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En las series m&#225;s amplias de APs publicadas hasta la fecha<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7-11</span></a>&#44; la prevalencia var&#237;a enormemente y oscila seg&#250;n la serie entre un 2-23&#37;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Existe cierta confusi&#243;n en la terminolog&#237;a empleada &#40;&#171;opera-glass hand syndrome&#187;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44; &#171;main en lorgnette&#187;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> o &#171;arthrititis mutilans&#187;&#44; &#171;artropat&#237;a resortiva&#187;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo de nuestro estudio ha sido describir la frecuencia de AM y estudiar su relaci&#243;n con otras variables de la APs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Es un estudio observacional&#44; transversal y multic&#233;ntrico sobre APs realizado en 8 centros reumatol&#243;gicos&#46; Todos los pacientes cumpl&#237;an criterios de CASPAR<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Las variables recogidas se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Se realiz&#243; una radiograf&#237;a antero-posterior de manos y pies a aquellos pacientes con una deformidad cl&#237;nica indicativa de AM &#40;dedos acortados&#41; o con signos actividad cl&#237;nica inflamatoria en dichas localizaciones&#46; Se consider&#243; al paciente como artropat&#237;a resortiva si en la radiograf&#237;a de manos y pies&#44; al menos una articulaci&#243;n&#44; presentaba resorci&#243;n de ambos extremos &#243;seos sin presencia de osteofitos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Estad&#237;stica</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se utilizaron el test de la chi al cuadrado para las variables cualitativas o test exacto de Fisher&#46; Para las variables cuantitativas se usaron las pruebas de la t de Student y no param&#233;trica de Mann-Whitney&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis multivariante de regresi&#243;n log&#237;stica por el m&#233;todo &#171;stepwise forward&#187;&#44; que mostr&#243; una asociaci&#243;n ajustada de las variables duraci&#243;n de la artritis&#44; afecci&#243;n de interfal&#225;ngicas distales y mHAQ&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Veinticuatro pacientes de la serie &#40;6&#44;7&#37;&#41; fueron diagnosticados de AM&#46; La descripci&#243;n de los pacientes se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; El an&#225;lisis de las diferentes variables entre el subgrupo de pacientes con resorci&#243;n &#243;sea y el resto de la serie de AP se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La duraci&#243;n de la artritis fue significativamente mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; en los pacientes con resorci&#243;n &#243;sea&#46; La afectaci&#243;n de interfal&#225;ngicas distales es significativamente m&#225;s frecuente en los pacientes con cambios resortivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">La capacidad funcional fue peor en este subgrupo de pacientes&#46; Tanto la percibida por el m&#233;dico seg&#250;n la escala ACR &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; como la autopercibida por el paciente en el cuestionario autoadministrado mHAQ &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Se objetiv&#243; una mayor concentraci&#243;n de AM en el centro sanitario de tercer nivel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante demostr&#243; asociaci&#243;n independiente de las variables duraci&#243;n de la artritis&#44; afecci&#243;n de interfal&#225;ngicas distales y mHAQ con respecto a la variable dependiente &#40;presencia o ausencia de AM&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">El t&#233;rmino &#171;arthritis mutilans&#187; generalmente transmite de idea de deformidades severas y uno recuerda el aspecto del &#171;opera glass syndrome&#187; con m&#250;ltiples acortamiento de los dedos&#46; Pero en ocasiones el proceso resortivo no es tan marcado como nosotros hemos demostrado en este estudio&#44; ya que un tercio de nuestros pacientes ten&#237;a menos de 3 radios afectados&#46; Incluso cuando el proceso se circunscribe a los pies puede llegar a pasar desapercibido y un 20&#37; de nuestra serie ten&#237;a el proceso de resorci&#243;n limitado a los pies&#46; Por esta raz&#243;n&#44; creemos que el t&#233;rmino &#171;artropat&#237;a resortiva&#187; basado en la imagen radiol&#243;gica acu&#241;ado por Swezey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> refleja mejor la naturaleza del proceso&#46; La deformidad en &#171;opera glass hand&#187; ser&#237;a el estadio final para algunos pacientes en los que el proceso de resorci&#243;n &#243;sea yuxtaarticular es m&#225;s severo&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La prevalencia exacta de la AM&#47;resortiva en la APs muestra resultados muy dispares que creemos son debidos a que la definici&#243;n no est&#225; consensuada y las series publicadas son de procedencia muy heterog&#233;nea&#46; Nuestra prevalencia es discretamente superior a otras series &#40;6&#44;7&#37;&#41; porque creemos que hemos incluido formas m&#225;s leves que solo se manifiestan en la radiolog&#237;a&#46; Si nos atenemos al &#171;opera glass syndrome&#187;&#44; la prevalencia en nuestra serie es del 1&#44;94&#37; y si solo tenemos en consideraci&#243;n a aquellos pacientes en los que se demuestra cl&#237;nicamente al acortamiento de alg&#250;n radio de la mano o pie la frecuencia es del 4&#44;4&#37;&#46; Si la comparamos con la serie m&#225;s amplia y reciente<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; que adem&#225;s consens&#250;a la opini&#243;n de los expertos del estudio CASPAR en cuanto a la definici&#243;n de &#171;arthritis mutilans&#187;&#44; la prevalencia es del 3&#44;7&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El patr&#243;n articular mayoritario es poliarticular y sim&#233;trico&#44; como hemos recogido nosotros y otros autores<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Pero debemos hacer constar que un 12&#44;5&#37; de nuestros pacientes la AM&#47;resortiva se present&#243; de forma oligoarticular&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Encontramos asociaci&#243;n con una mayor duraci&#243;n de la artritis&#44; la afectaci&#243;n de interfal&#225;ngicas distales y una peor capacidad funcional medida por el &#171;HAQ score&#187; y la escala funcional del ACR&#46; Datos del estudio CASPAR<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> muestran tambi&#233;n una asociaci&#243;n con una mayor duraci&#243;n de la artritis&#44; pero en cambio no demuestran una peor capacidad funcional seg&#250;n el &#171;HAQ score&#187;&#46; El hecho que se asocie a una mayor duraci&#243;n de la artritis puede hacer creer que la AM&#47;resortiva sea una consecuencia del proceso inflamatorio m&#225;s prolongado en el tiempo&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Uno de los hallazgos incidentales que llama la atenci&#243;n de nuestro estudio es la alta frecuencia &#40;30&#37;&#41; de la asociaci&#243;n de hallazgos de AM y osteoartrosis nodular&#46; La prevalencia de osteoartritis nodular en poblaci&#243;n normal de m&#225;s de 40 a&#241;os es inferior al 8&#44;5&#37;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; No hemos encontrado ninguna publicaci&#243;n que describa est&#225; asociaci&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Responsabilidades &#233;ticas</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protecci&#243;n de personas y animales</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los autores declaran que los procedimientos seguidos se conformaron a las normas &#233;ticas del comit&#233; de experimentaci&#243;n humana responsable y de acuerdo con la Asociaci&#243;n M&#233;dica Mundial y la Declaraci&#243;n de Helsinki&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidencialidad de los datos</span><p id="par0080" class="elsevierStylePara elsevierViewall">Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes y que todos los pacientes incluidos en el estudio han recibido informaci&#243;n suficiente y han dado su consentimiento informado por escrito para participar en dicho estudio&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Derecho a la privacidad y consentimiento informado</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los autores han obtenido el consentimiento informado de los pacientes y&#47;o sujetos referidos en el art&#237;culo&#46; Este documento obra en poder del autor de correspondencia&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0090" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Confidencialidad de los datos"
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    "fechaRecibido" => "2012-06-18"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec111467"
          "palabras" => array:3 [
            0 => "Artritis psori&#225;sica"
            1 => "Artritis mutilante"
            2 => "Artropat&#237;a resortiva"
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        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec111468"
          "palabras" => array:3 [
            0 => "Psoriatic arthritis"
            1 => "Arthritis mutilating"
            2 => "Resorptive arthropathy"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir una serie amplia de pacientes con artritis mutilante&#47;resortiva &#40;AM&#41; de una poblaci&#243;n representativa de pacientes con artritis psori&#225;sica &#40;APs&#41; y analizar las variables asociadas&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal multic&#233;ntrico que incluy&#243; de forma consecutiva a los pacientes afectados de APs de 8 centros&#46; A aquellos pacientes con tumefacci&#243;n o deformidad de manos o pies sospechosa de se les realiz&#243; una radiograf&#237;a antero-posterior&#46; Se consider&#243; que el paciente estaba afectado de AM si presentaba un trastorno erosivo que afectaba totalmente ambas superficies articulares&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De los 360 pacientes con APs estudiados&#44; 24 presentaban AM &#40;6&#44;7&#37;&#41;&#46; La duraci&#243;n de la enfermedad fue significativamente mayor y presentaban una peor capacidad funcional&#44; as&#237; como una mayor afecci&#243;n de IFD &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En un 30&#37; se detectaron cambios radiol&#243;gicos indistinguibles de una osteoartritis nodular&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La AM en la APs se asocia a una peor capacidad funcional&#46; Su posible asociaci&#243;n con la osteoartritis nodular de manos merece m&#225;s estudios&#46;</p>"
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      "en" => array:2 [
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To describe a large series of patients with mutilans&#47;resorptive arthritis &#40;AM&#41; of a representative population of patients with psoriatic arthritis &#40;PsA&#41; and analyze the associated variables&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Multicenter cross-sectional study of consecutive patients affected by PsA in 8 centers&#46; In patients with swelling or deformity of the hands or feet we performed an anteroposterior rx&#46; The patient was affected by AM if erosive disorder affecting both articular surfaces completely was present&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 360 patients studied&#44; 24 had PsA and AM &#40;6&#46;7&#37;&#41;&#46; The duration of their disease was significantly higher&#44; and they exhibited a worse functional capacity as well as more DIP joint affection <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;05&#41;&#46; 30&#37; had radiological changes indistinguishable from nodular osteoarthritis&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">AM in PA is associated with a worse functional capacity&#46; Its possible association with nodular hand osteoarthritis deserves further study&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;19&#44;1&#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">20 &#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab211417.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n entre los grupos de pacientes afectados de APs con y sin resorci&#243;n &#243;sea yuxtaarticular</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">OA&#58; osteoartritis nodular&#59; Oligoart&#58; oligoarticular&#59; Poliart&#58; poliarticular&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Paciente&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" style="border-bottom: 2px solid black">Sexo&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" style="border-bottom: 2px solid black">Edad&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" style="border-bottom: 2px solid black">Edad inicio psoriasis&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" style="border-bottom: 2px solid black">Duraci&#243;n psoriasis&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" style="border-bottom: 2px solid black">Edad inicio artritis&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" style="border-bottom: 2px solid black">Duraci&#243;n artritis&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" style="border-bottom: 2px solid black">Patr&#243;n de artritis perif&#233;rica&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" style="border-bottom: 2px solid black">Resorci&#243;n &#60; 3 radios&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" style="border-bottom: 2px solid black">Resorci&#243;n penacho&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" style="border-bottom: 2px solid black">&#171;Opera glass hand&#187;&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" style="border-bottom: 2px solid black">Solo pies&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" style="border-bottom: 2px solid black">Signos Rx OA nodular&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" style="border-bottom: 2px solid black">Interfal&#225;ngicas distales&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" style="border-bottom: 2px solid black">Afectaci&#243;n axial&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" style="border-bottom: 2px solid black">HLA B27 &#43;&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" style="border-bottom: 2px solid black">Corticoides&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">EBM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poliart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&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">JCV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poliart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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">JCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="char" 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">Oligoart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Artritis mutilante/resortiva. Estudio de 24 pacientes de una serie de 360 artritis psoriásicas
Mutilating/resorptive arthritis. a study of 24 patients in a series of 360 patients with psoriatic arthritis
Jesús Rodriguez-Morenoa,
Autor para correspondencia
jesus.rodriguez@bellvitgehospital.cat

Autor para correspondencia.
, Maria Bonetb, Jordi Del Blanco-Barnusellc, Carmen Castañod, Teresa Clavaguerae, Lourdes Mateo-Soriaf, Daniel Roig-Vilasecag, Jose M. Ruiz-Martinh
a Servicio de Reumatología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
b Unidad de Reumatología, Hospital Comarcal de l’Alt Penedès, Vilafranca del Penedés, Barcelona, España
c Unidad de Reumatología, Hospital Sant Jaume de Calella, Calella de Mar, Barcelona, España
d Unidad de Reumatología, Hospital Municipal de Badalona, Badalona, Barcelona, España
e Unidad de Reumatología, Hospital de Palamós, Palamós, Girona, España
f Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Barcelona, España
g Unidad de Reumatología, CAE Cornellà, Cornellà de Llobregat, Cornellà de Llobregat, Barcelona,España
h Unidad de Reumatología, Hospital de Viladecans, Viladecans, Barcelona, España
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transversal y multic&#233;ntrico sobre APs realizado en 8 centros reumatol&#243;gicos&#46; Todos los pacientes cumpl&#237;an criterios de CASPAR<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Las variables recogidas se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Se realiz&#243; una radiograf&#237;a antero-posterior de manos y pies a aquellos pacientes con una deformidad cl&#237;nica indicativa de AM &#40;dedos acortados&#41; o con signos actividad cl&#237;nica inflamatoria en dichas localizaciones&#46; Se consider&#243; al paciente como artropat&#237;a resortiva si en la radiograf&#237;a de manos y pies&#44; al menos una articulaci&#243;n&#44; presentaba resorci&#243;n de ambos extremos &#243;seos sin presencia de osteofitos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Estad&#237;stica</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se utilizaron el test de la chi al cuadrado para las variables cualitativas o test exacto de Fisher&#46; Para las variables cuantitativas se usaron las pruebas de la t de Student y no param&#233;trica de Mann-Whitney&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis multivariante de regresi&#243;n log&#237;stica por el m&#233;todo &#171;stepwise forward&#187;&#44; que mostr&#243; una asociaci&#243;n ajustada de las variables duraci&#243;n de la artritis&#44; afecci&#243;n de interfal&#225;ngicas distales y mHAQ&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Veinticuatro pacientes de la serie &#40;6&#44;7&#37;&#41; fueron diagnosticados de AM&#46; La descripci&#243;n de los pacientes se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; El an&#225;lisis de las diferentes variables entre el subgrupo de pacientes con resorci&#243;n &#243;sea y el resto de la serie de AP se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La duraci&#243;n de la artritis fue significativamente mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; en los pacientes con resorci&#243;n &#243;sea&#46; La afectaci&#243;n de interfal&#225;ngicas distales es significativamente m&#225;s frecuente en los pacientes con cambios resortivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">La capacidad funcional fue peor en este subgrupo de pacientes&#46; Tanto la percibida por el m&#233;dico seg&#250;n la escala ACR &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; como la autopercibida por el paciente en el cuestionario autoadministrado mHAQ &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Se objetiv&#243; una mayor concentraci&#243;n de AM en el centro sanitario de tercer nivel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante demostr&#243; asociaci&#243;n independiente de las variables duraci&#243;n de la artritis&#44; afecci&#243;n de interfal&#225;ngicas distales y mHAQ con respecto a la variable dependiente &#40;presencia o ausencia de AM&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">El t&#233;rmino &#171;arthritis mutilans&#187; generalmente transmite de idea de deformidades severas y uno recuerda el aspecto del &#171;opera glass syndrome&#187; con m&#250;ltiples acortamiento de los dedos&#46; Pero en ocasiones el proceso resortivo no es tan marcado como nosotros hemos demostrado en este estudio&#44; ya que un tercio de nuestros pacientes ten&#237;a menos de 3 radios afectados&#46; Incluso cuando el proceso se circunscribe a los pies puede llegar a pasar desapercibido y un 20&#37; de nuestra serie ten&#237;a el proceso de resorci&#243;n limitado a los pies&#46; Por esta raz&#243;n&#44; creemos que el t&#233;rmino &#171;artropat&#237;a resortiva&#187; basado en la imagen radiol&#243;gica acu&#241;ado por Swezey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> refleja mejor la naturaleza del proceso&#46; La deformidad en &#171;opera glass hand&#187; ser&#237;a el estadio final para algunos pacientes en los que el proceso de resorci&#243;n &#243;sea yuxtaarticular es m&#225;s severo&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La prevalencia exacta de la AM&#47;resortiva en la APs muestra resultados muy dispares que creemos son debidos a que la definici&#243;n no est&#225; consensuada y las series publicadas son de procedencia muy heterog&#233;nea&#46; Nuestra prevalencia es discretamente superior a otras series &#40;6&#44;7&#37;&#41; porque creemos que hemos incluido formas m&#225;s leves que solo se manifiestan en la radiolog&#237;a&#46; Si nos atenemos al &#171;opera glass syndrome&#187;&#44; la prevalencia en nuestra serie es del 1&#44;94&#37; y si solo tenemos en consideraci&#243;n a aquellos pacientes en los que se demuestra cl&#237;nicamente al acortamiento de alg&#250;n radio de la mano o pie la frecuencia es del 4&#44;4&#37;&#46; Si la comparamos con la serie m&#225;s amplia y reciente<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; que adem&#225;s consens&#250;a la opini&#243;n de los expertos del estudio CASPAR en cuanto a la definici&#243;n de &#171;arthritis mutilans&#187;&#44; la prevalencia es del 3&#44;7&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El patr&#243;n articular mayoritario es poliarticular y sim&#233;trico&#44; como hemos recogido nosotros y otros autores<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Pero debemos hacer constar que un 12&#44;5&#37; de nuestros pacientes la AM&#47;resortiva se present&#243; de forma oligoarticular&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Encontramos asociaci&#243;n con una mayor duraci&#243;n de la artritis&#44; la afectaci&#243;n de interfal&#225;ngicas distales y una peor capacidad funcional medida por el &#171;HAQ score&#187; y la escala funcional del ACR&#46; Datos del estudio CASPAR<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> muestran tambi&#233;n una asociaci&#243;n con una mayor duraci&#243;n de la artritis&#44; pero en cambio no demuestran una peor capacidad funcional seg&#250;n el &#171;HAQ score&#187;&#46; El hecho que se asocie a una mayor duraci&#243;n de la artritis puede hacer creer que la AM&#47;resortiva sea una consecuencia del proceso inflamatorio m&#225;s prolongado en el tiempo&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Uno de los hallazgos incidentales que llama la atenci&#243;n de nuestro estudio es la alta frecuencia &#40;30&#37;&#41; 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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir una serie amplia de pacientes con artritis mutilante&#47;resortiva &#40;AM&#41; de una poblaci&#243;n representativa de pacientes con artritis psori&#225;sica &#40;APs&#41; y analizar las variables asociadas&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal multic&#233;ntrico que incluy&#243; de forma consecutiva a los pacientes afectados de APs de 8 centros&#46; A aquellos pacientes con tumefacci&#243;n o deformidad de manos o pies sospechosa de se les realiz&#243; una radiograf&#237;a antero-posterior&#46; Se consider&#243; que el paciente estaba afectado de AM si presentaba un trastorno erosivo que afectaba totalmente ambas superficies articulares&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De los 360 pacientes con APs estudiados&#44; 24 presentaban AM &#40;6&#44;7&#37;&#41;&#46; La duraci&#243;n de la enfermedad fue significativamente mayor y presentaban una peor capacidad funcional&#44; as&#237; como una mayor afecci&#243;n de IFD &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En un 30&#37; se detectaron cambios radiol&#243;gicos indistinguibles de una osteoartritis nodular&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La AM en la APs se asocia a una peor capacidad funcional&#46; Su posible asociaci&#243;n con la osteoartritis nodular de manos merece m&#225;s estudios&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To describe a large series of patients with mutilans&#47;resorptive arthritis &#40;AM&#41; of a representative population of patients with psoriatic arthritis &#40;PsA&#41; and analyze the associated variables&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Multicenter cross-sectional study of consecutive patients affected by PsA in 8 centers&#46; In patients with swelling or deformity of the hands or feet we performed an anteroposterior rx&#46; The patient was affected by AM if erosive disorder affecting both articular surfaces completely was present&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 360 patients studied&#44; 24 had PsA and AM &#40;6&#46;7&#37;&#41;&#46; The duration of their disease was significantly higher&#44; and they exhibited a worse functional capacity as well as more DIP joint affection <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;05&#41;&#46; 30&#37; had radiological changes indistinguishable from nodular osteoarthritis&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">AM in PA is associated with a worse functional capacity&#46; Its possible association with nodular hand osteoarthritis deserves further study&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Resorci&#243;n &#60; 3 radios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#171;Opera glass hand&#187;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Solo pies&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">HLA B27 &#43;&nbsp;\t\t\t\t\t\t\n
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                  \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" style="border-bottom: 2px solid black">Corticoides&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poliart&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&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">JCV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Poliart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AHC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">Poliart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ARA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poliart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab211416.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Descripci&#243;n de los 24 pacientes afectados de artritis mutilante&#47;resortiva</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
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Información del artículo
ISSN: 1699258X
Idioma original: Español
DOI:10.1016/j.reuma.2012.06.015
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