se ha leído el artículo
array:23 [ "pii" => "S1699258X15001862" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2015.10.011" "estado" => "S300" "fechaPublicacion" => "2016-05-01" "aid" => "845" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Reumatol Clin. 2016;12:151-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7027 "formatos" => array:3 [ "EPUB" => 156 "HTML" => 4663 "PDF" => 2208 ] ] "itemSiguiente" => array:19 [ "pii" => "S1699258X15001217" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2015.07.005" "estado" => "S300" "fechaPublicacion" => "2016-05-01" "aid" => "814" "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2016;12:158-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3559 "formatos" => array:3 [ "EPUB" => 172 "HTML" => 2585 "PDF" => 802 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Calcifilaxis asociada a artritis reumatoide: comunicación de otro caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "158" "paginaFinal" => "160" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Calciphylaxis associated with rheumatoid arthritis: Communication of another case" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 250641 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Escara necrótica en pierna izquierda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alberto Ortiz, Susana Roverano, Jesica Gallo, Eduardo Henares, Mónica Eletti, Sergio Paira" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Alberto" "apellidos" => "Ortiz" ] 1 => array:2 [ "nombre" => "Susana" "apellidos" => "Roverano" ] 2 => array:2 [ "nombre" => "Jesica" "apellidos" => "Gallo" ] 3 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Henares" ] 4 => array:2 [ "nombre" => "Mónica" "apellidos" => "Eletti" ] 5 => array:2 [ "nombre" => "Sergio" "apellidos" => "Paira" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357431600040X" "doi" => "10.1016/j.reumae.2015.07.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431600040X?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15001217?idApp=UINPBA00004M" "url" => "/1699258X/0000001200000003/v2_201703310244/S1699258X15001217/v2_201703310244/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1699258X1500145X" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2015.08.002" "estado" => "S300" "fechaPublicacion" => "2016-05-01" "aid" => "819" "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2016;12:146-50" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3797 "formatos" => array:3 [ "EPUB" => 178 "HTML" => 2827 "PDF" => 792 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>" "titulo" => "Retraso diagnóstico y terapéutico de la artritis reumatoide y su relación con dispositivos asistenciales en Catalunya. Estudio AUDIT" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "146" "paginaFinal" => "150" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Diagnostic and therapeutic delay of rheumatoid arthritis and its relationship with health care devices in Catalonia. The AUDIT study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hèctor Corominas, Javier Narváez, César Díaz-Torné, Georgina Salvador, María Eugenia Gomez-Caballero, Diana de la Fuente, Ester Campoy, Daniel Roig-Vilaseca, Teresa Clavaguera, Rosa Morlà, Vicenç Torrente-Segarra, Xavier Arasa, José Alfredo Gomez-Puerta, Ingrid Möller, Cayetano Alegre, Eduard Graell, Andrés Ponce, María Pilar Lisbona, Carolina Pérez-Garcia, Ramon Fíguls, Elena Sirvent, Violan Poca, Raimon Sanmartí" "autores" => array:23 [ 0 => array:2 [ "nombre" => "Hèctor" "apellidos" => "Corominas" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Narváez" ] 2 => array:2 [ "nombre" => "César" "apellidos" => "Díaz-Torné" ] 3 => array:2 [ "nombre" => "Georgina" "apellidos" => "Salvador" ] 4 => array:2 [ "nombre" => "María Eugenia" "apellidos" => "Gomez-Caballero" ] 5 => array:2 [ "nombre" => "Diana" "apellidos" => "de la Fuente" ] 6 => array:2 [ "nombre" => "Ester" "apellidos" => "Campoy" ] 7 => array:2 [ "nombre" => "Daniel" "apellidos" => "Roig-Vilaseca" ] 8 => array:2 [ "nombre" => "Teresa" "apellidos" => "Clavaguera" ] 9 => array:2 [ "nombre" => "Rosa" "apellidos" => "Morlà" ] 10 => array:2 [ "nombre" => "Vicenç" "apellidos" => "Torrente-Segarra" ] 11 => array:2 [ "nombre" => "Xavier" "apellidos" => "Arasa" ] 12 => array:2 [ "nombre" => "José Alfredo" "apellidos" => "Gomez-Puerta" ] 13 => array:2 [ "nombre" => "Ingrid" "apellidos" => "Möller" ] 14 => array:2 [ "nombre" => "Cayetano" "apellidos" => "Alegre" ] 15 => array:2 [ "nombre" => "Eduard" "apellidos" => "Graell" ] 16 => array:2 [ "nombre" => "Andrés" "apellidos" => "Ponce" ] 17 => array:2 [ "nombre" => "María Pilar" "apellidos" => "Lisbona" ] 18 => array:2 [ "nombre" => "Carolina" "apellidos" => "Pérez-Garcia" ] 19 => array:2 [ "nombre" => "Ramon" "apellidos" => "Fíguls" ] 20 => array:2 [ "nombre" => "Elena" "apellidos" => "Sirvent" ] 21 => array:2 [ "nombre" => "Violan" "apellidos" => "Poca" ] 22 => array:2 [ "nombre" => "Raimon" "apellidos" => "Sanmartí" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574316000423" "doi" => "10.1016/j.reumae.2015.08.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316000423?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1500145X?idApp=UINPBA00004M" "url" => "/1699258X/0000001200000003/v2_201703310244/S1699258X1500145X/v2_201703310244/es/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Have complementary therapies demonstrated effectiveness in rheumatoid arthritis?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "151" "paginaFinal" => "157" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nagore Fernández-Llanio Comella, Meritxell Fernández Matilla, Juan Antonio Castellano Cuesta" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Nagore" "apellidos" => "Fernández-Llanio Comella" "email" => array:2 [ 0 => "nagorefll@gmail.com" 1 => "fernandezllanio_nag@gva.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Meritxell" "apellidos" => "Fernández Matilla" ] 2 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Castellano Cuesta" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Reumatología, Hospital Arnau de Vilanova, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondingauthor." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Han demostrado eficacia las terapias complementarias en la artritis reumatoide?" ] ] "textoCompleto" => """ <span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Recent advances have improved drug treatment of rheumatoid arthritis (RA). Despite this fact, most RA patients need lifelong pharmacological therapy. An increasing number of RA patients are resorting to various complementary and alternative medicine (CAM) approaches for relief of symptoms and general well-being. CAM is the term for medical products and practices that are not part of standard care and are not generally taught in conventional medical schools. Alternative medicine is used instead of conventional medicine, whereas complementary medicine is used together with it. CAM has been mainly used to treat back pain or other back problems, neck pain, joint pain or stiffness and anxiety or depression in RA patients.<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">1</span></a> For this reason, rheumatologists should be aware of CAM when treating RA patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The American College of Rheumatology (ACR) recognizes the interest in CAM approaches in the Position Statement Document. “The ACR supports rigorous scientific evaluation of all modalities that improve the treatment or rheumatic diseases. The ACR understands that certain characteristics of some CAMs and some conventional medical interventions make it difficult or impossible to conduct standard randomized controlled trials. For these modalities, innovative methods of evaluation are needed, as are measures and standards for the generation and interpretation of evidence. The ACR supports the integration of those modalities proven to be safe and effective by scientifically rigorous clinical trials published in the biomedical peer review literature. In the absence of such rigorous clinical trials, the ACR recommends advising patients that potential harm can occur from unproven or alternative therapies and thus advises caution in the use of unproven treatments. The ACR believes healthcare providers should be informed about the more common CAM modalities, based upon appropriate scientific evaluation as described above, and should be able to discuss them knowledgeably with patients”.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This article provides an overview of the current body of knowledge about the role of CAM in the treatment of RA.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">In order to explore available evidence about CAM used in RA patients, we performed a systematic search including Medline and Cochrane library databases. Medline search was performed including the following appropriate combination of MeSH (Medical Subject Heading) terms including: “complementary therapies”, “diet”, “dietary supplements”, “phytotherapy”, “medicinal plants”, “exercise”, “mind-body therapies”, “acupuncture”, “homeopathy”, “hydrotherapy” AND “rheumatoid arthritis”. The references cited in the obtained papers were also examined to identify additional studies not indexed by MEDLINE.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Nutrition</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Nutritional intervention</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nutritional intervention has been used in patients with chronic inflammatory diseases. Specifically, nutritional intervention used in RA patients included: supervised fasting (200–300<span class="elsevierStyleHsp" style=""></span>kcal/day) during 7–10 days, Mediterranean diet (small amount of meat, fish, more fruits and vegetables and olive oil), vegetarian diet, vegan diet, elemental diet (liquid diets that contain nutrients that are broken down to make digestion easier) and elimination diet (foods that are thought to be the cause of symptoms are eliminated, and then added one at a time to find which ones cause symptoms).</p><p id="par0030" class="elsevierStylePara elsevierViewall">There is evidence that fasting produces a decrease in pain and inflammation in RA patients.<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">3</span></a> However, the inflammation reappears when the patient starts his/her normal diet.<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">4</span></a> It has been shown that fasting followed by a vegetarian diet may help patients with RA. The effect of fasting followed by a year of a vegetarian diet was assessed in a randomized, single-blind controlled trial.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">5</span></a> The diet group showed a significant improvement in the number of tender joints, Ritchie's articular index, number of swollen joints, pain score, duration of morning stiffness, grip strength, erythrocyte sedimentation rate, C-reactive protein, white blood cell count, and a health assessment questionnaire score (HAQ). These benefits in the diet group were still present after one year<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">5</span></a> and this improvement can be sustained through an additional follow-up two-year diet period.<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A Mediterranean diet has been proved to reduce blood pressure; improve glucose metabolism, the lipid profile, and lipoprotein particle characteristics and decrease inflammation and oxidative stress.<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">7</span></a> In RA patients, a Mediterranean diet decreases pain, morning stiffness, the number of swollen joints and also improves HAQ, Disease Activity Score 28 (DAS28) and disease patient perception.<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">7</span></a> Three systematic reviews stated that a Mediterranean diet decreased pain in RA patients.<a class="elsevierStyleCrossRefs" href="#bib0515"><span class="elsevierStyleSup">8–10</span></a> Moreover, the Mediterranean diet has been recommended for cardiovascular diseases and osteoporosis (frequent RA comorbidities).</p><p id="par0040" class="elsevierStylePara elsevierViewall">A Cochrane review<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">8</span></a> assessed the effectiveness and safety of dietary interventions in the treatment of RA. The authors concluded that fasting, followed by 13 months on a vegetarian diet, may reduce pain. The effects of vegan and elimination diets are uncertain due to inadequate data reporting. Trials that studied elemental diets reported no significant differences in pain, function or stiffness.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Nutritional supplements</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Fish oil</span><p id="par0045" class="elsevierStylePara elsevierViewall">Fish oil is rich in Ω-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have been associated with reduced expression of TNF-α and interleukin-1β.<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">11,12</span></a> These properties are similar to synthetic drugs used in RA patients such as nonsteroidal anti-inflammatory drugs (NSAIDs) and TNF blockers. Furthermore, EPA and DHA can be metabolized in E-series and D-series of resolvins that reduce inflammation.<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">13</span></a> The American Heart Association recommends consuming fish oil to reduce the occurrence of cardiovascular disease events in patients with coronary artery disease.<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">14</span></a> RA patients present high cardiovascular morbid-mortality rate and fish oil consumption could represent an additional benefit in this population. A meta-analysis suggested that including omega-3 PUFAs at dosages >2.7<span class="elsevierStyleHsp" style=""></span>g/day in the diet for >3 months reduces NSAID consumption in RA patients.<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">15</span></a> A systematic review including 23 randomized controlled trials testing marine Ω-3 PUFAs has been performed in patients with RA. This review has showed a modest benefit on joint swelling and pain, duration of morning stiffness, global assessment of pain and disease activity, and a reduction in the use of NSAIDs.<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Proudman et al. studied in a randomized, double-blind controlled trial the effects of fish oil consumption in early RA, employing a ‘treat-to-target’ protocol in combination with disease-modifying anti-rheumatic drugs (DMARDs). Fish oil intake was associated with a higher rate of ACR remissions, and a reduction in DMARDs dosage.<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">17</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Although not necessarily clinically significant, when prescribing Ω-3 PUFAs, rheumatologist should be aware that high dose Ω-3 PUFAs are not recommended in patients who may be susceptible to increased bleeding (e.g<span class="elsevierStyleItalic">.</span>, patients taking warfarin), because they may increase coagulation times.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Virgin olive oil</span><p id="par0060" class="elsevierStylePara elsevierViewall">Virgin olive oil contains numerous compounds that exert potent anti-inflammatory and antioxidant actions.<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">19</span></a> The main active components of olive oil include oleic acid, linolenic acid, alpha-linoleic acid and phenolic constituents.<a class="elsevierStyleCrossRefs" href="#bib0575"><span class="elsevierStyleSup">20,21</span></a> Oleic acid is metabolized to eicosatrienoic acid (omega-9 fatty acid) with similar anti-inflammatory properties than fish oil omega-3 fatty acids.<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">21</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Berbert et al. evaluated whether supplementation with olive oil could improve clinical and laboratory parameters of disease activity in RA patients who were already taking fish oil supplements. RA patient groups that received fish oil omega-3 fatty acids and olive oil showed a more precocious and accentuated improvement.<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Vitamin D</span><p id="par0070" class="elsevierStylePara elsevierViewall">Vitamin D plays a role in the maintenance of the homeostasis of the calcium and phosphorus metabolism. Vitamin D deficiency is linked to osteopenia, which is frequently associated to RA. Nevertheless vitamin D functions go much further since it is considered an immune system regulator. It intervenes in the innate and acquired immune systems.<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">23</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In vitro</span>, vitamin D inhibits the activation of IL-2, IL-12, IL-6, interferon gamma (IF-γ), and TNF. Instead, vitamin D promotes monocyte differentiation into macrophages. Moreover, vitamin D has anti-inflammatory qualities through its capacity to regulate the production of prostaglandins.<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">24</span></a> In fact, in murine models of human arthritis, vitamin D inhibits the progression of arthritis.<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">25</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">A meta-analysis summarizes published results on the association between vitamin D intake and the development of RA. The authors conclude that an insufficient vitamin D intake is associated with an elevated risk of RA development.<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">26</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Vitamin D supplements could have an effect on RA treatment. Brohult et al. studied the effects of large doses of calciferol on patients with RA in a double-blind clinical trial. After 1 year, high dose oral calciferol therapy showed a positive effect on disease activity in RA patients.<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">27</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Furthermore, in a 3-month open-label trial, vitamin D administration as an adjunct therapy with DMARDs was correlated with a decrease in pain and PCR in RA patients. No adverse reactions related to vitamin D were reported.<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Probiotics</span><p id="par0095" class="elsevierStylePara elsevierViewall">Probiotics are live microorganisms that, when administered in adequate amounts, confer health benefits on the host.<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">29</span></a> Current evidence suggests that probiotics may play a therapeutic role in chronic inflammatory diseases such as RA.<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">30</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In murine models of RA, oral administration of <span class="elsevierStyleItalic">Lactobacillus casei</span> decreased the pro-inflammatory cytokines and improved RA index disease activity in comparison with a control group or even compare with a control group treated with indomethacin.<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">31</span></a> Furthermore, So et al. demonstrated that the administration of <span class="elsevierStyleItalic">Lactobacillus casei</span> improved histopathological changes, and the lymphocytic infiltrates in the joints, similarly to the administration of methotrexate (MTX).<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">32</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Several studies showed an improvement in HAQ or disease patient perception related to probiotics intake.<a class="elsevierStyleCrossRefs" href="#bib0640"><span class="elsevierStyleSup">33–36</span></a> However, the evidence of the use of probiotics in humans is scarce. A recently reported randomized, double-blind, clinical trial study showed beneficial effects of <span class="elsevierStyleItalic">Lactobacillus casei</span> in pain, tender and swollen joint counts and DAS28, in RA women patients. It also showed amelioration in PCR, TNFα, IL-12 e IL-10 levels.<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">36</span></a> No side effects were described.</p></span></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Herbal medicine</span><p id="par0110" class="elsevierStylePara elsevierViewall">Some herbal medicinal products have been shown to interact with the mediators of inflammation and, therefore, may be used in the treatment of RA.<a class="elsevierStyleCrossRefs" href="#bib0660"><span class="elsevierStyleSup">37,38</span></a> These products can also act as free radical scavengers, and through other mechanisms. For example, topical capsaicin is a highly selective agonist of TRPV1 receptors, which are expressed in afferent neuronal C fibers and some Aδ fibers. Capsaicin induces local depletion of substance P which is thought to be part of its mechanism for pain relief.<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">39</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">However, few high quality clinical trials have yet been carried out to substantiate the safety and efficacy of herbal medicines, which are not free of potentially serious side effects.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Eleven randomized controlled trials including 940 patients have reported the effects of <span class="elsevierStyleItalic">Tripterygium wilfordii</span> extracts (TWE) in the treatment of RA; the methodological quality of these studies was generally low and the results have been inconsistent.<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">40</span></a> A randomized controlled trial by Goldbach-Mansky et al., was conducted to compare the benefits and side effects of TWE with those of sulfasalazine for the treatment of active RA. The results showed that the attainment of the ACR 20 response criteria was significantly higher with TWE extract than with sulfasalazine.<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">41</span></a> A multicenter, open-label, randomized controlled trial compared the efficacy and safety of TWE with MTX in the treatment of active RA. After 6 months, the proportion of patients reaching the ACR50 response criteria was 46.4%, 55.1% and 76.8%, respectively, in the MTX, TWE and MTX<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>TWE groups. The authors concluded that TWE monotherapy was not worse than MTX, and that MTX<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>TWE was better than MTX alone in controlling disease activity in patients with active RA.<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">42</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">It has also been suggested that plants such as <span class="elsevierStyleItalic">Borago officinalis</span>, <span class="elsevierStyleItalic">Oenothera blennis</span> and <span class="elsevierStyleItalic">Ribes migrum</span> with a high grade of acid gamma linolenic (AGL) may improve pain and disease activity in RA patients.<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">39</span></a> AGL is an essential fatty acid precursor of prostaglandin E1, an eicosanoid with anti-inflammatory and immunomodulatory properties.<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">43</span></a> In clinical trials, the AGL group, developed more frequently adverse reactions than the placebo group, although no significant differences were reported. Cases of convulsions due to <span class="elsevierStyleItalic">Oenothera blennis</span> have been reported in epileptic patients or patients being treated with central nervous system medications.<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">39</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The quality of herbal medicines can directly affect their safety and efficacy. Good manufacturing practices (GMP) are one of the most important tools to avoid contamination of herbal products.<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">44</span></a> If the manufacturer keeps GMP, this issue is rare.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Physical activity</span><p id="par0135" class="elsevierStylePara elsevierViewall">Physical inactivity is the fourth leading risk factor for mortality.<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">45</span></a> People who exercise more have lower rates of coronary heart disease, hypertension, stroke, type 2 diabetes, metabolic syndrome, colon cancer, breast cancer, depression and mortality from all causes.<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">46</span></a> Physical activity decreases the risk of fracture and loss of bone mineral density and increases muscle mass, strength, power and intrinsic neuromuscular activity.<a class="elsevierStyleCrossRefs" href="#bib0705"><span class="elsevierStyleSup">46,47</span></a> However, in RA patients physical activity has been considered to increase joint stress, pain, disease activity and joint damage. Then, is it appropriate to recommend exercise to RA patients?</p><p id="par0140" class="elsevierStylePara elsevierViewall">According to the latest evidence, exercise has not been associated with harmful effects on disease activity, pain or radiological damage.<a class="elsevierStyleCrossRefs" href="#bib0715"><span class="elsevierStyleSup">48,49</span></a> Therefore, physical activity does not worsen RA, and probably provides additional benefits.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Hurkmans et al. reviewed the effectiveness and safety of short-term (\n <three months)="" and="" long-term="" (="">\n three months) dynamic exercise programs for RA patients. The authors concluded that aerobic capacity training combined with muscle strength training is recommended as routine practice in RA patients.\n </three><a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">48</span></a> A randomized controlled trial showed for the first time that after a 24 week progressive training program, RA patients gained muscle mass, also functional improvement was observed.<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">50</span></a> Therefore exercise must be recommended in RA patients. However, physical activity should be of low joint impact in order to avoid pain and musculoskeletal injuries.<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">46</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Yoga</span><p id="par0150" class="elsevierStylePara elsevierViewall">In western countries, mind-body interventions, such as yoga, which combines stress management with physical activity, are growing. Yoga modulates sweating response to dynamic exercise and improves respiratory muscle strength, handgrip strength, handgrip endurance and flexibility.<a class="elsevierStyleCrossRefs" href="#bib0730"><span class="elsevierStyleSup">51–53</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">There is very low evidence of the role yoga plays in RA patients. The methodological quality of the studies is poor because of a lack of patient blindness. Two trials showed a significant improvement of DAS28 associated with yoga.<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">54,55</span></a> In other studies, yoga improved pain, HAQ, balance and handgrip strength.<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">54,56,57</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Evans et al. aimed to assess the effects of a yoga program on health-related quality of life (HRQoL) for young adults with RA compared with a usual-care waitlist control group. The results of the study suggested that yoga is a feasible and safe complementary treatment for young people with RA, leading to HRQoL, pain, disability, fatigue, and mood benefits.<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">58</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">No side effects were reported for yoga in RA patients.<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">59</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Taichi</span><p id="par0170" class="elsevierStylePara elsevierViewall">Tai Chi is a Chinese martial art that combines meditation with slow, gentle, graceful movements, as well as, deep breathing and relaxation.<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">60</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Wang et al. conducted a systematic review of reports on the effects of Tai Chi over various chronic medical conditions. Nine randomized controlled trials, 23 non-randomized controlled studies, and 15 observational studies were included. Tai Chi appeared to have benefits and also appeared to be safe and effective in promoting balance control, flexibility, and cardiovascular fitness in older patients with chronic conditions.<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">61</span></a> Thus Tai Chi may benefit RA patients who have limited strength, mobility and comorbidities (cardiovascular risk, osteoporosis and depression).<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">60</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Several reviews about the effect of Tai Chi in RA patients have been published, including a Cochrane Review.<a class="elsevierStyleCrossRefs" href="#bib0770"><span class="elsevierStyleSup">59,60,62–64</span></a> Tai Chi was associated with improvement in terms of RA disease activity. Although existing evidence remains limited and inconclusive. No adverse events were observed and Tai Chi does not exacerbate RA symptoms.<a class="elsevierStyleCrossRef" href="#bib0795"><span class="elsevierStyleSup">64</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Meditation</span><p id="par0185" class="elsevierStylePara elsevierViewall">Meditation incorporates a diverse range of techniques that helps to focus attention and bring a state of self-awareness and inner calm. Meditation may alleviate patients’ suffering associated with physical, psychosomatic and psychiatric disorders, it can even reduce cardiovascular risk factors.<a class="elsevierStyleCrossRef" href="#bib0800"><span class="elsevierStyleSup">65</span></a> Meditation may improve pain,<a class="elsevierStyleCrossRef" href="#bib0805"><span class="elsevierStyleSup">66</span></a> anxiety,<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">67</span></a> depression in RA patients,<a class="elsevierStyleCrossRefs" href="#bib0815"><span class="elsevierStyleSup">68,69</span></a> and fibromyalgia.<a class="elsevierStyleCrossRef" href="#bib0825"><span class="elsevierStyleSup">70</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">In a randomized, waitlist-controlled pilot study Pradhan et al. evaluated the effect of mindfulness meditation on depressive symptoms, psychological status, and disease activity in 63 RA patients. After 2 months, there were no statistically significant differences between groups in any outcomes. After 6 months, there was significant improvement in psychological distress (35% reduction) and well-being. However, the intervention had no impact on RA disease activity.<a class="elsevierStyleCrossRef" href="#bib0830"><span class="elsevierStyleSup">71</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Acupuncture</span><p id="par0195" class="elsevierStylePara elsevierViewall">Acupuncture is a traditional Chinese medicine where thin needles are inserted in specific points of the body to facilitate the recovery of health and to enhance well-being. The effectiveness or efficacy of acupuncture has been tested in randomized controlled trials with poor methodological standards.<a class="elsevierStyleCrossRef" href="#bib0835"><span class="elsevierStyleSup">72</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">The mechanism of action in acupuncture is associated with an analgesic effect by interaction with endogen opioids and serotonin mediators. Mayer et al. reported that acupuncture analgesia was blocked after naloxone administration. These findings support the effect of acupuncture over endogenous opioids.<a class="elsevierStyleCrossRef" href="#bib0840"><span class="elsevierStyleSup">73</span></a> A positron emission tomography study showed that acupuncture therapy evoked short-term increases in μ-opioid cerebral receptors binding potential.<a class="elsevierStyleCrossRef" href="#bib0845"><span class="elsevierStyleSup">74</span></a> Despite these studies, the current evidence about decreased pain due to acupuncture in RA patients is scarce and non conclusive.<a class="elsevierStyleCrossRef" href="#bib0850"><span class="elsevierStyleSup">75</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Two studies involving a total of 84 people were included in a Cochrane review. One study used acupuncture and no significant differences between groups were observed.<a class="elsevierStyleCrossRef" href="#bib0855"><span class="elsevierStyleSup">76</span></a> In the second study, using electroacupuncture, a significant decrease in knee pain was reported in the experimental group when compared to the placebo group. However, the authors concluded that the poor quality of the trial, including the small sample size preclude any recommendation.<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">77</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">More recently, two systematic reviews reported that despite some favorable results in active-controlled trials, conflicting evidence exists in placebo-controlled trials concerning the efficacy of acupuncture for RA. Rigorous and well-controlled randomized trials are warranted. Minor adverse events in the acupuncture groups were observed.<a class="elsevierStyleCrossRefs" href="#bib0865"><span class="elsevierStyleSup">78–81</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Another systematic review assessed the effect of bee venom acupuncture (BVA) used as an RA therapy. The authors concluded that the evidence is insufficient to suggest that BVA is an effective treatment for RA.<a class="elsevierStyleCrossRef" href="#bib0885"><span class="elsevierStyleSup">82</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Homeopathy</span><p id="par0220" class="elsevierStylePara elsevierViewall">In 1978, the first study of homeopathy in RA patients was published. Ninety-five RA patients were randomized to receive acetylsalicylic acid or homeopathy. After 1 year of treatment, 42.6% patients of the homeopathy group and only 14.6% of the salicylate group continued. During the first year of the study, 33.4% patients of the homeopathy group and 85.4% in the salicylate group withdrew the study.<a class="elsevierStyleCrossRef" href="#bib0890"><span class="elsevierStyleSup">83</span></a> Gibson et al. compared orthodox first-line anti-inflammatory treatment plus homeopathy with anti-inflammatory treatment plus an inert preparation. In the treatment group improvement in subjective pain, articular index, stiffness and grip strength were observed.<a class="elsevierStyleCrossRef" href="#bib0895"><span class="elsevierStyleSup">84</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">In a 6-month double-blind trial, 44 RA patients were entered comparing homeopathy with a placebo. There was no statistically significant difference between groups.<a class="elsevierStyleCrossRef" href="#bib0900"><span class="elsevierStyleSup">85</span></a> A randomized controlled trial by Fisher and Scott was conducted to study if homeopathy was effective in reducing the symptoms of joint inflammation in RA. The results of the trial showed no evidence that active homeopathy improves the symptoms of RA.<a class="elsevierStyleCrossRef" href="#bib0905"><span class="elsevierStyleSup">86</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Brien et al. sought to assess whether any benefits from complementary homeopathic treatment in patients with RA are due to the homeopathic consultation, homeopathic remedies or both. The authors concluded that homeopathic consultations but not homeopathic remedies are associated with clinically relevant benefits in RA.<a class="elsevierStyleCrossRef" href="#bib0910"><span class="elsevierStyleSup">87</span></a> This publication has received several criticisms,<a class="elsevierStyleCrossRefs" href="#bib0915"><span class="elsevierStyleSup">88–90</span></a> mainly because the insufficient statistical power to detect differences between groups.</p><p id="par0235" class="elsevierStylePara elsevierViewall">In conclusion, we have limited clinical trials with adequate methodology to assess the effectiveness of homeopathy in patients with RA. None of the published studies have reported side effects associated with homeopathic drugs.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Balneotherapy/Hydrotherapy</span><p id="par0240" class="elsevierStylePara elsevierViewall">Hydrotherapy/Balneotherapy involves the use of water in treatments and in the case of RA is considered the oldest therapy. The recuperative and healing properties of these therapies are based on their mechanic and thermal effects.<a class="elsevierStyleCrossRef" href="#bib0930"><span class="elsevierStyleSup">91</span></a> The protracted application of heat, and the pressure exerted by the water carries impulses felt at the skin deeper into the body, where they are instrumental in stimulating the immune system, reducing stress, invigorating circulation and digestion, encouraging blood flow, lessening pain sensitivity and blocking the sympathetic nervous system.<a class="elsevierStyleCrossRef" href="#bib0935"><span class="elsevierStyleSup">92</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">A Cochrane review assessed the effectiveness of balneotherapy for RA patients. Nine trials, representing 579 people were included. Most trials reported positive findings, but were methodologically flawed to some extent, and withdrawals due to adverse events were not reported.<a class="elsevierStyleCrossRef" href="#bib0940"><span class="elsevierStyleSup">93</span></a> Another systematic review found evidence that aquatic exercise had small but statistically significant effects on pain relief and related outcomes in RA. However, due to the poor methodological quality of balneotherapy studies, we are unable to make any conclusion on the effects of this intervention.<a class="elsevierStyleCrossRef" href="#bib0945"><span class="elsevierStyleSup">94</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0250" class="elsevierStylePara elsevierViewall">The use of CAM in rheumatology is common.<a class="elsevierStyleCrossRef" href="#bib0950"><span class="elsevierStyleSup">95</span></a> The increased interest of RA patients in CAM approaches is a reality, thus rheumatologists should advice their patients with scientific rigor and the best evidence available. In this sense the ACR sets its position which supports rigorous scientific evaluation on all approaches that improve the treatment of rheumatic diseases.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">2</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the CAM approaches that may be beneficial for RA patients, although there is still a long way ahead in terms of research in order to draw firm conclusions. There are no long-term studies, nor studies to assess joint damage progression, however some complementary therapies may represent an opportunity to improve the quality of life of our patients, and in the future may be integrated in the management of RA patients.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors have no affiliations with or financial interest in any company or organization that could conflict with the views expressed in this manuscript.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical responsibilities</span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of people and animals</span><p id="par0260" class="elsevierStylePara elsevierViewall">The authors declare that this research has not been conducted experiments on humans or animals.</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0265" class="elsevierStylePara elsevierViewall">The authors declare that this article does not appear patient data.</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0270" class="elsevierStylePara elsevierViewall">The authors declare that this article does not appear patient data.</p></span></span></span> """ "textoCompletoSecciones" => array:1 [ "secciones" => array:19 [ 0 => array:3 [ "identificador" => "xres822491" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec819336" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres822492" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec819337" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Nutrition" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Nutritional intervention" ] 1 => array:3 [ "identificador" => "sec0025" "titulo" => "Nutritional supplements" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Fish oil" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Virgin olive oil" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Vitamin D" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Probiotics" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Herbal medicine" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Physical activity" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Yoga" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Taichi" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Meditation" ] 12 => array:2 [ "identificador" => "sec0075" "titulo" => "Acupuncture" ] 13 => array:2 [ "identificador" => "sec0080" "titulo" => "Homeopathy" ] 14 => array:2 [ "identificador" => "sec0085" "titulo" => "Balneotherapy/Hydrotherapy" ] 15 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusion" ] 16 => array:2 [ "identificador" => "sec0095" "titulo" => "Conflicts of interest" ] 17 => array:3 [ "identificador" => "sec0100" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0105" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0110" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0115" "titulo" => "Right to privacy and informed consent" ] ] ] 18 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-25" "fechaAceptado" => "2015-10-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec819336" "palabras" => array:11 [ 0 => "Rheumatoid arthritis" 1 => "Complementary therapy" 2 => "Diet" 3 => "Nutritional supplements" 4 => "Phytotherapy" 5 => "Medicinal plants" 6 => "Exercise" 7 => "Body–mind therapies" 8 => "Acupuncture" 9 => "Homeopathy" 10 => "Hydrotherapy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec819337" "palabras" => array:11 [ 0 => "Artritis reumatoide" 1 => "Terapia complementaria" 2 => "Dieta" 3 => "Suplementos nutricionales" 4 => "Fitoterapia" 5 => "Plantas medicinales" 6 => "Ejercicio" 7 => "Terapias cuerpo-mente" 8 => "Acupuntura" 9 => "Homeopatía" 10 => "Hidroterapia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In recent decades the treatment of rheumatoid arthritis (RA) has improved thanks to the use of highly effective drugs. However, patients usually require long term therapy, which is not free of side effects. Therefore RA patients often demand complementary medicine, they seek additional sources of relief and/or less side effects. In fact 30–60% of rheumatic patients use some form of complementary medicine. Therefore, from conventional medicine, if we want to optimally treat our patients facilitating communication with them we must know the most commonly used complementary medicines. The aim of this review is to assess, based on published scientific research, what complementary therapies commonly used by patients with RA are effective and safe.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En las últimas décadas el tratamiento de la Artritis Reumatoide (AR) ha mejorado mucho gracias a la utilización de fármacos altamente eficaces. Sin embargo, los enfermos suelen requerir tratamiento farmacológico de por vida, no exento de efectos adversos. Por esta razón los pacientes con AR a menudo acuden a la medicina complementaria, buscan fuentes adicionales de alivio y/o menores efectos secundarios. Un 30–60% de los pacientes reumáticos utilizan algún tipo de medicina complementaria. Por lo tanto, desde la medicina convencional, si queremos optimizar el tratamiento de nuestros pacientes y facilitar la comunicación con ellos debemos conocer las medicinas complementarias más utilizadas. El objetivo de esta revisión es valorar, en base a la investigación científica publicada, qué tratamientos complementarios habitualmente utilizados por los pacientes con AR son efectivos y seguros.</p></span>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fasting followed by vegetarian diet; Mediterranean diet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">May benefit patients with RA.<br>Mediterranean diet is safe and decreases cardiovascular risk (frequent RA comorbidity). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fish oil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Evidence of benefits in the use as complementary therapy in RA. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Virgin olive oil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Evidence of benefits <span class="elsevierStyleItalic">in vitro</span> and <span class="elsevierStyleItalic">in vivo</span> in inflammatory diseases such as RA. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vitamin D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Evidence <span class="elsevierStyleItalic">In vitro</span> and in animal experimentation of its anti-inflammatory and immunomodulatory effects. Epidemiological studies suggest that vitamin D supplementation could have a protective effect on the susceptibility to develop RA. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Probiotics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Several studies showed an improvement in HAQ or disease patient perception related to probiotics intake.<a class="elsevierStyleCrossRefs" href="#bib0640"><span class="elsevierStyleSup">33–36</span></a> However, the evidence of the use of probiotics in humans is scarce. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Herbal medicinal products \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Some herbal medicinal products, like Tripterygium wilfordii, have demonstrated beneficial effects for RA patients. However, there is a very limited evidence base available. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Physical Activity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Exercise is recommended in RA patients. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yoga and Taichi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adapt the exercise to patients’ joint restrictions and may reduce patient stress. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Meditation/Mindfulness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Possible improvement in psychological distress and well-being \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acupuncture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conflicting evidence concerning the efficacy of acupuncture for RA patients. There is positive evidence in the treatment of pain. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Homeopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">There is a very limited evidence base available. No adverse reactions were observed. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balneotherapy/Hydrotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Most trials reported positive findings, but methodological quality of balneotherapy studies is poor. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1383057.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CAM modalities that may be beneficial for RA patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:95 [ 0 => array:3 [ "identificador" => "bib0480" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complementary and alternative medicine use among adults: United States, 2002" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Adv Data" "fecha" => "2004" "volumen" => "343" "paginaInicial" => "1" "paginaFinal" => "19" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0485" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "American Collage of Rheumatology. American Collage of Rheumatology position statement: complementary and alternative medicine for rheumatic diseases. <a href="http://www.rheumatology.org/Practice-Quality/Administrative-Support/Position-Statements.09/2012">http://www.rheumatology.org/Practice-Quality/Administrative-Support/Position-Statements.09/2012</a>" ] ] ] 2 => array:3 [ "identificador" => "bib0490" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fasting: molecular mechanisms and clinical applications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cmet.2013.12.008" "Revista" => array:6 [ "tituloSerie" => "Cell Metab" "fecha" => "2014" "volumen" => "19" "paginaInicial" => "181" "paginaFinal" => "192" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0495" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "2001" "volumen" => "30" "paginaInicial" => "1" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0500" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1991" "volumen" => "338" "paginaInicial" => "899" "paginaFinal" => "902" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0505" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vegetarian diet for patients with rheumatoid arthritis – status: two years after introduction of the diet" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "1994" "volumen" => "13" "paginaInicial" => "475" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0510" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Importance of nutritional treatment in the inflammatory process of rheumatoid arthritis patients; a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3305/nh.2014.29.2.7067" "Revista" => array:6 [ "tituloSerie" => "Nutr Hosp" "fecha" => "2014" "volumen" => "29" "paginaInicial" => "237" "paginaFinal" => "245" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0515" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary interventions for rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2009" "paginaInicial" => "CD006400" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0520" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scientific evidence of interventions using the Mediterranean diet: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nutr Rev" "fecha" => "2006" "volumen" => "64" "paginaInicial" => "S27" "paginaFinal" => "S47" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0525" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jada.2010.02.010" "Revista" => array:6 [ "tituloSerie" => "J Am Diet Assoc" "fecha" => "2010" "volumen" => "110" "paginaInicial" => "727" "paginaFinal" => "735" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0530" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on Nutrition and autoimmune disease PUFA, inflammatory processes and rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0029665108008690" "Revista" => array:6 [ "tituloSerie" => "Proc Nutr Soc" "fecha" => "2008" "volumen" => "67" "paginaInicial" => "409" "paginaFinal" => "418" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0535" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary omega-3 fats for treatment of inflammatory joint disease: efficacy and utility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rdc.2008.03.003" "Revista" => array:6 [ "tituloSerie" => "Rheum Dis Clin North Am" "fecha" => "2008" "volumen" => "34" "paginaInicial" => "469" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0540" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nri2294" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Immunol" "fecha" => "2008" "volumen" => "8" "paginaInicial" => "349" "paginaFinal" => "361" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0545" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2002" "volumen" => "106" "paginaInicial" => "2747" "paginaFinal" => "2757" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0550" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arcmed.2012.06.011" "Revista" => array:6 [ "tituloSerie" => "Arch Med Res" "fecha" => "2012" "volumen" => "43" "paginaInicial" => "356" "paginaFinal" => "362" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0555" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0007114512001560" "Revista" => array:6 [ "tituloSerie" => "Br J Nutr" "fecha" => "2012" "volumen" => "107" "paginaInicial" => "S171" "paginaFinal" => "S184" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0560" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2013-204145" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2015" "volumen" => "74" "paginaInicial" => "89" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0565" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic potential of n-3 polyunsaturated fatty acids in disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2146/ajhp080411" "Revista" => array:6 [ "tituloSerie" => "Am J Health Syst Pharm" "fecha" => "2009" "volumen" => "66" "paginaInicial" => "1169" "paginaFinal" => "1179" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0570" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular mechanisms of inflammation. Anti-inflammatory benefits of virgin olive oil and the phenolic compound oleocanthal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Curr Pharm Des" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "754" "paginaFinal" => "768" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S073510970801838X" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0575" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Active components and clinical applications of olive oil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Altern Med Rev" "fecha" => "2007" "volumen" => "12" "paginaInicial" => "331" "paginaFinal" => "342" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0580" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of omega-3 fatty acids contained in olive oil on chronic inflammation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Med Indones" "fecha" => "2011" "volumen" => "43" "paginaInicial" => "138" "paginaFinal" => "143" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0585" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Supplementation of fish oil and olive oil in patients with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nut.2004.03.023" "Revista" => array:6 [ "tituloSerie" => "Nutrition" "fecha" => "2005" "volumen" => "21" "paginaInicial" => "131" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0590" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitamin D, immunoregulation, and rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RHU.0b013e31820edd18" "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "102" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0595" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does vitamin D affect risk of developing autoimmune disease? A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2010.07.009" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2011" "volumen" => "40" "paginaInicial" => "512" "paginaFinal" => "531" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0600" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "1,25-Dihydroxycholecalciferol inhibits the progression of arthritis in murine models of human arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Nutr" "fecha" => "1998" "volumen" => "128" "paginaInicial" => "68" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S014067361260110X" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0605" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between vitamin D intake and the risk of rheumatoid arthritis: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-012-2080-7" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "1733" "paginaFinal" => "1739" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0610" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of large doses of calciferol on patients with rheumatoid arthritis. A double-blind clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "1973" "volumen" => "2" "paginaInicial" => "173" "paginaFinal" => "176" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0615" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disease modifying and immunomodulatory effects of high dose 1 alpha (OH) D3 in rheumatoid arthritis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "1999" "volumen" => "17" "paginaInicial" => "453" "paginaFinal" => "456" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0620" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Probiotics in food: health and nutritional properties and guidelines for evaluation" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "FAO/WHO" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "FAO Food Nutr Pap" "fecha" => "2006" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0625" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of the microbiome in rheumatic diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11926-012-0314-y" "Revista" => array:5 [ "tituloSerie" => "Curr Rheumatol Rep" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "314" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0630" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Lactobacillus casei</span> reduces the inflammatory joint damage associated with collagen-induced arthritis (CIA) by reducing the pro-inflammatory cytokines: <span class="elsevierStyleItalic">Lactobacillus casei</span>: COX-2 inhibitor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10875-010-9457-7" "Revista" => array:7 [ "tituloSerie" => "J Clin Immunol" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "147" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0378512212001223" "estado" => "S300" "issn" => "03785122" ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0635" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Lactobacillus casei</span> suppresses experimental arthritis by down-regulating T helper 1 effector functions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.molimm.2007.12.010" "Revista" => array:6 [ "tituloSerie" => "Mol Immunol" "fecha" => "2008" "volumen" => "45" "paginaInicial" => "2690" "paginaFinal" => "2699" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0640" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritis – a pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "2003" "volumen" => "32" "paginaInicial" => "211" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0645" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Bacillus coagulans</span>: a viable adjunct therapy for relieving symptoms of rheumatoid arthritis according to a randomized, controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1472-6882-10-1" "Revista" => array:5 [ "tituloSerie" => "BMC Complement Altern Med" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "1" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0650" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized, double-blinded, placebo-controlled pilot study of probiotics in active rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Sci Monit" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "CR347" "paginaFinal" => "CR354" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0655" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of <span class="elsevierStyleItalic">Lactobacillus casei</span> supplementation on disease activity and inflammatory cytokines in rheumatoid arthritis patients: a randomized double-blind clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1756-185X.12333" "Revista" => array:6 [ "tituloSerie" => "Int J Rheum Dis" "fecha" => "2014" "volumen" => "17" "paginaInicial" => "519" "paginaFinal" => "527" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0660" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scientific basis of botanical medicine as alternative remedies for rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12016-012-8329-8" "Revista" => array:6 [ "tituloSerie" => "Clin Rev Allergy Immunol" "fecha" => "2013" "volumen" => "44" "paginaInicial" => "284" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0665" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part 2: Rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ptr.3006" "Revista" => array:6 [ "tituloSerie" => "Phytother Res" "fecha" => "2009" "volumen" => "23" "paginaInicial" => "1647" "paginaFinal" => "1662" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0670" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Herbal therapy for treating rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2011" "volumen" => "16" "paginaInicial" => "CD002948" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0675" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracts of <span class="elsevierStyleItalic">Tripterygium wilfordii</span> Hook F in the treatment of rheumatoid arthritis: a systemic review and meta-analysis of randomised controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2013/410793" "Revista" => array:5 [ "tituloSerie" => "Evid Based Complement Alternat Med" "fecha" => "2013" "volumen" => "2013" "paginaInicial" => "410793" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0680" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of <span class="elsevierStyleItalic">Tripterygium wilfordii</span> Hook F versus sulfasalazine in the treatment of rheumatoid arthritis: a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2009" "volumen" => "151" "paginaInicial" => "229" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0685" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of <span class="elsevierStyleItalic">Tripterygium wilfordii</span> Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2013-204807" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2015" "volumen" => "74" "paginaInicial" => "1078" "paginaFinal" => "1086" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0690" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma linolenic acid: an antiinflammatory omega-6 fatty acid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Pharm Biotechnol" "fecha" => "2006" "volumen" => "7" "paginaInicial" => "531" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0695" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "EFPIA. European Federation of Pharmaceutical Industries. Good manufacturing practices for active ingredient manufacturers. 1996." ] ] ] 44 => array:3 [ "identificador" => "bib0700" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "ISBN: 9789241563871" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global health risks: mortality and burden of disease attributable to selected major risks" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2009" "editorial" => "World Health Organization" ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0705" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2008 Physical Activity Guidelines for Americans" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "US Department of Health and Human Services" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1753-4887.2008.00136.x" "Revista" => array:6 [ "tituloSerie" => "Nutr Rev" "fecha" => "2009" "volumen" => "67" "paginaInicial" => "114" "paginaFinal" => "120" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0710" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "47–58" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New Canadian physical activity guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1139/H11-009" "Revista" => array:6 [ "tituloSerie" => "Appl Physiol Nutr Metab" "fecha" => "2011" "volumen" => "36" "paginaInicial" => "36" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0715" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2009" "volumen" => "7" "paginaInicial" => "CD006853" ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0720" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is dynamic exercise beneficial in patients with rheumatoid arthritis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jbspin.2007.04.015" "Revista" => array:6 [ "tituloSerie" => "Joint Bone Spine" "fecha" => "2008" "volumen" => "75" "paginaInicial" => "11" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0725" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.24891" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2009" "volumen" => "61" "paginaInicial" => "1726" "paginaFinal" => "1734" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0730" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of six weeks yoga training on weight loss following step test, respiratory pressures, handgrip strength and handgrip endurance in young healthy subjects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Indian J Physiol Pharmacol" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "164" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0735" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized controlled trial of yoga and exercise in multiple sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2004" "volumen" => "62" "paginaInicial" => "2058" "paginaFinal" => "2064" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0740" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Yoga as steadiness training: effects on motor variability in young adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1519/JSC.0b013e31818200dd" "Revista" => array:6 [ "tituloSerie" => "J Strength Cond Res" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "1659" "paginaFinal" => "1669" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0745" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The benefits of yoga for rheumatoid arthritis: results of a preliminary, structured 8-week program" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00296-009-0871-1" "Revista" => array:6 [ "tituloSerie" => "Rheumatol Int" "fecha" => "2009" "volumen" => "29" "paginaInicial" => "1417" "paginaFinal" => "1421" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0750" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Yoga for arthritis: a scoping review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rdc.2010.11.001" "Revista" => array:6 [ "tituloSerie" => "Rheum Dis Clin North Am" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "33" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0755" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measuring the effects of yoga in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Rheumatol" "fecha" => "1994" "volumen" => "33" "paginaInicial" => "787" "paginaFinal" => "788" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0760" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional and physiological effects of yoga in women with rheumatoid arthritis: a pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Altern Ther Health Med" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "24" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0765" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of iyengar yoga on quality of life in young women with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AJP.0b013e31827da381" "Revista" => array:6 [ "tituloSerie" => "Clin J Pain" "fecha" => "2013" "volumen" => "29" "paginaInicial" => "988" "paginaFinal" => "997" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0770" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tai Chi and yoga as complementary therapies in rheumatologic conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.berh.2012.05.006" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Rheumatol" "fecha" => "2012" "volumen" => "26" "paginaInicial" => "387" "paginaFinal" => "398" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0775" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tai chi and rheumatic diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rdc.2010.11.002" "Revista" => array:7 [ "tituloSerie" => "Rheum Dis Clin North Am" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "19" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0735109711014033" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0780" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinte.164.5.493" "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2004" "volumen" => "164" "paginaInicial" => "493" "paginaFinal" => "501" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0785" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tai chi for treating rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane database Syst Rev" "fecha" => "2004" "paginaInicial" => "CD004849" ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0790" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tai chi for rheumatoid arthritis: systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/kem151" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "1648" "paginaFinal" => "1651" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0795" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of Tai Chi in the treatment of rheumatologic diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11926-012-0294-y" "Revista" => array:6 [ "tituloSerie" => "Curr Rheumatol Rep" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "598" "paginaFinal" => "603" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0800" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mindfulness-based stress reduction and health benefits. A meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0022-3999(03)00573-7" "Revista" => array:6 [ "tituloSerie" => "J Psychosom Res" "fecha" => "2004" "volumen" => "57" "paginaInicial" => "35" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0805" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical use of mindfulness meditation for the self-regulation of chronic pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Behav Med" "fecha" => "1985" "volumen" => "8" "paginaInicial" => "163" "paginaFinal" => "190" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0810" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gen Hosp Psychiatry" "fecha" => "1995" "volumen" => "17" "paginaInicial" => "192" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0815" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of depression and rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Psychosomatics" "fecha" => "2003" "volumen" => "44" "paginaInicial" => "209" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0820" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1037/0022-006X.72.1.31" "Revista" => array:6 [ "tituloSerie" => "J Consult Clin Psychol" "fecha" => "2004" "volumen" => "72" "paginaInicial" => "31" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0825" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.22478" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "77" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib0830" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of mindfulness-based stress reduction in rheumatoid arthritis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.23010" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "1134" "paginaFinal" => "1142" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib0835" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Controversies in acupuncture research: selection of controls and outcome measures in acupuncture clinical trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/acm.2006.12.943" "Revista" => array:6 [ "tituloSerie" => "J Altern Complement Med" "fecha" => "2006" "volumen" => "12" "paginaInicial" => "943" "paginaFinal" => "953" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 72 => array:3 [ "identificador" => "bib0840" "etiqueta" => "73" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Brain Res" "fecha" => "1977" "volumen" => "121" "paginaInicial" => "368" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 73 => array:3 [ "identificador" => "bib0845" "etiqueta" => "74" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.neuroimage.2009.05.083" "Revista" => array:6 [ "tituloSerie" => "Neuroimage" "fecha" => "2009" "volumen" => "47" "paginaInicial" => "1077" "paginaFinal" => "1085" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 74 => array:3 [ "identificador" => "bib0850" "etiqueta" => "75" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acupuncture for rheumatic conditions: an overview of systematic reviews" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/keq180" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2010" "volumen" => "49" "paginaInicial" => "1957" "paginaFinal" => "1961" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 75 => array:3 [ "identificador" => "bib0855" "etiqueta" => "76" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2005" "volumen" => "19" "paginaInicial" => "CD003788" "itemHostRev" => array:3 [ "pii" => "S0140673611619314" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 76 => array:3 [ "identificador" => "bib0860" "etiqueta" => "77" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of acupuncture on patients with rheumatoid arthritis: a randomized, placebo-controlled cross-over study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "1999" "volumen" => "38" "paginaInicial" => "864" "paginaFinal" => "869" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 77 => array:3 [ "identificador" => "bib0865" "etiqueta" => "78" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of evidence for the effectiveness of practitioner-based complementary and alternative therapies in the management of rheumatic diseases: rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true …1 ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/kes133" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2012" "volumen" => "51" "paginaInicial" => "1707" "paginaFinal" => "1713" "link" => array:1 [ …1] ] ] ] ] ] ] 78 => array:3 [ "identificador" => "bib0870" "etiqueta" => "79" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.24009" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2008" "volumen" => "59" "paginaInicial" => "1249" "paginaFinal" => "1256" "link" => array:1 [ …1] ] ] ] ] ] ] 79 => array:3 [ "identificador" => "bib0875" "etiqueta" => "80" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acupuncture for rheumatoid arthritis: a systematic review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/ken330" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "1747" "paginaFinal" => "1753" "link" => array:1 [ …1] ] ] ] ] ] ] 80 => array:3 [ "identificador" => "bib0880" "etiqueta" => "81" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The evidence for acupuncture as a treatment for rheumatologic conditions" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rheum Dis Clin North Am" "fecha" => "2000" "volumen" => "26" "paginaInicial" => "103" "paginaFinal" => "115" "link" => array:1 [ …1] ] ] ] ] ] ] 81 => array:3 [ "identificador" => "bib0885" "etiqueta" => "82" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bee venom acupuncture for rheumatoid arthritis: a systematic review of randomised clinical trials" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjopen-2014-006140" "Revista" => array:5 [ "tituloSerie" => "BMJ Open" "fecha" => "2014" "volumen" => "4" "paginaInicial" => "e006140" "link" => array:1 [ …1] ] ] ] ] ] ] 82 => array:3 [ "identificador" => "bib0890" "etiqueta" => "83" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Salicylates and homoeopathy in rheumatoid arthritis: preliminary observations" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Clin Pharmacol" "fecha" => "1978" "volumen" => "6" "paginaInicial" => "391" "paginaFinal" => "395" "link" => array:1 [ …1] ] ] ] ] ] ] 83 => array:3 [ "identificador" => "bib0895" "etiqueta" => "84" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Homoeopathic therapy in rheumatoid arthritis: evaluation by double-blind clinical therapeutic trial" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Clin Pharmacol" "fecha" => "1980" "volumen" => "9" "paginaInicial" => "453" "paginaFinal" => "459" "link" => array:1 [ …1] ] ] ] ] ] ] 84 => array:3 [ "identificador" => "bib0900" "etiqueta" => "85" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "1991" "volumen" => "20" "paginaInicial" => "204" "paginaFinal" => "208" "link" => array:1 [ …1] ] ] ] ] ] ] 85 => array:3 [ "identificador" => "bib0905" "etiqueta" => "86" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized controlled trial of homeopathy in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2001" "volumen" => "40" "paginaInicial" => "1052" "paginaFinal" => "1055" "link" => array:1 [ …1] ] ] ] ] ] ] 86 => array:3 [ "identificador" => "bib0910" "etiqueta" => "87" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/keq234" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2011" "volumen" => "50" "paginaInicial" => "1070" "paginaFinal" => "1082" "link" => array:1 [ …1] ] ] ] ] ] ] 87 => array:3 [ "identificador" => "bib0915" "etiqueta" => "88" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "author reply 1531–2" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comment 1 on: Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/ker109" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2011" "volumen" => "50" "paginaInicial" => "1529" "link" => array:1 [ …1] "itemHostRev" => array:3 [ …3] ] ] ] ] ] ] 88 => array:3 [ "identificador" => "bib0920" "etiqueta" => "89" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "author reply 1531-2" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comment 2 on: Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/ker109" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2011" "volumen" => "50" "paginaInicial" => "1529" "paginaFinal" => "1531" "link" => array:1 [ …1] ] ] ] ] ] ] 89 => array:3 [ "identificador" => "bib0925" "etiqueta" => "90" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical trial of homeopathy in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Homeopathy. The Faculty of Homeopathy" "fecha" => "2011" "volumen" => "100" "paginaInicial" => "300" ] ] ] ] ] ] 90 => array:3 [ "identificador" => "bib0930" "etiqueta" => "91" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hydrotherapy, balneotherapy, and spa treatment in pain management" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00296-004-0487-4" "Revista" => array:6 [ "tituloSerie" => "Rheumatol Int" "fecha" => "2005" "volumen" => "25" "paginaInicial" => "220" "paginaFinal" => "224" "link" => array:1 [ …1] ] ] ] ] ] ] 91 => array:3 [ "identificador" => "bib0935" "etiqueta" => "92" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Forearm vascular and neuroendocrine responses to graded water immersion in humans" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-201x.2000.00680.x" "Revista" => array:6 [ "tituloSerie" => "Acta Physiol Scand" "fecha" => "2000" "volumen" => "169" "paginaInicial" => "87" "paginaFinal" => "94" "link" => array:1 [ …1] ] ] ] ] ] ] 92 => array:3 [ "identificador" => "bib0940" "etiqueta" => "93" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balneotherapy (or spa therapy) for rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "CD000518" ] ] ] ] ] ] 93 => array:3 [ "identificador" => "bib0945" "etiqueta" => "94" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of aquatic exercise and Balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Epidemiol" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "2" "paginaFinal" => "12" "link" => array:1 [ …1] ] ] ] ] ] ] 94 => array:3 [ "identificador" => "bib0950" "etiqueta" => "95" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perspectives about complementary and alternative medicine in rheumatology" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rdc.2010.11.008" "Revista" => array:6 [ "tituloSerie" => "Rheum Dis Clin North Am" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ …1] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/1699258X/0000001200000003/v2_201703310244/S1699258X15001862/v2_201703310244/en/main.assets" "Apartado" => array:4 [ "identificador" => "17501" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Revisión" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001200000003/v2_201703310244/S1699258X15001862/v2_201703310244/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15001862?idApp=UINPBA00004M" ]
año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 30 | 16 | 46 |
2024 Octubre | 284 | 61 | 345 |
2024 Septiembre | 237 | 47 | 284 |
2024 Agosto | 192 | 63 | 255 |
2024 Julio | 195 | 42 | 237 |
2024 Junio | 206 | 63 | 269 |
2024 Mayo | 260 | 53 | 313 |
2024 Abril | 247 | 75 | 322 |
2024 Marzo | 263 | 54 | 317 |
2024 Febrero | 145 | 50 | 195 |
2024 Enero | 235 | 35 | 270 |
2023 Diciembre | 139 | 39 | 178 |
2023 Noviembre | 178 | 74 | 252 |
2023 Octubre | 189 | 65 | 254 |
2023 Septiembre | 312 | 70 | 382 |
2023 Agosto | 143 | 37 | 180 |
2023 Julio | 137 | 36 | 173 |
2023 Junio | 145 | 60 | 205 |
2023 Mayo | 148 | 54 | 202 |
2023 Abril | 138 | 25 | 163 |
2023 Marzo | 176 | 56 | 232 |
2023 Febrero | 163 | 47 | 210 |
2023 Enero | 107 | 47 | 154 |
2022 Diciembre | 183 | 61 | 244 |
2022 Noviembre | 142 | 81 | 223 |
2022 Octubre | 158 | 70 | 228 |
2022 Septiembre | 122 | 97 | 219 |
2022 Agosto | 101 | 78 | 179 |
2022 Julio | 126 | 60 | 186 |
2022 Junio | 138 | 70 | 208 |
2022 Mayo | 140 | 78 | 218 |
2022 Abril | 160 | 93 | 253 |
2022 Marzo | 157 | 85 | 242 |
2022 Febrero | 170 | 52 | 222 |
2022 Enero | 120 | 69 | 189 |
2021 Diciembre | 121 | 68 | 189 |
2021 Noviembre | 107 | 74 | 181 |
2021 Octubre | 154 | 75 | 229 |
2021 Septiembre | 194 | 68 | 262 |
2021 Agosto | 170 | 57 | 227 |
2021 Julio | 94 | 73 | 167 |
2021 Junio | 128 | 89 | 217 |
2021 Mayo | 132 | 106 | 238 |
2021 Abril | 580 | 147 | 727 |
2021 Marzo | 177 | 90 | 267 |
2021 Febrero | 142 | 53 | 195 |
2021 Enero | 196 | 46 | 242 |
2020 Diciembre | 251 | 40 | 291 |
2020 Noviembre | 181 | 52 | 233 |
2020 Octubre | 308 | 47 | 355 |
2020 Septiembre | 209 | 55 | 264 |
2020 Agosto | 83 | 28 | 111 |
2020 Julio | 100 | 51 | 151 |
2020 Junio | 172 | 41 | 213 |
2020 Mayo | 142 | 46 | 188 |
2020 Abril | 116 | 50 | 166 |
2020 Marzo | 112 | 49 | 161 |
2020 Febrero | 165 | 76 | 241 |
2020 Enero | 128 | 63 | 191 |
2019 Diciembre | 165 | 52 | 217 |
2019 Noviembre | 101 | 33 | 134 |
2019 Octubre | 130 | 49 | 179 |
2019 Septiembre | 397 | 66 | 463 |
2019 Agosto | 83 | 34 | 117 |
2019 Julio | 78 | 49 | 127 |
2019 Junio | 107 | 50 | 157 |
2019 Mayo | 97 | 81 | 178 |
2019 Abril | 150 | 31 | 181 |
2019 Marzo | 139 | 72 | 211 |
2019 Febrero | 107 | 53 | 160 |
2019 Enero | 73 | 55 | 128 |
2018 Diciembre | 230 | 75 | 305 |
2018 Noviembre | 471 | 43 | 514 |
2018 Octubre | 136 | 30 | 166 |
2018 Septiembre | 57 | 40 | 97 |
2018 Agosto | 54 | 25 | 79 |
2018 Julio | 28 | 20 | 48 |
2018 Mayo | 5 | 7 | 12 |
2018 Abril | 67 | 41 | 108 |
2018 Marzo | 69 | 33 | 102 |
2018 Febrero | 57 | 40 | 97 |
2018 Enero | 31 | 35 | 66 |
2017 Diciembre | 49 | 31 | 80 |
2017 Noviembre | 94 | 55 | 149 |
2017 Octubre | 80 | 56 | 136 |
2017 Septiembre | 93 | 38 | 131 |
2017 Agosto | 83 | 43 | 126 |
2017 Julio | 77 | 57 | 134 |
2017 Junio | 100 | 52 | 152 |
2017 Mayo | 111 | 61 | 172 |
2017 Abril | 97 | 53 | 150 |
2017 Marzo | 93 | 44 | 137 |
2017 Febrero | 72 | 27 | 99 |
2017 Enero | 72 | 44 | 116 |
2016 Diciembre | 114 | 60 | 174 |
2016 Noviembre | 98 | 64 | 162 |
2016 Octubre | 113 | 82 | 195 |
2016 Septiembre | 99 | 55 | 154 |
2016 Agosto | 109 | 52 | 161 |
2016 Julio | 55 | 56 | 111 |
2016 Mayo | 2 | 159 | 161 |