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La b&#250;squeda se limit&#243; a estudios en seres humanos y a estudios publicados en ingl&#233;s y espa&#241;ol&#46; Adem&#225;s&#44; se realiz&#243; una b&#250;squeda manual en la bibliograf&#237;a de los art&#237;culos incluidos y en los congresos americano y europeo de Reumatolog&#237;a de los 2 &#250;ltimos a&#241;os&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dos revisoras &#40;RA&#44; LC&#41; examinaron de forma independiente los t&#237;tulos y los res&#250;menes de los art&#237;culos recuperados para los criterios de selecci&#243;n&#46; A continuaci&#243;n&#44; se recogieron los datos de los estudios seleccionados&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se incluyeron &#250;nicamente&#58; <span class="elsevierStyleItalic">1&#41;</span> ensayos cl&#237;nicos aleatorizados &#40;ECA&#41;&#44; en los que <span class="elsevierStyleItalic">2&#41;</span> la poblaci&#243;n a tratar fuesen pacientes con APs&#44; <span class="elsevierStyleItalic">3&#41;</span> la intervenci&#243;n fuera cualquier medida encaminada al control de peso &#40;dieta&#44; ejercicio&#44; f&#225;rmacos&#44; cirug&#237;as&#44; etc&#46;&#41;&#44; <span class="elsevierStyleItalic">4&#41;</span> se comparara frente a no realizaci&#243;n de intervenci&#243;n alguna o control&#44; y <span class="elsevierStyleItalic">5&#41;</span> se realizara alguna medida de evaluaci&#243;n de la actividad&#44; perif&#233;rica &#40;recuento articular 66&#47;68&#44; DAS28&#44; DAS&#44; VAS&#44; &#237;ndices de entesitis&#41; o axial &#40;ASDAS&#44; BASDAI&#44; BASFI&#44; BASMI&#41;&#44; reactantes de fase aguda &#40;VSG y prote&#237;na C reactiva &#91;PCR&#93;&#41; o de imagen&#44; u otros &#237;ndices de eficacia documentado en el art&#237;culo&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Todos los art&#237;culos obtenidos se revisaron en detalle con apoyo de hojas de recogida de datos confeccionadas <span class="elsevierStyleItalic">ad hoc</span>&#46; Se recogieron todos los datos de la descripci&#243;n de la muestra y de los resultados espec&#237;ficos del control de peso sobre la actividad inflamatoria&#46; Se evaluaron as&#237; mismo los riesgos de sesgos mediante los dominios propuestos por la Colaboraci&#243;n Cochrane<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis cualitativo de la informaci&#243;n recogida por tipo de estudio y poblaci&#243;n estudiada&#44; por calidad y por resultados espec&#237;ficos&#44; as&#237; como una evaluaci&#243;n cualitativa de la heterogeneidad&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">En el diagrama de la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se detallan los resultados de la b&#250;squeda&#46; En la estrategia de b&#250;squeda se identific&#243; un total de 215 art&#237;culos&#44; de los cuales 5 fueron seleccionados para una revisi&#243;n en detalle tras la exclusi&#243;n de 210 referencias por t&#237;tulo y resumen&#46; Finalmente&#44; 3 art&#237;culos fueron excluidos &#40;en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se detallan los estudios excluidos y los motivos de su exclusi&#243;n&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se presentan los datos de los 2 art&#237;culos incluidos finalmente en el an&#225;lisis<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;19</span></a>&#46; Se trata de 2 ECA&#44; uno de ellos en formato abstract&#46; Los riesgos de sesgos son moderados en el estudio de di Minno et al&#46; y altos en el de Abou-Raya et al&#46;&#44; en este &#250;ltimo por falta de informaci&#243;n&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En el estudio de di Minno et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> se aleatoriz&#243; a pacientes con APs y obesidad a recibir una dieta hipocal&#243;rica basada en una ingesta de grasa del 30-35&#37; de la ingesta total diaria&#44; aumento de la fibra y pescado al menos un d&#237;a a la semana&#44; o una dieta libre&#44; recibiendo unos consejos nutricionales&#46; Al mismo tiempo&#44; y por falta de control sintom&#225;tico&#44; los pacientes iniciaban tratamiento con f&#225;rmacos anti-TNF&#44; no pudiendo haber recibido tratamiento biol&#243;gico previamente para poder entrar en el estudio&#46; El 58&#44;7&#37; logr&#243; una p&#233;rdida de peso &#8805; 5&#37;&#44; ocurriendo esta m&#225;s frecuentemente en el grupo de dieta hipocal&#243;rica &#40;49 de 63&#41; que en el de dieta libre &#40;25 de 63&#59; p &#60; 0&#44;001&#41;&#46; Con ambas dietas se logr&#243; una mejor&#237;a significativa en los recuentos articulares&#44; de entesis&#44; PASI&#44; HAQ&#44; EVA&#44; PCR y VSG a los 6 meses&#46; Los pacientes con una p&#233;rdida peso superior al 5&#37; mostraron con mayor frecuencia actividad m&#237;nima de la enfermedad seg&#250;n Coates y Helliwell<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> &#40;50&#37;&#41; que los que no lograron tanta p&#233;rdida de peso &#40;23&#37;&#59; odds ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;20&#59; intervalo de confianza del 95&#37;&#44; 1&#44;82 a 9&#44;66&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El estudio de Abou-Raya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> pretend&#237;a evaluar si la p&#233;rdida de peso a trav&#233;s del ejercicio o la dieta&#44; o ambos&#44; es m&#225;s eficaz que solo el tratamiento est&#225;ndar &#40;antiinflamatorios no esteroideos&#44; f&#225;rmacos modificadores de enfermedad&#44; anti-TNF-&#945;&#41; en la mejor&#237;a de los s&#237;ntomas &#40;dolor&#44; funci&#243;n f&#237;sica&#44; fatiga&#44; depresi&#243;n&#41; e inflamaci&#243;n sist&#233;mica en pacientes adultos obesos con APs&#46; La reducci&#243;n media de peso corporal fue del 15&#37; en todos los grupos de intervenci&#243;n frente al 2&#37; en grupo control p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46; En el grupo de ejercicio se observ&#243; una mejor&#237;a significativa en ACR20&#44; HAQ&#44; BDI&#44; fatiga&#44; PASI y PGA&#44; y en el grupo de la dieta una mejora significativa en ACR20 y respuesta PASI75 y unas reducciones significativas en los marcadores inflamatorios sist&#233;micos&#46; En el grupo dieta y ejercicio se observ&#243; una mejor&#237;a significativa en ACR20&#44; HAQ&#44; depresi&#243;n&#44; fatiga&#44; DAS28-CRP&#44; PASI&#44; valoraci&#243;n global del m&#233;dico&#44; junto con reducciones significativas en los niveles s&#233;ricos de PCR ultrasensible&#44; IL-6&#44; IL-17 y TNF en comparaci&#243;n con los controles&#46; Se encontr&#243; una correlaci&#243;n moderada entre el porcentaje de p&#233;rdida de peso y la reducci&#243;n en el PASI &#40;r &#61; 0&#44;587&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Numerosos estudios han descrito la elevada prevalencia de factores de riesgo cardiovascular&#44; como hipertensi&#243;n arterial&#44; obesidad&#44; diabetes mellitus y dislipidemia&#44; en pacientes con APs<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">21-27</span></a>&#46; Es m&#225;s&#44; la evidencia indica que la obesidad&#44; la resistencia a la insulina&#44; la psoriasis y la APs pueden compartir una predisposici&#243;n com&#250;n en t&#233;rminos de inflamaci&#243;n de bajo grado<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#46; Tambi&#233;n se ha visto que el &#237;ndice de masa corporal se asocia en APs a peor respuesta al tratamiento<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a>&#46; Lo que no estaba tan claro es si la reducci&#243;n del peso podr&#237;a tener un efecto sobre la actividad&#46; En nuestra revisi&#243;n sistem&#225;tica hemos encontrado 2 estudios que apoyan esta hip&#243;tesis&#44; uno con un nivel de evidencia alto y otro con un nivel algo menor por encontrarse a&#250;n en formato de resumen solo&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Existen estrechos v&#237;nculos entre el sistema metab&#243;lico y el sistema inmunol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a>&#46; Por ejemplo&#44; la IL-6 es una citocina proinflamatoria clave que puede estimular el hipot&#225;lamo&#44; que se asocia con la obesidad central&#44; la hipertensi&#243;n y la resistencia a la insulina e induce la producci&#243;n de la PCR<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#46; Existen adem&#225;s datos de que la restricci&#243;n cal&#243;rica disminuye los niveles de PCR y TNF-&#945;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a>&#44; por lo que los pacientes sometidos a una dieta de 1&#46;500 calor&#237;as&#47;d&#237;a pueden tener descensos en los niveles de PCR por este motivo y no solo por una disminuci&#243;n en su actividad inflamatoria&#46; Esto podr&#237;a justificar el efecto observado sobre la actividad en los estudios&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Otros factores podr&#237;an ser los que tengan un efecto sobre el peso y sobre la actividad&#46; Por ejemplo&#44; en el estudio de di Minno et al&#46;&#44; un 20&#37; de los pacientes estaban recibiendo tratamiento cr&#243;nico con hipoglucemiantes orales y es conocida la acci&#243;n que sobre el peso corporal pueden tener los agonistas del glucag&#243;n p&#233;ptido-1&#44; la metformina y la sulfonilurea&#59; adem&#225;s&#44; tambi&#233;n se iniciaba el tratamiento con anti-TNF&#46; Si bien los pacientes estaban con dosis estables de hipoglucemiantes y todos iniciaban anti-TNF&#44; no se puede descartar del todo que el efecto del peso sobre la actividad se debiera en parte a estos otros tratamientos&#46; Incluso se podr&#237;a considerar que los pacientes m&#225;s adherentes a la dieta o al ejercicio sean tambi&#233;n los m&#225;s adherentes a los tratamientos<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nuestra revisi&#243;n se ha visto limitada por el bajo n&#250;mero de estudios publicados y por la calidad intermedia de los mismos&#46; La hip&#243;tesis de que la p&#233;rdida de peso en APs podr&#237;a llevar aparejada una reducci&#243;n de la actividad&#44; aunque indicativa&#44; se sustenta &#250;nicamente en 2 estudios aleatorizados&#44; uno de ellos solo comunicado en forma de abstract&#44; por lo que concluimos que a&#250;n merece ser investigada en m&#225;s profundidad&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Responsabilidades &#233;ticas</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protecci&#243;n de personas y animales</span><p id="par0075" 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="sect0095">Confidencialidad de datos</span><p id="par0080" class="elsevierStylePara elsevierViewall">Los autores declaran que en este art&#237;culo no aparecen datos de pacientes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Derecho a la privacidad y consentimiento informado</span><p id="par0085" 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="sect0105">Financiaci&#243;n</span><p id="par0090" class="elsevierStylePara elsevierViewall">MSD&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar la asociaci&#243;n entre la p&#233;rdida de peso y cambios en la actividad en pacientes con artritis psori&#225;sica &#40;APs&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se llev&#243; a cabo una revisi&#243;n sistem&#225;tica en Medline&#44; Embase y Cochrane Central desde el inicio hasta abril del 2015&#46; Criterios de inclusi&#243;n&#58; <span class="elsevierStyleItalic">1&#41;</span> ensayos cl&#237;nicos aleatorizados controlados &#40;ECA&#41;&#59; <span class="elsevierStyleItalic">2&#41;</span> pacientes con APs&#59; <span class="elsevierStyleItalic">3&#41;</span> cualquier intervenci&#243;n encaminada al control de peso&#44; y <span class="elsevierStyleItalic">4&#41;</span> evaluaci&#243;n de la actividad de la APs&#46; Se evaluaron los riesgos de sesgos seg&#250;n la escala Cochrane&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De 215 art&#237;culos identificados&#44; solo 2 ECA cumplieron los criterios de inclusi&#243;n&#44; uno de ellos en formato abstract&#46; Ambos ten&#237;an riesgos de sesgos moderados&#46; Los pacientes que lograban perder peso&#44; por cualquier m&#233;todo&#44; mostraban menores niveles de actividad e inflamaci&#243;n&#46; El porcentaje de p&#233;rdida de peso correlaciona moderadamente con cambios en medidas de inflamaci&#243;n&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La p&#233;rdida de peso en APs podr&#237;a asociarse a menor inflamaci&#243;n&#44; si bien la evidencia que lo apoya es limitada&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate the association between weight loss and changes in disease activity in patients with psoriatic arthritis &#40;PsA&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We performed a systematic review of the literature&#44; with searches in Medline&#44; Embase and Cochrane Central Library from inception until April 2015&#46; Inclusion criteria&#58; 1&#41; randomized controlled trials &#40;RCT&#41;&#59; 2&#41; PsA patients&#59; 3&#41; interventions were any intervention aimed at weight control&#59; and 4&#41; a PsA activity-related outcome measure was evaluated&#46; Risks of bias were assessed by the Cochrane Collaboration scale&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 215 articles identified&#44; only 2 RCT met the inclusion criteria&#44; 1 in abstract format&#46; Both showed moderate risk of bias&#46; Patients who managed to lose weight&#8212;by any method&#8212;had better results in terms of activity and inflammation&#46; The percentage of weight loss correlated moderately with changes in inflammatory outcomes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Weight loss in PsA could be associated with less inflammation&#59; however&#44; the evidence to support this is limited&#46;</p></span>"
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                  \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">&#35;1 &#8216;psoriatic arthritis&#8217;&nbsp;\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">&#35;2 &#8216;psoriatic arthritis&#8217;&#47;exp&nbsp;\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">&#35;3 &#35;1 OR &#35;2&nbsp;\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">&#35;4 &#8216;diet&#8217;&nbsp;\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">&#35;5 &#8216;weight control&#8217;&nbsp;\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">&#35;6 &#8216;weight reduction&#8217;&nbsp;\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">&#35;7 &#8216;weight reduction&#8217;&#47;exp&nbsp;\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">&#35;8 &#8216;antiobesity agents&#8217;&nbsp;\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">&#35;9 &#8216;antiobesity agents&#8217;&nbsp;\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">&#35;10 &#8216;anti obesity agents&#8217;&nbsp;\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">&#35;11 &#8216;metformin&#8217;&nbsp;\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">&#35;12 &#8216;sibutramine&#8217;&nbsp;\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">&#35;13 &#8216;orlistat&#8217;&nbsp;\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">&#35;14 &#8216;xenical&#8217;&nbsp;\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">&#35;15 &#8216;meridia&#8217;&nbsp;\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">&#35;16 &#8216;glucophage&#8217;&nbsp;\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">&#35;17 &#8216;low calorie diet&#8217;&nbsp;\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">&#35;18 &#8216;low fat diet&#8217;&nbsp;\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">&#35;19 nutrition&#36; AND &#40;intervention&#36; OR education&#36;&#41;&nbsp;\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">&#35;20 diet&#36; AND &#40;intervention&#36; OR education&#36;&#41;&nbsp;\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">&#35;21 &#8216;weight loss&#8217; AND &#40;intervention&#36; OR education&#36;&#41;&nbsp;\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">&#35;22 weight AND reduction&nbsp;\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">&#35;23 &#8216;weight reduction&#8217;&#47;exp&nbsp;\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">&#35;24 &#40;&#35;4 - &#35;23&#41; OR&nbsp;\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">&#35;25 &#35;3 AND &#35;24&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estrategia de b&#250;squeda</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Raz&#243;n para exclusi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Schett et al&#46;&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No analiza el efecto del control del peso<span class="elsevierStyleItalic"><span class="elsevierStyleBold">&#46;</span></span> Es un ensayo cl&#237;nico aleatorizado a 24 semanas que eval&#250;a el impacto del peso e &#237;ndice de masa corporal basales sobre la respuesta cl&#237;nica &#40;ACR 20 y HAQ&#41; a apremilast en APs&#44; no el cambio en el peso&nbsp;\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">Di Minnet et al&#46;&#44; 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abstract a congreso&#46; Eval&#250;a el efecto de la reducci&#243;n de peso mediante dieta&#44; para alcanzar la actividad m&#237;nima en pacientes con sobrepeso&#47;obesos con APs&#44; que inician tratamiento anti-TNF&#46; Se excluye porque posteriormente se ha publicado en 2014 y es el incluido en la revisi&#243;n sistem&#225;tica&nbsp;\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">Sullivan et al&#46;&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ensayo abierto a 24 semanas que analiza el efecto del an&#225;logo GLP-<span class="elsevierStyleSmallCaps">I</span> &#40;liraglutida&#41; en la actividad en 15 pacientes con artritis inflamatoria &#40;11 artritis reumatoide&#59; 4 APs&#41; y diabetes mellitus tipo 2&#46; No aporta datos por separado y el tama&#241;o muestral es demasiado peque&#241;o&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Estudios excluidos y razones</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Los colores indican la adecuaci&#243;n a los determinados dominios de la escala de sesgos&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ACR20&#58; American College of Rheumatology&#59; APs&#58; artritis psori&#225;sica&#59; BDI&#58; inventario de depresi&#243;n Beck&#39;s&#59; DAS28-CRP&#58; Disease activity score-PCR&#59; EVA&#58; escala visual anal&#243;gica&#59; HAQ&#58; Health Assessment Questionnaire&#59; IMC&#58; &#237;ndice de masa corporal&#59; NAD&#58; n&#250;mero de articulaciones dolorosas&#59; NAI&#58; n&#250;mero de articulaciones inflamadas&#59; PASI&#58; Psoriasis Area Severity Index&#59; PCR&#58; prote&#237;na C reactiva&#59; PGA&#58; Physician&#39;s Global Assessment&#59; VSG&#58; velocidad de sedimentaci&#243;n globular&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201808030431238561"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201808030431238562"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201808030431238563"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201808030431238564"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201808030431238565"></elsevierMultimedia>&nbsp;\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">Abou-Raya et al&#46;&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA ciego simple 12 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55<br>Adultos con APs e IMC &#8805; 30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Control<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>tratamiento est&#225;ndar<br>Dieta<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>tratamiento est&#225;ndar<br>Ejercicio&#43; tratamiento est&#225;ndar<br>Dieta<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ejercicio<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>tratamiento est&#225;ndar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ACR20&#44; HAQ&#44; BDI&#44; fatiga&#44; PASI&#44; PGA&#44; DAS28-PCR&#44; PCR ultrasensible&#44; IL-6&#44; IL-17 y TNF&nbsp;\t\t\t\t\t\t\n
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Original
Efecto de la pérdida de peso en la actividad en artritis psoriásica: una revisión sistemática
Effect of weight loss on activity in psoriatic arthritis: A systematic review
Raquel Almodóvara,
Autor para correspondencia
ralmodovar@fhalcorcon.es

Autor para correspondencia.
, Pedro Zarcoa, Teresa Otónb, Loreto Carmonab
a Hospital Universitario Fundación Alcorcón, Madrid, España
b Instituto de Salud Musculoesquelética, InMusc, Madrid, España
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que en el de dieta libre &#40;25 de 63&#59; p &#60; 0&#44;001&#41;&#46; Con ambas dietas se logr&#243; una mejor&#237;a significativa en los recuentos articulares&#44; de entesis&#44; PASI&#44; HAQ&#44; EVA&#44; PCR y VSG a los 6 meses&#46; Los pacientes con una p&#233;rdida peso superior al 5&#37; mostraron con mayor frecuencia actividad m&#237;nima de la enfermedad seg&#250;n Coates y Helliwell<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> &#40;50&#37;&#41; que los que no lograron tanta p&#233;rdida de peso &#40;23&#37;&#59; odds ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;20&#59; intervalo de confianza del 95&#37;&#44; 1&#44;82 a 9&#44;66&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El estudio de Abou-Raya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> pretend&#237;a evaluar si la p&#233;rdida de peso a trav&#233;s del ejercicio o la dieta&#44; o ambos&#44; es m&#225;s eficaz que solo el tratamiento est&#225;ndar &#40;antiinflamatorios no esteroideos&#44; f&#225;rmacos modificadores de enfermedad&#44; anti-TNF-&#945;&#41; en la mejor&#237;a de los s&#237;ntomas &#40;dolor&#44; funci&#243;n f&#237;sica&#44; fatiga&#44; depresi&#243;n&#41; e inflamaci&#243;n sist&#233;mica en pacientes adultos obesos con APs&#46; La reducci&#243;n media de peso corporal fue del 15&#37; en todos los grupos de intervenci&#243;n frente al 2&#37; en grupo control p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46; En el grupo de ejercicio se observ&#243; una mejor&#237;a significativa en ACR20&#44; HAQ&#44; BDI&#44; fatiga&#44; PASI y PGA&#44; y en el grupo de la dieta una mejora significativa en ACR20 y respuesta PASI75 y unas reducciones significativas en los marcadores inflamatorios sist&#233;micos&#46; En el grupo dieta y ejercicio se observ&#243; una mejor&#237;a significativa en ACR20&#44; HAQ&#44; depresi&#243;n&#44; fatiga&#44; DAS28-CRP&#44; PASI&#44; valoraci&#243;n global del m&#233;dico&#44; junto con reducciones significativas en los niveles s&#233;ricos de PCR ultrasensible&#44; IL-6&#44; IL-17 y TNF en comparaci&#243;n con los controles&#46; Se encontr&#243; una correlaci&#243;n moderada entre el porcentaje de p&#233;rdida de peso y la reducci&#243;n en el PASI &#40;r &#61; 0&#44;587&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Numerosos estudios han descrito la elevada prevalencia de factores de riesgo cardiovascular&#44; como hipertensi&#243;n arterial&#44; obesidad&#44; diabetes mellitus y dislipidemia&#44; en pacientes con APs<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">21-27</span></a>&#46; Es m&#225;s&#44; la evidencia indica que la obesidad&#44; la resistencia a la insulina&#44; la psoriasis y la APs pueden compartir una predisposici&#243;n com&#250;n en t&#233;rminos de inflamaci&#243;n de bajo grado<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#46; Tambi&#233;n se ha visto que el &#237;ndice de masa corporal se asocia en APs a peor respuesta al tratamiento<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a>&#46; Lo que no estaba tan claro es si la reducci&#243;n del peso podr&#237;a tener un efecto sobre la actividad&#46; En nuestra revisi&#243;n sistem&#225;tica hemos encontrado 2 estudios que apoyan esta hip&#243;tesis&#44; uno con un nivel de evidencia alto y otro con un nivel algo menor por encontrarse a&#250;n en formato de resumen solo&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Existen estrechos v&#237;nculos entre el sistema metab&#243;lico y el sistema inmunol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a>&#46; Por ejemplo&#44; la IL-6 es una citocina proinflamatoria clave que puede estimular el hipot&#225;lamo&#44; que se asocia con la obesidad central&#44; la hipertensi&#243;n y la resistencia a la insulina e induce la producci&#243;n de la PCR<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#46; Existen adem&#225;s datos de que la restricci&#243;n cal&#243;rica disminuye los niveles de PCR y TNF-&#945;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a>&#44; por lo que los pacientes sometidos a una dieta de 1&#46;500 calor&#237;as&#47;d&#237;a pueden tener descensos en los niveles de PCR por este motivo y no solo por una disminuci&#243;n en su actividad inflamatoria&#46; Esto podr&#237;a justificar el efecto observado sobre la actividad en los estudios&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Otros factores podr&#237;an ser los que tengan un efecto sobre el peso y sobre la actividad&#46; Por ejemplo&#44; en el estudio de di Minno et al&#46;&#44; un 20&#37; de los pacientes estaban recibiendo tratamiento cr&#243;nico con hipoglucemiantes orales y es conocida la acci&#243;n que sobre el peso corporal pueden tener los agonistas del glucag&#243;n p&#233;ptido-1&#44; la metformina y la sulfonilurea&#59; adem&#225;s&#44; tambi&#233;n se iniciaba el tratamiento con anti-TNF&#46; Si bien los pacientes estaban con dosis estables de hipoglucemiantes y todos iniciaban anti-TNF&#44; no se puede descartar del todo que el efecto del peso sobre la actividad se debiera en parte a estos otros tratamientos&#46; Incluso se podr&#237;a considerar que los pacientes m&#225;s adherentes a la dieta o al ejercicio sean tambi&#233;n los m&#225;s adherentes a los tratamientos<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nuestra revisi&#243;n se ha visto limitada por el bajo n&#250;mero de estudios publicados y por la calidad intermedia de los mismos&#46; La hip&#243;tesis de que la p&#233;rdida de peso en APs podr&#237;a llevar aparejada una reducci&#243;n de la actividad&#44; aunque indicativa&#44; se sustenta &#250;nicamente en 2 estudios aleatorizados&#44; uno de ellos solo comunicado en forma de abstract&#44; por lo que concluimos que a&#250;n merece ser investigada en m&#225;s profundidad&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Responsabilidades &#233;ticas</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protecci&#243;n de personas y animales</span><p id="par0075" 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="sect0095">Confidencialidad de datos</span><p id="par0080" class="elsevierStylePara elsevierViewall">Los autores declaran que en este art&#237;culo no aparecen datos de pacientes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Derecho a la privacidad y consentimiento informado</span><p id="par0085" 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="sect0105">Financiaci&#243;n</span><p id="par0090" class="elsevierStylePara elsevierViewall">MSD&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2016-03-02"
    "fechaAceptado" => "2017-01-26"
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            0 => "&#205;ndice de masa corporal"
            1 => "Obesidad"
            2 => "Artritis psori&#225;sica"
            3 => "P&#233;rdida de peso"
            4 => "Dieta"
            5 => "Respuesta al tratamiento"
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            1 => "Obesity"
            2 => "Psoriatic arthritis"
            3 => "Weight loss"
            4 => "Diet"
            5 => "Response to treatment"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar la asociaci&#243;n entre la p&#233;rdida de peso y cambios en la actividad en pacientes con artritis psori&#225;sica &#40;APs&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se llev&#243; a cabo una revisi&#243;n sistem&#225;tica en Medline&#44; Embase y Cochrane Central desde el inicio hasta abril del 2015&#46; Criterios de inclusi&#243;n&#58; <span class="elsevierStyleItalic">1&#41;</span> ensayos cl&#237;nicos aleatorizados controlados &#40;ECA&#41;&#59; <span class="elsevierStyleItalic">2&#41;</span> pacientes con APs&#59; <span class="elsevierStyleItalic">3&#41;</span> cualquier intervenci&#243;n encaminada al control de peso&#44; y <span class="elsevierStyleItalic">4&#41;</span> evaluaci&#243;n de la actividad de la APs&#46; Se evaluaron los riesgos de sesgos seg&#250;n la escala Cochrane&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De 215 art&#237;culos identificados&#44; solo 2 ECA cumplieron los criterios de inclusi&#243;n&#44; uno de ellos en formato abstract&#46; Ambos ten&#237;an riesgos de sesgos moderados&#46; Los pacientes que lograban perder peso&#44; por cualquier m&#233;todo&#44; mostraban menores niveles de actividad e inflamaci&#243;n&#46; El porcentaje de p&#233;rdida de peso correlaciona moderadamente con cambios en medidas de inflamaci&#243;n&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La p&#233;rdida de peso en APs podr&#237;a asociarse a menor inflamaci&#243;n&#44; si bien la evidencia que lo apoya es limitada&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate the association between weight loss and changes in disease activity in patients with psoriatic arthritis &#40;PsA&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We performed a systematic review of the literature&#44; with searches in Medline&#44; Embase and Cochrane Central Library from inception until April 2015&#46; Inclusion criteria&#58; 1&#41; randomized controlled trials &#40;RCT&#41;&#59; 2&#41; PsA patients&#59; 3&#41; interventions were any intervention aimed at weight control&#59; and 4&#41; a PsA activity-related outcome measure was evaluated&#46; Risks of bias were assessed by the Cochrane Collaboration scale&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 215 articles identified&#44; only 2 RCT met the inclusion criteria&#44; 1 in abstract format&#46; Both showed moderate risk of bias&#46; Patients who managed to lose weight&#8212;by any method&#8212;had better results in terms of activity and inflammation&#46; The percentage of weight loss correlated moderately with changes in inflammatory outcomes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Weight loss in PsA could be associated with less inflammation&#59; however&#44; the evidence to support this is limited&#46;</p></span>"
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                  \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">&#35;2 &#8216;psoriatic arthritis&#8217;&#47;exp&nbsp;\t\t\t\t\t\t\n
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                  \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">&#35;5 &#8216;weight control&#8217;&nbsp;\t\t\t\t\t\t\n
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                  \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">&#35;7 &#8216;weight reduction&#8217;&#47;exp&nbsp;\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">&#35;8 &#8216;antiobesity agents&#8217;&nbsp;\t\t\t\t\t\t\n
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                  \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">&#35;10 &#8216;anti obesity agents&#8217;&nbsp;\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">&#35;11 &#8216;metformin&#8217;&nbsp;\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">&#35;12 &#8216;sibutramine&#8217;&nbsp;\t\t\t\t\t\t\n
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                  \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">&#35;14 &#8216;xenical&#8217;&nbsp;\t\t\t\t\t\t\n
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                  \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">&#35;16 &#8216;glucophage&#8217;&nbsp;\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">&#35;17 &#8216;low calorie diet&#8217;&nbsp;\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">&#35;18 &#8216;low fat diet&#8217;&nbsp;\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">&#35;19 nutrition&#36; AND &#40;intervention&#36; OR education&#36;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">&#35;22 weight AND reduction&nbsp;\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">&#35;23 &#8216;weight reduction&#8217;&#47;exp&nbsp;\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">&#35;24 &#40;&#35;4 - &#35;23&#41; OR&nbsp;\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">&#35;25 &#35;3 AND &#35;24&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estrategia de b&#250;squeda</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Raz&#243;n para exclusi&#243;n&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">No analiza el efecto del control del peso<span class="elsevierStyleItalic"><span class="elsevierStyleBold">&#46;</span></span> Es un ensayo cl&#237;nico aleatorizado a 24 semanas que eval&#250;a el impacto del peso e &#237;ndice de masa corporal basales sobre la respuesta cl&#237;nica &#40;ACR 20 y HAQ&#41; a apremilast en APs&#44; no el cambio en el peso&nbsp;\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">Di Minnet et al&#46;&#44; 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abstract a congreso&#46; Eval&#250;a el efecto de la reducci&#243;n de peso mediante dieta&#44; para alcanzar la actividad m&#237;nima en pacientes con sobrepeso&#47;obesos con APs&#44; que inician tratamiento anti-TNF&#46; Se excluye porque posteriormente se ha publicado en 2014 y es el incluido en la revisi&#243;n sistem&#225;tica&nbsp;\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">Sullivan et al&#46;&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ensayo abierto a 24 semanas que analiza el efecto del an&#225;logo GLP-<span class="elsevierStyleSmallCaps">I</span> &#40;liraglutida&#41; en la actividad en 15 pacientes con artritis inflamatoria &#40;11 artritis reumatoide&#59; 4 APs&#41; y diabetes mellitus tipo 2&#46; No aporta datos por separado y el tama&#241;o muestral es demasiado peque&#241;o&nbsp;\t\t\t\t\t\t\n
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                            3 => "C&#46; Vera Kellet"
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                      "titulo" => "Cardiovascular comorbidities in patients with psoriatic arthritis&#58; A systematic review"
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                            0 => "A&#46; Jamnitski"
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                            3 => "N&#46; Sattar"
                            4 => "I&#46; McInnes"
                            5 => "M&#46;T&#46; Nurmohamed"
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                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2011-201194"
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                        "tituloSerie" => "Ann Rheum Dis&#46;"
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                        "paginaFinal" => "216"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22532629"
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                      "titulo" => "Obesity&#44; waist circumference&#44; weight change and the risk of psoriasis in US women"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Kumar"
                            1 => "J&#46; Han"
                            2 => "T&#46; Li"
                            3 => "A&#46;A&#46; Qureshi"
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                    0 => array:2 [
                      "doi" => "10.1111/jdv.12001"
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                        "tituloSerie" => "J Eur Acad Dermatol Venereol&#46;"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23057623"
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ISSN: 1699258X
Idioma original: Español
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