; PM&#44; polymyositis&#59; DM&#44; dermatomyositis&#59; OM&#44; overlap myositis&#44; jDM&#44; juvenile dermatomyositis&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Our study&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wilkinsin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antiga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
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