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tambi&#233;n se ha estudiado el efecto gastroerosivo de otros f&#225;rmacos como los esteroides&#44; aunque en este caso su riesgo resulta controvertido&#59; seg&#250;n algunas publicaciones&#44; los esteroides orales aumentar&#237;an al doble el riesgo de complicaciones gastrointestinales&#44; efecto que&#44; adem&#225;s&#44; depender&#237;a de la dosis<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a>&#46; Dado que actualmente en la especialidad de reumatolog&#237;a el uso de esteroides y AINE es muy frecuente en el tratamiento de las enfermedades reum&#225;ticas&#44; determinar los posibles efectos de su uso concomitante &#40;especialmente en relaci&#243;n con la toxicidad gastrointestinal&#44; aunque extensible a cualquier otro evento adverso&#41; es de m&#225;ximo inter&#233;s en nuestro medio&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">Por todo lo comentado&#44; el objetivo de la presente revisi&#243;n sistem&#225;tica es buscar la evidencia publicada en torno a la seguridad del uso concomitante de AINE y esteroides&#44; para as&#237; contribuir a un mejor manejo de nuestros pacientes&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Material y m&#233;todos</span><p id="p0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; una revisi&#243;n sistem&#225;tica para analizar la seguridad del uso concomitante de AINE y esteroides&#46; Los criterios de selecci&#243;n de estudios fueron&#58; <span class="elsevierStyleItalic">a&#41;</span> estudios en que los pacientes tuvieran diagn&#243;stico de alguna enfermedad osteomuscular y estuvieran en tratamiento con esteroides&#44; sin restricci&#243;n en cuanto al tipo y la dosis del f&#225;rmaco&#59; <span class="elsevierStyleItalic">b&#41;</span> estudios en que los pacientes&#44; adem&#225;s del esteroide&#44; tomaran concomitantemente alg&#250;n AINE&#44; sin restricci&#243;n en cuanto al tipo y la dosis de &#233;ste&#44; pero excluyendo los estudios en que los sujetos tomaban AINE a dosis antiagregante y no analg&#233;sica&#47;antiinflamatoria o en tratamientos t&#243;picos&#59; <span class="elsevierStyleItalic">c&#41;</span> para evaluar la seguridad del uso concomitante de los f&#225;rmacos&#44; se incluyeron estudios en que se analizara alguna de las siguientes variables&#58; toxicidad gastrointestinal &#40;como sangrado&#44; perforaci&#243;n&#44; obstrucci&#243;n&#44; etc&#46;&#41;&#44; renal y cardiovascular&#44; entre otras&#44; y <span class="elsevierStyleItalic">d&#41;</span> ensayos cl&#237;nicos &#40;EC&#41; y estudios de cohortes &#40;prospectivas o retrospectivas&#41; de buena calidad&#46; Se excluyeron los estudios que s&#243;lo aportaban datos de farmacocin&#233;tica y&#47;o farmacodin&#225;mica&#44; as&#237; como estudios en sujetos sanos voluntarios y estudios en animales&#46; Finalmente se seleccionaron art&#237;culos en ingl&#233;s y espa&#241;ol&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">Se busc&#243; en las siguientes bases de datos electr&#243;nicas hasta diciembre de 2007&#58; MEDLINE &#40;desde 1960&#41;&#44; EMBASE &#40;desde 1980&#41; 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mediante sesiones de 20<span class="elsevierStyleHsp" style=""></span>min de duraci&#243;n m&#225;xima&#46; Tras este proceso&#44; los art&#237;culos restantes se analizaron en detalle&#46; Finalmente se realiz&#243; una b&#250;squeda manual con las referencias de los art&#237;culos seleccionados para su an&#225;lisis en detalle&#46; Todas las referencias se recuperaron de internet y se introdujeron en el programa Procite 5&#46;1 para facilitar su gesti&#243;n&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">Para evaluar la calidad metodol&#243;gica de los estudios incluidos se utiliz&#243;&#44; para los EC&#44; la escala de Jadad<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> &#40;1 a 5&#44; consider&#225;ndose de buena calidad los estudios con Jadad de 3&#8211;5&#41; y&#44; para los estudios de cohortes&#44; la escala de calidad de Oxford&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Resultados</span><p id="p0045" class="elsevierStylePara elsevierViewall">Los resultados de la b&#250;squeda se detallan en la <a class="elsevierStyleCrossRef" href="#f0005">figura 1</a>&#46; Finalmente se incluyeron 10 art&#237;culos&#46; Un total de 6 fueron EC<a class="elsevierStyleCrossRefs" href="#bb0025"><span class="elsevierStyleSup">5&#8211;10</span></a> y 4&#44; estudios de cohortes prospectivas<a class="elsevierStyleCrossRefs" href="#bb0055"><span class="elsevierStyleSup">11&#8211;14</span></a> que incluyeron a m&#225;s de 20&#46;000 pacientes&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Resumen de la evidencia</span><p id="p0050" class="elsevierStylePara elsevierViewall">A continuaci&#243;n se describen los principales resultados de los estudios incluidos&#44; que se pueden consultar en la <a class="elsevierStyleCrossRef" href="#t0015">tabla 3</a>&#46; El listado de art&#237;culos excluidos<a class="elsevierStyleCrossRefs" href="#bb0075"><span class="elsevierStyleSup">15&#8211;47</span></a> y la causa de exclusi&#243;n de la revisi&#243;n sistem&#225;tica se detallan en la <a class="elsevierStyleCrossRef" href="#t0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><elsevierMultimedia ident="t0020"></elsevierMultimedia><p id="p0055" class="elsevierStylePara elsevierViewall">Como ya se ha comentado&#44; se incluyeron 10 art&#237;culos de buena calidad&#44; 6 EC &#40;Jadad 3&#41; y 4 estudios de cohortes prospectivas &#40;calidad 2a&#41;&#46; Estos estudios analizaron a pacientes con afecci&#243;n osteomuscular&#44; pero sobre todo incluyeron a pacientes con artritis reumatoide &#40;AR&#41; y&#47;o artrosis &#40;OA&#41;&#44; la mayor&#237;a mujeres&#44; de mediana edad&#46; La duraci&#243;n del tratamiento vari&#243; de 1&#8211;15 semanas los EC a 3&#8211;21 a&#241;os las cohortes&#44; o no fue posible hallar este dato&#46; Se utilizaron diferentes tipos de AINE y esteroides&#44; as&#237; como dosis&#44; aunque el esteroide m&#225;s empleado fue la prednisona a dosis bajas&#44; pr&#243;ximas a los 10<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46; La mayor&#237;a de los estudios no permit&#237;an expresamente el uso de protectores g&#225;stricos o no registraron que los pacientes los tomaran&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">En cuanto a los resultados de seguridad&#44; 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el uso de tenidap 120<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a m&#225;s prednisona &#40;&#60; 10<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; durante 15 semanas&#44; en comparaci&#243;n con AINE en monoterapia&#44; no se asoci&#243; a mayor riesgo de ulcus gastroduodenal&#44; pero s&#237; a mayor n&#250;mero de alteraciones anal&#237;ticas&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8211;</span><p id="p0090" class="elsevierStylePara elsevierViewall">En el estudio de Paulus et al<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a>&#44; el uso de AINE &#40;etodolaco 300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#44; etodolaco 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a o ibuprofeno 2&#46;400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; con prednisona &#40;&#60; 5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; en comparaci&#243;n con los AINE solos&#44; no se asoci&#243; con la aparici&#243;n de mayor n&#250;mero de eventos adversos o alteraciones anal&#237;ticas&#46;</p></li></ul></p><p id="p0095" class="elsevierStylePara elsevierViewall">En cuanto a los estudios de cohortes prospectivas&#44; se incluyeron 4&#58; Benito-Garc&#237;a et al<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#44; Fries et al<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a>&#44; Gabriel et al<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a> y Wolfe et al<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a>&#46; En ellos se analiz&#243; a un total de 12&#46;365 pacientes&#46; En general&#44; la incidencia de evento gastrointestinal serio fue baja y no se asoci&#243; al uso concomitante de AINE y esteroides&#46; Destaca el estudio de Wolf et al<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a>&#44; en el que la combinaci&#243;n de AINE con esteroides no increment&#243; el riesgo de evento gastrointestinal importante en comparaci&#243;n con los AINE en monoterapia&#44; mientras que fueron los esteroides en monoterapia los que aumentaron m&#225;s el riesgo del evento&#46;</p></span></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Discusi&#243;n</span><p id="p0100" class="elsevierStylePara elsevierViewall">En la presente revisi&#243;n sistem&#225;tica se ha analizado la seguridad del uso concomitante de los AINE y los esteroides en pacientes con enfermedades reum&#225;ticas&#46; Para ello&#44; se realiz&#243; una extensa b&#250;squeda en las principales bases de datos bibliogr&#225;ficas disponibles&#44; tal y como se ha descrito&#46; S&#243;lo incluimos EC y estudios de cohortes de calidad&#44; porque consideramos que era la mejor forma de contestar a esta pregunta de investigaci&#243;n&#46;</p><p id="p0105" class="elsevierStylePara elsevierViewall">Finalmente&#44; se incluyeron 10 estudios &#40;6 EC<a class="elsevierStyleCrossRefs" href="#bb0025"><span class="elsevierStyleSup">5&#8211;10</span></a>&#44; 4 estudios de cohortes<a class="elsevierStyleCrossRefs" href="#bb0055"><span class="elsevierStyleSup">11&#8211;14</span></a>&#41; de calidad aceptable&#58; los EC fueron todos Jadad 3 y los de cohortes&#44; calidad 2a&#46; En cuanto a los pacientes estudiados&#44; todos ten&#237;an alg&#250;n tipo de afecci&#243;n osteomuscular&#44; aunque es importante destacar que pr&#225;cticamente todos eran pacientes con AR o artrosis&#46; Los AINE y los esteroides estudiados fueron diversos&#44; as&#237; como las dosis preescritas &#40;en los estudios en este dato estaba disponible&#41;&#46; En relaci&#243;n con los eventos estudiados&#44; todos los art&#237;culos incluidos evaluaron eventos adversos gastrointestinales&#44; y la mayor&#237;a de ellos tambi&#233;n analizaron los eventos adversos cl&#237;nicamente m&#225;s relevantes y&#47;o graves&#44; como el ulcus gastroduodenal o las hemorragias digestivas&#46; En general&#44; estas medidas de resultado fueron definidas por criterios muy similares en todos los estudios&#46;</p><p id="p0110" class="elsevierStylePara elsevierViewall">En primer lugar&#44; en la presente revisi&#243;n sistem&#225;tica se ha visto que la incidencia general de eventos adversos gastrointestinales serios &#40;sangrado&#44; perforaci&#243;n&#44; obstrucci&#243;n&#44; etc&#46;&#41; que pudieran generar la hip&#243;tesis de contraindicar el uso combinado de ambos f&#225;rmacos es baja&#46; Adem&#225;s&#44; los resultados de los EC indican que la combinaci&#243;n no incrementa el riesgo de eventos adversos gastrointestinales &#40;tanto graves como otros como la dispepsia leve o las n&#225;useas&#41; u otros &#40;trastornos del sistema nervioso central o dolor tor&#225;cico&#41; en comparaci&#243;n con el uso de los AINE sin esteroides&#46; En cuanto a los estudios de cohortes prospectivas&#44; tampoco se demostr&#243; que el uso combinado de AINE y esteroides incrementara el riesgo de evento adverso gastrointestinal en comparaci&#243;n con su uso en monoterapia&#46; Entre ellos destacamos el estudio de Wolfe et al<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a>&#44; en el que la combinaci&#243;n de AINE y esteroides no increment&#243; el riesgo de evento gastrointestinal grave de los esteroides&#44; que fueron los que mayor incidencia originaron&#46; Por todo ello&#44; se puede recomendar el uso de los AINE en combinaci&#243;n con esteroides &#40;al menos a dosis bajas&#41;&#44; en pacientes con enfermedades osteomusculares&#44; con una evidencia 2a y una fuerza de la recomendaci&#243;n B&#47;C&#46;</p><p id="p0115" class="elsevierStylePara elsevierViewall">No obstante&#44; hay que interpretar todos estos datos con mucha cautela&#44; ya que no est&#225;n exentos de algunas limitaciones&#46; En el caso de los EC&#44; las limitaciones se derivan sobre todo por la representatividad de los pacientes incluidos en ellos&#44; ya que probablemente no sean como muchos otros pacientes que habitualmente se siguen en las consultas de reumatolog&#237;a&#44; es decir&#44; pacientes con mayor n&#250;mero de factores independientes de riesgo de eventos adversos gastrointestinales&#44; como por ejemplo los de edad m&#225;s avanzada&#44; con comorbilidades&#44; etc&#46;</p><p id="p0120" class="elsevierStylePara elsevierViewall">Por otro lado&#44; en los estudios de cohortes es muy dif&#237;cil definir claramente las duraciones y las dosis de los f&#225;rmacos estudiados para poder establecer relaciones causales m&#225;s s&#243;lidas entre las combinaciones farmacol&#243;gicas y sus posibles eventos adversos&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall">Pero&#44; por otro lado&#44; es importante comentar que estos datos contrastan con lo publicado en referencia a la poblaci&#243;n general y el uso de AINE con esteroides&#44; para el que se ha descrito un riesgo incrementado de complicaciones gastrointestinales graves<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a>&#46; Esto podr&#237;a deberse&#44; al menos en parte&#44; a que -como bien se ha descrito claramente en al menos dos de los EC y en uno de los estudios de cohortes y probablemente as&#237; sea en los dem&#225;s&#8211; las dosis de esteroides utilizadas en los estudios incluidos en esta revisi&#243;n sistem&#225;tica fueron bajas&#44; menores que las que habitualmente toman muchos pacientes con enfermedades reum&#225;ticas&#46; En general&#44; son dosis mucho m&#225;s bajas que las dosis de esteroides utilizadas&#44; por ejemplo&#44; para el tratamiento de otras afecciones como las pulmonares y algunas neurol&#243;gicas&#44; que se incluir&#237;an en los estudios poblacionales&#44; lo que probablemente incremente el riesgo de evento adverso del uso concomitante de AINE y esteroides&#46;</p><p id="p0130" class="elsevierStylePara elsevierViewall">Continuando con los eventos adversos en relaci&#243;n con estos f&#225;rmacos&#44; no cabe duda de que los gastrointestinales&#44; por su frecuencia y su potencial gravedad&#44; son de estudio y seguimiento obligatorios&#44; pero destacamos la poca informaci&#243;n disponible sobre otro tipo de eventos que pudieran ser de inter&#233;s&#44; como los renales o cardiovasculares&#46;</p><p id="p0135" class="elsevierStylePara elsevierViewall">Para terminar&#44; en relaci&#243;n con el uso combinado de AINE y esteroides&#44; en esta revisi&#243;n sistem&#225;tica se han incluido estudios con diferentes f&#225;rmacos&#44; tanto AINE como esteroides &#40;aunque claramente el esteroide m&#225;s empleado fue la prednisona&#41;&#44; as&#237; como diferentes dosis y combinaciones de ambos&#44; por lo que resulta extremadamente dif&#237;cil establecer comparaciones entre combinaciones de ellos para definir cu&#225;l es la combinaci&#243;n de AINE y esteroide &#40;y en qu&#233; dosis de cada uno&#41; que presenta un mejor perfil de seguridad&#46; Por ello&#44; se deber&#225; realizar en el futuro otros estudios especialmente dise&#241;ados para responder a esta cuesti&#243;n&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el uso de AINE con esteroides a dosis bajas en pacientes con afecciones osteomusculares no parece incrementar el riesgo de eventos adversos gastrointestinales tanto leves como graves&#44; por lo que se puede recomendar su uso en la pr&#225;ctica diaria&#46;</p></span></span>"
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        2 => array:2 [
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          "titulo" => "Introducci&#243;n"
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        3 => array:2 [
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          "titulo" => "Material y m&#233;todos"
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        4 => array:3 [
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          "titulo" => "Resultados"
          "secciones" => array:2 [
            0 => array:2 [
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              "titulo" => "Resumen de la evidencia"
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            1 => array:2 [
              "identificador" => "s0025"
              "titulo" => "Resultados detallados del uso combinado de AINE y esteroides"
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        5 => array:2 [
          "identificador" => "s0030"
          "titulo" => "Discusi&#243;n"
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        6 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2008-02-15"
    "fechaAceptado" => "2008-06-25"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec112594"
          "palabras" => array:3 [
            0 => "Antiinflamatorios no esteroideos"
            1 => "Esteroides"
            2 => "Seguridad"
          ]
        ]
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      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec112595"
          "palabras" => array:2 [
            0 => "Non-steroidal anti-inflammatory drugs &#59;Steroids"
            1 => "Safety"
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    "resumen" => array:2 [
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="st0005">Objetivos</span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Analizar la seguridad del uso concomitante de antiinflamatorios no esteroideos &#40;AINE&#41; con esteroides en pacientes con enfermedad reum&#225;tica&#46;</p> <span class="elsevierStyleSectionTitle" id="st0010">M&#233;todos</span><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n sistem&#225;tica&#46; Se defini&#243; una estrategia de b&#250;squeda bibliogr&#225;fica sensible en MEDLINE &#40;desde 1961&#41;&#44; EMBASE &#40;desde 1980&#41; y Cochrane Library hasta diciembre del 2007&#44; definiendo la poblaci&#243;n &#40;sujetos con enfermedad reum&#225;tica en tratamiento con esteroides&#41; y la intervenci&#243;n &#40;tratamiento concomitante con AINE&#41; y definiendo como resultados variables de seguridad &#40;toxicidad gastrointestinal&#44; renal y cardiovascular&#41;&#46; Se seleccionaron ensayos cl&#237;nicos y estudios de cohortes de calidad&#46;</p> <span class="elsevierStyleSectionTitle" id="st0015">Resultados</span><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">Se recuperaron 4&#46;164 estudios&#44; de los que 42 se analizaron en detalle&#59; finalmente se incluyeron 10 en los an&#225;lisis&#44; 6 de los cuales fueron ensayos cl&#237;nicos y 4&#44; estudios de cohortes prospectivos&#44; que incluyeron a m&#225;s de 20&#46;000 pacientes&#46;</p> <span class="elsevierStyleSectionTitle" id="st0020">Conclusiones</span><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">El uso concomitante de AINE y esteroides a dosis bajas en pacientes con enfermedad reum&#225;tica no parece que incremente el riesgo de eventos adversos gastrointestinales&#46;</p>"
      ]
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="st0025">Objectives</span><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">To analyze the safety of combining nonsteroidal anti-inflammatory drugs &#40;NSAID&#41; and steroids&#46;</p> <span class="elsevierStyleSectionTitle" id="st0030">Methods</span><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall">A systematic review following a sensitive search strategy was performed&#46; All articles published in MEDLINE &#40;since 1961&#41;&#44; EMBASE &#40;since 1961&#41;&#44; and Cochrane Library&#44; up to December 2007 were examined&#46; Selection criteria&#58; the population &#40;subjects with musculoskeletal diseases on steroids&#41;&#44; the intervention &#40;concomitant use of NSAID&#41;&#44; and outcomes related to drugs safety &#40;gastrointestinal&#44; renal&#44; and cardiovascular toxicity&#41;&#46; Titles and abstracts of retrieved articles meeting inclusion criteria from the search were reviewed&#46; Only randomized controlled trials &#40;RCT&#41; or high quality cohort studies with a control group were included&#46;</p> <span class="elsevierStyleSectionTitle" id="st0035">Results</span><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">Of a total of 4164 references retrieved&#44; 42 were analyzed in detail&#44; and 10 were finally included&#44; 6 RCT and 4 prospective cohort studies&#44; which included more than 20 000 patients&#46;</p> <span class="elsevierStyleSectionTitle" id="st0040">Conclusions</span><p id="sp0080" class="elsevierStyleSimplePara elsevierViewall">The use of NSAID and low dose of steroids in patients with musculoskeletal diseases does not seem to increase the risk of gastrointestinal adverse events&#46;</p>"
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                  \t\t\t\t">Estrategia de b&#250;squeda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;Steroids OR steroid OR corticoids OR corticoid OR corticosteroids OR corticosteroid OR glucosteroids OR glucosteroid OR glucocorticoids OR glucocorticoid OR prednisone OR prednison OR prednisolone OR methylprednisolone OR cortisone OR cortisol OR triamcinolone OR dexamethasone OR betamethasone&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NSAID OR Nonsteroidal Anti-Inflammatory Agents OR Nonsteroidal Antiinflammatory Agents OR Analgesics&#44; Anti Inflammatory OR Non-Steroidal Anti-Rheumatic Agents OR Non-Steroidal Antirheumatic Agents OR Aspirin-Like Agents OR Agents&#44; Aspirin-Like OR naproxen&#42; OR ibuprofen&#42; OR dexibuprofen OR dexketoprofen OR flurbiprofen OR Ketoprofen OR Ketorola&#42; <span class="elsevierStyleSmallCaps">Or</span> aceclofenac <span class="elsevierStyleSmallCaps">Or</span> diclofenac OR lornoxicam OR meloxicam OR piroxicam OR tenoxicam OR indometacin OR sulindac OR tolmetin OR fenilbutazon OR Phenylbutazone OR nabumeton OR celecoxib OR etoricoxib OR parecoxib OR rofecoxib OR valdecoxib OR lumiracoxib OR salicylic acid OR acetylsalicylic acid OR diflunisal OR Cyclooxygenase 2 Inhibitors OR COX-2 Inhibitors OR COX2 Inhibitors&#44; OR Coxibs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Randomized &#91;All Fields&#93; OR random allocation&#34;&#91;TIAB&#93; NOT Medline&#91;SB&#93;&#41; OR &#34;random allocation&#34;&#91;MeSH Terms&#93; OR randomized&#91;Text Word&#93; OR controlled&#91;All Fields&#93; AND &#40;&#34;clinical trials as topic&#34;&#91;MeSH Terms&#93; OR trial&#91;Text Word&#93;&#41; OR placebo OR blinded&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">acute &#91;All Fields&#93; OR acute OR post-operative &#91;All Fields&#93; OR post-surgical&#91;All Fields&#93; OR postsurgical &#91;All Fields&#93; OR postoperative &#91;All Fields&#93; OR postoperative OR Postoperative Complications &#91;Mesh&#93; OR intraoperative &#91;All fields&#93; OR Intraoperative Complications &#91;Mesh&#93; dysmenorrhoea &#91;All Fields&#93; OR dysmenorrhea OR orthodontic &#91;All fields&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;411&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&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">&#35;6 LimitsLimits&#58; Humans&#44; Clinical Trial&#44; Meta-Analysis&#44; Randomized Controlled Trial&#44; Clinical Trial&#44; Phase I&#44; Clinical Trial&#44; Phase II&#44; Clinical Trial&#44; Phase III&#44; Clinical Trial&#44; Phase IV&#44; Comparative Study&#44; Controlled Clinical Trial&#44; English&#44; Spanish&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab211975.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Estrategia de b&#250;squeda y art&#237;culos rescatados en MEDLINE</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "t0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#35;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estrategia de b&#250;squeda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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&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">steroids&#46;mp&#46; or exp Steroid &#47; OR glucocorticoids&#46;mp&#46; or exp Glucocorticoid &#47;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">568&#46;743&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&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">nsaid&#46;mp&#46; or Nonsteroid Antiinflammatory Agent&#47; or Nonsteroidal Anti-Inflammatory Agents&#46;mp&#46; or &#40;coxib or Cyclooxygenase 2 Inhibitor&#41;&#46;mp&#46; or Acetylsalicylic Acid&#47; or Aspirin-Like Agents&#46;mp&#46; or naproxen&#46;mp&#46; or NAPROXEN&#47; or ibuprofen&#46;mp&#46; or IBUPROFEN&#47; or dexibuprofen&#36;&#46;mp&#46; or DEXIBUPROFEN&#47; or dexketoprofen&#46;mp&#46; or DEXKETOPROFEN&#47; or flurbiprofen&#46;mp&#46; or FLURBIPROFEN&#47; or Ketoprofen&#46;mp&#46; or KETOPROFEN&#47; or KETOROLAC&#47; or Ketorolac&#46;mp&#46; or aceclofenac&#46;mp&#46; or ACECLOFENAC&#47; or diclofenac&#46;mp&#46; or DICLOFENAC&#47; or lornoxicam&#46;mp&#46; or LORNOXICAM&#47; or meloxicam&#46;mp&#46; or MELOXICAM&#47; or PIROXICAM&#47; or piroxicam&#46;mp&#46; or PIROXICAM&#47; or piroxicam&#46;mp&#46; or tenoxicam&#46;mp&#46; or TENOXICAM&#47; or INDOMETACIN&#47; or indometacin&#46;mp&#46; or sulindac&#46;mp&#46; or SULINDAC&#47; or tolmetin&#46;mp&#46; or TOLMETIN&#47; or Phenylbutazone&#46;mp&#46; or PHENYLBUTAZONE&#47; or nabumetone&#47; or nabumeton&#46;mp&#46; or celecoxib&#46;mp&#46; or CELECOXIB&#47; or etoricoxib&#46;mp&#46; or ETORICOXIB&#47; or parecoxib&#46;mp&#46; or PARECOXIB&#47; or rofecoxib&#46;mp&#46; or ROFECOXIB&#47; or salicylic acid&#46;mp&#46; or Salicylic Acid&#47; or acetylsalicylic acid&#46;mp&#46; or Acetylsalicylic Acid&#47; or diflunisal&#46;mp&#46; or DIFLUNISAL&#47; or valdecoxib&#46;mp&#46; or VALDECOXIB&#47; or lumiracoxib&#46;mp&#46; or LUMIRACOXIB&#47;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">207&#46;945&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&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">exp clinical trial&#47; or evidence based medicine&#47; or outcomes research&#47; or crossover procedure&#47; or double blind procedure&#47; or single blind procedure&#47; or prospective study&#47; or major clinical study&#47; or exp comparative study&#47; or placebo&#47; or &#34;evaluation and follow up&#34;&#47; or follow up&#47; or randomization&#47;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;964&#46;112&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">controlled study&#47; not case control study&#47;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;568&#46;695&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&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 or 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;774&#46;593&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&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">&#40;&#40;clinic&#36; adj5 trial&#36;&#41; or &#40;&#40;singl&#36; or doubl&#36; or trebl&#36; or tripl&#36;&#41; adj &#40;blind&#36; or mask&#36;&#41;&#41; or random&#36; or placebo&#36;&#41;&#46;ti&#44;ab&#46;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">489&#46;355&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&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 or 6&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;890&#46;101&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  " 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><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 and 2 and 7&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;876&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  " 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><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">perioperative period&#46;mp&#46; or PERIOPERATIVE PERIOD&#47; or perioperative care&#46;mp&#46; or SURGERY&#47; or surgery&#46;mp&#46; or SURGICAL TECHNIQUE&#47; or surgical procedures&#46;mp&#46; or PEROPERATIVE CARE&#47; or preoperative care&#46;mp&#46; or intraoperative care&#46;mp&#46; or PEROPERATIVE COMPLICATION&#47; or POSTOPERATIVE COMPLICATION&#47; or dysmenorrhoea&#46;mp&#46; or Dysmenorrhea&#47; or orthodontic&#46;mp&#46; or Orthodontics&#47; or exp malignant neoplastic disease&#47; or cancer&#47; or exp metastasis&#47; or exp mixed tumor&#47; or exp &#34;neoplasms of uncertain behavior&#34;&#47; or exp neoplasms subdivided by anatomical site&#47; or exp &#34;oncogenesis and malignant transformation&#34;&#47; or exp paraneoplastic syndrome&#47; or exp &#34;precancer and cancer-in-situ&#34;&#47; or adolescent&#46;mp&#46; or adolescent&#47; or hospitalized adolescent&#47; or juvenile&#46;mp&#46; or juvenile&#47; or child&#46;mp&#46; or child&#47; or boy&#46;mp&#46; or boy&#47; or gifted child&#47; or girl&#46;mp&#46; or girl&#47; or handicapped child&#47; or hospitalized child&#47; or preschool child&#47; or school child&#47; or infant&#46;mp&#46; or infant&#47; or baby&#46;mp&#46; or baby&#47; or high risk infant&#47; or hospitalized infant&#47; or newborn&#46;mp&#46; or newborn&#47; or suckling&#46;mp&#46; or suckling&#47; or pediatric&#46;mp&#46; or review&#47; or guideline&#46;mp&#46;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;370&#46;213&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&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 not 9&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">666&#46;390&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&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">exp musculoskeletal disease&#47; or musculoskeletal disease&#46;mp&#46; or rheumatic polymyalgia&#46;mp&#46; or polymyalgia&#47; or lupus erythematosus systemic&#46;mp&#46; or systemic lupus erythematosus&#47; or vasculitis&#47; or vasculitis&#46;mp&#46; or polymyositis&#46;mp&#46; or polymyositis&#47; or dermatomyositis&#46;mp&#46; or dermatomyositis&#47;&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&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 and 11&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;391&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&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">Limit 12 to humans&#44; abstracts&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;091&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab211976.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Estrategia de b&#250;squeda y art&#237;culos rescatados en EMBASE</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "t0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">AINE&#58; antiinflamatorios no esteroideos&#59; AR&#58; artritis reumatoide&#59; CE&#58; criterios de exclusi&#243;n&#59; EC&#58; ensayo cl&#237;nico&#59; FAME&#58; f&#225;rmacos modificadores de la enfermedad&#59;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">LES&#58; lupus eritematoso sist&#233;mico&#59; OA&#58; osteoartrosis&#59; PM&#58; polimiositis&#59; PMR&#58; polimialgia reum&#225;tica&#59; RR&#58; riesgo relativo&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Participantes e intervenci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Benito-Garcia<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#59;cohorte prospectiva&#59; seguimiento&#44; 3 a&#241;os&#59; calidad&#44; 2a&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">n &#61; 4&#46;240 AR&#47;OA &#40;79&#37; mujeres&#59; media de edad&#44; 61&#41;&#59; COX2 &#43; prednisona &#40;n &#61; 1&#46;314&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RR &#40;ajustada&#41; no significativa para&#58; malestar epig&#225;strico &#40;p &#61; 0&#44;8&#41;&#44; acidez g&#225;strica &#40;p &#61; 0&#44;88&#41;&#44; n&#225;useas &#40;0&#44;066&#41;&#44; ulcus gastroduodenal &#40;p &#61; 0&#44;259&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fries<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a>&#59; cohorte prospectiva&#59; seguimiento&#44; 4 a&#241;os&#59; calidad 2a&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">n &#61; 2&#46;224 AR&#59; AINE&#58; naproxeno&#44; &#225;cido acetilsalic&#237;lico&#44; piroxicam&#44; sulindac&#44; ibuprofeno &#43; prednisona &#40;dosis media&#44; 7<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tasa de hospitalizaci&#243;n por evento gastrointestinal&#58; AINE frente a AINE &#43; prednisona &#40;0&#44;86 frente a 1&#44;59&#37;&#59; p &#62; 0&#44;050&#41;&#59; naproxeno frente a naproxeno &#43; prednisona &#40;1&#44;14 frente a 2&#44;58&#37;&#59; p &#62; 0&#44;050&#41;&#59; AAS frente a AAS &#43; prednisona &#40;1&#44;26 frente a 2&#44;22&#37;&#59; p &#62; 0&#44;050&#41;&#59; piroxicam frente a piroxicam &#43; prednisona &#40;2&#44;22 frente a 1&#44;79&#37;&#59; p &#62; 0&#44;050&#41;&#59; sulindac frente a sulindac &#43; prednisona &#40;2&#44;1 frente a 0&#44;75&#37;&#59; p &#62; 0&#44;050&#41;&#59; ibuprofeno frente a ibuprofeno &#43; prednisona &#40;0&#44;89 frente a 7&#44;8&#37;&#59; p &#62; 0&#44;050&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gabriel<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a>&#59; cohorte prospectiva&#59; seguimiento&#44; 21 a&#241;os&#59; calidad 2a&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">n &#61; 232 PMR &#40;70&#37; mujeres&#59; media de edad&#44; 72 a&#241;os&#41;&#46; CE&#58; AR&#44; LES&#44; PM&#44; infecciones&#44; mieloma&#46; AINE &#43; esteroides &#40;n &#61; 51&#41;&#59; AINE solo &#40;n &#61; 57&#41;&#59; esteroides solos &#40;n &#61; 124&#41;&#59; duraci&#243;n media tratamiento esteroides&#44; 2&#44;5 a&#241;os&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"><span class="elsevierStyleItalic">a&#41;</span> Cualquier evento adverso&#58; AINE solo &#40;n &#61; 38&#41;&#44; AINE &#43; esteroides &#40;n &#61; 41&#41; &#40;p &#61; 0&#44;120&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> hemorragia gastroduodenal&#58; AINE solo &#40;n &#61; 5&#41;&#44; AINE &#43; esteroides &#40;n &#61; 2&#41; &#40;p &#62; 0&#44;050&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Goldstein5&#59; EC doble ciego multic&#233;ntrico&#59; seguimiento&#44; 12 semanas&#59; Jadad 3&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">n &#61; 536 AR&#47;OA &#40;67&#37; mujeres&#59; media de edad&#44; 57 a&#241;os&#41;&#59; CE&#58; otras enfermedades inflamatorias&#44; enfermedad gastrointestinal activa&#44; protectores g&#225;stricos&#44; AINE&#59; celecoxib 400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 12 semanas &#40;n &#61; 185&#41;&#59; celecoxib 400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; esteroides 12 semanas &#40;n &#61; 26&#41;&#59; naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 12 semanas &#40;n &#61; 194&#41;&#59; naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; esteroides 12 semanas &#40;n &#61; 20&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ulcus gastroduodenal &#40;diagn&#243;stico endosc&#243;pico&#41;&#59; celecoxib &#40;n &#61; 16&#41;&#59; celecoxib &#43; esteroides &#40;n &#61; 2&#41; &#40;p &#61; 0&#44;969&#41;&#59; naproxeno &#40;n &#61; 79&#41;&#59; naproxeno &#43; esteroides &#40;n &#61; 8&#41; &#40;p &#62; 0&#44;050&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jick<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a>&#59; EC cruzado&#59; seguimiento&#44; 2 semanas&#59; Jadad 3&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">n &#61; 26 pacientes con enfermedad reum&#225;tica&#40;75&#37; mujeres&#59; media de edad&#44; 54 a&#241;os&#41;&#58; dexametasona 1&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 1 semanas &#40;n &#61; 26&#41;&#59; dexametasona 0&#44;75<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 1 semana &#43; AAS 1&#46;500<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 1 semana &#40;n &#61; 26&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">a&#41;</span> Trastornos gastrointestinales &#40;dolor&#44; n&#225;useas&#44; diarrea&#41;&#59; dexametasona &#40;n &#61; 3&#41;&#44; dexametasona &#43; AAS &#40;n &#61; 0&#41; &#40;p &#61; 0&#44;074&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> trastornos del SNC &#40;cefalea&#44; v&#233;rtigo&#44; tinnitus&#41;&#58; dexametasona &#40;n &#61; 2&#41;&#44; dexametasona &#43; AAS &#40;n &#61; 5&#41; &#40;p &#61; 0&#44;222&#41;&#59; <span class="elsevierStyleItalic">c&#41;</span> dolor tor&#225;cico&#58; dexametasona &#40;n &#61; 0&#41;&#44; dexametasona &#43; AAS &#40;n &#61; 1&#41; &#40;p &#61; 0&#44;312&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laine7&#59; EC ciego multic&#233;ntrico&#59; seguimiento&#44; 13 meses&#59; Jadad 3&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">n &#61; 8&#46;076 AR &#40;79&#44;7&#37; mujeres&#59; media de edad&#44; 58 a&#241;os&#41;&#46; Criterios de exclusi&#243;n&#58; protectores g&#225;stricos&#46; Rofecoxib 50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;n &#61; 4&#46;047&#41;&#59; naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;n &#61; 4&#46;029&#41;&#59; todos toman esteroides&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">Incidencia &#40;100 pacientes-a&#241;o&#41; de trastorno gastrointestinal serio &#40;sangrado&#44; perforaci&#243;n obstrucci&#243;n&#44; ulcus&#41;&#58; rofecoxib solo&#44; 2&#44;1&#59; rofecoxib &#43; esteroides&#44; 2&#44;1 &#40;p &#61; 1&#41;&#59; naproxeno solo&#44; 4&#44;5&#59; naproxeno &#43; esteroides&#44; 5&#44;67 &#40;p &#61; 0&#44;274&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laine<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a>&#59; EC ciegomultic&#233;ntrico&#59; seguimiento&#44; 13 meses&#59; Jadad 3&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">n &#61; 8&#46;076 AR &#40;79&#44;7&#37; mujeres&#59; media de edad&#44; 58 a&#241;os&#41;&#46; CE&#58; protectores g&#225;stricos&#46; Rofecoxib 50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; esteroides &#40;n &#61; 4&#46;047&#41;&#59; naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; esteroides &#40;n &#61; 4&#46;029&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Riesgo relativo de sangrado&#44; perforaci&#243;n&#44; obstrucci&#243;n&#44; ulceraci&#243;n&#44; diverticulitis&#44; en intestino grueso&#58; rofecoxib&#44; RR &#61; 0&#44;26&#59; rofecoxib &#43; esteroides&#44; RR &#61; 0&#44;59 &#40;p &#62; 0&#44;050&#41;&#59; naproxeno&#44; RR &#61; 0&#44;99&#59; naproxeno &#43; esteroides&#44; RR &#61; 0&#44;76 &#40;p &#62; 0&#44;050&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Littman9&#59; EC doble ciego placebo control&#59; seguimiento&#44; 15 semanas&#59; Jadad 3&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">n &#61; 32 PMR &#40;63&#37; mujeres&#59; media de edad&#44; 66&#41;&#46; CE&#58; otras enfermedades reum&#225;ticas&#46; Tenidap 120<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; prednisona &#60; 10<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 15 semanas &#40;n &#61; 16&#41;&#59; placebo &#43; esteroides &#60; 10<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 15 semanas &#40;n &#61; 16&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">a&#41;</span> Ulcus gastroduodenal&#58; tenidap &#43; esteroides &#40;n &#61; 1&#41;&#44; esteroides &#40;n &#61; 0&#41; &#40;p &#61; 0&#44;242&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> aumento de transaminasas&#58; tenidap &#43; esteroides &#40;n &#61; 3&#41;&#44; esteroides &#40;n &#61; 0&#41; &#40;p &#61; 0&#44;045&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paulus10&#59; EC&#59; seguimiento&#44; 3 a&#241;os&#59; Jadad 3&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">n &#61; 1&#46;434 AR &#40;71&#37; mujeres&#59; media de edad&#44; 52 a&#241;os&#41;&#46; CE&#58; otros AINE o FAME&#44; prednisona &#62; 5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46; AINE&#58; etodolaco 300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#44; etodolaco 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a o ibuprofeno 2&#46;400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;n &#61; 1&#46;105&#41;&#59; AINE &#40;anteriores&#41; &#43; prednisona &#60; 5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;n &#61; 328&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">a&#41;</span> cualquier evento adverso&#58; AINE &#40;n &#61; 118&#41;&#44; AINE &#43; prednisona &#40;n &#61; 34&#41; &#40;p &#61; 0&#44;439&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> alteraciones en an&#225;lisis de laboratorio&#58; AINE &#40;n &#61; 30&#41;&#44; AINE &#43; prednisona &#40;n &#61; 7&#41; &#40;p &#61; 0&#44;212&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wolfe14&#59; cohorteprospectiva&#59; seguimiento&#44; 13 a&#241;os&#59; calidad 2a&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">n &#61; 8&#46;605 AR&#47;OA&#46; AINE&#59; AINE &#43; prednisona&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">Incidencia de hospitalizaci&#243;n en AR &#40;100 pacientes&#47;a&#241;o&#41; por sangrado gastrointestinal&#58; prednisona&#44; 0&#44;97 &#40;0&#44;43-2&#44;14&#41;&#59; AINE&#44; 0&#44;19 &#40;0&#44;09-0&#44;39&#41;&#59; AINE &#43; prednisona&#44; 1&#44;31 &#40;0&#44;82-2&#44;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Estudios incluidos&#44; caracter&#237;sticas y principales resultados</p>"
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      4 => array:7 [
        "identificador" => "t0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">AINE&#58; antiinflamatorios no esteroideos&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Motivo de exclusi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Abelson<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a> &#40;1989&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay enfermedad reum&#225;tica&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambanelli<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a> &#40;1991&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Avidan<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a> &#40;2001&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Awni<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a> &#40;1995&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; Voluntarios sanos&#46; No hay datos cl&#237;nicos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Badia<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a> &#40;1975&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bowers<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> &#40;1975&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Del Campo<a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a> &#40;1981&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No es posible valorar correctamente el uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Flores<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a> &#40;1973&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No es posible valorar correctamente el uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Furtado<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> &#40;2005&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garcia<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> &#40;2006&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garg<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> &#40;1992&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; Voluntarios sanos&#46; No hay datos cl&#237;nicos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gergely<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> &#40;1989&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Goycochea-Robles<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> &#40;2007&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Green<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a> &#40;1998&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay rama que estudie el uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Harris<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a> &#40;2006&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Helin-Salmivaara<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a> &#40;2005&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hochain<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a> &#40;1995&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; Estudio de mala calidad&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hern&#225;ndez-D&#237;az<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> &#40;2001&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; Estudio en poblaci&#243;n general&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Holvoet<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a> &#40;1991&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huerta<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a> &#40;2005&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Joshi<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a> &#40;1977&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kolopp-Sarda<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a> &#40;2001&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Komajda<a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a> &#40;2003&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lanier<a class="elsevierStyleCrossRef" href="#bb0190"><span class="elsevierStyleSup">38</span></a> &#40;1987&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Luftschein<a class="elsevierStyleCrossRef" href="#bb0195"><span class="elsevierStyleSup">39</span></a> &#40;1979&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Martinez<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a> &#40;1988&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Martio<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a> &#40;1980&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">McNeil<a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a> &#40;1993&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neustadt<a class="elsevierStyleCrossRef" href="#bb0215"><span class="elsevierStyleSup">43</span></a> &#40;1987&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paulus<a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a> &#40;2004&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No guarda relaci&#243;n con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rejholec<a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a> &#40;1979&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sheldon<a class="elsevierStyleCrossRef" href="#bb0230"><span class="elsevierStyleSup">46</span></a> &#40;2003&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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
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Originales
Revisión sistemática: ¿hay alguna razón para contraindicar el uso concomitante de antiinflamatorios no esteroideos y esteroides?
Systematic Review: Is There Contraindication to the Concomitant Use of Non-Sterodial Anti-Inflammatory Drugs and Steroids?
Estíbaliz Loza
Autor para correspondencia
eloza.hcsc@salud.madrid.org

Dra. E. Loza. Hospital Clínico San Carlos. Prof. Martín Lagos, s/n. 28015 Madrid. España.
Servicio de Reumatología. Hospital Clínico San Carlos. Madrid. España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Introducci&#243;n</span><p id="p0005" class="elsevierStylePara elsevierViewall">El uso de f&#225;rmacos antiinflamatorios no esteroideos &#40;AINE&#41; es muy frecuente en la poblaci&#243;n con enfermedades reum&#225;ticas&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">Es bien conocida la relaci&#243;n de los AINE con las complicaciones gastroduodenales &#40;ulcus&#44; hemorragia&#44; perforaci&#243;n&#41;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a>&#44; aunque tambi&#233;n se ha visto que existen factores de riesgo independientes asociados a estas complicaciones digestivas en consumidores de AINE&#44; como la edad avanzada&#44; los antecedentes de ulcus gastroduodenal&#44; el consumo de alcohol o la toma de otras medicaciones como antiagregantes y anticoagulantes<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Por otro lado&#44; tambi&#233;n se ha estudiado el efecto gastroerosivo de otros f&#225;rmacos como los esteroides&#44; aunque en este caso su riesgo resulta controvertido&#59; seg&#250;n algunas publicaciones&#44; los esteroides orales aumentar&#237;an al doble el riesgo de complicaciones gastrointestinales&#44; efecto que&#44; adem&#225;s&#44; depender&#237;a de la dosis<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a>&#46; Dado que actualmente en la especialidad de reumatolog&#237;a el uso de esteroides y AINE es muy frecuente en el tratamiento de las enfermedades reum&#225;ticas&#44; determinar los posibles efectos de su uso concomitante &#40;especialmente en relaci&#243;n con la toxicidad gastrointestinal&#44; aunque extensible a cualquier otro evento adverso&#41; es de m&#225;ximo inter&#233;s en nuestro medio&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">Por todo lo comentado&#44; el objetivo de la presente revisi&#243;n sistem&#225;tica es buscar la evidencia publicada en torno a la seguridad del uso concomitante de AINE y esteroides&#44; para as&#237; contribuir a un mejor manejo de nuestros pacientes&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Material y m&#233;todos</span><p id="p0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; una revisi&#243;n sistem&#225;tica para analizar la seguridad del uso concomitante de AINE y esteroides&#46; Los criterios de selecci&#243;n de estudios fueron&#58; <span class="elsevierStyleItalic">a&#41;</span> estudios en que los pacientes tuvieran diagn&#243;stico de alguna enfermedad osteomuscular y estuvieran en tratamiento con esteroides&#44; sin restricci&#243;n en cuanto al tipo y la dosis del f&#225;rmaco&#59; <span class="elsevierStyleItalic">b&#41;</span> estudios en que los pacientes&#44; adem&#225;s del esteroide&#44; tomaran concomitantemente alg&#250;n AINE&#44; sin restricci&#243;n en cuanto al tipo y la dosis de &#233;ste&#44; pero excluyendo los estudios en que los sujetos tomaban AINE a dosis antiagregante y no analg&#233;sica&#47;antiinflamatoria o en tratamientos t&#243;picos&#59; <span class="elsevierStyleItalic">c&#41;</span> para evaluar la seguridad del uso concomitante de los f&#225;rmacos&#44; se incluyeron estudios en que se analizara alguna de las siguientes variables&#58; toxicidad gastrointestinal &#40;como sangrado&#44; perforaci&#243;n&#44; obstrucci&#243;n&#44; etc&#46;&#41;&#44; renal y cardiovascular&#44; entre otras&#44; y <span class="elsevierStyleItalic">d&#41;</span> ensayos cl&#237;nicos &#40;EC&#41; y estudios de cohortes &#40;prospectivas o retrospectivas&#41; de buena calidad&#46; Se excluyeron los estudios que s&#243;lo aportaban datos de farmacocin&#233;tica y&#47;o farmacodin&#225;mica&#44; as&#237; como estudios en sujetos sanos voluntarios y estudios en animales&#46; Finalmente se seleccionaron art&#237;culos en ingl&#233;s y espa&#241;ol&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">Se busc&#243; en las siguientes bases de datos electr&#243;nicas hasta diciembre de 2007&#58; MEDLINE &#40;desde 1960&#41;&#44; EMBASE &#40;desde 1980&#41; y la Cochrane Library &#40;Central&#41;&#46; Se buscaron tanto t&#233;rminos MeSH como en formato de texto libre&#46; No se puso l&#237;mites a la fecha de publicaci&#243;n&#46; La estrategia de b&#250;squeda espec&#237;fica se detalla en las <a class="elsevierStyleCrossRefs" href="#t0005">tablas 1 y 2</a>&#46; No se realiz&#243; b&#250;squeda manual en lo publicado en congresos nacionales &#40;SER&#41; o internacionales &#40;ACR&#44; EULAR&#41;&#44; dado el gran volumen de art&#237;culos rescatados en las bases de datos electr&#243;nicas&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0035" class="elsevierStylePara elsevierViewall">Un &#250;nico revisor analiz&#243; los art&#237;culos resultantes de la estrategia de b&#250;squeda&#44; as&#237; como el an&#225;lisis en detalle de los art&#237;culos incluidos&#46; El resultado de la b&#250;squeda primeramente se depur&#243; por t&#237;tulo y resumen&#44; o por art&#237;culo entero en caso de que no existiera resumen&#44; mediante sesiones de 20<span class="elsevierStyleHsp" style=""></span>min de duraci&#243;n m&#225;xima&#46; Tras este proceso&#44; los art&#237;culos restantes se analizaron en detalle&#46; Finalmente se realiz&#243; una b&#250;squeda manual con las referencias de los art&#237;culos seleccionados para su an&#225;lisis en detalle&#46; Todas las referencias se recuperaron de internet y se introdujeron en el programa Procite 5&#46;1 para facilitar su gesti&#243;n&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">Para evaluar la calidad metodol&#243;gica de los estudios incluidos se utiliz&#243;&#44; para los EC&#44; la escala de Jadad<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> &#40;1 a 5&#44; consider&#225;ndose de buena calidad los estudios con Jadad de 3&#8211;5&#41; y&#44; para los estudios de cohortes&#44; la escala de calidad de Oxford&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Resultados</span><p id="p0045" class="elsevierStylePara elsevierViewall">Los resultados de la b&#250;squeda se detallan en la <a class="elsevierStyleCrossRef" href="#f0005">figura 1</a>&#46; Finalmente se incluyeron 10 art&#237;culos&#46; Un total de 6 fueron EC<a class="elsevierStyleCrossRefs" href="#bb0025"><span class="elsevierStyleSup">5&#8211;10</span></a> y 4&#44; estudios de cohortes prospectivas<a class="elsevierStyleCrossRefs" href="#bb0055"><span class="elsevierStyleSup">11&#8211;14</span></a> que incluyeron a m&#225;s de 20&#46;000 pacientes&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Resumen de la evidencia</span><p id="p0050" class="elsevierStylePara elsevierViewall">A continuaci&#243;n se describen los principales resultados de los estudios incluidos&#44; que se pueden consultar en la <a class="elsevierStyleCrossRef" href="#t0015">tabla 3</a>&#46; El listado de art&#237;culos excluidos<a class="elsevierStyleCrossRefs" href="#bb0075"><span class="elsevierStyleSup">15&#8211;47</span></a> y la causa de exclusi&#243;n de la revisi&#243;n sistem&#225;tica se detallan en la <a class="elsevierStyleCrossRef" href="#t0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><elsevierMultimedia ident="t0020"></elsevierMultimedia><p id="p0055" class="elsevierStylePara elsevierViewall">Como ya se ha comentado&#44; se incluyeron 10 art&#237;culos de buena calidad&#44; 6 EC &#40;Jadad 3&#41; y 4 estudios de cohortes prospectivas &#40;calidad 2a&#41;&#46; Estos estudios analizaron a pacientes con afecci&#243;n osteomuscular&#44; pero sobre todo incluyeron a pacientes con artritis reumatoide &#40;AR&#41; y&#47;o artrosis &#40;OA&#41;&#44; la mayor&#237;a mujeres&#44; de mediana edad&#46; La duraci&#243;n del tratamiento vari&#243; de 1&#8211;15 semanas los EC a 3&#8211;21 a&#241;os las cohortes&#44; o no fue posible hallar este dato&#46; Se utilizaron diferentes tipos de AINE y esteroides&#44; as&#237; como dosis&#44; aunque el esteroide m&#225;s empleado fue la prednisona a dosis bajas&#44; pr&#243;ximas a los 10<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46; La mayor&#237;a de los estudios no permit&#237;an expresamente el uso de protectores g&#225;stricos o no registraron que los pacientes los tomaran&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">En cuanto a los resultados de seguridad&#44; no se ha encontrado evidencia suficiente que contraindique el uso concomitante de AINE y esteroides en pacientes con enfermedades reum&#225;ticas&#46; Esto se basa en que no se ha visto una clara relaci&#243;n entre el uso combinado de estos f&#225;rmacos y la aparici&#243;n de eventos adversos gastrointestinales &#40;leves o graves&#41; u otro tipo de eventos&#44; en comparaci&#243;n con el uso de AINE sin esteroides&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Resultados detallados del uso combinado de AINE y esteroides</span><p id="p0065" class="elsevierStylePara elsevierViewall">Entre los resultados de seguridad del uso en combinaci&#243;n de AINE y esteroides&#44; en los EC destacan&#58;<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">&#8211;</span><p id="p0070" class="elsevierStylePara elsevierViewall">En el estudio de Goldstein et al<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a>&#44; se objetiv&#243; que el uso de celecoxib 400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a o naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a con esteroides durante 12 semanas no se asoci&#243; a ulcus gastroduodenal en comparaci&#243;n con estos AINE sin esteroides&#46;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8211;</span><p id="p0075" class="elsevierStylePara elsevierViewall">Seg&#250;n Jick et al<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a>&#44; el uso de &#225;cido acetilsalic&#237;lico 1&#46;500<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a con dexametasona 0&#44;75<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a durante 1 semana&#44; en comparaci&#243;n con dexametasona sola&#44; no se asoci&#243; a mayor n&#250;mero de trastornos gastrointestinales menores &#40;no incluye ulcus ni hemorragias&#41;&#44; trastornos en el SNC &#40;cefalea&#44; v&#233;rtigo&#44; tinnitus&#41; o dolor tor&#225;cico&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8211;</span><p id="p0080" class="elsevierStylePara elsevierViewall">En los art&#237;culos de Laine et al<a class="elsevierStyleCrossRefs" href="#bb0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#44; se observ&#243; que el uso de rofecoxib 50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a o naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a con esteroides&#44; en comparaci&#243;n con el uso de los AINE solos&#44; no se asoci&#243; a mayor riesgo de eventos adversos digestivos superiores e inferiores serios &#40;ulcus&#44; hemorragia&#44; perforaci&#243;n&#44; obstrucci&#243;n o diverticulitis&#41;&#46;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8211;</span><p id="p0085" class="elsevierStylePara elsevierViewall">En el art&#237;culo de Littman et al<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a>&#44; el uso de tenidap 120<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a m&#225;s prednisona &#40;&#60; 10<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; durante 15 semanas&#44; en comparaci&#243;n con AINE en monoterapia&#44; no se asoci&#243; a mayor riesgo de ulcus gastroduodenal&#44; pero s&#237; a mayor n&#250;mero de alteraciones anal&#237;ticas&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8211;</span><p id="p0090" class="elsevierStylePara elsevierViewall">En el estudio de Paulus et al<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a>&#44; el uso de AINE &#40;etodolaco 300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#44; etodolaco 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a o ibuprofeno 2&#46;400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; con prednisona &#40;&#60; 5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; en comparaci&#243;n con los AINE solos&#44; no se asoci&#243; con la aparici&#243;n de mayor n&#250;mero de eventos adversos o alteraciones anal&#237;ticas&#46;</p></li></ul></p><p id="p0095" class="elsevierStylePara elsevierViewall">En cuanto a los estudios de cohortes prospectivas&#44; se incluyeron 4&#58; Benito-Garc&#237;a et al<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#44; Fries et al<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a>&#44; Gabriel et al<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a> y Wolfe et al<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a>&#46; En ellos se analiz&#243; a un total de 12&#46;365 pacientes&#46; En general&#44; la incidencia de evento gastrointestinal serio fue baja y no se asoci&#243; al uso concomitante de AINE y esteroides&#46; Destaca el estudio de Wolf et al<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a>&#44; en el que la combinaci&#243;n de AINE con esteroides no increment&#243; el riesgo de evento gastrointestinal importante en comparaci&#243;n con los AINE en monoterapia&#44; mientras que fueron los esteroides en monoterapia los que aumentaron m&#225;s el riesgo del evento&#46;</p></span></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Discusi&#243;n</span><p id="p0100" class="elsevierStylePara elsevierViewall">En la presente revisi&#243;n sistem&#225;tica se ha analizado la seguridad del uso concomitante de los AINE y los esteroides en pacientes con enfermedades reum&#225;ticas&#46; Para ello&#44; se realiz&#243; una extensa b&#250;squeda en las principales bases de datos bibliogr&#225;ficas disponibles&#44; tal y como se ha descrito&#46; S&#243;lo incluimos EC y estudios de cohortes de calidad&#44; porque consideramos que era la mejor forma de contestar a esta pregunta de investigaci&#243;n&#46;</p><p id="p0105" class="elsevierStylePara elsevierViewall">Finalmente&#44; se incluyeron 10 estudios &#40;6 EC<a class="elsevierStyleCrossRefs" href="#bb0025"><span class="elsevierStyleSup">5&#8211;10</span></a>&#44; 4 estudios de cohortes<a class="elsevierStyleCrossRefs" href="#bb0055"><span class="elsevierStyleSup">11&#8211;14</span></a>&#41; de calidad aceptable&#58; los EC fueron todos Jadad 3 y los de cohortes&#44; calidad 2a&#46; En cuanto a los pacientes estudiados&#44; todos ten&#237;an alg&#250;n tipo de afecci&#243;n osteomuscular&#44; aunque es importante destacar que pr&#225;cticamente todos eran pacientes con AR o artrosis&#46; Los AINE y los esteroides estudiados fueron diversos&#44; as&#237; como las dosis preescritas &#40;en los estudios en este dato estaba disponible&#41;&#46; En relaci&#243;n con los eventos estudiados&#44; todos los art&#237;culos incluidos evaluaron eventos adversos gastrointestinales&#44; y la mayor&#237;a de ellos tambi&#233;n analizaron los eventos adversos cl&#237;nicamente m&#225;s relevantes y&#47;o graves&#44; como el ulcus gastroduodenal o las hemorragias digestivas&#46; En general&#44; estas medidas de resultado fueron definidas por criterios muy similares en todos los estudios&#46;</p><p id="p0110" class="elsevierStylePara elsevierViewall">En primer lugar&#44; en la presente revisi&#243;n sistem&#225;tica se ha visto que la incidencia general de eventos adversos gastrointestinales serios &#40;sangrado&#44; perforaci&#243;n&#44; obstrucci&#243;n&#44; etc&#46;&#41; que pudieran generar la hip&#243;tesis de contraindicar el uso combinado de ambos f&#225;rmacos es baja&#46; Adem&#225;s&#44; los resultados de los EC indican que la combinaci&#243;n no incrementa el riesgo de eventos adversos gastrointestinales &#40;tanto graves como otros como la dispepsia leve o las n&#225;useas&#41; u otros &#40;trastornos del sistema nervioso central o dolor tor&#225;cico&#41; en comparaci&#243;n con el uso de los AINE sin esteroides&#46; En cuanto a los estudios de cohortes prospectivas&#44; tampoco se demostr&#243; que el uso combinado de AINE y esteroides incrementara el riesgo de evento adverso gastrointestinal en comparaci&#243;n con su uso en monoterapia&#46; Entre ellos destacamos el estudio de Wolfe et al<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a>&#44; en el que la combinaci&#243;n de AINE y esteroides no increment&#243; el riesgo de evento gastrointestinal grave de los esteroides&#44; que fueron los que mayor incidencia originaron&#46; Por todo ello&#44; se puede recomendar el uso de los AINE en combinaci&#243;n con esteroides &#40;al menos a dosis bajas&#41;&#44; en pacientes con enfermedades osteomusculares&#44; con una evidencia 2a y una fuerza de la recomendaci&#243;n B&#47;C&#46;</p><p id="p0115" class="elsevierStylePara elsevierViewall">No obstante&#44; hay que interpretar todos estos datos con mucha cautela&#44; ya que no est&#225;n exentos de algunas limitaciones&#46; En el caso de los EC&#44; las limitaciones se derivan sobre todo por la representatividad de los pacientes incluidos en ellos&#44; ya que probablemente no sean como muchos otros pacientes que habitualmente se siguen en las consultas de reumatolog&#237;a&#44; es decir&#44; pacientes con mayor n&#250;mero de factores independientes de riesgo de eventos adversos gastrointestinales&#44; como por ejemplo los de edad m&#225;s avanzada&#44; con comorbilidades&#44; etc&#46;</p><p id="p0120" class="elsevierStylePara elsevierViewall">Por otro lado&#44; en los estudios de cohortes es muy dif&#237;cil definir claramente las duraciones y las dosis de los f&#225;rmacos estudiados para poder establecer relaciones causales m&#225;s s&#243;lidas entre las combinaciones farmacol&#243;gicas y sus posibles eventos adversos&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall">Pero&#44; por otro lado&#44; es importante comentar que estos datos contrastan con lo publicado en referencia a la poblaci&#243;n general y el uso de AINE con esteroides&#44; para el que se ha descrito un riesgo incrementado de complicaciones gastrointestinales graves<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a>&#46; Esto podr&#237;a deberse&#44; al menos en parte&#44; a que -como bien se ha descrito claramente en al menos dos de los EC y en uno de los estudios de cohortes y probablemente as&#237; sea en los dem&#225;s&#8211; las dosis de esteroides utilizadas en los estudios incluidos en esta revisi&#243;n sistem&#225;tica fueron bajas&#44; menores que las que habitualmente toman muchos pacientes con enfermedades reum&#225;ticas&#46; En general&#44; son dosis mucho m&#225;s bajas que las dosis de esteroides utilizadas&#44; por ejemplo&#44; para el tratamiento de otras afecciones como las pulmonares y algunas neurol&#243;gicas&#44; que se incluir&#237;an en los estudios poblacionales&#44; lo que probablemente incremente el riesgo de evento adverso del uso concomitante de AINE y esteroides&#46;</p><p id="p0130" class="elsevierStylePara elsevierViewall">Continuando con los eventos adversos en relaci&#243;n con estos f&#225;rmacos&#44; no cabe duda de que los gastrointestinales&#44; por su frecuencia y su potencial gravedad&#44; son de estudio y seguimiento obligatorios&#44; pero destacamos la poca informaci&#243;n disponible sobre otro tipo de eventos que pudieran ser de inter&#233;s&#44; como los renales o cardiovasculares&#46;</p><p id="p0135" class="elsevierStylePara elsevierViewall">Para terminar&#44; en relaci&#243;n con el uso combinado de AINE y esteroides&#44; en esta revisi&#243;n sistem&#225;tica se han incluido estudios con diferentes f&#225;rmacos&#44; tanto AINE como esteroides &#40;aunque claramente el esteroide m&#225;s empleado fue la prednisona&#41;&#44; as&#237; como diferentes dosis y combinaciones de ambos&#44; por lo que resulta extremadamente dif&#237;cil establecer comparaciones entre combinaciones de ellos para definir cu&#225;l es la combinaci&#243;n de AINE y esteroide &#40;y en qu&#233; dosis de cada uno&#41; que presenta un mejor perfil de seguridad&#46; Por ello&#44; se deber&#225; realizar en el futuro otros estudios especialmente dise&#241;ados para responder a esta cuesti&#243;n&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el uso de AINE con esteroides a dosis bajas en pacientes con afecciones osteomusculares no parece incrementar el riesgo de eventos adversos gastrointestinales tanto leves como graves&#44; por lo que se puede recomendar su uso en la pr&#225;ctica diaria&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="st0005">Objetivos</span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Analizar la seguridad del uso concomitante de antiinflamatorios no esteroideos &#40;AINE&#41; con esteroides en pacientes con enfermedad reum&#225;tica&#46;</p> <span class="elsevierStyleSectionTitle" id="st0010">M&#233;todos</span><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n sistem&#225;tica&#46; Se defini&#243; una estrategia de b&#250;squeda bibliogr&#225;fica sensible en MEDLINE &#40;desde 1961&#41;&#44; EMBASE &#40;desde 1980&#41; y Cochrane Library hasta diciembre del 2007&#44; definiendo la poblaci&#243;n &#40;sujetos con enfermedad reum&#225;tica en tratamiento con esteroides&#41; y la intervenci&#243;n &#40;tratamiento concomitante con AINE&#41; y definiendo como resultados variables de seguridad &#40;toxicidad gastrointestinal&#44; renal y cardiovascular&#41;&#46; Se seleccionaron ensayos cl&#237;nicos y estudios de cohortes de calidad&#46;</p> <span class="elsevierStyleSectionTitle" id="st0015">Resultados</span><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">Se recuperaron 4&#46;164 estudios&#44; de los que 42 se analizaron en detalle&#59; finalmente se incluyeron 10 en los an&#225;lisis&#44; 6 de los cuales fueron ensayos cl&#237;nicos y 4&#44; estudios de cohortes prospectivos&#44; que incluyeron a m&#225;s de 20&#46;000 pacientes&#46;</p> <span class="elsevierStyleSectionTitle" id="st0020">Conclusiones</span><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">El uso concomitante de AINE y esteroides a dosis bajas en pacientes con enfermedad reum&#225;tica no parece que incremente el riesgo de eventos adversos gastrointestinales&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle" id="st0025">Objectives</span><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">To analyze the safety of combining nonsteroidal anti-inflammatory drugs &#40;NSAID&#41; and steroids&#46;</p> <span class="elsevierStyleSectionTitle" id="st0030">Methods</span><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall">A systematic review following a sensitive search strategy was performed&#46; All articles published in MEDLINE &#40;since 1961&#41;&#44; EMBASE &#40;since 1961&#41;&#44; and Cochrane Library&#44; up to December 2007 were examined&#46; Selection criteria&#58; the population &#40;subjects with musculoskeletal diseases on steroids&#41;&#44; the intervention &#40;concomitant use of NSAID&#41;&#44; and outcomes related to drugs safety &#40;gastrointestinal&#44; renal&#44; and cardiovascular toxicity&#41;&#46; Titles and abstracts of retrieved articles meeting inclusion criteria from the search were reviewed&#46; Only randomized controlled trials &#40;RCT&#41; or high quality cohort studies with a control group were included&#46;</p> <span class="elsevierStyleSectionTitle" id="st0035">Results</span><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">Of a total of 4164 references retrieved&#44; 42 were analyzed in detail&#44; and 10 were finally included&#44; 6 RCT and 4 prospective cohort studies&#44; which included more than 20 000 patients&#46;</p> <span class="elsevierStyleSectionTitle" id="st0040">Conclusions</span><p id="sp0080" class="elsevierStyleSimplePara elsevierViewall">The use of NSAID and low dose of steroids in patients with musculoskeletal diseases does not seem to increase the risk of gastrointestinal adverse events&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
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        "identificador" => "f0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "es" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Flujo de la selecci&#243;n de los estudios&#46;</p>"
        ]
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      1 => array:7 [
        "identificador" => "t0005"
        "etiqueta" => "Tabla 1"
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        "mostrarFloat" => true
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        "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#35;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estrategia de b&#250;squeda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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&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">&#40;Steroids OR steroid OR corticoids OR corticoid OR corticosteroids OR corticosteroid OR glucosteroids OR glucosteroid OR glucocorticoids OR glucocorticoid OR prednisone OR prednison OR prednisolone OR methylprednisolone OR cortisone OR cortisol OR triamcinolone OR dexamethasone OR betamethasone&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">738&#46;575&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&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">NSAID OR Nonsteroidal Anti-Inflammatory Agents OR Nonsteroidal Antiinflammatory Agents OR Analgesics&#44; Anti Inflammatory OR Non-Steroidal Anti-Rheumatic Agents OR Non-Steroidal Antirheumatic Agents OR Aspirin-Like Agents OR Agents&#44; Aspirin-Like OR naproxen&#42; OR ibuprofen&#42; OR dexibuprofen OR dexketoprofen OR flurbiprofen OR Ketoprofen OR Ketorola&#42; <span class="elsevierStyleSmallCaps">Or</span> aceclofenac <span class="elsevierStyleSmallCaps">Or</span> diclofenac OR lornoxicam OR meloxicam OR piroxicam OR tenoxicam OR indometacin OR sulindac OR tolmetin OR fenilbutazon OR Phenylbutazone OR nabumeton OR celecoxib OR etoricoxib OR parecoxib OR rofecoxib OR valdecoxib OR lumiracoxib OR salicylic acid OR acetylsalicylic acid OR diflunisal OR Cyclooxygenase 2 Inhibitors OR COX-2 Inhibitors OR COX2 Inhibitors&#44; OR Coxibs&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&#46;391&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&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">Randomized &#91;All Fields&#93; OR random allocation&#34;&#91;TIAB&#93; NOT Medline&#91;SB&#93;&#41; OR &#34;random allocation&#34;&#91;MeSH Terms&#93; OR randomized&#91;Text Word&#93; OR controlled&#91;All Fields&#93; AND &#40;&#34;clinical trials as topic&#34;&#91;MeSH Terms&#93; OR trial&#91;Text Word&#93;&#41; OR placebo OR blinded&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">819&#46;404&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#35;1 AND &#35;2 AND &#35;3&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;430&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&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">acute &#91;All Fields&#93; OR acute OR post-operative &#91;All Fields&#93; OR post-surgical&#91;All Fields&#93; OR postsurgical &#91;All Fields&#93; OR postoperative &#91;All Fields&#93; OR postoperative OR Postoperative Complications &#91;Mesh&#93; OR intraoperative &#91;All fields&#93; OR Intraoperative Complications &#91;Mesh&#93; dysmenorrhoea &#91;All Fields&#93; OR dysmenorrhea OR orthodontic &#91;All fields&#93;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;328&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&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">&#35;4 NOT &#35;5&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;411&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&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">&#35;6 LimitsLimits&#58; Humans&#44; Clinical Trial&#44; Meta-Analysis&#44; Randomized Controlled Trial&#44; Clinical Trial&#44; Phase I&#44; Clinical Trial&#44; Phase II&#44; Clinical Trial&#44; Phase III&#44; Clinical Trial&#44; Phase IV&#44; Comparative Study&#44; Controlled Clinical Trial&#44; English&#44; Spanish&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab211975.png"
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        "descripcion" => array:1 [
          "es" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Estrategia de b&#250;squeda y art&#237;culos rescatados en MEDLINE</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "t0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#35;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estrategia de b&#250;squeda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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&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">steroids&#46;mp&#46; or exp Steroid &#47; OR glucocorticoids&#46;mp&#46; or exp Glucocorticoid &#47;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">568&#46;743&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&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">nsaid&#46;mp&#46; or Nonsteroid Antiinflammatory Agent&#47; or Nonsteroidal Anti-Inflammatory Agents&#46;mp&#46; or &#40;coxib or Cyclooxygenase 2 Inhibitor&#41;&#46;mp&#46; or Acetylsalicylic Acid&#47; or Aspirin-Like Agents&#46;mp&#46; or naproxen&#46;mp&#46; or NAPROXEN&#47; or ibuprofen&#46;mp&#46; or IBUPROFEN&#47; or dexibuprofen&#36;&#46;mp&#46; or DEXIBUPROFEN&#47; or dexketoprofen&#46;mp&#46; or DEXKETOPROFEN&#47; or flurbiprofen&#46;mp&#46; or FLURBIPROFEN&#47; or Ketoprofen&#46;mp&#46; or KETOPROFEN&#47; or KETOROLAC&#47; or Ketorolac&#46;mp&#46; or aceclofenac&#46;mp&#46; or ACECLOFENAC&#47; or diclofenac&#46;mp&#46; or DICLOFENAC&#47; or lornoxicam&#46;mp&#46; or LORNOXICAM&#47; or meloxicam&#46;mp&#46; or MELOXICAM&#47; or PIROXICAM&#47; or piroxicam&#46;mp&#46; or PIROXICAM&#47; or piroxicam&#46;mp&#46; or tenoxicam&#46;mp&#46; or TENOXICAM&#47; or INDOMETACIN&#47; or indometacin&#46;mp&#46; or sulindac&#46;mp&#46; or SULINDAC&#47; or tolmetin&#46;mp&#46; or TOLMETIN&#47; or Phenylbutazone&#46;mp&#46; or PHENYLBUTAZONE&#47; or nabumetone&#47; or nabumeton&#46;mp&#46; or celecoxib&#46;mp&#46; or CELECOXIB&#47; or etoricoxib&#46;mp&#46; or ETORICOXIB&#47; or parecoxib&#46;mp&#46; or PARECOXIB&#47; or rofecoxib&#46;mp&#46; or ROFECOXIB&#47; or salicylic acid&#46;mp&#46; or Salicylic Acid&#47; or acetylsalicylic acid&#46;mp&#46; or Acetylsalicylic Acid&#47; or diflunisal&#46;mp&#46; or DIFLUNISAL&#47; or valdecoxib&#46;mp&#46; or VALDECOXIB&#47; or lumiracoxib&#46;mp&#46; or LUMIRACOXIB&#47;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">207&#46;945&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&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">exp clinical trial&#47; or evidence based medicine&#47; or outcomes research&#47; or crossover procedure&#47; or double blind procedure&#47; or single blind procedure&#47; or prospective study&#47; or major clinical study&#47; or exp comparative study&#47; or placebo&#47; or &#34;evaluation and follow up&#34;&#47; or follow up&#47; or randomization&#47;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;964&#46;112&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">controlled study&#47; not case control study&#47;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;568&#46;695&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&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 or 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;774&#46;593&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&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">&#40;&#40;clinic&#36; adj5 trial&#36;&#41; or &#40;&#40;singl&#36; or doubl&#36; or trebl&#36; or tripl&#36;&#41; adj &#40;blind&#36; or mask&#36;&#41;&#41; or random&#36; or placebo&#36;&#41;&#46;ti&#44;ab&#46;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">489&#46;355&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&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 or 6&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;890&#46;101&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  " 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><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 and 2 and 7&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;876&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  " 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><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">perioperative period&#46;mp&#46; or PERIOPERATIVE PERIOD&#47; or perioperative care&#46;mp&#46; or SURGERY&#47; or surgery&#46;mp&#46; or SURGICAL TECHNIQUE&#47; or surgical procedures&#46;mp&#46; or PEROPERATIVE CARE&#47; or preoperative care&#46;mp&#46; or intraoperative care&#46;mp&#46; or PEROPERATIVE COMPLICATION&#47; or POSTOPERATIVE COMPLICATION&#47; or dysmenorrhoea&#46;mp&#46; or Dysmenorrhea&#47; or orthodontic&#46;mp&#46; or Orthodontics&#47; or exp malignant neoplastic disease&#47; or cancer&#47; or exp metastasis&#47; or exp mixed tumor&#47; or exp &#34;neoplasms of uncertain behavior&#34;&#47; or exp neoplasms subdivided by anatomical site&#47; or exp &#34;oncogenesis and malignant transformation&#34;&#47; or exp paraneoplastic syndrome&#47; or exp &#34;precancer and cancer-in-situ&#34;&#47; or adolescent&#46;mp&#46; or adolescent&#47; or hospitalized adolescent&#47; or juvenile&#46;mp&#46; or juvenile&#47; or child&#46;mp&#46; or child&#47; or boy&#46;mp&#46; or boy&#47; or gifted child&#47; or girl&#46;mp&#46; or girl&#47; or handicapped child&#47; or hospitalized child&#47; or preschool child&#47; or school child&#47; or infant&#46;mp&#46; or infant&#47; or baby&#46;mp&#46; or baby&#47; or high risk infant&#47; or hospitalized infant&#47; or newborn&#46;mp&#46; or newborn&#47; or suckling&#46;mp&#46; or suckling&#47; or pediatric&#46;mp&#46; or review&#47; or guideline&#46;mp&#46;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;370&#46;213&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&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 not 9&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">666&#46;390&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&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">exp musculoskeletal disease&#47; or musculoskeletal disease&#46;mp&#46; or rheumatic polymyalgia&#46;mp&#46; or polymyalgia&#47; or lupus erythematosus systemic&#46;mp&#46; or systemic lupus erythematosus&#47; or vasculitis&#47; or vasculitis&#46;mp&#46; or polymyositis&#46;mp&#46; or polymyositis&#47; or dermatomyositis&#46;mp&#46; or dermatomyositis&#47;&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&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 and 11&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;391&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&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">Limit 12 to humans&#44; abstracts&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;091&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab211976.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Estrategia de b&#250;squeda y art&#237;culos rescatados en EMBASE</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "t0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">AINE&#58; antiinflamatorios no esteroideos&#59; AR&#58; artritis reumatoide&#59; CE&#58; criterios de exclusi&#243;n&#59; EC&#58; ensayo cl&#237;nico&#59; FAME&#58; f&#225;rmacos modificadores de la enfermedad&#59;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">LES&#58; lupus eritematoso sist&#233;mico&#59; OA&#58; osteoartrosis&#59; PM&#58; polimiositis&#59; PMR&#58; polimialgia reum&#225;tica&#59; RR&#58; riesgo relativo&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Participantes e intervenci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Benito-Garcia<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#59;cohorte prospectiva&#59; seguimiento&#44; 3 a&#241;os&#59; calidad&#44; 2a&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">n &#61; 4&#46;240 AR&#47;OA &#40;79&#37; mujeres&#59; media de edad&#44; 61&#41;&#59; COX2 &#43; prednisona &#40;n &#61; 1&#46;314&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RR &#40;ajustada&#41; no significativa para&#58; malestar epig&#225;strico &#40;p &#61; 0&#44;8&#41;&#44; acidez g&#225;strica &#40;p &#61; 0&#44;88&#41;&#44; n&#225;useas &#40;0&#44;066&#41;&#44; ulcus gastroduodenal &#40;p &#61; 0&#44;259&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fries<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a>&#59; cohorte prospectiva&#59; seguimiento&#44; 4 a&#241;os&#59; calidad 2a&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">n &#61; 2&#46;224 AR&#59; AINE&#58; naproxeno&#44; &#225;cido acetilsalic&#237;lico&#44; piroxicam&#44; sulindac&#44; ibuprofeno &#43; prednisona &#40;dosis media&#44; 7<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tasa de hospitalizaci&#243;n por evento gastrointestinal&#58; AINE frente a AINE &#43; prednisona &#40;0&#44;86 frente a 1&#44;59&#37;&#59; p &#62; 0&#44;050&#41;&#59; naproxeno frente a naproxeno &#43; prednisona &#40;1&#44;14 frente a 2&#44;58&#37;&#59; p &#62; 0&#44;050&#41;&#59; AAS frente a AAS &#43; prednisona &#40;1&#44;26 frente a 2&#44;22&#37;&#59; p &#62; 0&#44;050&#41;&#59; piroxicam frente a piroxicam &#43; prednisona &#40;2&#44;22 frente a 1&#44;79&#37;&#59; p &#62; 0&#44;050&#41;&#59; sulindac frente a sulindac &#43; prednisona &#40;2&#44;1 frente a 0&#44;75&#37;&#59; p &#62; 0&#44;050&#41;&#59; ibuprofeno frente a ibuprofeno &#43; prednisona &#40;0&#44;89 frente a 7&#44;8&#37;&#59; p &#62; 0&#44;050&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gabriel<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a>&#59; cohorte prospectiva&#59; seguimiento&#44; 21 a&#241;os&#59; calidad 2a&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">n &#61; 232 PMR &#40;70&#37; mujeres&#59; media de edad&#44; 72 a&#241;os&#41;&#46; CE&#58; AR&#44; LES&#44; PM&#44; infecciones&#44; mieloma&#46; AINE &#43; esteroides &#40;n &#61; 51&#41;&#59; AINE solo &#40;n &#61; 57&#41;&#59; esteroides solos &#40;n &#61; 124&#41;&#59; duraci&#243;n media tratamiento esteroides&#44; 2&#44;5 a&#241;os&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"><span class="elsevierStyleItalic">a&#41;</span> Cualquier evento adverso&#58; AINE solo &#40;n &#61; 38&#41;&#44; AINE &#43; esteroides &#40;n &#61; 41&#41; &#40;p &#61; 0&#44;120&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> hemorragia gastroduodenal&#58; AINE solo &#40;n &#61; 5&#41;&#44; AINE &#43; esteroides &#40;n &#61; 2&#41; &#40;p &#62; 0&#44;050&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Goldstein5&#59; EC doble ciego multic&#233;ntrico&#59; seguimiento&#44; 12 semanas&#59; Jadad 3&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">n &#61; 536 AR&#47;OA &#40;67&#37; mujeres&#59; media de edad&#44; 57 a&#241;os&#41;&#59; CE&#58; otras enfermedades inflamatorias&#44; enfermedad gastrointestinal activa&#44; protectores g&#225;stricos&#44; AINE&#59; celecoxib 400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 12 semanas &#40;n &#61; 185&#41;&#59; celecoxib 400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; esteroides 12 semanas &#40;n &#61; 26&#41;&#59; naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 12 semanas &#40;n &#61; 194&#41;&#59; naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; esteroides 12 semanas &#40;n &#61; 20&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ulcus gastroduodenal &#40;diagn&#243;stico endosc&#243;pico&#41;&#59; celecoxib &#40;n &#61; 16&#41;&#59; celecoxib &#43; esteroides &#40;n &#61; 2&#41; &#40;p &#61; 0&#44;969&#41;&#59; naproxeno &#40;n &#61; 79&#41;&#59; naproxeno &#43; esteroides &#40;n &#61; 8&#41; &#40;p &#62; 0&#44;050&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jick<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a>&#59; EC cruzado&#59; seguimiento&#44; 2 semanas&#59; Jadad 3&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">n &#61; 26 pacientes con enfermedad reum&#225;tica&#40;75&#37; mujeres&#59; media de edad&#44; 54 a&#241;os&#41;&#58; dexametasona 1&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 1 semanas &#40;n &#61; 26&#41;&#59; dexametasona 0&#44;75<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 1 semana &#43; AAS 1&#46;500<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 1 semana &#40;n &#61; 26&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">a&#41;</span> Trastornos gastrointestinales &#40;dolor&#44; n&#225;useas&#44; diarrea&#41;&#59; dexametasona &#40;n &#61; 3&#41;&#44; dexametasona &#43; AAS &#40;n &#61; 0&#41; &#40;p &#61; 0&#44;074&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> trastornos del SNC &#40;cefalea&#44; v&#233;rtigo&#44; tinnitus&#41;&#58; dexametasona &#40;n &#61; 2&#41;&#44; dexametasona &#43; AAS &#40;n &#61; 5&#41; &#40;p &#61; 0&#44;222&#41;&#59; <span class="elsevierStyleItalic">c&#41;</span> dolor tor&#225;cico&#58; dexametasona &#40;n &#61; 0&#41;&#44; dexametasona &#43; AAS &#40;n &#61; 1&#41; &#40;p &#61; 0&#44;312&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laine7&#59; EC ciego multic&#233;ntrico&#59; seguimiento&#44; 13 meses&#59; Jadad 3&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">n &#61; 8&#46;076 AR &#40;79&#44;7&#37; mujeres&#59; media de edad&#44; 58 a&#241;os&#41;&#46; Criterios de exclusi&#243;n&#58; protectores g&#225;stricos&#46; Rofecoxib 50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;n &#61; 4&#46;047&#41;&#59; naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;n &#61; 4&#46;029&#41;&#59; todos toman esteroides&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">Incidencia &#40;100 pacientes-a&#241;o&#41; de trastorno gastrointestinal serio &#40;sangrado&#44; perforaci&#243;n obstrucci&#243;n&#44; ulcus&#41;&#58; rofecoxib solo&#44; 2&#44;1&#59; rofecoxib &#43; esteroides&#44; 2&#44;1 &#40;p &#61; 1&#41;&#59; naproxeno solo&#44; 4&#44;5&#59; naproxeno &#43; esteroides&#44; 5&#44;67 &#40;p &#61; 0&#44;274&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laine<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a>&#59; EC ciegomultic&#233;ntrico&#59; seguimiento&#44; 13 meses&#59; Jadad 3&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">n &#61; 8&#46;076 AR &#40;79&#44;7&#37; mujeres&#59; media de edad&#44; 58 a&#241;os&#41;&#46; CE&#58; protectores g&#225;stricos&#46; Rofecoxib 50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; esteroides &#40;n &#61; 4&#46;047&#41;&#59; naproxeno 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; esteroides &#40;n &#61; 4&#46;029&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Riesgo relativo de sangrado&#44; perforaci&#243;n&#44; obstrucci&#243;n&#44; ulceraci&#243;n&#44; diverticulitis&#44; en intestino grueso&#58; rofecoxib&#44; RR &#61; 0&#44;26&#59; rofecoxib &#43; esteroides&#44; RR &#61; 0&#44;59 &#40;p &#62; 0&#44;050&#41;&#59; naproxeno&#44; RR &#61; 0&#44;99&#59; naproxeno &#43; esteroides&#44; RR &#61; 0&#44;76 &#40;p &#62; 0&#44;050&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Littman9&#59; EC doble ciego placebo control&#59; seguimiento&#44; 15 semanas&#59; Jadad 3&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">n &#61; 32 PMR &#40;63&#37; mujeres&#59; media de edad&#44; 66&#41;&#46; CE&#58; otras enfermedades reum&#225;ticas&#46; Tenidap 120<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#43; prednisona &#60; 10<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 15 semanas &#40;n &#61; 16&#41;&#59; placebo &#43; esteroides &#60; 10<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a 15 semanas &#40;n &#61; 16&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">a&#41;</span> Ulcus gastroduodenal&#58; tenidap &#43; esteroides &#40;n &#61; 1&#41;&#44; esteroides &#40;n &#61; 0&#41; &#40;p &#61; 0&#44;242&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> aumento de transaminasas&#58; tenidap &#43; esteroides &#40;n &#61; 3&#41;&#44; esteroides &#40;n &#61; 0&#41; &#40;p &#61; 0&#44;045&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paulus10&#59; EC&#59; seguimiento&#44; 3 a&#241;os&#59; Jadad 3&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">n &#61; 1&#46;434 AR &#40;71&#37; mujeres&#59; media de edad&#44; 52 a&#241;os&#41;&#46; CE&#58; otros AINE o FAME&#44; prednisona &#62; 5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46; AINE&#58; etodolaco 300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#44; etodolaco 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a o ibuprofeno 2&#46;400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;n &#61; 1&#46;105&#41;&#59; AINE &#40;anteriores&#41; &#43; prednisona &#60; 5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;n &#61; 328&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">a&#41;</span> cualquier evento adverso&#58; AINE &#40;n &#61; 118&#41;&#44; AINE &#43; prednisona &#40;n &#61; 34&#41; &#40;p &#61; 0&#44;439&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> alteraciones en an&#225;lisis de laboratorio&#58; AINE &#40;n &#61; 30&#41;&#44; AINE &#43; prednisona &#40;n &#61; 7&#41; &#40;p &#61; 0&#44;212&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wolfe14&#59; cohorteprospectiva&#59; seguimiento&#44; 13 a&#241;os&#59; calidad 2a&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">n &#61; 8&#46;605 AR&#47;OA&#46; AINE&#59; AINE &#43; prednisona&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">Incidencia de hospitalizaci&#243;n en AR &#40;100 pacientes&#47;a&#241;o&#41; por sangrado gastrointestinal&#58; prednisona&#44; 0&#44;97 &#40;0&#44;43-2&#44;14&#41;&#59; AINE&#44; 0&#44;19 &#40;0&#44;09-0&#44;39&#41;&#59; AINE &#43; prednisona&#44; 1&#44;31 &#40;0&#44;82-2&#44;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab211974.png"
              ]
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        "descripcion" => array:1 [
          "es" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Estudios incluidos&#44; caracter&#237;sticas y principales resultados</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "t0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">AINE&#58; antiinflamatorios no esteroideos&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Motivo de exclusi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Abelson<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a> &#40;1989&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay enfermedad reum&#225;tica&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambanelli<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a> &#40;1991&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Avidan<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a> &#40;2001&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Awni<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a> &#40;1995&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; Voluntarios sanos&#46; No hay datos cl&#237;nicos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Badia<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a> &#40;1975&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bowers<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> &#40;1975&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Del Campo<a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a> &#40;1981&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No es posible valorar correctamente el uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Flores<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a> &#40;1973&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No es posible valorar correctamente el uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Furtado<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> &#40;2005&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garcia<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> &#40;2006&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garg<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> &#40;1992&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; Voluntarios sanos&#46; No hay datos cl&#237;nicos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gergely<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> &#40;1989&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Goycochea-Robles<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> &#40;2007&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Green<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a> &#40;1998&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay rama que estudie el uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Harris<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a> &#40;2006&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Helin-Salmivaara<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a> &#40;2005&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hochain<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a> &#40;1995&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; Estudio de mala calidad&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hern&#225;ndez-D&#237;az<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> &#40;2001&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; Estudio en poblaci&#243;n general&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Holvoet<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a> &#40;1991&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huerta<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a> &#40;2005&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Joshi<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a> &#40;1977&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kolopp-Sarda<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a> &#40;2001&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Komajda<a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a> &#40;2003&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No relacionado con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lanier<a class="elsevierStyleCrossRef" href="#bb0190"><span class="elsevierStyleSup">38</span></a> &#40;1987&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Luftschein<a class="elsevierStyleCrossRef" href="#bb0195"><span class="elsevierStyleSup">39</span></a> &#40;1979&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Martinez<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a> &#40;1988&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Martio<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a> &#40;1980&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">McNeil<a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a> &#40;1993&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neustadt<a class="elsevierStyleCrossRef" href="#bb0215"><span class="elsevierStyleSup">43</span></a> &#40;1987&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paulus<a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a> &#40;2004&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No guarda relaci&#243;n con la pregunta de investigaci&#243;n&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rejholec<a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a> &#40;1979&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sheldon<a class="elsevierStyleCrossRef" href="#bb0230"><span class="elsevierStyleSup">46</span></a> &#40;2003&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; No hay datos espec&#237;ficos del uso concomitante de esteroides y AINE&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tougas<a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">47</span></a> &#40;1987&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&#46; Art&#237;culo de opini&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "es" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Estudios excluidos &#40;por autor y fecha del estudio&#41; y motivos de exclusi&#243;n</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bs0005"
          "bibliografiaReferencia" => array:47 [
            0 => array:3 [
              "identificador" => "bb0005"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Advances in the adverse effects of NSAIDs in the gastrointestinal tract&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Lanas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Gastroenterol Hepatol"
                        "fecha" => "2006"
                        "volumen" => "29"
                        "paginaInicial" => "16"
                        "paginaFinal" => "22"
                      ]
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              "identificador" => "bb0010"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs&#46; A meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;E&#46; Gabriel"
                            1 => "L&#46; Jaakkimainen"
                            2 => "C&#46; Bombardier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1991"
                        "volumen" => "115"
                        "paginaInicial" => "787"
                        "paginaFinal" => "796"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1834002"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            2 => array:3 [
              "identificador" => "bb0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The risk of upper gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs&#44; glucocorticoids&#44; acetaminophen&#44; and combinations of these agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;A&#46; Garcia Rodriguez"
                            1 => "S&#46; Hernandez-Diaz"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/ar146"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Res"
                        "fecha" => "2001"
                        "volumen" => "3"
                        "paginaInicial" => "98"
                        "paginaFinal" => "101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11178116"
                            "web" => "Medline"
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                      ]
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                  ]
                ]
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            ]
            3 => array:3 [
              "identificador" => "bb0020"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing the quality of reports of randomized clinical trials&#58; is blinding necessary&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;R&#46; Jadad"
                            1 => "R&#46;A&#46; Moore"
                            2 => "D&#46; Carroll"
                            3 => "C&#46; Jenkinson"
                            4 => "D&#46;J&#46; Reynolds"
                            5 => "D&#46;J&#46; Gavaghan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Control Clin Trials"
                        "fecha" => "1996"
                        "volumen" => "17"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8721797"
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                ]
              ]
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            4 => array:3 [
              "identificador" => "bb0025"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reduced incidence of gastroduodenal ulcers with celecoxib&#44; a novel cyclooxygenase-2 inhibitor&#44; compared to naproxen in patients with arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Goldstein"
                            1 => "P&#46; Correa"
                            2 => "W&#46;W&#46; Zhao"
                            3 => "A&#46;M&#46; Burr"
                            4 => "R&#46;C&#46; Hubbard"
                            5 => "K&#46;M&#46; Verburg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2001.03740.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2001"
                        "volumen" => "96"
                        "paginaInicial" => "1019"
                        "paginaFinal" => "1027"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11316141"
                            "web" => "Medline"
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                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bb0030"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dexamethasone and dexamethasone-aspirin in the treatment of chronic rheumatoid arthritis&#46; A controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Jick"
                            1 => "R&#46;S&#46; Pinals"
                            2 => "R&#46; Ullian"
                            3 => "D&#46; Slone"
                            4 => "H&#46; Muench"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1965"
                        "volumen" => "2"
                        "paginaInicial" => "1203"
                        "paginaFinal" => "1205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2903419"
                            "web" => "Medline"
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                        ]
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                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bb0035"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stratifying the risk of NSAID-related upper gastrointestinal clinical events&#58; results of a double-blind outcomes study in patients with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Laine"
                            1 => "C&#46; Bombardier"
                            2 => "C&#46;J&#46; Hawkey"
                            3 => "B&#46; Davis"
                            4 => "D&#46; Shapiro"
                            5 => "C&#46; Brett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2002"
                        "volumen" => "123"
                        "paginaInicial" => "1006"
                        "paginaFinal" => "1012"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12360461"
                            "web" => "Medline"
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                  ]
                ]
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            7 => array:3 [
              "identificador" => "bb0040"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serious lower gastrointestinal clinical events with nonselective NSAID or coxib use"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Laine"
                            1 => "L&#46;G&#46; Connors"
                            2 => "A&#46; Reicin"
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Información del artículo
ISSN: 1699258X
Idioma original: Español
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