array:24 [
  "pii" => "S217357431630082X"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2015.11.016"
  "estado" => "S300"
  "fechaPublicacion" => "2016-11-01"
  "aid" => "852"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Reumatol Clin. 2016;12:354-5"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1224
    "formatos" => array:3 [
      "EPUB" => 64
      "HTML" => 848
      "PDF" => 312
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X1500193X"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2015.11.007"
      "estado" => "S300"
      "fechaPublicacion" => "2016-11-01"
      "aid" => "852"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Reumatol Clin. 2016;12:354-5"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4501
        "formatos" => array:3 [
          "EPUB" => 199
          "HTML" => 3147
          "PDF" => 1155
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Reumatolog&#237;a cl&#237;nica en im&#225;genes</span>"
        "titulo" => "S&#237;ndrome de Rowell&#58; las 2 caras de la verdad"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "354"
            "paginaFinal" => "355"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Rowell&#39;s syndrome&#58; The two sides of the truth"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 728
                "Ancho" => 1800
                "Tamanyo" => 379744
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#41; Epidermis con degeneraci&#243;n vacuolar de la basal &#40;asterisco&#41;&#44; queratinocitos necr&#243;ticos aislados &#40;flecha&#41; e infiltrado linfocitario discreto asociado&#46; Se observa verticalizaci&#243;n de las c&#233;lulas de la capa basal &#40;cabeza de flecha&#41;&#44; rasgo histol&#243;gico asociado con frecuencia a eritema multiforme&#46; Infiltrados linfoplasmocitarios y melan&#243;fagos en dermis papilar&#46; B&#41; Dermis reticular con infiltraci&#243;n intersticial de mucina &#225;cida &#40;asterisco&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juan Francisco L&#243;pez Caleya, Laura Mart&#237;n Rodrigo, Pablo Gonzalvo Rodriguez, Yolanda Hidalgo Garc&#237;a"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Juan Francisco"
                "apellidos" => "L&#243;pez Caleya"
              ]
              1 => array:2 [
                "nombre" => "Laura"
                "apellidos" => "Mart&#237;n Rodrigo"
              ]
              2 => array:2 [
                "nombre" => "Pablo"
                "apellidos" => "Gonzalvo Rodriguez"
              ]
              3 => array:2 [
                "nombre" => "Yolanda"
                "apellidos" => "Hidalgo Garc&#237;a"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S217357431630082X"
          "doi" => "10.1016/j.reumae.2015.11.016"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431630082X?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1500193X?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001200000006/v1_201610280501/S1699258X1500193X/v1_201610280501/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574316300946"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2016.02.004"
    "estado" => "S300"
    "fechaPublicacion" => "2016-11-01"
    "aid" => "891"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Reumatol Clin. 2016;12:356-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 948
      "formatos" => array:3 [
        "EPUB" => 60
        "HTML" => 613
        "PDF" => 275
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Vitamin D and Autoimmune Rheumatic Diseases"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "356"
          "paginaFinal" => "357"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Vitamina D y enfermedades reum&#225;ticas"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mar&#237;a A&#46; Mart&#237;n-Mart&#237;nez, Santos Casta&#241;eda, Ana Urruticoechea-Arana, Miguel A&#46; Gonz&#225;lez-Gay"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Mar&#237;a A&#46;"
              "apellidos" => "Mart&#237;n-Mart&#237;nez"
            ]
            1 => array:2 [
              "nombre" => "Santos"
              "apellidos" => "Casta&#241;eda"
            ]
            2 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Urruticoechea-Arana"
            ]
            3 => array:2 [
              "nombre" => "Miguel A&#46;"
              "apellidos" => "Gonz&#225;lez-Gay"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X16000401"
        "doi" => "10.1016/j.reuma.2016.02.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16000401?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316300946?idApp=UINPBA00004M"
    "url" => "/21735743/0000001200000006/v1_201611050033/S2173574316300946/v1_201611050033/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173574316300831"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2015.09.011"
    "estado" => "S300"
    "fechaPublicacion" => "2016-11-01"
    "aid" => "853"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2016;12:351-3"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1498
      "formatos" => array:3 [
        "EPUB" => 64
        "HTML" => 1212
        "PDF" => 222
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
      "titulo" => "Pyrophosphate Arthropathy Causing Shoulder Pain&#58; Value of Ultrasound in Its Therapeutic Approach"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "351"
          "paginaFinal" => "353"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Artropat&#237;a por pirofosfato c&#225;lcico como causa de hombro doloroso&#58; valor de la ecograf&#237;a en el abordaje diagn&#243;stico"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 849
              "Ancho" => 925
              "Tamanyo" => 83082
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Osteophytosis of the humeral head in relation to degenerative changes in the glenohumeral joint &#40;thick arrows&#41;&#46; Calcification of the acromioclavicular joint and humeral cartilage &#40;thin arrows&#41;&#46; No tendinous calcifications or subacromial impingement are observed&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#243;nica M&#46; Rom&#225;n Sastre, M&#46; Luisa Vega Gonz&#225;lez"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "M&#243;nica M&#46;"
              "apellidos" => "Rom&#225;n Sastre"
            ]
            1 => array:2 [
              "nombre" => "M&#46; Luisa"
              "apellidos" => "Vega Gonz&#225;lez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X15001941"
        "doi" => "10.1016/j.reuma.2015.09.005"
        "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/S1699258X15001941?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316300831?idApp=UINPBA00004M"
    "url" => "/21735743/0000001200000006/v1_201611050033/S2173574316300831/v1_201611050033/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
    "titulo" => "Rowell&#39;s Syndrome&#58; The Two Sides of the Truth"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "354"
        "paginaFinal" => "355"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Juan Francisco L&#243;pez Caleya, Laura Mart&#237;n Rodrigo, Pablo Gonzalvo Rodriguez, Yolanda Hidalgo Garc&#237;a"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Juan Francisco"
            "apellidos" => "L&#243;pez Caleya"
            "email" => array:1 [
              0 => "jflcaleya&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Laura"
            "apellidos" => "Mart&#237;n Rodrigo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Pablo"
            "apellidos" => "Gonzalvo Rodriguez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Yolanda"
            "apellidos" => "Hidalgo Garc&#237;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital de Cabue&#241;es&#44; Gij&#243;n&#44; Asturias&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Fundaci&#243;n Hospital de Jove&#44; Gij&#243;n&#44; Asturias&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Anatom&#237;a Patol&#243;gica&#44; Hospital de Cabue&#241;es&#44; Gij&#243;n&#44; Asturias&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital de Cabue&#241;es&#44; Gij&#243;n&#44; Asturias&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "S&#237;ndrome de Rowell&#58; las 2 caras de la verdad"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 746
            "Ancho" => 1749
            "Tamanyo" => 228971
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Scaly&#44; maculopapular eczema on trunk and extremities&#46; &#40;B&#41; Trunk involvement&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2000&#44; Zeitouni et al&#46; updated the diagnostic criteria of Rowell&#39;s syndrome &#40;RS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> They included the development of lupus erythematosus &#40;LE&#41; in its systemic&#44; discoid and subacute cutaneous forms&#44; erythema multiforme &#40;EM&#41; and antinuclear antibodies &#40;ANA&#41; &#40;a speckled pattern&#41; as the more important criteria&#46; Moreover&#44; they associated rheumatoid factor &#40;RF&#41;&#44; positive anti-Ro&#47;SS-A or anti-La&#47;SS-B antibodies and pernio &#40;chilblains&#41; as less significant criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 91-year-old woman with a 2-month history of generalized itching and painful dermatitis&#44; with a poor response to corticosteroid therapy&#46; She had not had infections or previous use of these medications&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination showed a scaly&#44; maculopapular eczema&#44; with crusting areas in trunk and all 4 extremities&#44; creating a typical result has shown &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The laboratory tests included RF &#40;83&#46;1<span class="elsevierStyleHsp" style=""></span>IU&#47;mL&#41;&#44; ANA &#40;1&#47;2560 speckled pattern&#41; and positive anti-Ro&#47;SSA and anti-La&#47;SSB&#46; The skin biopsy was compatible with LE and EM &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">For some authors&#44; the coexistence of LE and EM are not considered different entities&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It is difficult to distinguish between subacute cutaneous LE &#40;SCLE&#41; and EM&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;5</span></a> However&#44; other authors insist that the classical EM be acute and self-limited&#44; and that the lesions be bull&#39;s-eyes&#46; This is commonly associated with infections and previous drug exposure&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In RS&#44; the typical findings are recurrent&#44; EM-like lesions&#44; with no triggering factors and with positive antibodies and RF&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The speckled pattern of the ANA is the immunological characteristic most consistent of RS&#44; appearing in 60&#46;4&#37; to of the cases&#44; although it is not exclusive of this condition&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Therapy should be initiated with corticosteroid and hydroxychloroquine&#46; In some cases&#44; success was obtained with dapsone&#44; cyclosporine or azathioprine&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Although the pathological finding is not a diagnostic criterion&#44; it is indispensable for the identification of this disorder&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The diagnostic criteria should be reviewed in order to limit the forms of LE and to assess the need of EM-like lesions without a known triggering agent as essential&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest with regard to this work&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:3 [
        0 => array:3 [
          "identificador" => "sec0005"
          "titulo" => "Ethical Disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0010"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of Interest"
        ]
        2 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-09-18"
    "fechaAceptado" => "2015-11-05"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#243;pez Caleya JF&#44; Mart&#237;n Rodrigo L&#44; Gonzalvo Rodriguez P&#44; Hidalgo Garc&#237;a Y&#46; S&#237;ndrome de Rowell&#58; las 2 caras de la verdad&#46; Reumatol Clin&#46; 2016&#59;12&#58;354&#8211;355&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 746
            "Ancho" => 1749
            "Tamanyo" => 228971
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Scaly&#44; maculopapular eczema on trunk and extremities&#46; &#40;B&#41; Trunk involvement&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 728
            "Ancho" => 1800
            "Tamanyo" => 379744
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Epidermis with vacuolar degeneration of the basal cells &#40;asterisks&#41;&#44; isolated necrotic keratinocytes &#40;arrows&#41; and associated lymphocyte infiltrate&#46; The image shows the verticality of the basal cells &#40;arrowheads&#41;&#44; a histological feature associated with erythema multiforme&#46; Infiltrated lymphocytes and melanophages in papillary dermis&#46; &#40;B&#41; Reticular dermis with interstitial mucin &#40;asterisks&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lupus erythematosus and erythema multiforme-like lesions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;R&#46; Rowell"
                            1 => "S&#46; Beck"
                            2 => "J&#46;R&#46; Anderson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1963"
                        "volumen" => "88"
                        "paginaInicial" => "176"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14043605"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Redefining Rowell&#39;s syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46;C&#46; Zeitouni"
                            1 => "D&#46; Funaro"
                            2 => "R&#46;A&#46; Cloutier"
                            3 => "E&#46; Gagne"
                            4 => "J&#46; Claveau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2000"
                        "volumen" => "142"
                        "paginaInicial" => "343"
                        "paginaFinal" => "346"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10730772"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "S&#237;ndrome de Rowell o lupus eritematoso sist&#233;mico y eritema multiforme&#58;&#191;correlaci&#243;n o concomitancia&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Tirado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1699-258X(06)73038-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reumatol Clin"
                        "fecha" => "2006"
                        "volumen" => "2"
                        "paginaInicial" => "155"
                        "paginaFinal" => "157"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21794320"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lupus erythematous associated with erythema multiforme&#58; report of two cases and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Aydogan"
                            1 => "S&#46;K&#46; Karadogan"
                            2 => "S&#46;B&#46; Adim"
                            3 => "S&#46; Tunalit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "JEADV"
                        "fecha" => "2005"
                        "paginaInicial" => "621"
                        "paginaFinal" => "627"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subacute cutaneous lupus erythematosus presenting as erythroderma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46;V&#46; Pai"
                            1 => "K&#46; Naveen"
                            2 => "S&#46;B&#46; Athanikar"
                            3 => "U&#46; Dinesh"
                            4 => "P&#46; Reshme"
                            5 => "R&#46; Divyashree"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Indian J Dermatol"
                        "fecha" => "2014"
                        "volumen" => "59"
                        "paginaInicial" => "634"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rowell syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;Y&#46; Bhat"
                            1 => "C&#46; Varma"
                            2 => "S&#46; Bhatt"
                            3 => "C&#46; Balachandran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/2229-5178.144526"
                      "Revista" => array:7 [
                        "tituloSerie" => "Indian Dermatol Online J"
                        "fecha" => "2014"
                        "volumen" => "5"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "S33"
                        "paginaFinal" => "S35"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25506561"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systemic lupus erythematosus associated with Rowell&#39;s syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;S&#46; Kim"
                            1 => "C&#46; Magro"
                            2 => "R&#46;D&#46; Granstein"
                            3 => "A&#46; Bass"
                            4 => "D&#46; Erkan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "HSS J"
                        "fecha" => "2013"
                        "volumen" => "9"
                        "paginaInicial" => "289"
                        "paginaFinal" => "292"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The last word on the so-called Rowell&#39;s syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Antiga"
                            1 => "M&#46; Caproni"
                            2 => "D&#46; Bonciani"
                            3 => "V&#46; Bonciolini"
                            4 => "P&#46; Fabbri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0961203311430513"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "2012"
                        "volumen" => "21"
                        "paginaInicial" => "577"
                        "paginaFinal" => "585"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22170759"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Succesful treatment of Rowell syndrome using oral cyclosporine A"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;L&#46; Cornelia"
                            1 => "M&#46;D&#46; M&#252;ller"
                            2 => "R&#46; Louisa"
                            3 => "M&#46;D&#46; Hinterberger"
                            4 => "T&#46; Vogt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2011"
                        "volumen" => "50"
                        "paginaInicial" => "1020"
                        "paginaFinal" => "1022"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rowell&#39;s syndrome to ds-DNA negative lupus nephritis&#58; a yet unreported progression"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;R&#46; Bhobe"
                            1 => "S&#46; Tambe"
                            2 => "S&#46; Jindal"
                            3 => "H&#46;R&#46; Jerajani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0019-5154.152608"
                      "Revista" => array:5 [
                        "tituloSerie" => "Indian J Dermatol"
                        "fecha" => "2015"
                        "volumen" => "60"
                        "paginaInicial" => "215"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25814752"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001200000006/v1_201611050033/S217357431630082X/v1_201611050033/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5795"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Images in Clinical Rheumatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001200000006/v1_201611050033/S217357431630082X/v1_201611050033/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431630082X?idApp=UINPBA00004M"
]
Share
Journal Information
Vol. 12. Issue 6.
Pages 354-355 (November - December 2016)
Vol. 12. Issue 6.
Pages 354-355 (November - December 2016)
Images in Clinical Rheumatology
Full text access
Rowell's Syndrome: The Two Sides of the Truth
Síndrome de Rowell: las 2 caras de la verdad
Visits
8187
Juan Francisco López Caleyaa,
Corresponding author
jflcaleya@hotmail.com

Corresponding author.
, Laura Martín Rodrigob, Pablo Gonzalvo Rodriguezc, Yolanda Hidalgo Garcíad
a Servicio de Medicina Interna, Hospital de Cabueñes, Gijón, Asturias, Spain
b Servicio de Medicina Interna, Fundación Hospital de Jove, Gijón, Asturias, Spain
c Servicio de Anatomía Patológica, Hospital de Cabueñes, Gijón, Asturias, Spain
d Servicio de Dermatología, Hospital de Cabueñes, Gijón, Asturias, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (2)
Full Text

In 2000, Zeitouni et al. updated the diagnostic criteria of Rowell's syndrome (RS).1,2 They included the development of lupus erythematosus (LE) in its systemic, discoid and subacute cutaneous forms, erythema multiforme (EM) and antinuclear antibodies (ANA) (a speckled pattern) as the more important criteria. Moreover, they associated rheumatoid factor (RF), positive anti-Ro/SS-A or anti-La/SS-B antibodies and pernio (chilblains) as less significant criteria.2

The patient was a 91-year-old woman with a 2-month history of generalized itching and painful dermatitis, with a poor response to corticosteroid therapy. She had not had infections or previous use of these medications.

The physical examination showed a scaly, maculopapular eczema, with crusting areas in trunk and all 4 extremities, creating a typical result has shown (Fig. 1A and B).

Fig. 1.

(A) Scaly, maculopapular eczema on trunk and extremities. (B) Trunk involvement.

(0.22MB).

The laboratory tests included RF (83.1IU/mL), ANA (1/2560 speckled pattern) and positive anti-Ro/SSA and anti-La/SSB. The skin biopsy was compatible with LE and EM (Fig. 2A and B).

Fig. 2.

(A) Epidermis with vacuolar degeneration of the basal cells (asterisks), isolated necrotic keratinocytes (arrows) and associated lymphocyte infiltrate. The image shows the verticality of the basal cells (arrowheads), a histological feature associated with erythema multiforme. Infiltrated lymphocytes and melanophages in papillary dermis. (B) Reticular dermis with interstitial mucin (asterisks).

(0.36MB).

For some authors, the coexistence of LE and EM are not considered different entities.3

It is difficult to distinguish between subacute cutaneous LE (SCLE) and EM.4,5 However, other authors insist that the classical EM be acute and self-limited, and that the lesions be bull's-eyes. This is commonly associated with infections and previous drug exposure.6,7

In RS, the typical findings are recurrent, EM-like lesions, with no triggering factors and with positive antibodies and RF.7

The speckled pattern of the ANA is the immunological characteristic most consistent of RS, appearing in 60.4% to of the cases, although it is not exclusive of this condition.8 Therapy should be initiated with corticosteroid and hydroxychloroquine. In some cases, success was obtained with dapsone, cyclosporine or azathioprine.9,10

Although the pathological finding is not a diagnostic criterion, it is indispensable for the identification of this disorder.

The diagnostic criteria should be reviewed in order to limit the forms of LE and to assess the need of EM-like lesions without a known triggering agent as essential.

Ethical DisclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that no patient data appear in this article.

Right to privacy and informed consent

The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.

Conflicts of Interest

The authors declare they have no conflicts of interest with regard to this work.

References
[1]
N.R. Rowell, S. Beck, J.R. Anderson.
Lupus erythematosus and erythema multiforme-like lesions.
Arch Dermatol, 88 (1963), pp. 176-180
[2]
N.C. Zeitouni, D. Funaro, R.A. Cloutier, E. Gagne, J. Claveau.
Redefining Rowell's syndrome.
Br J Dermatol, 142 (2000), pp. 343-346
[3]
A. Tirado.
Síndrome de Rowell o lupus eritematoso sistémico y eritema multiforme:¿correlación o concomitancia?.
Reumatol Clin, 2 (2006), pp. 155-157
[4]
K. Aydogan, S.K. Karadogan, S.B. Adim, S. Tunalit.
Lupus erythematous associated with erythema multiforme: report of two cases and review of the literature.
JEADV, (2005), pp. 621-627
[5]
V.V. Pai, K. Naveen, S.B. Athanikar, U. Dinesh, P. Reshme, R. Divyashree.
Subacute cutaneous lupus erythematosus presenting as erythroderma.
Indian J Dermatol, 59 (2014), pp. 634
[6]
R.Y. Bhat, C. Varma, S. Bhatt, C. Balachandran.
Rowell syndrome.
Indian Dermatol Online J, 5 (2014), pp. S33-S35
[7]
S.S. Kim, C. Magro, R.D. Granstein, A. Bass, D. Erkan.
Systemic lupus erythematosus associated with Rowell's syndrome.
HSS J, 9 (2013), pp. 289-292
[8]
E. Antiga, M. Caproni, D. Bonciani, V. Bonciolini, P. Fabbri.
The last word on the so-called Rowell's syndrome.
Lupus, 21 (2012), pp. 577-585
[9]
S.L. Cornelia, M.D. Müller, R. Louisa, M.D. Hinterberger, T. Vogt.
Succesful treatment of Rowell syndrome using oral cyclosporine A.
Int J Dermatol, 50 (2011), pp. 1020-1022
[10]
M.R. Bhobe, S. Tambe, S. Jindal, H.R. Jerajani.
Rowell's syndrome to ds-DNA negative lupus nephritis: a yet unreported progression.
Indian J Dermatol, 60 (2015), pp. 215

Please cite this article as: López Caleya JF, Martín Rodrigo L, Gonzalvo Rodriguez P, Hidalgo García Y. Síndrome de Rowell: las 2 caras de la verdad. Reumatol Clin. 2016;12:354–355.

Copyright © 2015. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
Download PDF
Idiomas
Reumatología Clínica (English Edition)
Article options
Tools
es en

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

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