Original breve
Weather conditions may worsen symptoms in rheumatoid arthritis patients: The possible effect of temperature
Influencia de las condiciones climáticas en el empeoramiento de los síntomas de artritis reumatoide: El posible efecto de la temperatura
Lydia Abasoloa, Aurelio Tobíasb, Leticia Leona,c,
, Loreto Carmonac, Jose Luis Fernandez-Ruedaa, Ana Belen Rodriguezd, Benjamin Fernandez-Gutierrezd, Juan Angel Joverd
Autor para correspondencia
a Rheumatology Unit, Fundación para la Investigación Biomédica, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain
b Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
c Camilo José Cela University, Madrid, Spain
d Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain
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array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "Loreto" "apellidos" => "Carmona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Jose Luis" "apellidos" => "Fernandez-Rueda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Ana Belen" "apellidos" => "Rodriguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 6 => array:3 [ "nombre" => "Benjamin" "apellidos" => "Fernandez-Gutierrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "Juan Angel" "apellidos" => "Jover" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Rheumatology Unit, Fundación para la Investigación Biomédica, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Camilo José Cela University, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Influencia de las condiciones climáticas en el empeoramiento de los síntomas de artritis reumatoide: El posible efecto de la temperatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1750 "Ancho" => 2382 "Tamanyo" => 180367 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Graphical representation of the non-parametric adjustment of the relationship between daily RA worsening and daily mean temperature, by age group.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Patients with rheumatic conditions often complain that certain meteorological conditions aggravate their disease symptoms.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> However, studies on influence of weather conditions<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3–8</span></a> have reported conflicting results, most related to rheumatoid arthritis patients (RA). Some studies indicated that weather conditions do not influence the symptoms of arthritis,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> whereas others found an influence related to low temperature, high atmospheric pressure, and high humidity.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,9</span></a> Moreover, some authors found a seasonal effect<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> but others did not.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,8</span></a> Thus, scientific evidence on the effects of atmospheric factors on rheumatic diseases is sparse and non-conclusive. Discrepancies could be related to the diverse climatic conditions from each geographic area studied and also due to the different methodologies used.</p><p id="par0010" class="elsevierStylePara elsevierViewall">To our knowledge no study has previously been conducted in our setting for these rheumatic disorders. Our objective is to investigate the short-term effects of weather conditions on the acute worsening in rheumatic patients due to RA related conditions and also to determine possible seasonal fluctuations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This study was conducted in the city of Madrid, Spain, with a Mediterranean continental climate very influenced by urban conditions. Winters are cold, with mean temperatures below 10<span class="elsevierStyleHsp" style=""></span>°C with frequent frosts at night and occasional snowfalls. Summers are warm with mean temperatures over 20<span class="elsevierStyleHsp" style=""></span>°C.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Daily cases of RA worsening, were defined as those patients who come to the emergency room, were attended by a rheumatologist of Hospital Clínico San Carlos, and were diagnosed with RA as the main cause reflected in the ICD code (10th revision), from 1st January 2004 until 31st December 2007. The Hospital Clínico San Carlos is a tertiary hospital, covering a population over 500,000 inhabitants. For all cases we also collected age, gender, and disability index.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The study was approved by the HCSC Ethics Committee.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As weather conditions we measured: Daily mean, maximum and minimum temperatures (in °C), relative humidity (%), pressure (hPA), rain (mm), hours of sun, and cloud cover (octas) were obtained from the European Climate Assessment & Dataset (ECA&D).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The association of weather conditions with daily RA worsening was investigated using a case-crossover design,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> which uses the day on which the RA aggravation occurs as a case day. Exposure on case days is compared with exposure on days on which the RA worsening does not occur (control days). A time-stratified approach was selecting control days from the same day of the week, month, and year as case days. This minimise bias from time-trends and other time-varying confounders.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Short-term effects of weather variables on daily cases, from the same day up to one-week lag, were estimated using conditional logistic regression.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 245 patients with 306 RA visits to the emergency room due to RA as the main diagnostic reason during the study period were included. Most were women (71%), with a mean age of 63.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.4 years. Two thirds were attended at least twice in the emergency room due to RA worsening, with some level of disability (90% with a Rosser index less than 0.990). During the study period weather conditions were on average: 14.6<span class="elsevierStyleHsp" style=""></span>°C of temperature (ranging from −5 to 39), 54% of relative humidity (15–96), 1.018<span class="elsevierStyleHsp" style=""></span>hPA of pressure (904–1408), 111<span class="elsevierStyleHsp" style=""></span>mm of rain (0–420), 8.3<span class="elsevierStyleHsp" style=""></span>h of sun (1–14), and 3.2 octas of cloud cover (0–8).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Statistical significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) association with RA worsening was only found for daily mean temperature, with a lagged effect of 1 day, in middle age patients from 50 to 65 years old (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). These were 16% more likely to present symptomatic deterioration of RA, with lower mean temperature (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.86, 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>[0.78–0.96] for an increase of 1<span class="elsevierStyleHsp" style=""></span>°C). Both, men and women, showed similar risk estimates with mean temperature. No other weather conditions were statistically associated with the need of RA patients to bee attended in the emergency room due to RA related conditions.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">To evaluate seasonal variations mean temperature was fitted in the conditional logistic regression model using a cubic spline, with 3 degrees of freedom (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Significant effects were only found in the most extreme ranges of mean temperature for middle age people, being 15% and 20% more likely of RA worsening with mean temperatures below 10<span class="elsevierStyleHsp" style=""></span>°C (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.83, 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>[0.69–0.99]) and above 20<span class="elsevierStyleHsp" style=""></span>°C (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.82, 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>[0.66–0.99]).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">There is a popular belief that rheumatic conditions are particularly sensitive to fluctuations of weather. We have found associations with meteorological conditions (specifically with temperature), and RA related problems in the subgroup of middle age patients.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The failure to find associations with other age groups could be explained because age itself is a risk factor for disability, thus elderly could have in general more difficulty to go to the emergency room by themselves. Moreover, rheumatic pain is frequently considered to be a natural part of the aging process. Otherwise, the younger may have problems to miss work using other ways rather than emergency room to control their RA symptoms.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Previous studies in similar settings have also found that mean temperature is related with rheumatic disorders.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,9</span></a> Nevertheless, we did not find associations with other weather variables, as atmospheric pressure or relative humidity, probably due to Madrid has a Mediterranean continental climate much dryer and less humid than other cities studied.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,9</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">We found that the strongest effects of daily mean temperature on RA worsening were found below 10<span class="elsevierStyleHsp" style=""></span>°C and above 20<span class="elsevierStyleHsp" style=""></span>°C, meanwhile no statistical association was observed between 10 and 20<span class="elsevierStyleHsp" style=""></span>°C. This could reflect the possible seasonal distribution of RA symptomatic deterioration with higher incidence in winter and summer. Additionally, between 10 and 20<span class="elsevierStyleHsp" style=""></span>°C the thermal sensation and small changes probably are better tolerated than in the others, where we subjectively feel cooler or warmer.</p><p id="par0075" class="elsevierStylePara elsevierViewall">It is important to note that in our setting, RA patients receive long-term monitoring, with self-education in the management of pain and small flares. They are encourage to contact us when they have some kind of medical problem, either by telephone or by medical appointments in 24–48<span class="elsevierStyleHsp" style=""></span>h. When they have the need to go to the emergency room is often a due to a disabling pain or significant inflammatory activity. With the data available we cannot specify the main cause of RA symptomatic deterioration.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The main contribution of our study is the methodological approach using a case-crossover design, a common study design to assess for short-term effects of environmental factors on health.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> Moreover, our RA patients were well represented, 70% women in their sixties.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The explanation of the influence of temperature on rheumatic diseases is not clear enough. It is known that cold unleash some diseases such as Raynaud phenomenon or crioglobulinemia, both closely related to rheumatic diseases. Maybe muscles also play a role in relation to flares or pain in RA patients and cold weather, due to coldness stiffens muscles around the joints, and this might worsen the arthritis symptoms.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion, our results support that weather conditions, essentially daily mean temperature, may be influencing in RA patients.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical considerations</span><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects</span>. The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration.<span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Confidentiality of data</span>. The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.<span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Right to privacy and informed consent</span>. The authors declare that no patient data appears in this article.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">Authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres276965" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec258848" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres276966" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec258847" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical considerations" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-05-29" "fechaAceptado" => "2012-09-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec258848" "palabras" => array:3 [ 0 => "Weather conditions" 1 => "Rheumatoid arthritis" 2 => "Temperature" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec258847" "palabras" => array:3 [ 0 => "Condiciones meteorológicas" 1 => "Artritis reumatoide" 2 => "Temperatura" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients with rheumatoid arthritis (RA) complain that weather conditions aggravate their symptoms. We investigated the short-term effects of weather conditions on worsening of RA and determined possible seasonal fluctuations.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted a case-crossover study in Madrid, Spain. Daily cases of RA flares were collected from the emergency room of a tertiary level hospital between 2004 and 2007.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">245 RA patients who visited the emergency room 306 times due to RA related complaints as the main diagnostic reason were included in the study. Patients from 50 to 65 years old were 16% more likely to present a flare with lower mean temperatures.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our results support the belief that weather influences rheumatic pain in middle aged patients.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con artritis reumatoide (AR) se quejan de que las condiciones meteorológicas empeoran sus síntomas. Este estudio trata de ver los efectos a corto plazo de las condiciones climáticas en empeoramiento sintomático en pacientes con AR y determinar posibles fluctuaciones estacionales.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio de casos cruzados en Madrid, España. Los casos diarios de empeoramiento de la AR se obtuvieron de la sala de urgencias de un hospital terciario entre 2004 y 2007.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">245 pacientes con AR con 306 visitas a urgencias con AR como diagnostico principal se incluyeron en el estudio. Los pacientes de 50 a 65 años tuvieron un 16% más de probabilidades de presentar empeoramiento sintomático de la AR con una menor temperatura media.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados apoyan la creencia de que el clima influye en el dolor reumático de los pacientes con mediana edad.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1750 "Ancho" => 2382 "Tamanyo" => 180367 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Graphical representation of the non-parametric adjustment of the relationship between daily RA worsening and daily mean temperature, by age group.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \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"><span class="elsevierStyleItalic">n</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \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">(%) \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">OR \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">95% CI \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"><span class="elsevierStyleItalic">p</span> \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 " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age group</span></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"> \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"><span class="elsevierStyleHsp" style=""></span><50 years \t\t\t\t\t\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">60 \t\t\t\t\t\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">(20.0) \t\t\t\t\t\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">0.999 \t\t\t\t\t\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">(0.909–1.098) \t\t\t\t\t\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">0.986 \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"><span class="elsevierStyleHsp" style=""></span>50–65 years \t\t\t\t\t\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">73 \t\t\t\t\t\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">(23.5) \t\t\t\t\t\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">0.868 \t\t\t\t\t\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">(0.783–0.962) \t\t\t\t\t\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">0.007 \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"><span class="elsevierStyleHsp" style=""></span>>65 years \t\t\t\t\t\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">173 \t\t\t\t\t\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">(56.5) \t\t\t\t\t\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">1.035 \t\t\t\t\t\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">(0.979–1.095) \t\t\t\t\t\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">0.223 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Total</span> \t\t\t\t\t\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">306 \t\t\t\t\t\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">(100) \t\t\t\t\t\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">0.993 \t\t\t\t\t\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">(0.952–1.037) \t\t\t\t\t\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">0.776 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab398802.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">Number of AR cases.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Odds ratio (OR), and 95% confidence interval (95% CI), of daily RA worsening for an increase of 1<span class="elsevierStyleHsp" style=""></span>°C of daily mean temperature (for a 1-day lag), by age group.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weather effects in rheumatoid arthritis: from controversy to consensus. A review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.R. Patberg" 1 => "J.J. Rasker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2004" "volumen" => "31" "paginaInicial" => "1327" "paginaFinal" => "1334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15229951" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does the weather really matter? A cohort study of influences of weather and solar conditions on daily variations of joint pain in patients with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Smedslund" 1 => "P. Mowinckel" 2 => "T. Heiberg" 3 => "T.K. Kvien" 4 => "K.B. Hagen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.24729" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2009" "volumen" => "61" "paginaInicial" => "1243" "paginaFinal" => "1247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19714599" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rheumatoid arthritis patients show weather sensitivity in daily life, but the relationship is not clinically significant" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.A. Gorin" 1 => "J.M. Smyth" 2 => "J.N. Weisberg" 3 => "G. Affleck" 4 => "H. Tennen" 5 => "S. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 17 | 39 |
| 2024 Octubre | 95 | 35 | 130 |
| 2024 Septiembre | 121 | 26 | 147 |
| 2024 Agosto | 117 | 43 | 160 |
| 2024 Julio | 82 | 35 | 117 |
| 2024 Junio | 111 | 76 | 187 |
| 2024 Mayo | 104 | 52 | 156 |
| 2024 Abril | 76 | 28 | 104 |
| 2024 Marzo | 100 | 37 | 137 |
| 2024 Febrero | 98 | 30 | 128 |
| 2024 Enero | 84 | 25 | 109 |
| 2023 Diciembre | 98 | 36 | 134 |
| 2023 Noviembre | 100 | 64 | 164 |
| 2023 Octubre | 97 | 38 | 135 |
| 2023 Septiembre | 129 | 41 | 170 |
| 2023 Agosto | 84 | 18 | 102 |
| 2023 Julio | 77 | 31 | 108 |
| 2023 Junio | 66 | 21 | 87 |
| 2023 Mayo | 80 | 28 | 108 |
| 2023 Abril | 57 | 23 | 80 |
| 2023 Marzo | 115 | 32 | 147 |
| 2023 Febrero | 64 | 34 | 98 |
| 2023 Enero | 77 | 24 | 101 |
| 2022 Diciembre | 114 | 22 | 136 |
| 2022 Noviembre | 86 | 42 | 128 |
| 2022 Octubre | 83 | 45 | 128 |
| 2022 Septiembre | 76 | 35 | 111 |
| 2022 Agosto | 76 | 85 | 161 |
| 2022 Julio | 83 | 83 | 166 |
| 2022 Junio | 74 | 39 | 113 |
| 2022 Mayo | 113 | 59 | 172 |
| 2022 Abril | 111 | 58 | 169 |
| 2022 Marzo | 105 | 59 | 164 |
| 2022 Febrero | 68 | 49 | 117 |
| 2022 Enero | 61 | 42 | 103 |
| 2021 Diciembre | 91 | 60 | 151 |
| 2021 Noviembre | 102 | 47 | 149 |
| 2021 Octubre | 90 | 58 | 148 |
| 2021 Septiembre | 51 | 49 | 100 |
| 2021 Agosto | 58 | 52 | 110 |
| 2021 Julio | 43 | 46 | 89 |
| 2021 Junio | 80 | 48 | 128 |
| 2021 Mayo | 64 | 42 | 106 |
| 2021 Abril | 238 | 74 | 312 |
| 2021 Marzo | 82 | 35 | 117 |
| 2021 Febrero | 50 | 24 | 74 |
| 2021 Enero | 58 | 22 | 80 |
| 2020 Diciembre | 45 | 14 | 59 |
| 2020 Noviembre | 278 | 20 | 298 |
| 2020 Octubre | 277 | 20 | 297 |
| 2020 Septiembre | 82 | 39 | 121 |
| 2020 Agosto | 88 | 20 | 108 |
| 2020 Julio | 53 | 18 | 71 |
| 2020 Junio | 45 | 27 | 72 |
| 2020 Mayo | 52 | 22 | 74 |
| 2020 Abril | 74 | 12 | 86 |
| 2020 Marzo | 85 | 28 | 113 |
| 2020 Febrero | 76 | 24 | 100 |
| 2020 Enero | 53 | 25 | 78 |
| 2019 Diciembre | 54 | 32 | 86 |
| 2019 Noviembre | 27 | 17 | 44 |
| 2019 Octubre | 65 | 20 | 85 |
| 2019 Septiembre | 51 | 33 | 84 |
| 2019 Agosto | 67 | 44 | 111 |
| 2019 Julio | 60 | 14 | 74 |
| 2019 Junio | 45 | 20 | 65 |
| 2019 Mayo | 67 | 50 | 117 |
| 2019 Abril | 59 | 16 | 75 |
| 2019 Marzo | 48 | 22 | 70 |
| 2019 Febrero | 39 | 14 | 53 |
| 2019 Enero | 58 | 26 | 84 |
| 2018 Diciembre | 99 | 50 | 149 |
| 2018 Noviembre | 115 | 13 | 128 |
| 2018 Octubre | 106 | 9 | 115 |
| 2018 Septiembre | 37 | 9 | 46 |
| 2018 Agosto | 33 | 9 | 42 |
| 2018 Julio | 16 | 6 | 22 |
| 2018 Mayo | 4 | 0 | 4 |
| 2018 Abril | 34 | 9 | 43 |
| 2018 Marzo | 99 | 5 | 104 |
| 2018 Febrero | 24 | 6 | 30 |
| 2018 Enero | 25 | 9 | 34 |
| 2017 Diciembre | 36 | 9 | 45 |
| 2017 Noviembre | 27 | 7 | 34 |
| 2017 Octubre | 23 | 11 | 34 |
| 2017 Septiembre | 22 | 8 | 30 |
| 2017 Agosto | 28 | 20 | 48 |
| 2017 Julio | 27 | 23 | 50 |
| 2017 Junio | 50 | 23 | 73 |
| 2017 Mayo | 51 | 17 | 68 |
| 2017 Abril | 27 | 11 | 38 |
| 2017 Marzo | 34 | 53 | 87 |
| 2017 Febrero | 30 | 10 | 40 |
| 2017 Enero | 34 | 21 | 55 |
| 2016 Diciembre | 59 | 23 | 82 |
| 2016 Noviembre | 57 | 20 | 77 |
| 2016 Octubre | 60 | 20 | 80 |
| 2016 Septiembre | 58 | 19 | 77 |
| 2016 Agosto | 35 | 15 | 50 |
| 2016 Julio | 17 | 8 | 25 |
| 2016 Mayo | 0 | 22 | 22 |
| 2016 Febrero | 1 | 28 | 29 |
| 2016 Enero | 2 | 0 | 2 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Octubre | 1 | 25 | 26 |
| 2015 Septiembre | 3 | 0 | 3 |
| 2015 Agosto | 3 | 0 | 3 |
| 2015 Julio | 30 | 5 | 35 |
| 2015 Junio | 51 | 9 | 60 |
| 2015 Mayo | 63 | 22 | 85 |
| 2015 Abril | 56 | 13 | 69 |
| 2015 Marzo | 56 | 19 | 75 |
| 2015 Febrero | 55 | 0 | 55 |
| 2015 Enero | 55 | 0 | 55 |
| 2014 Diciembre | 31 | 0 | 31 |
| 2014 Noviembre | 45 | 0 | 45 |
| 2014 Octubre | 63 | 0 | 63 |
| 2014 Septiembre | 52 | 0 | 52 |
| 2014 Agosto | 55 | 0 | 55 |
| 2014 Julio | 52 | 0 | 52 |
| 2014 Junio | 70 | 0 | 70 |
| 2014 Mayo | 57 | 0 | 57 |
| 2014 Abril | 56 | 0 | 56 |
| 2014 Marzo | 65 | 13 | 78 |
| 2014 Febrero | 47 | 19 | 66 |
| 2014 Enero | 44 | 9 | 53 |
| 2013 Diciembre | 46 | 7 | 53 |
| 2013 Noviembre | 48 | 8 | 56 |
| 2013 Octubre | 64 | 13 | 77 |
| 2013 Septiembre | 65 | 16 | 81 |
| 2013 Agosto | 83 | 48 | 131 |
| 2013 Julio | 202 | 137 | 339 |
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