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as&#237; como la cara<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; La ES se clasifica en preesclerodermia&#44; forma limitada&#44; forma difusa y ES sin esclerodermia &#40;ESse&#41;&#46; La ESse se distingue por afecci&#243;n de &#243;rganos&#44; pero sin endurecimiento de la piel&#44; su frecuencia es del 2-8&#37; y la afectaci&#243;n visceral&#58; es&#243;fago &#40;53-86&#37;&#41;&#44; pulm&#243;n &#40;25-57&#37;&#41; y ri&#241;ones &#40;2&#44;5-3&#44;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Observaci&#243;n cl&#237;nica</span><p id="par0010" class="elsevierStylePara elsevierViewall">Se estudiaron de forma retrospectiva a 10 pacientes con ESse de una cohorte de 500 pacientes con ES&#44; durante el periodo comprendido entre 2005 a 2015&#46; Criterios de inclusi&#243;n&#58; pacientes sin esclerosis cut&#225;nea y las manifestaciones siguientes&#58; 1&#41; FR o equivalentes &#40;<span class="elsevierStyleItalic">pitting</span> o &#250;lceras en pulpejos o alteraciones capilarosc&#243;picas&#41;&#59; 2&#41; anticuerpos antinucleares &#40;ANA&#41; positivos&#59; y 3&#41; al menos una de las siguientes manifestaciones viscerales&#58; hipomotilidad esof&#225;gica distal y del intestino delgado&#44; neumopat&#237;a intersticial &#40;NI&#41;&#44; HAP&#44; afecci&#243;n cardiaca t&#237;pica de esclerodermia o crisis renal esclerod&#233;rmica&#59; sin ninguna enfermedad del tejido conectivo u otra enfermedad que explique las manifestaciones antes mencionadas<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a>&#46; Se excluyeron los pacientes con otras formas de ES&#46; A todos los pacientes se les realiz&#243; endoscopia del tubo digestivo superior&#44; manometr&#237;a esof&#225;gica&#44; serie es&#243;fago-gastroduodenal&#44; tr&#225;nsito intestinal&#44; tomograf&#237;a pulmonar de alta resoluci&#243;n&#44; pruebas de funci&#243;n respiratoria&#44; ecocardiograma doppler&#44; cateterismo cardiaco derecho en 4 pacientes&#44; electrocardiograma&#44; holter &#40;4 pacientes&#41;&#44; ANA por inmunofluorescencia &#40;sustratos c&#233;lulas Hep-2&#41;&#44; anticuerpos extra&#237;bles del n&#250;cleo&#58; anti topo-isomerasa&#44; anti Ro&#47;La&#44; RNP&#44; anti Sm&#44; Jo1 y anticuerpos anti-centr&#243;meros &#40;AAC&#41;&#46; Se efectu&#243; biopsia de es&#243;fago en todos los pacientes y biopsia pulmonar en uno&#46; No se realiz&#243; capilaroscopia&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="par0015" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describe las caracter&#237;sticas cl&#237;nicas y autoanticuerpos de estos pacientes&#46; Predomin&#243; el sexo femenino en 9 casos y hubo un hombre&#44; la edad promedio fue de 49&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;1 a&#241;os&#44; la evoluci&#243;n promedio de la enfermedad 8&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;4 a&#241;os y el retraso en el diagn&#243;stico de 2&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5 a&#241;os&#46; Las principales manifestaciones cl&#237;nicas encontradas&#58; FR 9&#47;10&#44; afecci&#243;n esof&#225;gica 8&#47;10 con reflujo gastroesof&#225;gico de moderado a grave&#59; pulmonar 4&#47;10 con NI&#44; HAP 4&#47;10 &#40;grado moderado en 4 pacientes y leve en un paciente&#41;&#44; afecci&#243;n cardiaca 3&#47;10 con disfunci&#243;n diast&#243;lica del ventr&#237;culo izquierdo&#58; grado <span class="elsevierStyleSmallCaps">II</span> en 2 pacientes y <span class="elsevierStyleSmallCaps">iii</span> en un paciente&#44; trastornos de conducci&#243;n e insuficiencia cardiaca en 1&#47;10&#46; Los ANA se encontraron presentes con t&#237;tulos entre 1&#58;320 a 1&#58;1280 &#40;3 pacientes mostraron un patr&#243;n nucleolar&#44; en especial los pacientes 1<span class="elsevierStyleHsp" style=""></span>y 4 de la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; El paciente 1 tambi&#233;n tuvo positivos los anti-Scl-70&#46; Los AAC estuvieron presentes en la mayor&#237;a de los pacientes&#44; en 9&#47;10&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se presentan las principales manifestaciones cl&#237;nicas de ESse y se comparan con otras series publicadas&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusi&#243;n</span><p id="par0020" class="elsevierStylePara elsevierViewall">La ESse es una forma infrecuente de ES&#46; En nuestro estudio la prevalencia de ESse fue del 2&#37;&#44; con rangos de 1&#44;5-10&#37;&#44; similar a lo informado previamente<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;4&#8211;8</span></a>&#46; Esta prevalencia probablemente es subestimada debido a la ausencia de afecci&#243;n cut&#225;nea en estos pacientes&#44; lo que conduce en forma frecuente a un retraso en el diagn&#243;stico&#46; En nuestros pacientes el tiempo promedio del diagn&#243;stico de ESse fue de 2&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5 a&#241;os&#46; Los pacientes con afecci&#243;n pulmonar &#40;NI y&#47;o HAP&#41; y FR&#44; como se observ&#243; en algunos de nuestros pacientes&#44; fueron datos que orientaron al diagn&#243;stico de ESse&#46; En la clasificaci&#243;n actual de ES<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> la ESse se considera un subtipo de ES&#59; sin embargo&#44; para algunos autores a&#250;n no est&#225; claro si es una forma diferente de la ES o es parte del espectro cl&#237;nico de la ESl<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; La ESse tiene similitudes cl&#237;nicas con la ESl&#44; excepto en la presencia de telangiectasias<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>&#46; El FR fue la manifestaci&#243;n cl&#237;nica m&#225;s frecuente en la mayor&#237;a de nuestros pacientes &#40;90&#37;&#41;&#46; El es&#243;fago fue el &#243;rgano visceral m&#225;s afectado con enfermedad por reflujo gastroesof&#225;gico&#44; seguido del pulm&#243;n con NI y HAP en el 40&#37; respectivamente&#44; afecci&#243;n del coraz&#243;n &#40;30&#37;&#41; con manifestaciones de disfunci&#243;n diast&#243;lica del ventr&#237;culo izquierdo y trastornos de conducci&#243;n&#46; Estas manifestaciones cl&#237;nicas observadas son similares a lo informado en otras series de pacientes&#44; a excepci&#243;n de la crisis renal&#44; que en nuestra serie no se observ&#243; ning&#250;n caso<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los AAC se encontraron en el 80&#37; de los casos&#44; como ha sido descrito&#44; y en el resto de los pacientes tuvieron anticuerpos antinucleares<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>&#46; En la ESse&#44; debido a que no existe afecci&#243;n en la piel&#44; por lo general su diagn&#243;stico y tratamiento se establece de forma tard&#237;a&#44; lo que puede conducir a una mayor morbimortalidad<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a>&#46; El tratamiento de la ESse es semejante a los casos de pacientes con ES&#44; con &#233;nfasis en el &#243;rgano involucrado<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5&#44;8</span></a>&#46; La ESse se considera una forma leve de ES con buen pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>&#44; aunque este depender&#225; del &#243;rgano afectado&#46; Para algunos autores el pron&#243;stico de ESse es similar al de ESl<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; en los pacientes con NI o HAP y dismotilidad esof&#225;gica se deben evaluar los AAC e investigar ESse para establecer un diagn&#243;stico y tratamiento oportunos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Responsabilidades &#233;ticas</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protecci&#243;n de personas y animales</span><p id="par0035" class="elsevierStylePara elsevierViewall">Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Confidencialidad de los datos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Derecho a la privacidad y consentimiento informado</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los autores declaran que en este art&#237;culo no aparecen datos de pacientes&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicto de intereses</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Confidencialidad de los datos"
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              "titulo" => "Derecho a la privacidad y consentimiento informado"
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    "fechaRecibido" => "2016-07-28"
    "fechaAceptado" => "2016-11-23"
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          "palabras" => array:3 [
            0 => "Esclerosis sist&#233;mica sin esclerodermia"
            1 => "Manifestaciones cl&#237;nicas"
            2 => "Prevalencia"
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            0 => "Systemic sclerosis sine scleroderma"
            1 => "Clinical manifestations"
            2 => "Prevalence"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La esclerosis sist&#233;mica <span class="elsevierStyleItalic">sine</span> esclerodermia &#40;ESse&#41; es una forma de esclerosis sist&#233;mica caracterizada por fen&#243;meno de Raynaud &#40;FR&#41;&#44; afecci&#243;n visceral sin endurecimiento de la piel y anticuerpos anti-centr&#243;meros &#40;AAC&#41;&#46; Se estudiaron a 10 pacientes con ESse&#44; con prevalencia del 2&#37;&#46; Manifestaciones cl&#237;nicas&#58; FR 9&#47;10&#44; esof&#225;gica 8&#47;10&#44; hipertensi&#243;n arterial pulmonar 4&#47;10&#44; neumopat&#237;a intersticial 4&#47;10&#44; cardiaca 3&#47;10 y AAC 8&#47;10&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conclusi&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En pacientes con FR&#44; dismotilidad esof&#225;gica&#44; neumopat&#237;a intersticial e hipertensi&#243;n arterial pulmonar se debe investigar AAC y establecer un diagn&#243;stico y tratamiento oportuno de ESse&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Systemic sclerosis sine scleroderma &#40;ssSSc&#41; is a form of systemic sclerosis that is characterized by Raynaud&#39;s phenomenon &#40;RP&#41;&#44; visceral involvement without thickening of skin and anticentromere antibodies &#40;ACA&#41;&#46; We studied 10 ssSsc patients with a prevalence of 2&#37;&#46; The clinical signs were&#58; RP 9&#47;10&#44; esophageal manifestations 8&#47;10&#44; pulmonary arterial hypertension 4&#47;10&#44; interstitial lung disease 4&#47;10&#44; cardiac signs 3&#47;10 and ACA 8&#47;10&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In patients with RP&#44; esophageal dysmotility&#44; interstitial lung disease and pulmonary arterial hypertension should be tested for ACA in order to establish a prompt diagnosis and treatment of ssSSc&#46;</p></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">s&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">s&#47;d&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&nbsp;\t\t\t\t\t\t\n
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Caso clínico
Esclerosis sistémica sin esclerodermia en pacientes mexicanos. Serie de casos
Systemic Sclerosis Sine Scleroderma in Mexican Patients. Case Reports
Olga Vera-Lastraa,b,
Autor para correspondencia
Olgavera62@yahoo.com.mx

Autor para correspondencia.
, Christian Alexis Sauceda-Casasc,d, María del Pilar Cruz Domínguezb,e, Sergio Alberto Mendoza Alvareza,b, Jesús Sepulceda-Delgadoa
a Departamento de Medicina Interna, Unidad Médica de Alta Especialidad, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional, La Raza, Instituto Mexicano del Seguro Social, México D.F., México
b División de Estudios de posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México
c Universidad Autónoma de Sinaloa, México
d Academia Mexicana de la Ciencia, México
e División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Dr. Antonio Fraga Mouret, Centro Médico Nacional, La Raza. Instituto Mexicano del Seguro Social, México D.F., México
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tr&#225;nsito intestinal&#44; tomograf&#237;a pulmonar de alta resoluci&#243;n&#44; pruebas de funci&#243;n respiratoria&#44; ecocardiograma doppler&#44; cateterismo cardiaco derecho en 4 pacientes&#44; electrocardiograma&#44; holter &#40;4 pacientes&#41;&#44; ANA por inmunofluorescencia &#40;sustratos c&#233;lulas Hep-2&#41;&#44; anticuerpos extra&#237;bles del n&#250;cleo&#58; anti topo-isomerasa&#44; anti Ro&#47;La&#44; RNP&#44; anti Sm&#44; Jo1 y anticuerpos anti-centr&#243;meros &#40;AAC&#41;&#46; Se efectu&#243; biopsia de es&#243;fago en todos los pacientes y biopsia pulmonar en uno&#46; No se realiz&#243; capilaroscopia&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="par0015" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describe las caracter&#237;sticas cl&#237;nicas y autoanticuerpos de estos pacientes&#46; 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En nuestro estudio la prevalencia de ESse fue del 2&#37;&#44; con rangos de 1&#44;5-10&#37;&#44; similar a lo informado previamente<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;4&#8211;8</span></a>&#46; Esta prevalencia probablemente es subestimada debido a la ausencia de afecci&#243;n cut&#225;nea en estos pacientes&#44; lo que conduce en forma frecuente a un retraso en el diagn&#243;stico&#46; En nuestros pacientes el tiempo promedio del diagn&#243;stico de ESse fue de 2&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5 a&#241;os&#46; Los pacientes con afecci&#243;n pulmonar &#40;NI y&#47;o HAP&#41; y FR&#44; como se observ&#243; en algunos de nuestros pacientes&#44; fueron datos que orientaron al diagn&#243;stico de ESse&#46; En la clasificaci&#243;n actual de ES<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> la ESse se considera un subtipo de ES&#59; sin embargo&#44; para algunos autores a&#250;n no est&#225; claro si es una forma diferente de la ES o es parte del espectro cl&#237;nico de la ESl<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; La ESse tiene similitudes cl&#237;nicas con la ESl&#44; excepto en la presencia de telangiectasias<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>&#46; El FR fue la manifestaci&#243;n cl&#237;nica m&#225;s frecuente en la mayor&#237;a de nuestros pacientes &#40;90&#37;&#41;&#46; El es&#243;fago fue el &#243;rgano visceral m&#225;s afectado con enfermedad por reflujo gastroesof&#225;gico&#44; seguido del pulm&#243;n con NI y HAP en el 40&#37; respectivamente&#44; afecci&#243;n del coraz&#243;n &#40;30&#37;&#41; con manifestaciones de disfunci&#243;n diast&#243;lica del ventr&#237;culo izquierdo y trastornos de conducci&#243;n&#46; Estas manifestaciones cl&#237;nicas observadas son similares a lo informado en otras series de pacientes&#44; a excepci&#243;n de la crisis renal&#44; que en nuestra serie no se observ&#243; ning&#250;n caso<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los AAC se encontraron en el 80&#37; de los casos&#44; como ha sido descrito&#44; y en el resto de los pacientes tuvieron anticuerpos antinucleares<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>&#46; En la ESse&#44; debido a que no existe afecci&#243;n en la piel&#44; por lo general su diagn&#243;stico y tratamiento se establece de forma tard&#237;a&#44; lo que puede conducir a una mayor morbimortalidad<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a>&#46; El tratamiento de la ESse es semejante a los casos de pacientes con ES&#44; con &#233;nfasis en el &#243;rgano involucrado<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5&#44;8</span></a>&#46; La ESse se considera una forma leve de ES con buen pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>&#44; aunque este depender&#225; del &#243;rgano afectado&#46; Para algunos autores el pron&#243;stico de ESse es similar al de ESl<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; en los pacientes con NI o HAP y dismotilidad esof&#225;gica se deben evaluar los AAC e investigar ESse para establecer un diagn&#243;stico y tratamiento oportunos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Responsabilidades &#233;ticas</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protecci&#243;n de personas y animales</span><p id="par0035" class="elsevierStylePara elsevierViewall">Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Confidencialidad de los datos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Derecho a la privacidad y consentimiento informado</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los autores declaran que en este art&#237;culo no aparecen datos de pacientes&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicto de intereses</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflicto de intereses&#46;</p></span></span>"
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    "fechaAceptado" => "2016-11-23"
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          "palabras" => array:3 [
            0 => "Esclerosis sist&#233;mica sin esclerodermia"
            1 => "Manifestaciones cl&#237;nicas"
            2 => "Prevalencia"
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            2 => "Prevalence"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La esclerosis sist&#233;mica <span class="elsevierStyleItalic">sine</span> esclerodermia &#40;ESse&#41; es una forma de esclerosis sist&#233;mica caracterizada por fen&#243;meno de Raynaud &#40;FR&#41;&#44; afecci&#243;n visceral sin endurecimiento de la piel y anticuerpos anti-centr&#243;meros &#40;AAC&#41;&#46; Se estudiaron a 10 pacientes con ESse&#44; con prevalencia del 2&#37;&#46; Manifestaciones cl&#237;nicas&#58; FR 9&#47;10&#44; esof&#225;gica 8&#47;10&#44; hipertensi&#243;n arterial pulmonar 4&#47;10&#44; neumopat&#237;a intersticial 4&#47;10&#44; cardiaca 3&#47;10 y AAC 8&#47;10&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conclusi&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En pacientes con FR&#44; dismotilidad esof&#225;gica&#44; neumopat&#237;a intersticial e hipertensi&#243;n arterial pulmonar se debe investigar AAC y establecer un diagn&#243;stico y tratamiento oportuno de ESse&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Systemic sclerosis sine scleroderma &#40;ssSSc&#41; is a form of systemic sclerosis that is characterized by Raynaud&#39;s phenomenon &#40;RP&#41;&#44; visceral involvement without thickening of skin and anticentromere antibodies &#40;ACA&#41;&#46; We studied 10 ssSsc patients with a prevalence of 2&#37;&#46; The clinical signs were&#58; RP 9&#47;10&#44; esophageal manifestations 8&#47;10&#44; pulmonary arterial hypertension 4&#47;10&#44; interstitial lung disease 4&#47;10&#44; cardiac signs 3&#47;10 and ACA 8&#47;10&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In patients with RP&#44; esophageal dysmotility&#44; interstitial lung disease and pulmonary arterial hypertension should be tested for ACA in order to establish a prompt diagnosis and treatment of ssSSc&#46;</p></span>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">AAC&#58; anticuerpos anti-centr&#243;meros&#59; FR&#58; fen&#243;meno de Raynaud&#59; HAP&#58; hipertensi&#243;n arterial pulmonar&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">s&#47;d&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">s&#47;d&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Systemic sclerosis&#58; An update in 2016"
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                            0 => "A&#46;C&#46; Desbois"
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                      "doi" => "10.1016/j.autrev.2016.01.007"
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                        "tituloSerie" => "Autoimmun Rev"
                        "fecha" => "2016"
                        "volumen" => "15"
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