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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La artritis reumatoide &#40;AR&#41; es una enfermedad inflamatoria cr&#243;nica sist&#233;mica de etiolog&#237;a desconocida caracterizada por destrucci&#243;n articular que se presenta mayormente en edad productiva&#46; La mayor incidencia se encuentra entre los 35 a 45<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad y afecta entre el 0&#44;03 y el 1&#44;5&#37; de la poblaci&#243;n mundial&#44; predominando en mujeres a una relaci&#243;n de 3&#58;1<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#46; En M&#233;xico&#44; la AR tiene una prevalencia estimada del 1&#44;6&#37; de la poblaci&#243;n adulta<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a>&#59; esta enfermedad constituye actualmente un problema de salud p&#250;blica debido a los altos &#237;ndices de discapacidad laboral y pensi&#243;n por invalidez que conlleva<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#44; con un impacto catastr&#243;fico en la econom&#237;a familiar y de las instituciones de salud<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4-6</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El impacto de la AR en el trabajo remunerado se describe como p&#233;rdida del tiempo laboral efectivo &#40;ausentismo laboral&#41;&#44; rendimiento disminuido en horario de trabajo &#40;presentismo laboral&#41; y cambios de horario o p&#233;rdida del empleo &#40;cambio de estatus laboral&#41;&#46; El impacto en trabajo no pagado se refiere a las dificultades que el individuo presenta en el desempe&#241;o de actividades rutinarias como aseo dom&#233;stico&#44; compras o cuidado de ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Se ha descrito que la mayor&#237;a de los pacientes con AR presentar&#225;n alg&#250;n grado de discapacidad laboral durante su evoluci&#243;n<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a>&#46; Cerca del 80&#37; de los adultos en edad laboral con esta enfermedad experimentar&#225;n limitaci&#243;n para llevar a cabo actividades laborales e importantes restricciones en desempe&#241;o de roles sociales<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a>&#44; lo cual se ha relacionado con menor capacidad funcional&#44; menor calidad de vida y mayor nivel de actividad de la AR<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; A pesar de que el nivel de discapacidad funcional y dolor se han asociado consistentemente con problemas en la participaci&#243;n laboral incluso desde fases tempranas de la enfermedad&#44; solo algunos estudios proveen informaci&#243;n sobre los determinantes de este efecto<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El cuestionario <span class="elsevierStyleItalic">Work Productivity and Activity Impairment Questionnaire in Rheumatoid Arthritis</span> &#40;WPAI-AR&#41; es un instrumento validado al espa&#241;ol de nuestro pa&#237;s que permite medir la dificultad para realizar actividades laborales y actividades b&#225;sicas de la vida diaria &#40;ABVD&#41; en pacientes con AR<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">13&#44;14</span></a>&#59; mediante esta prueba es posible medir el rendimiento laboral y las dificultades en trabajo no pagado durante los 7<span class="elsevierStyleHsp" style=""></span>d&#237;as previos a su aplicaci&#243;n&#44; temporalidad que ha sido reportada como una estimaci&#243;n adecuada para representar los efectos negativos sobre la productividad laboral debido a la enfermedad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El ausentismo y el presentismo laboral son fen&#243;menos comunes en pacientes con AR que no han sido descritos en poblaci&#243;n mexicana&#46; El presente estudio tiene como objetivo valorar la relaci&#243;n entre la productividad laboral y diversos factores propios de la enfermedad&#44; como grado de actividad de la AR&#44; nivel de discapacidad&#44; calidad de vida&#44; carga laboral&#44; farmacoterapia recibida y comorbilidades asociadas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se trata de un estudio transversal&#44; observacional y descriptivo el cual fue aprobado por el Comit&#233; de &#201;tica en Investigaci&#243;n del Hospital Universitario &#171;Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#187;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Selecci&#243;n de pacientes</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fueron considerados dentro de los criterios de inclusi&#243;n todos los pacientes de 18 a 75<span class="elsevierStyleHsp" style=""></span>a&#241;os con diagn&#243;stico de AR seg&#250;n criterios del <span class="elsevierStyleItalic">American College of Rheumatology</span> &#40;ACR&#41; del a&#241;o 1987 y&#47;o la <span class="elsevierStyleItalic">European League Against Rheumatism</span> &#40;EULAR&#41;&#47;ACR del a&#241;o 2010<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#44;17</span></a> que acudieron regularmente y de manera consecutiva a la consulta ambulatoria de Reumatolog&#237;a del Hospital Universitario &#171;Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#187; en el periodo comprendido de enero a marzo del a&#241;o 2017&#46; Se excluyeron los individuos que presentaban discapacidad visual&#44; auditiva&#44; verbal&#44; cognitiva o que se rehusaron a participar en el estudio&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables</span><p id="par0040" class="elsevierStylePara elsevierViewall">Tras obtener consentimiento verbal se aplic&#243; el test WPAI-AR traducido al idioma espa&#241;ol a todos los sujetos de estudio como parte de su consulta rutinaria&#46; El nivel de discapacidad funcional en AR fue medido mediante el cuestionario <span class="elsevierStyleItalic">Health Assessment Questionnaire Disability Index</span> &#40;HAQ-DI&#41;&#44; el cual se compone de 20 preguntas a modo de enunciado y permite valorar 8 aspectos b&#225;sicos de la vida diaria como vestirse&#44; comer o caminar&#59; una calificaci&#243;n mayor representa una mayor limitaci&#243;n funcional<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a>&#46; La calidad de vida de los pacientes fue medida mediante el cuestionario <span class="elsevierStyleItalic">Rheumatoid Arthritis Quality of Life Scale</span> &#40;RAQoL&#41;&#44; el cual es un instrumento conformado por 30 reactivos a modo de afirmaciones en primera persona con respuesta dicot&#243;mica que eval&#250;a distintos aspectos en la calidad de vida de los individuos que padecen AR&#59; cuanto m&#225;s alta la puntuaci&#243;n&#44; peor es la calidad de vida<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a>&#46; Se llev&#243; a cabo el c&#225;lculo de actividad de la AR mediante la escala <span class="elsevierStyleItalic">Disease Activity Score de 28 articulaciones</span> &#40;DAS-28 score&#41; por PCR<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Dentro de las variables estudiadas se encuentran adem&#225;s las caracter&#237;sticas demogr&#225;ficas de los pacientes tales como edad&#44; g&#233;nero&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; estado civil&#44; tipo de trabajo&#44; carga laboral&#44; tiempo de evoluci&#243;n de la AR&#44; comorbilidades y tratamiento&#46; Se estim&#243; el grado de demanda f&#237;sica laboral utilizando la escala descrita por Pujol<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&#44; as&#237; como el tipo de empleo mediante la Clasificaci&#243;n Internacional Uniforme de Ocupaciones 2008 de la Organizaci&#243;n Internacional del Trabajo &#40;CIUO-08&#41;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a>&#46; Se consideraron empleados aquellos sujetos cuyas actividades productivas fueran remuneradas econ&#243;micamente &#40;autoempleo o contrato por terceros&#41;&#46; Todos los instrumentos fueron aplicados por un mismo residente de cuarto a&#241;o de medicina interna&#46; Los datos obtenidos fueron almacenados en una base de datos electr&#243;nica&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Datos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se determin&#243; la normalidad de la distribuci&#243;n de las variables cuantitativas mediante la prueba de Shapiro Wilk&#46; Variables con distribuci&#243;n normal fueron descritas utilizando media &#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar &#40;DE&#41;&#59; las variables con distribuci&#243;n no normal se describieron con mediana y rango intercuartil &#40;RIC&#41; de percentil 25 y 75&#46; Se utiliz&#243; Rho de Spearman para medir la correlaci&#243;n entre la productividad laboral y los resultados obtenidos mediante los instrumentos empleados&#46; Para comparaci&#243;n de variables se utiliz&#243; prueba de ANOVA&#46; Se realiz&#243; adem&#225;s un an&#225;lisis de regresi&#243;n lineal multivariable con las caracter&#237;sticas basales de los pacientes&#46; Los datos fueron analizados utilizando el paquete estad&#237;stico SPSS versi&#243;n<span class="elsevierStyleHsp" style=""></span>22 &#40;IBM&#44; New York&#44; Estados Unidos&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas cl&#237;nicas y demogr&#225;ficas de ambos grupos se describen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Se incluyeron 204 sujetos&#44; de los cuales la mayor&#237;a fueron mujeres &#40;92&#44;6&#37;&#41;&#59; la edad media fue de 54&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;3<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; con un IMC de 28&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;41<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; La mediana de evoluci&#243;n de la AR fue de 90<span class="elsevierStyleHsp" style=""></span>meses &#40;RIC<span class="elsevierStyleHsp" style=""></span>36-168&#41;&#44; con un nivel de actividad de la misma medido por DAS-28-PCR de 2&#44;82 &#40;RIC<span class="elsevierStyleHsp" style=""></span>2&#44;22-3&#44;83&#41;&#46; En capacidad funcional medida por HAQ-DI&#44; se obtuvo una mediana de 0&#44;75<span class="elsevierStyleHsp" style=""></span>puntos &#40;RIC<span class="elsevierStyleHsp" style=""></span>0&#44;15-1&#44;75&#41;&#44; mientras que en calidad de vida se obtuvo un puntaje de 9 &#40;RIC<span class="elsevierStyleHsp" style=""></span>3-16&#41; utilizando el cuestionario de RAQoL&#46; Cincuenta pacientes realizaban actividades laborales remuneradas&#44; lo que corresponde a 24&#44;5&#37; del total de la muestra&#46; Al comparar los grupos de empleados y desempleados se encontr&#243; diferencia estad&#237;sticamente significativa en edad&#44; sexo&#44; a&#241;os de estudio&#44; carga laboral&#44; prevalencia de hipertensi&#243;n arterial&#44; nivel de actividad de la AR medida por DAS-28-PCR&#44; capacidad funcional por HAQ-DI y calidad de vida por RAQoL&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis multivariable&#44; relacionando las caracter&#237;sticas basales de los pacientes con su nivel de capacidad funcional&#46; En relaci&#243;n a la escala HAQ-DI&#44; se encontr&#243; asociaci&#243;n estad&#237;sticamente significativa con la presencia de diabetes mellitus tipo<span class="elsevierStyleHsp" style=""></span>2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;043&#41;&#44; lupus eritematoso sist&#233;mico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; y neuropat&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#46; Entre los indicadores que fueron medidos en el presente estudio se encontr&#243; relaci&#243;n estad&#237;sticamente significativa con la evaluaci&#243;n an&#225;loga de dolor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; la actividad de la AR por DAS-28-PCR &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;033&#41; y el porcentaje de d&#233;ficit en ABVD &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Los indicadores de productividad laboral calculados por WPAI-AR se describen en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; El porcentaje de d&#233;ficit en ABVD fue del 20&#37; &#40;RIC<span class="elsevierStyleHsp" style=""></span>0-40&#37;&#41; en el grupo de trabajadores&#44; mientras que en el de desempleados fue del 40&#37; &#40;RIC<span class="elsevierStyleHsp" style=""></span>17&#44;5-70&#41;&#46; Se encontr&#243; diferencia estad&#237;sticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; entre ambos grupos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Mediante prueba de Rho de Spearman se encontr&#243; correlaci&#243;n positiva d&#233;bil entre la actividad de la AR medida por DAS-28-PCR y los porcentajes de presentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;400&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; p&#233;rdida de productividad laboral total &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;388&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; y el porcentaje de d&#233;ficit en ABVD &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;486&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se realizaron correlaciones seg&#250;n la clasificaci&#243;n del &#237;ndice de actividad en AR por DAS-28-PCR y el cuestionario de WPAI-AR&#44; separ&#225;ndose en grupos de pacientes en remisi&#243;n cl&#237;nica&#44; actividad leve&#44; moderada o alta&#46; No se encontr&#243; relaci&#243;n lineal entre los distintos grupos de actividad de la enfermedad y el rendimiento laboral&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se encontr&#243; correlaci&#243;n positiva d&#233;bil entre un mayor puntaje en el cuestionario RAQoL y el porcentaje de ausentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;414&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#59; correlaci&#243;n positiva moderada con el porcentaje de presentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;641&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; porcentaje de p&#233;rdida de la productividad total &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;653&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y porcentaje de d&#233;ficit en ABVD &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;728&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La capacidad funcional obtenida mediante HAQ-DI tuvo correlaci&#243;n positiva con el porcentaje de ausentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;448&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y correlaci&#243;n positiva fuerte con los porcentajes de presentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;911&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; porcentaje de p&#233;rdida de la productividad total &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;894&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y porcentaje de d&#233;ficit en ABVD &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;945&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La duraci&#243;n de la enfermedad tuvo una correlaci&#243;n negativa d&#233;bil con el porcentaje de ausentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;320&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#46; El IMC tuvo correlaci&#243;n negativa d&#233;bil con la duraci&#243;n de la enfermedad &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;343&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Seg&#250;n la CIUO-2008&#44; el tipo de empleo del grupo de trabajadores se clasific&#243; en su mayor&#237;a como comerciante &#40;34&#37;&#41;&#44; aseo dom&#233;stico &#40;16&#37;&#41;&#44; oficinista &#40;10&#37;&#41; y secretaria &#40;8&#37;&#41;&#46; La mayor parte de los pacientes evaluados percibieron el grado de demanda de actividad f&#237;sica realizada en su empleo como sedentaria &#40;28&#37;&#41; o liviana &#40;62&#37;&#41;&#46; El grado de carga laboral no se asoci&#243; con mayor porcentaje de d&#233;ficit en la capacidad laboral global&#46; Asimismo&#44; el nivel educativo careci&#243; de asociaci&#243;n significativa con respecto al ausentismo o presentismo laboral&#44; as&#237; como ABVD&#44; con una mediana de 10&#44;5 &#40;RIC<span class="elsevierStyleHsp" style=""></span>9-16&#41; a&#241;os de estudio en el grupo de empleados&#46; No se encontr&#243; correlaci&#243;n estad&#237;sticamente significativa entre el sexo de los pacientes&#44; edad o estado civil con los indicadores de desempe&#241;o laboral descritos en el WPAI-AR&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Todos los sujetos del grupo de empleados presentaron al menos una comorbilidad asociada&#44; dentro de las cuales las m&#225;s comunes fueron osteoartrosis &#40;32&#37;&#41;&#44; dislipidemia &#40;13&#37;&#41;&#44; osteoporosis &#40;24&#37;&#41;&#44; enfermedades osteomusculares &#40;24&#37;&#41; y fibromialgia &#40;10&#37;&#41;&#46; En el an&#225;lisis por patolog&#237;as se encontr&#243; asociaci&#243;n estad&#237;sticamente significativa entre la presencia de fibromialgia y el porcentaje de d&#233;ficit en ABVD &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; El resto de las comorbilidades individuales descritas no mostraron asociaci&#243;n con productividad laboral o desempe&#241;o de ABVD&#46; La presencia de dos o m&#225;s comorbilidades acumuladas en un mismo paciente tampoco tuvo correlaci&#243;n estad&#237;sticamente significativa con el desempe&#241;o laboral&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">De acuerdo a los medicamentos prescritos en el grupo de empleados&#44; en la poblaci&#243;n de pacientes con AR el 92&#37; utiliza metotrexato&#44; el 48&#37; prednisona&#44; el 24&#37; sulfasalazina&#44; el 18&#37; leflunomida&#44; el 24&#37; cloroquina o sus derivados y el 2&#37; agentes biol&#243;gicos&#46; No se encontr&#243; correlaci&#243;n estad&#237;sticamente significativa entre los indicadores de productividad laboral y el tipo de farmacoterapia recibida por los pacientes al ser evaluado cada medicamento de forma individual&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">Es posible establecer una relaci&#243;n entre la calidad de vida de los pacientes con AR y su desempe&#241;o laboral mediante los distintos desenlaces cl&#237;nicos representados en los cuestionarios HAQ-DI&#44; RAQoL y WPAI-AR&#46; Los resultados obtenidos en el cuestionario WPAI-AR demuestran que el grupo de pacientes empleados mostr&#243; una mayor capacidad para desempe&#241;ar ABVD en comparaci&#243;n con el grupo de desempleados&#46; Se pueden determinar una serie de factores que pueden contribuir a explicar este fen&#243;meno&#44; como menor edad&#44; mejor control de la enfermedad&#44; mejor calidad de vida y tipo de trabajo f&#237;sico realizado seg&#250;n su escolaridad y capacidad funcional&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En el estudio prospectivo de Gonz&#225;lez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> en pacientes mexicanos se evidenci&#243; que una cuarta parte de los sujetos incluidos con AR presentaron al menos un episodio de incapacidad laboral durante un a&#241;o de seguimiento&#44; mientras que el 4&#37; desarrollaron discapacidad laboral permanente&#46; El presente estudio eval&#250;a de manera sistem&#225;tica ausentismo y presentismo laboral&#44; los cuales previamente no hab&#237;an sido descritos en nuestra poblaci&#243;n&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Al estudiar el grupo de pacientes empleados se encontr&#243; correlaci&#243;n positiva entre grado de actividad de la AR&#44; calidad de vida y capacidad funcional con los indicadores de desempe&#241;o laboral descritos en el WPAI-AR&#46; Esto coincide con lo encontrado por Chaparro et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> en poblaci&#243;n argentina&#46; Aun cuando la mayor&#237;a de las correlaciones encontradas entre actividad de la AR y calidad de vida fueron estad&#237;sticamente pobres&#44; la capacidad funcional evaluada mediante HAQ-DI tuvo un grado de correlaci&#243;n fuerte con la capacidad laboral&#44; confiri&#233;ndole a esta prueba un excelente valor predictivo para detectar d&#233;ficit en el desempe&#241;o de dichas actividades&#46; Como se&#241;alan Nagasawa y Kameda<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a>&#44; diferentes factores como la funcionalidad y un adecuado apego al tratamiento tienen repercusi&#243;n sobre el desempe&#241;o de actividades laborales y ABVD&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La correlaci&#243;n negativa encontrada entre la duraci&#243;n de la enfermedad y el porcentaje de ausentismo laboral en los sujetos estudiados pudiera ser explicada por la adaptaci&#243;n de estos a sus s&#237;ntomas&#44; siendo capaces de desempe&#241;ar actividades laborales en mayor medida con el paso del tiempo&#59; lo anterior contrasta con lo descrito previamente<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; Por otro lado&#44; la correlaci&#243;n negativa que se encontr&#243; entre el IMC y la duraci&#243;n de la enfermedad pudiera ser explicada por la caquexia reum&#225;tica propia de la AR&#44; la cual se encuentra documentada en la literatura<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariable realizado en el presente estudio refiere que algunas comorbilidades tales como diabetes&#44; neuropat&#237;a y el lupus eritematoso generalizado tienen efectos delet&#233;reos en el desempe&#241;o de las ABVD&#46; Se ha descrito una asociaci&#243;n entre la presencia de comorbilidades en pacientes con AR y peores desenlaces globales<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a>&#46; Sin embargo&#44; seg&#250;n el an&#225;lisis de correlaciones realizado&#44; solo la fibromialgia predispuso una mayor dificultad para realizar las ABVD&#44; sin impactar de manera significativa en la capacidad para trabajar&#46; El resto de las comorbilidades asociadas descritas no incidieron de manera significativa en los &#237;ndices de desempe&#241;o global&#44; lo que contrasta con lo descrito por Dougados et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a>&#46; Lo anterior pudiera ser explicado por el hecho de que en la cl&#237;nica de AR se atiende de manera integral la mayor&#237;a de estas enfermedades&#46; El tipo de trabajo llevado a cabo por los pacientes con AR &#40;siendo en su mayor&#237;a de carga leve&#41; pudiera justificar tambi&#233;n este hallazgo&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Es importante destacar que la poblaci&#243;n estudiada tiene un bajo &#237;ndice de uso de agentes biol&#243;gicos&#44; lo cual pudiera asociarse a factores socioecon&#243;micos&#46; Al ser evaluada de forma individual&#44; la farmacoterapia espec&#237;fica para el tratamiento de la AR no se relacion&#243; con mayor dificultad para llevar a cabo actividades laborales&#46; Sin embargo&#44; es necesario un mayor an&#225;lisis de este apartado&#44; incluyendo medicamentos utilizados para tratar el resto de las comorbilidades existentes y el rol de la polifarmacia en este contexto&#44; la cual se ha asociado a peores desenlaces en estos pacientes<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Tras realizar el an&#225;lisis de correlaciones no se pudo establecer una relaci&#243;n significativa entre sexo&#44; edad&#44; nivel de demanda f&#237;sica laboral o escolaridad con el grado de d&#233;ficit en el desempe&#241;o laboral de los sujetos evaluados&#46; Es importante se&#241;alar que en este estudio m&#225;s del 90&#37; de los pacientes incluidos son mujeres&#44; y que un gran porcentaje de ellas no cuenta con un empleo bajo sueldo&#59; aun cuando el presente estudio se centra en los pacientes con empleo&#44; gran parte de la poblaci&#243;n analizada desempe&#241;a actividades laborales orientadas al aseo y limpieza dom&#233;stica&#46; A este respecto&#44; se ha demostrado que los factores socioecon&#243;micos y el nivel de actividad de la enfermedad tienen un gran impacto en la capacidad para llevar a cabo ABVD<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Dentro de las limitaciones del presente estudio se encuentra que solamente se realiz&#243; el reclutamiento de los pacientes de un centro de referencia&#59; adem&#225;s&#44; el dise&#241;o transversal no permite establecer una relaci&#243;n temporal entre efectos de los factores evaluados y la capacidad laboral global&#46; Al existir adem&#225;s tantos factores que afectan el resultado de inter&#233;s&#44; el an&#225;lisis ponderando todas las variables relacionadas es complejo&#46; Los instrumentos empleados no permiten discernir entre personas que desempe&#241;an actividades laborales bajo su propia iniciativa &#40;autoempleo&#41; y las que trabajan bajo contrato remunerado por un tercero&#59; esto es algo que debe ser evaluado en futuros estudios&#44; ya que influye en el perfil laboral del paciente&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Dentro de las fortalezas se puede mencionar que es el primer estudio de su tipo en pacientes mexicanos&#44; en el n&#250;mero de instrumentos empleados para su evaluaci&#243;n y en el n&#250;mero de sujetos incluidos&#44; el cual fue mayor con respecto a publicaciones previas&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El ausentismo y el presentismo laboral son fen&#243;menos presentes en esta poblaci&#243;n de pacientes con AR&#44; principalmente quienes tienen mayor actividad de la enfermedad&#44; menor capacidad funcional o peor calidad de vida&#46; El nivel de capacidad funcional fue el factor m&#225;s fuertemente asociado a este respecto&#46; En aras de disminuir el impacto econ&#243;mico y social que representan el ausentismo y presentismo laboral&#44; se recomienda valorar el nivel de rendimiento laboral al evaluar la respuesta al tratamiento en estos pacientes&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Selecci&#243;n de pacientes"
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            1 => "Productividad laboral"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Valorar la relaci&#243;n entre la productividad laboral y diversos factores propios de la artritis reumatoide &#40;AR&#41; como grado de actividad de la enfermedad&#44; nivel de discapacidad&#44; calidad de vida&#44; carga laboral&#44; farmacoterapia recibida y comorbilidades asociadas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio transversal&#44; observacional y descriptivo&#46; Se incluyeron pacientes de 18 a 75<span class="elsevierStyleHsp" style=""></span>a&#241;os con diagn&#243;stico de AR seg&#250;n criterios ACR&#47;EULAR 2010 que acudieron consecutivamente a la consulta de Reumatolog&#237;a del Hospital Universitario en el periodo comprendido entre enero y marzo del a&#241;o 2017&#46; Se aplicaron los cuestionarios WPAI-AR&#44; HAQ-DI y RAQoL&#59; el grado de actividad de la AR se calcul&#243; mediante DAS28-PCR&#46; Se realizaron correlaciones entre las caracter&#237;sticas cl&#237;nicas obtenidas y la capacidad laboral por WPAI-AR&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 204 pacientes con AR&#44; de los cuales el 92&#44;6&#37; fueron mujeres&#59; la edad media fue de 54&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;3<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; En el porcentaje de d&#233;ficit en actividades b&#225;sicas de la vida diaria &#40;ABVD&#41; se encontr&#243; diferencia estad&#237;sticamente significativa entre pacientes empleados y desempleados &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Se encontr&#243; correlaci&#243;n positiva entre actividad de la enfermedad por DAS28-PCR&#44; nivel de calidad de vida por RAQoL y capacidad funcional por HAQ-DI con los porcentajes de ausentismo y presentismo laboral&#44; p&#233;rdida de la productividad laboral total y d&#233;ficit en ABVD&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Existe correlaci&#243;n entre el grado de actividad de la AR&#44; calidad de vida y capacidad funcional con el rendimiento laboral de la poblaci&#243;n estudiada&#46; La asociaci&#243;n m&#225;s fuerte encontrada fue con la capacidad funcional&#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">This study assesses the relationship between the ability to perform productive activities and the clinical characteristics of RA&#44; such as disease activity&#44; quality of life&#44; functional capacity&#44; workload&#44; pharmacotherapy&#44; and comorbidities&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional&#44; observational and descriptive study was conducted&#46; Patients aged 18-75<span class="elsevierStyleHsp" style=""></span>years with a diagnosis of RA according to ACR&#47;EULAR 2010 criteria who attended regularly to the Rheumatology service in the period between January and March 2017 were included&#46; The questionnaires&#44; WPAI-AR&#44; HAQ-DI and RAQoL&#44; were applied&#46; RA disease activity was measured by DAS28-PCR&#46; Correlations were made between the clinical data obtained and work productivity and activity impairment measured by WPAI-AR&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Two hundred four patients with a diagnosis of RA were included&#44; of whom 92&#46;6&#37; were women&#46; Mean age was 54&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;3<span class="elsevierStyleHsp" style=""></span>years&#46; Regarding the percentage of impairment of daily life activities&#44; we found a significant difference between employed and unemployed patients &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; A positive correlation was found between RA activity measured by DAS28-PCR&#44; quality of life&#44; and functional ability with the percentages of absenteeism&#44; presenteeism&#44; overall productivity loss&#44; and impairment of daily life activities&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A correlation between RA disease activity&#44; functional capacity&#44; quality of life&#44; and working impairment was found&#46; The strongest association was established with the degree of functional capacity&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">AR&#58; artritis reumatoide&#59; DAS-28-PCR&#58; <span class="elsevierStyleItalic">Disease Activity Score de 28 articulaciones</span>&#59; DE&#58; desviaci&#243;n est&#225;ndar&#59; HAQ-DI&#58; <span class="elsevierStyleItalic">Health Assessment Questionnaire Disability Index</span>&#59; IMC&#58; &#237;ndice de masa corporal&#59;&#59; HAQ-DIRAQoL&#58; <span class="elsevierStyleItalic">Rheumatoid Arthritis Quality of Life Scale</span>&#46;</p>"
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                  \t\t\t\t">30 &#40;19&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;568&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Osteoartrosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69 &#40;33&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;754&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Osteoporosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">53 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;26&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;714&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibromialgia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;12&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;13&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Farmacoterapia&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metotrexato&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">182 &#40;89&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">136 &#40;88&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;466&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sulfasalazina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">39 &#40;19&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;323&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leflunomida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;30&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;081&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cloroquina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">37 &#40;18&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;18&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;977&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prednisona&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">99 &#40;48&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;931&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Meses de Evoluci&#243;n de la AR&#44; mediana &#40;p25-p75&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">90 &#40;36-168&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">84 &#40;45-147&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96 &#40;36-180&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;434&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">DAS-28-PCR&#44; mediana &#40;p25-p75&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;82 &#40;2&#44;22-3&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;61 &#40;2&#44;11-3&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;0 &#40;2&#44;3-4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;028&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">HAQ-DI&#44; mediana &#40;p25-p75&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;75 &#40;0&#44;15-1&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;09-1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;87 &#40;0&#44;25-2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;3-18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  """
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                  \t\t\t\t">Meses de evoluci&#243;n de la AR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">A&#241;os de estudio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Empleo &#47; no empleo&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="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">IAM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;463&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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;807&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DM2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;099&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;043&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;195&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;917&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;091&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoporosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;472&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;053&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Depresi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;696&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8722;0&#44;183&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;031&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;426&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8722;0&#44;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;045&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibromialgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;002&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;972&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipotiroidismo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;083&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8722;0&#44;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">LES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8722;0&#44;423&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8722;0&#44;077&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Sj&#246;gren&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;648&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">C&#225;ncer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;182&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;071&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;379&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neumopat&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;055&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;543&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8722;0&#44;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad osteomuscular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;953&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;098&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;093&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neuropat&#237;a&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Actualizaci&#243;n de la Gu&#237;a Mexicana para el Tratamiento Farmacol&#243;gico de la Artritis Reumatoide del Colegio Mexicano de Reumatolog&#237;a"
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                            3 => "J&#46;I&#46; G&#225;mez-Nava"
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Original
Relación entre productividad laboral y características clínicas de la artritis reumatoide
Relationship Between Work Productivity and Clinical Characteristics in Rheumatoid Arthritis
Carlos Eduardo Salazar-Mejíaa, Dionicio Ángel Galarza-Delgadob, Iris Jazmín Colunga-Pedrazab,
Autor para correspondencia
iriscolunga@hotmail.com

Autor para correspondencia.
, José Ramón Azpiri-Lópezc, Martín Wah-Suáreza, Blanca Otilia Wimer-Castilloa, Laura Leticia Salazar-Sepúlvedaa
a Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
b Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
c Servicio de Cardiología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La artritis reumatoide &#40;AR&#41; es una enfermedad inflamatoria cr&#243;nica sist&#233;mica de etiolog&#237;a desconocida caracterizada por destrucci&#243;n articular que se presenta mayormente en edad productiva&#46; La mayor incidencia se encuentra entre los 35 a 45<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad y afecta entre el 0&#44;03 y el 1&#44;5&#37; de la poblaci&#243;n mundial&#44; predominando en mujeres a una relaci&#243;n de 3&#58;1<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#46; En M&#233;xico&#44; la AR tiene una prevalencia estimada del 1&#44;6&#37; de la poblaci&#243;n adulta<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a>&#59; esta enfermedad constituye actualmente un problema de salud p&#250;blica debido a los altos &#237;ndices de discapacidad laboral y pensi&#243;n por invalidez que conlleva<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#44; con un impacto catastr&#243;fico en la econom&#237;a familiar y de las instituciones de salud<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4-6</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El impacto de la AR en el trabajo remunerado se describe como p&#233;rdida del tiempo laboral efectivo &#40;ausentismo laboral&#41;&#44; rendimiento disminuido en horario de trabajo &#40;presentismo laboral&#41; y cambios de horario o p&#233;rdida del empleo &#40;cambio de estatus laboral&#41;&#46; El impacto en trabajo no pagado se refiere a las dificultades que el individuo presenta en el desempe&#241;o de actividades rutinarias como aseo dom&#233;stico&#44; compras o cuidado de ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Se ha descrito que la mayor&#237;a de los pacientes con AR presentar&#225;n alg&#250;n grado de discapacidad laboral durante su evoluci&#243;n<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a>&#46; Cerca del 80&#37; de los adultos en edad laboral con esta enfermedad experimentar&#225;n limitaci&#243;n para llevar a cabo actividades laborales e importantes restricciones en desempe&#241;o de roles sociales<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a>&#44; lo cual se ha relacionado con menor capacidad funcional&#44; menor calidad de vida y mayor nivel de actividad de la AR<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; A pesar de que el nivel de discapacidad funcional y dolor se han asociado consistentemente con problemas en la participaci&#243;n laboral incluso desde fases tempranas de la enfermedad&#44; solo algunos estudios proveen informaci&#243;n sobre los determinantes de este efecto<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El cuestionario <span class="elsevierStyleItalic">Work Productivity and Activity Impairment Questionnaire in Rheumatoid Arthritis</span> &#40;WPAI-AR&#41; es un instrumento validado al espa&#241;ol de nuestro pa&#237;s que permite medir la dificultad para realizar actividades laborales y actividades b&#225;sicas de la vida diaria &#40;ABVD&#41; en pacientes con AR<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">13&#44;14</span></a>&#59; mediante esta prueba es posible medir el rendimiento laboral y las dificultades en trabajo no pagado durante los 7<span class="elsevierStyleHsp" style=""></span>d&#237;as previos a su aplicaci&#243;n&#44; temporalidad que ha sido reportada como una estimaci&#243;n adecuada para representar los efectos negativos sobre la productividad laboral debido a la enfermedad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El ausentismo y el presentismo laboral son fen&#243;menos comunes en pacientes con AR que no han sido descritos en poblaci&#243;n mexicana&#46; El presente estudio tiene como objetivo valorar la relaci&#243;n entre la productividad laboral y diversos factores propios de la enfermedad&#44; como grado de actividad de la AR&#44; nivel de discapacidad&#44; calidad de vida&#44; carga laboral&#44; farmacoterapia recibida y comorbilidades asociadas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se trata de un estudio transversal&#44; observacional y descriptivo el cual fue aprobado por el Comit&#233; de &#201;tica en Investigaci&#243;n del Hospital Universitario &#171;Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#187;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Selecci&#243;n de pacientes</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fueron considerados dentro de los criterios de inclusi&#243;n todos los pacientes de 18 a 75<span class="elsevierStyleHsp" style=""></span>a&#241;os con diagn&#243;stico de AR seg&#250;n criterios del <span class="elsevierStyleItalic">American College of Rheumatology</span> &#40;ACR&#41; del a&#241;o 1987 y&#47;o la <span class="elsevierStyleItalic">European League Against Rheumatism</span> &#40;EULAR&#41;&#47;ACR del a&#241;o 2010<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#44;17</span></a> que acudieron regularmente y de manera consecutiva a la consulta ambulatoria de Reumatolog&#237;a del Hospital Universitario &#171;Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#187; en el periodo comprendido de enero a marzo del a&#241;o 2017&#46; Se excluyeron los individuos que presentaban discapacidad visual&#44; auditiva&#44; verbal&#44; cognitiva o que se rehusaron a participar en el estudio&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables</span><p id="par0040" class="elsevierStylePara elsevierViewall">Tras obtener consentimiento verbal se aplic&#243; el test WPAI-AR traducido al idioma espa&#241;ol a todos los sujetos de estudio como parte de su consulta rutinaria&#46; El nivel de discapacidad funcional en AR fue medido mediante el cuestionario <span class="elsevierStyleItalic">Health Assessment Questionnaire Disability Index</span> &#40;HAQ-DI&#41;&#44; el cual se compone de 20 preguntas a modo de enunciado y permite valorar 8 aspectos b&#225;sicos de la vida diaria como vestirse&#44; comer o caminar&#59; una calificaci&#243;n mayor representa una mayor limitaci&#243;n funcional<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a>&#46; La calidad de vida de los pacientes fue medida mediante el cuestionario <span class="elsevierStyleItalic">Rheumatoid Arthritis Quality of Life Scale</span> &#40;RAQoL&#41;&#44; el cual es un instrumento conformado por 30 reactivos a modo de afirmaciones en primera persona con respuesta dicot&#243;mica que eval&#250;a distintos aspectos en la calidad de vida de los individuos que padecen AR&#59; cuanto m&#225;s alta la puntuaci&#243;n&#44; peor es la calidad de vida<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a>&#46; Se llev&#243; a cabo el c&#225;lculo de actividad de la AR mediante la escala <span class="elsevierStyleItalic">Disease Activity Score de 28 articulaciones</span> &#40;DAS-28 score&#41; por PCR<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Dentro de las variables estudiadas se encuentran adem&#225;s las caracter&#237;sticas demogr&#225;ficas de los pacientes tales como edad&#44; g&#233;nero&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; estado civil&#44; tipo de trabajo&#44; carga laboral&#44; tiempo de evoluci&#243;n de la AR&#44; comorbilidades y tratamiento&#46; Se estim&#243; el grado de demanda f&#237;sica laboral utilizando la escala descrita por Pujol<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&#44; as&#237; como el tipo de empleo mediante la Clasificaci&#243;n Internacional Uniforme de Ocupaciones 2008 de la Organizaci&#243;n Internacional del Trabajo &#40;CIUO-08&#41;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a>&#46; Se consideraron empleados aquellos sujetos cuyas actividades productivas fueran remuneradas econ&#243;micamente &#40;autoempleo o contrato por terceros&#41;&#46; Todos los instrumentos fueron aplicados por un mismo residente de cuarto a&#241;o de medicina interna&#46; Los datos obtenidos fueron almacenados en una base de datos electr&#243;nica&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Datos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se determin&#243; la normalidad de la distribuci&#243;n de las variables cuantitativas mediante la prueba de Shapiro Wilk&#46; Variables con distribuci&#243;n normal fueron descritas utilizando media &#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar &#40;DE&#41;&#59; las variables con distribuci&#243;n no normal se describieron con mediana y rango intercuartil &#40;RIC&#41; de percentil 25 y 75&#46; Se utiliz&#243; Rho de Spearman para medir la correlaci&#243;n entre la productividad laboral y los resultados obtenidos mediante los instrumentos empleados&#46; Para comparaci&#243;n de variables se utiliz&#243; prueba de ANOVA&#46; Se realiz&#243; adem&#225;s un an&#225;lisis de regresi&#243;n lineal multivariable con las caracter&#237;sticas basales de los pacientes&#46; Los datos fueron analizados utilizando el paquete estad&#237;stico SPSS versi&#243;n<span class="elsevierStyleHsp" style=""></span>22 &#40;IBM&#44; New York&#44; Estados Unidos&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas cl&#237;nicas y demogr&#225;ficas de ambos grupos se describen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Se incluyeron 204 sujetos&#44; de los cuales la mayor&#237;a fueron mujeres &#40;92&#44;6&#37;&#41;&#59; 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utilizando el cuestionario de RAQoL&#46; Cincuenta pacientes realizaban actividades laborales remuneradas&#44; lo que corresponde a 24&#44;5&#37; del total de la muestra&#46; Al comparar los grupos de empleados y desempleados se encontr&#243; diferencia estad&#237;sticamente significativa en edad&#44; sexo&#44; a&#241;os de estudio&#44; carga laboral&#44; prevalencia de hipertensi&#243;n arterial&#44; nivel de actividad de la AR medida por DAS-28-PCR&#44; capacidad funcional por HAQ-DI y calidad de vida por RAQoL&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis multivariable&#44; relacionando las caracter&#237;sticas basales de los pacientes con su nivel de capacidad funcional&#46; En relaci&#243;n a la escala HAQ-DI&#44; se encontr&#243; asociaci&#243;n estad&#237;sticamente significativa con la presencia de diabetes mellitus tipo<span class="elsevierStyleHsp" style=""></span>2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;043&#41;&#44; lupus eritematoso sist&#233;mico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; y neuropat&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#46; Entre los indicadores que fueron medidos en el presente estudio se encontr&#243; relaci&#243;n estad&#237;sticamente significativa con la evaluaci&#243;n an&#225;loga de dolor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; la actividad de la AR por DAS-28-PCR &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;033&#41; y el porcentaje de d&#233;ficit en ABVD &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Los indicadores de productividad laboral calculados por WPAI-AR se describen en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; El porcentaje de d&#233;ficit en ABVD fue del 20&#37; &#40;RIC<span class="elsevierStyleHsp" style=""></span>0-40&#37;&#41; en el grupo de trabajadores&#44; mientras que en el de desempleados fue del 40&#37; &#40;RIC<span class="elsevierStyleHsp" style=""></span>17&#44;5-70&#41;&#46; Se encontr&#243; diferencia estad&#237;sticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; entre ambos grupos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Mediante prueba de Rho de Spearman se encontr&#243; correlaci&#243;n positiva d&#233;bil entre la actividad de la AR medida por DAS-28-PCR y los porcentajes de presentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;400&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; p&#233;rdida de productividad laboral total &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;388&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; y el porcentaje de d&#233;ficit en ABVD &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;486&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se realizaron correlaciones seg&#250;n la clasificaci&#243;n del &#237;ndice de actividad en AR por DAS-28-PCR y el cuestionario de WPAI-AR&#44; separ&#225;ndose en grupos de pacientes en remisi&#243;n cl&#237;nica&#44; actividad leve&#44; moderada o alta&#46; No se encontr&#243; relaci&#243;n lineal entre los distintos grupos de actividad de la enfermedad y el rendimiento laboral&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se encontr&#243; correlaci&#243;n positiva d&#233;bil entre un mayor puntaje en el cuestionario RAQoL y el porcentaje de ausentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;414&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#59; correlaci&#243;n positiva moderada con el porcentaje de presentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;641&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; porcentaje de p&#233;rdida de la productividad total &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;653&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y porcentaje de d&#233;ficit en ABVD &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;728&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La capacidad funcional obtenida mediante HAQ-DI tuvo correlaci&#243;n positiva con el porcentaje de ausentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;448&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y correlaci&#243;n positiva fuerte con los porcentajes de presentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;911&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; porcentaje de p&#233;rdida de la productividad total &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;894&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y porcentaje de d&#233;ficit en ABVD &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;945&#59; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La duraci&#243;n de la enfermedad tuvo una correlaci&#243;n negativa d&#233;bil con el porcentaje de ausentismo laboral &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;320&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#46; El IMC tuvo correlaci&#243;n negativa d&#233;bil con la duraci&#243;n de la enfermedad &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;343&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Seg&#250;n la CIUO-2008&#44; el tipo de empleo del grupo de trabajadores se clasific&#243; en su mayor&#237;a como comerciante &#40;34&#37;&#41;&#44; aseo dom&#233;stico &#40;16&#37;&#41;&#44; oficinista &#40;10&#37;&#41; y secretaria &#40;8&#37;&#41;&#46; La mayor parte de los pacientes evaluados percibieron el grado de demanda de actividad f&#237;sica realizada en su empleo como sedentaria &#40;28&#37;&#41; o liviana &#40;62&#37;&#41;&#46; El grado de carga laboral no se asoci&#243; con mayor porcentaje de d&#233;ficit en la capacidad laboral global&#46; Asimismo&#44; el nivel educativo careci&#243; de asociaci&#243;n significativa con respecto al ausentismo o presentismo laboral&#44; as&#237; como ABVD&#44; con una mediana de 10&#44;5 &#40;RIC<span class="elsevierStyleHsp" style=""></span>9-16&#41; a&#241;os de estudio en el grupo de empleados&#46; No se encontr&#243; correlaci&#243;n estad&#237;sticamente significativa entre el sexo de los pacientes&#44; edad o estado civil con los indicadores de desempe&#241;o laboral descritos en el WPAI-AR&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Todos los sujetos del grupo de empleados presentaron al menos una comorbilidad asociada&#44; dentro de las cuales las m&#225;s comunes fueron osteoartrosis &#40;32&#37;&#41;&#44; dislipidemia &#40;13&#37;&#41;&#44; osteoporosis &#40;24&#37;&#41;&#44; enfermedades osteomusculares &#40;24&#37;&#41; y fibromialgia &#40;10&#37;&#41;&#46; En el an&#225;lisis por patolog&#237;as se encontr&#243; asociaci&#243;n estad&#237;sticamente significativa entre la presencia de fibromialgia y el porcentaje de d&#233;ficit en ABVD &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; El resto de las comorbilidades individuales descritas no mostraron asociaci&#243;n con productividad laboral o desempe&#241;o de ABVD&#46; La presencia de dos o m&#225;s comorbilidades acumuladas en un mismo paciente tampoco tuvo correlaci&#243;n estad&#237;sticamente significativa con el desempe&#241;o laboral&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">De acuerdo a los medicamentos prescritos en el grupo de empleados&#44; en la poblaci&#243;n de pacientes con AR el 92&#37; utiliza metotrexato&#44; el 48&#37; prednisona&#44; el 24&#37; sulfasalazina&#44; el 18&#37; leflunomida&#44; el 24&#37; cloroquina o sus derivados y el 2&#37; agentes biol&#243;gicos&#46; No se encontr&#243; correlaci&#243;n estad&#237;sticamente significativa entre los indicadores de productividad laboral y el tipo de farmacoterapia recibida por los pacientes al ser evaluado cada medicamento de forma individual&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">Es posible establecer una relaci&#243;n entre la calidad de vida de los pacientes con AR y su desempe&#241;o laboral mediante los distintos desenlaces cl&#237;nicos representados en los cuestionarios HAQ-DI&#44; RAQoL y WPAI-AR&#46; Los resultados obtenidos en el cuestionario WPAI-AR demuestran que el grupo de pacientes empleados mostr&#243; una mayor capacidad para desempe&#241;ar ABVD en comparaci&#243;n con el grupo de desempleados&#46; Se pueden determinar una serie de factores que pueden contribuir a explicar este fen&#243;meno&#44; como menor edad&#44; mejor control de la enfermedad&#44; mejor calidad de vida y tipo de trabajo f&#237;sico realizado seg&#250;n su escolaridad y capacidad funcional&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En el estudio prospectivo de Gonz&#225;lez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> en pacientes mexicanos se evidenci&#243; que una cuarta parte de los sujetos incluidos con AR presentaron al menos un episodio de incapacidad laboral durante un a&#241;o de seguimiento&#44; mientras que el 4&#37; desarrollaron discapacidad laboral permanente&#46; El presente estudio eval&#250;a de manera sistem&#225;tica ausentismo y presentismo laboral&#44; los cuales previamente no hab&#237;an sido descritos en nuestra poblaci&#243;n&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Al estudiar el grupo de pacientes empleados se encontr&#243; correlaci&#243;n positiva entre grado de actividad de la AR&#44; calidad de vida y capacidad funcional con los indicadores de desempe&#241;o laboral descritos en el WPAI-AR&#46; Esto coincide con lo encontrado por Chaparro et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> en poblaci&#243;n argentina&#46; Aun cuando la mayor&#237;a de las correlaciones encontradas entre actividad de la AR y calidad de vida fueron estad&#237;sticamente pobres&#44; la capacidad funcional evaluada mediante HAQ-DI tuvo un grado de correlaci&#243;n fuerte con la capacidad laboral&#44; confiri&#233;ndole a esta prueba un excelente valor predictivo para detectar d&#233;ficit en el desempe&#241;o de dichas actividades&#46; Como se&#241;alan Nagasawa y Kameda<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a>&#44; diferentes factores como la funcionalidad y un adecuado apego al tratamiento tienen repercusi&#243;n sobre el desempe&#241;o de actividades laborales y ABVD&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La correlaci&#243;n negativa encontrada entre la duraci&#243;n de la enfermedad y el porcentaje de ausentismo laboral en los sujetos estudiados pudiera ser explicada por la adaptaci&#243;n de estos a sus s&#237;ntomas&#44; siendo capaces de desempe&#241;ar actividades laborales en mayor medida con el paso del tiempo&#59; lo anterior contrasta con lo descrito previamente<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; Por otro lado&#44; la correlaci&#243;n negativa que se encontr&#243; entre el IMC y la duraci&#243;n de la enfermedad pudiera ser explicada por la caquexia reum&#225;tica propia de la AR&#44; la cual se encuentra documentada en la literatura<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariable realizado en el presente estudio refiere que algunas comorbilidades tales como diabetes&#44; neuropat&#237;a y el lupus eritematoso generalizado tienen efectos delet&#233;reos en el desempe&#241;o de las ABVD&#46; Se ha descrito una asociaci&#243;n entre la presencia de comorbilidades en pacientes con AR y peores desenlaces globales<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a>&#46; Sin embargo&#44; seg&#250;n el an&#225;lisis de correlaciones realizado&#44; solo la fibromialgia predispuso una mayor dificultad para realizar las ABVD&#44; sin impactar de manera significativa en la capacidad para trabajar&#46; El resto de las comorbilidades asociadas descritas no incidieron de manera significativa en los &#237;ndices de desempe&#241;o global&#44; lo que contrasta con lo descrito por Dougados et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a>&#46; Lo anterior pudiera ser explicado por el hecho de que en la cl&#237;nica de AR se atiende de manera integral la mayor&#237;a de estas enfermedades&#46; El tipo de trabajo llevado a cabo por los pacientes con AR &#40;siendo en su mayor&#237;a de carga leve&#41; pudiera justificar tambi&#233;n este hallazgo&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Es importante destacar que la poblaci&#243;n estudiada tiene un bajo &#237;ndice de uso de agentes biol&#243;gicos&#44; lo cual pudiera asociarse a factores socioecon&#243;micos&#46; Al ser evaluada de forma individual&#44; la farmacoterapia espec&#237;fica para el tratamiento de la AR no se relacion&#243; con mayor dificultad para llevar a cabo actividades laborales&#46; Sin embargo&#44; es necesario un mayor an&#225;lisis de este apartado&#44; incluyendo medicamentos utilizados para tratar el resto de las comorbilidades existentes y el rol de la polifarmacia en este contexto&#44; la cual se ha asociado a peores desenlaces en estos pacientes<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Tras realizar el an&#225;lisis de correlaciones no se pudo establecer una relaci&#243;n significativa entre sexo&#44; edad&#44; nivel de demanda f&#237;sica laboral o escolaridad con el grado de d&#233;ficit en el desempe&#241;o laboral de los sujetos evaluados&#46; Es importante se&#241;alar que en este estudio m&#225;s del 90&#37; de los pacientes incluidos son mujeres&#44; y que un gran porcentaje de ellas no cuenta con un empleo bajo sueldo&#59; aun cuando el presente estudio se centra en los pacientes con empleo&#44; gran parte de la poblaci&#243;n analizada desempe&#241;a actividades laborales orientadas al aseo y limpieza dom&#233;stica&#46; A este respecto&#44; se ha demostrado que los factores socioecon&#243;micos y el nivel de actividad de la enfermedad tienen un gran impacto en la capacidad para llevar a cabo ABVD<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Dentro de las limitaciones del presente estudio se encuentra que solamente se realiz&#243; el reclutamiento de los pacientes de un centro de referencia&#59; adem&#225;s&#44; el dise&#241;o transversal no permite establecer una relaci&#243;n temporal entre efectos de los factores evaluados y la capacidad laboral global&#46; Al existir adem&#225;s tantos factores que afectan el resultado de inter&#233;s&#44; el an&#225;lisis ponderando todas las variables relacionadas es complejo&#46; Los instrumentos empleados no permiten discernir entre personas que desempe&#241;an actividades laborales bajo su propia iniciativa &#40;autoempleo&#41; y las que trabajan bajo contrato remunerado por un tercero&#59; esto es algo que debe ser evaluado en futuros estudios&#44; ya que influye en el perfil laboral del paciente&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Dentro de las fortalezas se puede mencionar que es el primer estudio de su tipo en pacientes mexicanos&#44; en el n&#250;mero de instrumentos empleados para su evaluaci&#243;n y en el n&#250;mero de sujetos incluidos&#44; el cual fue mayor con respecto a publicaciones previas&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El ausentismo y el presentismo laboral son fen&#243;menos presentes en esta poblaci&#243;n de pacientes con AR&#44; principalmente quienes tienen mayor actividad de la enfermedad&#44; menor capacidad funcional o peor calidad de vida&#46; El nivel de capacidad funcional fue el factor m&#225;s fuertemente asociado a este respecto&#46; En aras de disminuir el impacto econ&#243;mico y social que representan el ausentismo y presentismo laboral&#44; se recomienda valorar el nivel de rendimiento laboral al evaluar la respuesta al tratamiento en estos pacientes&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0155" 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">Valorar la relaci&#243;n entre la productividad laboral y diversos factores propios de la artritis reumatoide &#40;AR&#41; como grado de actividad de la enfermedad&#44; nivel de discapacidad&#44; calidad de vida&#44; carga laboral&#44; farmacoterapia recibida y comorbilidades asociadas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio transversal&#44; observacional y descriptivo&#46; Se incluyeron pacientes de 18 a 75<span class="elsevierStyleHsp" style=""></span>a&#241;os con diagn&#243;stico de AR seg&#250;n criterios ACR&#47;EULAR 2010 que acudieron consecutivamente a la consulta de Reumatolog&#237;a del Hospital Universitario en el periodo comprendido entre enero y marzo del a&#241;o 2017&#46; Se aplicaron los cuestionarios WPAI-AR&#44; HAQ-DI y RAQoL&#59; el grado de actividad de la AR se calcul&#243; mediante DAS28-PCR&#46; Se realizaron correlaciones entre las caracter&#237;sticas cl&#237;nicas obtenidas y la capacidad laboral por WPAI-AR&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 204 pacientes con AR&#44; de los cuales el 92&#44;6&#37; fueron mujeres&#59; la edad media fue de 54&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;3<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; En el porcentaje de d&#233;ficit en actividades b&#225;sicas de la vida diaria &#40;ABVD&#41; se encontr&#243; diferencia estad&#237;sticamente significativa entre pacientes empleados y desempleados &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Se encontr&#243; correlaci&#243;n positiva entre actividad de la enfermedad por DAS28-PCR&#44; nivel de calidad de vida por RAQoL y capacidad funcional por HAQ-DI con los porcentajes de ausentismo y presentismo laboral&#44; p&#233;rdida de la productividad laboral total y d&#233;ficit en ABVD&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Existe correlaci&#243;n entre el grado de actividad de la AR&#44; calidad de vida y capacidad funcional con el rendimiento laboral de la poblaci&#243;n estudiada&#46; La asociaci&#243;n m&#225;s fuerte encontrada fue con la capacidad funcional&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusi&#243;n"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study assesses the relationship between the ability to perform productive activities and the clinical characteristics of RA&#44; such as disease activity&#44; quality of life&#44; functional capacity&#44; workload&#44; pharmacotherapy&#44; and comorbidities&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional&#44; observational and descriptive study was conducted&#46; Patients aged 18-75<span class="elsevierStyleHsp" style=""></span>years with a diagnosis of RA according to ACR&#47;EULAR 2010 criteria who attended regularly to the Rheumatology service in the period between January and March 2017 were included&#46; The questionnaires&#44; WPAI-AR&#44; HAQ-DI and RAQoL&#44; were applied&#46; RA disease activity was measured by DAS28-PCR&#46; Correlations were made between the clinical data obtained and work productivity and activity impairment measured by WPAI-AR&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Two hundred four patients with a diagnosis of RA were included&#44; of whom 92&#46;6&#37; were women&#46; Mean age was 54&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;3<span class="elsevierStyleHsp" style=""></span>years&#46; Regarding the percentage of impairment of daily life activities&#44; we found a significant difference between employed and unemployed patients &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; A positive correlation was found between RA activity measured by DAS28-PCR&#44; quality of life&#44; and functional ability with the percentages of absenteeism&#44; presenteeism&#44; overall productivity loss&#44; and impairment of daily life activities&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A correlation between RA disease activity&#44; functional capacity&#44; quality of life&#44; and working impairment was found&#46; The strongest association was established with the degree of functional capacity&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materials and methods"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusion"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">AR&#58; artritis reumatoide&#59; DAS-28-PCR&#58; <span class="elsevierStyleItalic">Disease Activity Score de 28 articulaciones</span>&#59; DE&#58; desviaci&#243;n est&#225;ndar&#59; HAQ-DI&#58; <span class="elsevierStyleItalic">Health Assessment Questionnaire Disability Index</span>&#59; IMC&#58; &#237;ndice de masa corporal&#59;&#59; HAQ-DIRAQoL&#58; <span class="elsevierStyleItalic">Rheumatoid Arthritis Quality of Life Scale</span>&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">28&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;41&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;6-9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Soltero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21 &#40;13&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Separado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Viudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Carga laboral&#44; n &#40;&#37;&#41;</span></td><td class="td" title="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sedentario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Liviano&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pesado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Osteoartrosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69 &#40;33&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;754&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Osteoporosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;26&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;714&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibromialgia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;12&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;13&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Farmacoterapia&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metotrexato&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">182 &#40;89&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">136 &#40;88&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;466&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sulfasalazina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39 &#40;19&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;009&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meses de evoluci&#243;n de la AR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;056&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estado civil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;022&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;231&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;014&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;057&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">A&#241;os de estudio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;009&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;068&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Empleo &#47; no empleo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;014&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;858&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;174&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carga laboral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;763&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;112&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;153&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">IAM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;883&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;463&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">EVC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;073&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DM2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">HAS&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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Osteoporosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Depresi&#243;n&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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">OA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;045&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fibromialgia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;972&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;106&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 1699258X
Idioma original: Español
DOI:10.1016/j.reuma.2017.12.006
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