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y su forma de inicio en el anciano representa el 10-33&#37; de todas las AR<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Se espera un incremento en el n&#250;mero de casos por mayor expectativa de vida&#46; Con frecuencia la AR de inicio en el anciano tiene una forma de inicio agudo&#44; s&#237;ntomas constitucionales&#44; marcadores de inflamaci&#243;n&#44; compromiso similar a la polimialgia reum&#225;tica &#40;PMR&#41; y menor positividad de factor reumatoide<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;5</span></a>&#46; Debido al efecto de la edad y de la AR en el proceso de envejecimiento inmunol&#243;gico&#44; estos pacientes tienen m&#225;s comorbilidades&#44; mayores valores de eritrosedimentaci&#243;n &#40;ESR&#41; y de deterioro funcional medido con el <span class="elsevierStyleItalic">Health Assessment Questionnaire-disability index</span> &#40;HAQ-DI&#41;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En la pr&#225;ctica habitual la conducta terap&#233;utica en la AR de inicio en el anciano suele ser distinta a la del grupo de inicio en el adulto<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&#44; posiblemente por temor a potenciales efectos adversos por las comorbilidades y por su escasa representaci&#243;n en los ensayos cl&#237;nicos&#46; El empleo de corticoides es m&#225;s frecuente y a mayores dosis en la AR de inicio en el anciano y suelen utilizarse f&#225;rmacos modificadores de la enfermedad sint&#233;ticos cl&#225;sicos &#40;FAMEsc&#41; en dosis menores a las del grupo de inicio en el adulto<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a>&#46; El uso de FAME sint&#233;ticos dirigidos &#40;FAMEsd&#41; y de FAME biol&#243;gicos &#40;FAMEb&#41; es menos frecuente<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Son escasos los estudios latinoamericanos que compararon la AR de inicio en el anciano con la de inicio en el adulto<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; El objetivo del estudio fue explorar diferencias en las caracter&#237;sticas cl&#237;nicas&#44; en la evoluci&#243;n y en la elecci&#243;n terap&#233;utica entre los pacientes con AR de inicio antes o despu&#233;s de los 60<span class="elsevierStyleHsp" style=""></span>a&#241;os en cuatro centros de Argentina&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio observacional en una muestra consecutiva de pacientes con diagn&#243;stico de AR atendidos desde el 1 de agosto de 2021 hasta el 31 de marzo de 2022 en el servicio de reumatolog&#237;a de cuatro hospitales generales de Argentina&#44; ubicados en centros urbanos&#46; Se incluyeron pacientes mayores de 18<span class="elsevierStyleHsp" style=""></span>a&#241;os con inicio de s&#237;ntomas posterior al 1 de enero del 2010&#44; a partir del cual se contaba con disponibilidad en el pa&#237;s de FAMEb&#44; que cumpl&#237;an criterios de clasificaci&#243;n del <span class="elsevierStyleItalic">American College of Rheumatology</span> &#40;ACR&#41; y del <span class="elsevierStyleItalic">European Alliance of Associations for Rheumatology</span> &#40;EULAR&#41; 2010 para AR<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&#46; Se excluyeron pacientes con superposici&#243;n con otra enfermedad del tejido conectivo&#44; excepto s&#237;ndrome de Sj&#246;gren&#46; Los pacientes firmaron el consentimiento informado&#59; el protocolo fue aprobado por los comit&#233;s de Docencia y &#201;tica de los centros participantes y se condujo seg&#250;n los lineamientos que estipula la Ley 3301&#47;09 del Ministerio de Salud del Gobierno de la ciudad de Buenos Aires y la Declaraci&#243;n de Helsinki&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Seg&#250;n la edad de inicio de la enfermedad&#44; antes o despu&#233;s de los 60<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; se clasific&#243; a los pacientes en AR de inicio en el adulto y AR de inicio en el anciano&#44; respectivamente&#46; Se revisaron las historias cl&#237;nicas para recolectar datos sociodemogr&#225;ficos&#44; comorbilidades&#44; manifestaciones cl&#237;nicas al momento del diagn&#243;stico y la presencia de factor reumatoide y&#47;o anti-prote&#237;nas c&#237;clicas citrulinadas &#40;PCC&#41;&#46; Se utilizaron las definiciones de GLADEL para la etnia<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&#46; Se defini&#243; demora diagn&#243;stica al tiempo transcurrido entre el inicio de los s&#237;ntomas y el momento del diagn&#243;stico&#44; y duraci&#243;n de la enfermedad al comprendido entre el momento del diagn&#243;stico y la fecha de la &#250;ltima evaluaci&#243;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se consignaron los tratamientos recibidos desde el diagn&#243;stico seg&#250;n el uso de FAMEsc &#40;metotrexato&#44; leflunomida&#44; sulfasalazina&#41;&#44; de FAMEsd &#40;tofacitinib&#44; baricitinib&#44; upadacitinib&#41; y de FAMEb &#40;adalimumab&#44; certolizumab&#44; etanercept&#44; golimumab&#44; abatacept&#44; tocilizumab&#44; o rituximab&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Al momento de la &#250;ltima visita se registr&#243; el n&#250;mero de articulaciones tumefactas y dolorosas y la actividad de la enfermedad por el paciente y por el m&#233;dico mediante una escala visual an&#225;loga &#40;EVA&#41; num&#233;rica de 0 a 10&#46; Se evaluaron la presencia de manifestaciones extraarticulares&#44; la de erosiones radiogr&#225;ficas y el estado funcional mediante el HAQ-DI&#46; Se defini&#243; remisi&#243;n como la ausencia de enfermedad activa medida por <span class="elsevierStyleItalic">Disease Activity Score</span> &#40;DAS<span class="elsevierStyleHsp" style=""></span>28&#41; &#8804;<span class="elsevierStyleHsp" style=""></span>2&#44;6 o <span class="elsevierStyleItalic">Clinical Disease Activity Index</span> &#40;CDAI&#41; &#8804;<span class="elsevierStyleHsp" style=""></span>2&#44;8 o <span class="elsevierStyleItalic">Simplified Disease Activity Index</span> &#40;SDAI&#41; &#8804;<span class="elsevierStyleHsp" style=""></span>3&#44;3&#44; seg&#250;n el m&#233;dico tratante&#46; Se consign&#243; el tiempo hasta lograrla&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los resultados se informan como porcentaje en variables categ&#243;ricas y como media &#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#231;on est&#225;ndar o mediana y rango intercuartil &#40;RIQ&#41; para variables num&#233;ricas&#46; Para comparar proporciones se utilizaron las pruebas de chi cuadrado o exacta de Fisher&#44; seg&#250;n correspond&#237;a&#46; Para comparar variables num&#233;ricas se utilizaron el test de Student o la prueba de la U de Mann-Whitney&#44; acorde a la distribuci&#243;n de la variable&#46; Para testear normalidad se utiliz&#243; la prueba de Shapiro Wilk&#46; Para ajustar relaciones de variables de desenlace dicot&#243;micas se utiliz&#243; la regresi&#243;n log&#237;stica m&#250;ltiple&#46; En todos los casos se consider&#243; significativo un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; El an&#225;lisis se realiz&#243; con el programa Stata 16&#46;1 &#40;StataCorp&#44; Texas&#44; EE&#46;UU&#46;&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se analizaron 102 pacientes con AR&#58; 51 con AR de inicio en el adulto y 51 con AR de inicio en el anciano&#46; El Instituto Lanari incluy&#243; 26 pacientes de cada grupo y el Hospital &#193;ngel Cruz Padilla 10 de cada grupo&#44; mientras el Hospital Torn&#250; 5 con AR del adulto y 12 con AR del anciano y el Instituto de Rehabilitaci&#243;n Psicof&#237;sica 11 y 2 pacientes&#44; respectivamente&#46; Se encontraron diferencias significativas en la etnia con mayor proporci&#243;n de blancos atendidos en el Instituto Lanari &#40;46&#44;1&#37;&#41;&#44; amerindios puros en el Hospital &#193;ngel Cruz Padilla &#40;50&#37;&#41;&#44; y mestizos en el Instituto de Rehabilitaci&#243;n Psicof&#237;sica &#40;84&#37;&#41; y el Hospital Torn&#250; &#40;71&#37;&#41;&#44; con p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#46; No se encontraron diferencias significativas en la distribuci&#243;n por g&#233;nero entre los centros&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Al analizar los 102 pacientes&#44; la edad promedio al momento del diagn&#243;stico fue de 56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; La mediana en la demora diagn&#243;stica fue de 4&#44;9 &#40;2&#44;1-7&#44;6&#41; meses&#46; En <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se presentan la comparaci&#243;n de los datos demogr&#225;ficos y las comorbilidades entre los grupos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Se encontraron diferencias significativas en la etnia&#44; con mayor proporci&#243;n de amerindios en el grupo de AR de inicio en el adulto y de blancos en el grupo de AR de inicio en el anciano&#46; Este &#250;ltimo tuvo significativamente una mayor proporci&#243;n de fumadores y de pacientes con antecedentes cardiovasculares&#46; La demora diagn&#243;stica fue levemente mayor en el grupo de AR de inicio en el anciano&#44; pero no alcanz&#243; significaci&#243;n estad&#237;stica&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se comparan las caracter&#237;sticas cl&#237;nicas y serol&#243;gicas al momento del diagn&#243;stico entre ambos grupos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">El grupo de AR de inicio en el anciano tuvo mayor proporci&#243;n de pacientes con inicio abrupto y con s&#237;ntomas similares a la PMR&#46; El grupo de inicio en el adulto present&#243; mayor frecuencia de factor reumatoide y anti-PCC positivos&#44; pero la diferencia no alcanz&#243; significaci&#243;n estad&#237;stica&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se presentan las caracter&#237;sticas cl&#237;nicas en la &#250;ltima visita en ambos grupos&#46; No se encontraron diferencias significativas entre los grupos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Los valores de HAQ en la &#250;ltima visita fueron similares en ambos grupos y no se observaron diferencias significativas luego de ajustar por la edad a la &#250;ltima visita&#44; por la edad al diagn&#243;stico ni por la duraci&#243;n de la enfermedad en el an&#225;lisis multivariado&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> se presentan los tratamientos recibidos&#46; El uso de tofacitinib fue significativamente m&#225;s frecuente en el grupo de AR de inicio en el adulto&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">El uso de FAMEsc fue similar en los dos grupos&#58; 48 pacientes &#40;94&#44;1&#37;&#41; en el grupo de AR de inicio en el adulto y 46 &#40;90&#44;2&#37;&#41; en el grupo de inicio en el anciano &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;715&#41;&#46; Hubo diferencias significativas en la dosis m&#225;xima empleada de metotrexato&#44; 21&#44;9<span class="elsevierStyleHsp" style=""></span>mg &#40;20-25&#41; en el grupo de AR de inicio en el adulto vs 19<span class="elsevierStyleHsp" style=""></span>mg &#40;15-25&#41; en el grupo de inicio en el anciano &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0036&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a> se muestra el uso de FAMEb o FAMEsd&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Se registraron efectos adversos asociados al tratamiento en 16 pacientes del grupo de AR de inicio en el adulto y en 9 en el grupo de inicio en el anciano &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;107&#41;&#46; El aumento de transaminasas fue el m&#225;s frecuente en ambos grupos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">La AR de inicio en el anciano&#44; en su descripci&#243;n inicial&#44; fue considerada como una forma benigna de AR en t&#233;rminos de lograr la remisi&#243;n o la baja actividad de la enfermedad y obtener menor da&#241;o estructural<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&#46; Esta evidencia se obtuvo antes del desarrollo de los criterios de clasificaci&#243;n de la ACR de 1987&#44; donde algunos pacientes pod&#237;an responder a otros diagn&#243;sticos&#44; como PMR<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&#46; Con el tiempo&#44; con trabajos comparativos de AR de inicio en el anciano vs inicio en el adulto&#44; se observ&#243; una evoluci&#243;n cl&#237;nica similar<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;14&#44;15</span></a> o a&#250;n m&#225;s severa en el grupo de AR de inicio en el anciano<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;16-18</span></a>&#46; Los resultados de la presente cohorte son consistentes con estas &#250;ltimas observaciones&#44; dado que tanto el porcentaje de pacientes que alcanzaron la remisi&#243;n como la presencia de erosiones fueron similares en ambos grupos&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La AR es una de las enfermedades cr&#243;nicas autoinmunes que predomina en mujeres&#46; En la AR de inicio en el anciano se ha descrito una distribuci&#243;n por g&#233;nero m&#225;s pareja&#44; con una relaci&#243;n mujer-hombre 1&#44;5-2&#58;1 comparado con 4-4&#44;5&#58;1 en otros grupos etarios<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;19-21</span></a>&#46; En este trabajo hubo mayor&#237;a de g&#233;nero femenino en ambos grupos&#44; sin diferencias en la relaci&#243;n mujer-hombre<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&#46; Con respecto a la etnia&#44; hubo mayor proporci&#243;n de amerindios en el grupo de AR de inicio en el adulto y de blancos en el grupo de inicio en el anciano&#46; Estos datos no son comparables con lo publicado hasta el momento en otros trabajos en poblaci&#243;n sudamericana&#44; ya que utilizaron una clasificaci&#243;n diferente para etnia o no informaron este dato<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Respecto a diferencias en la presentaci&#243;n cl&#237;nica al momento del diagn&#243;stico entre los grupos de AR de inicio en el anciano y de inicio en el adulto&#44; en este estudio el grupo de inicio en el adulto present&#243; con mayor frecuencia inicio abrupto&#44; similar a lo reportado por otros autores<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#44;14&#44;18</span></a>&#46; Aunque en esta serie no se observ&#243; diferencia en la frecuencia de fiebre&#44; p&#233;rdida de peso y sudoraci&#243;n nocturna como forma de presentaci&#243;n&#44; otros autores las hab&#237;an reportado m&#225;s frecuentemente en el grupo de AR de inicio en el anciano<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23-25</span></a>&#46; Los pacientes con AR de inicio en el anciano pueden debutar con un cuadro cl&#237;nico similar a la PMR<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;21</span></a>&#44; cuadro que se caracteriza por dolor y rigidez en las cinturas escapular y pelviana con reactantes de fase aguda elevados&#46; La polimialgia reum&#225;tica es m&#225;s com&#250;n despu&#233;s de los 50<span class="elsevierStyleHsp" style=""></span>a&#241;os y tiene buena respuesta a bajas dosis de corticoides&#46; Ambas entidades pueden presentar artritis en manos&#46; Estas similitudes hacen que el diagn&#243;stico de AR o PMR pueda ser realizado en el mismo paciente en diferentes momentos dependiendo de la expresi&#243;n cl&#237;nica de la enfermedad&#44; y pacientes que inicialmente son considerados con el diagn&#243;stico de PMR&#44; finalmente son diagnosticados como AR de inicio en el anciano en un per&#237;odo mayor de seguimiento<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a>&#46; En este estudio&#44; dicha forma de presentaci&#243;n fue&#44; como se ha descrito&#44; m&#225;s frecuente en el grupo de AR de inicio en el anciano&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El HAQ se emplea en la pr&#225;ctica diaria para evaluar el estado funcional en pacientes con AR&#46; Si bien no hay un consenso a partir de qu&#233; valor se considera discapacidad relevante&#44; una puntuaci&#243;n de &#8805;<span class="elsevierStyleHsp" style=""></span>1&#44;0 ser&#237;a un indicativo de discapacidad significativa<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a>&#46; Sin embargo&#44; se ha descrito que el valor del HAQ aumenta con la edad y con la duraci&#243;n de la enfermedad&#44; pero se desconoce si la edad de inicio de la AR incide en su resultado<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a>&#46; Jaime Calvo-Al&#233;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> informaron mayor p&#233;rdida funcional y mayor da&#241;o anat&#243;mico en pacientes con AR de inicio en el anciano&#44; en quienes&#44; si bien tuvieron tratamiento menos agresivo&#44; la edad de inicio tuvo un efecto independiente en ambos desenlaces&#46; En la literatura se obtuvieron resultados dispares&#44; algunos evidenciando peores resultados de HAQ en el grupo de AR de inicio en el anciano<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;27</span></a> y otros mejores<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;15</span></a>&#46; En este trabajo no se observaron diferencias en el HAQ en la &#250;ltima visita al comparar grupos de AR de inicio en el anciano y de inicio en el adulto&#44; ni luego de ajustar por edad al diagn&#243;stico&#44; por duraci&#243;n de la enfermedad y por edad en la &#250;ltima visita&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">El tratamiento de la AR tiene como objetivos el control de las manifestaciones cl&#237;nicas&#44; prevenir el da&#241;o estructural&#44; preservar la funci&#243;n y disminuir el exceso de mortalidad<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a>&#46; Se inicia con FAME tan pronto como se realiza el diagn&#243;stico de AR&#44; con el objetivo de lograr la remisi&#243;n o&#44; si no es posible&#44; lograr una baja actividad de la enfermedad&#44; y se controla al paciente con visitas cada 1-3<span class="elsevierStyleHsp" style=""></span>meses<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a>&#46; Demoras en el inicio de los FAME se asocian a mayor inflamaci&#243;n y destrucci&#243;n articular&#44; con impacto negativo en la funci&#243;n f&#237;sica y en el desarrollo de complicaciones&#46; Aunque las terapias disponibles en AR tienen similar eficacia y seguridad tanto en j&#243;venes como en longevos<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a>&#44; en la pr&#225;ctica el grupo de AR de inicio en el anciano recibe terapias menos agresivas&#44; con esteroides y monoterapia con metotrexato en dosis bajas u otro FAMEsc<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a>&#46; Consistente con otros estudios&#44; en este trabajo las tasas de uso de FAMEb o FAMEsd y dosis m&#225;ximas de metotrexato fueron menores en grupo de AR de inicio en el anciano&#46; Esto sugiere que la edad avanzada constituye una barrera para el tratamiento precoz y efectivo de la AR&#44; ya que condiciona la selecci&#243;n terap&#233;utica del reumat&#243;logo&#44; posiblemente por temor a eventos adversos&#44; principalmente infecciones&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El porcentaje de pacientes que alcanz&#243; la remisi&#243;n en alg&#250;n momento de la enfermedad o que se encontraba en remisi&#243;n en la &#250;ltima visita fue similar en ambos grupos&#44; a pesar de haber recibido tratamiento menos intensivo los pacientes con AR de inicio en el anciano&#46; Una de las limitaciones de este estudio en que no se cuenta con la dosis acumulada de esteroides o con la dosis al momento de la &#250;ltima visita&#46; Debe considerarse esta falencia a la hora de analizar las tasas de remisi&#243;n&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n del estudio es el enfoque retrospectivo&#44; y aunque se cumplieron la mayor&#237;a de los criterios STROBE para estudios observacionales&#44; podemos identificar otras limitaciones&#44; como el tama&#241;o peque&#241;o de la muestra y no haber utilizado una t&#233;cnica de muestreo probabil&#237;stico&#46; Sin embargo&#44; con una muestra consecutiva se intent&#243; incorporar toda la poblaci&#243;n accesible a los investigadores&#46; Adem&#225;s&#44; existieron diferencias entre los centros en la proporci&#243;n de pacientes incluidos por cada uno y en la etnia&#46; Un estudio prospectivo permitir&#237;a obtener mayor informaci&#243;n que incluya complicaciones y mortalidad&#46; Sin embargo&#44; dado que la literatura en este tema en Sudam&#233;rica es escasa&#44; se considera valioso el aporte al conocimiento de la AR de inicio en el anciano&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0135" class="elsevierStylePara elsevierViewall">La informaci&#243;n disponible sobre las caracter&#237;sticas cl&#237;nicas&#44; la evoluci&#243;n y el pron&#243;stico de los pacientes con AR de inicio en el anciano ha evolucionado en las &#250;ltimas d&#233;cadas desde su descripci&#243;n inicial&#44; como una entidad benigna&#44; a la actual&#44; como una forma de AR similar de inicio en el adulto<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;12&#44;14&#44;15</span></a>&#46; Se han descrito los beneficios del tratamiento precoz en pacientes con AR&#46; En este trabajo&#44; el empleo de FAME en el grupo de AR de inicio en el anciano fue menos intensivo&#44; sugiriendo que la edad avanzada constituye una barrera en la elecci&#243;n terap&#233;utica&#46; Se requieren estudios prospectivos con evaluaci&#243;n de complicaciones y mortalidad para evaluar si el abordaje de los pacientes con AR de inicio en el anciano tiene que ser similar al resto de pacientes con AR&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0140" 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">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cuando la artritis reumatoide &#40;AR&#41; comienza despu&#233;s de los 60<span class="elsevierStyleHsp" style=""></span>a&#241;os se denomina artritis reumatoide de inicio en el anciano&#44; y cuando se inicia antes&#44; artritis reumatoide de inicio en el adulto&#46; Son escasos los estudios latinoamericanos que compararon ambos grupos&#46; El objetivo del estudio fue evaluar diferencias en las caracter&#237;sticas cl&#237;nicas&#44; en la evoluci&#243;n y en la elecci&#243;n terap&#233;utica entre los pacientes con AR de inicio antes o despu&#233;s de los 60<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional de pacientes con AR atendidos en forma consecutiva en cuatro centros de Argentina&#46; Se recolectaron datos sociodemogr&#225;ficos&#44; comorbilidades&#44; manifestaciones cl&#237;nicas al diagn&#243;stico&#44; presencia de factor reumatoide y&#47;o anti-prote&#237;nas c&#237;clicas citrulinadas &#40;PCC&#41; y tratamientos recibidos&#46; En la &#250;ltima visita se registraron las articulaciones tumefactas o dolorosas&#44; la evaluaci&#243;n de la actividad de la enfermedad por el paciente y por el m&#233;dico&#44; la presencia de erosiones radiogr&#225;ficas y el estado funcional mediante el HAQ-DI&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 51 pacientes de cada grupo&#46; El grupo de AR del anciano tuvo significativamente mayor proporci&#243;n de fumadores &#40;58&#44;8&#37; vs 35&#44;3&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#44; de antecedentes cardiovasculares &#40;54&#44;9&#37; vs 21&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; de inicio abrupto &#40;49&#37; vs 29&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#41; o con s&#237;ntomas similares a la PMR &#40;19&#44;6&#37; vs 0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; menores dosis de metotrexato&#58; 19<span class="elsevierStyleHsp" style=""></span>mg &#40;15-25&#41; vs 21&#44;9<span class="elsevierStyleHsp" style=""></span>mg &#40;20-25&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0036&#41; y con mayor frecuencia no recibieron FAMEb o FAMEsd&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discusi&#243;n y conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se han descrito los beneficios del tratamiento intensivo en pacientes con AR&#46; En este trabajo&#44; el empleo de FAME en el grupo de AR de inicio en el anciano fue menos intensivo&#44; sugiriendo que la edad avanzada constituye una barrera en la elecci&#243;n terap&#233;utica&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">When rheumatoid arthritis &#40;RA&#41; starts after the age of 60 it is called elderly-onset rheumatoid arthritis &#40;EORA&#41; and when it starts earlier&#44; young-onset rheumatoid arthritis &#40;YORA&#41;&#46; There are few Latin American studies that compared both groups&#46; The objective of the study was to evaluate differences in the clinical characteristics&#44; evolution and treatment among patients with RA with onset before or after 60<span class="elsevierStyleHsp" style=""></span>years of age&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Observational study of patients with RA attended consecutively in four centers in Argentina&#46; Sociodemographic data&#44; comorbidities&#44; clinical manifestations at diagnosis&#44; presence of rheumatoid factor and&#47;or anti-CCP &#40;cyclic citrullinated peptide&#41; and treatments received were collected&#46; At the last visit&#44; swollen and tender joints&#44; assessment of disease activity by the patient and physician&#44; the presence of radiographic erosions&#44; and functional status using the HAQ-DI were recorded&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fifty-one patients from each group were analyzed&#46; The EORA group had a significantly higher proportion of smokers &#40;58&#46;8&#37; vs&#46; 35&#46;3&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;029&#41;&#44; cardiovascular history &#40;54&#46;9&#37; vs&#46; 21&#46;6&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; abrupt onset &#40;49&#37; vs&#46; 29&#46;4&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;034&#41; or with symptoms similar to PMR &#40;19&#46;6&#37; vs&#46; 0&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Lower methotrexate doses were used in the EORA group&#58; 19<span class="elsevierStyleHsp" style=""></span>mg &#40;15-25&#41; vs&#46; 21&#46;9<span class="elsevierStyleHsp" style=""></span>mg &#40;20-25&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0036&#41; and more frequently did not receive bDMARDs or tsDMARDs&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion and conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The benefits of intensive treatment in patients with RA have been described&#46; In this study&#44; the use of DMARDs in the EORA group was less intensive&#44; suggesting that advanced age constitutes a barrier in the therapeutic choice&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mestizos&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">24 &#40;47&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\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\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>Amerindios puros&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">15 &#40;29&#44;4&#41;&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">1 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">A&#241;os de estudio&#44; mediana &#40;RIQ&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;12-16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;1075&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alteraci&#243;n de la funci&#243;n renal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;7&#44;8&#41;&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">Fiebre&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;500&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">P&#233;rdida de peso&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;487&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Sudoraci&#243;n nocturna&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;3&#44;9&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&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">Rigidez matinal&#44; n &#40;&#37;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;75&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;70&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;659&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">Anemia&#44; n &#40;&#37;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;27&#44;5&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;27&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&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">Factor reumatoide&#44; n &#40;&#37;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;84&#44;3&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;74&#44;5&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;327&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">Anti-PCC&#44; n &#40;&#37;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;76&#44;5&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;66&#44;7&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;380&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas evaluadas en la &#250;ltima visita&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AR inicio adulto&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AR inicio anciano&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&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">Duraci&#243;n de la enfermedad &#40;meses&#41;&#44; mediana &#40;RIQ&#41;</span>&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">63 &#40;20-97&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;15-94&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2071&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="elsevierStyleItalic">Edad &#250;ltima visita&#44; media</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE</span>&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">48&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;7&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">72&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;2&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;0000&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"><span class="elsevierStyleItalic">Manifestaciones extraarticulares&#44; n &#40;&#37;&#41;</span>&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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#243;dulos&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">4&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">4&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">1&#44;00&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"><span class="elsevierStyleHsp" style=""></span>Raynaud&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">2&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
                  \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;495&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"><span class="elsevierStyleHsp" style=""></span>Fatiga&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">8&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">6&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;775&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"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome de Sj&#246;gren asociado&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">4&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">4&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">1&#44;00&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"><span class="elsevierStyleHsp" style=""></span>Epiescleritis&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">1&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">1&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">1&#44;00&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"><span class="elsevierStyleHsp" style=""></span>Escleritis&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">1&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">1&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">1&#44;00&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"><span class="elsevierStyleHsp" style=""></span>&#218;lceras cut&#225;neas&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
                  \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">1&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">1&#44;00&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"><span class="elsevierStyleHsp" style=""></span>Enfermedad intersticial pulmonar&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">17&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;108&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">Sulfasalazina&#44; n&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">6&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">1&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;050&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">Adalimumab&#44; n&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">6&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">3&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;295&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">Etanercept&#44; n&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">6&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">1&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;050&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">Golimumab&#44; n&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">4&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">1&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;169&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">Certolizumab&#44; n&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">5&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">2&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;436&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">Tocilizumab&#44; n&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">4&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">1&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;169&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">Abatacept&#44; n&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">3&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">4&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;695&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">Tofacitinib&#44; n&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">12&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">2&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;008&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">Upadacitinib&#44; n&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">3&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
                  \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;243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3471857.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Tratamientos recibidos</p>"
        ]
      ]
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tratamientos recibidos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AR inicio adulto&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AR inicio anciano&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Sin FAMEb o FAMEsd&#44; n &#40;&#37;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;45&#44;1&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;86&#44;3&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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">Uno solo&#44; n &#40;&#37;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;37&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#44;9&#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
                  \t\t\t\t\ttop\n
                  \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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dos o m&#225;s FAMEb o FAMEsd&#44; n &#40;&#37;&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;17&#44;7&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;9&#44;8&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3471854.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Tratamiento con FAMEb o FAMEsd</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age at onset determines severity and choice of treatment in early rheumatoid arthritis&#58; A prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Innala"
                            1 => "E&#46; Berglin"
                            2 => "B&#46; M&#246;ller"
                            3 => "L&#46; Ljung"
                            4 => "T&#46; Smedby"
                            5 => "A&#46; S&#246;dergren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/ar4540"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Res Ther&#46;"
                        "fecha" => "2014"
                        "volumen" => "16"
                        "paginaInicial" => "R94"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24731866"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rheumatoid arthritis in the elderly&#58; Characteristics and treatment considerations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Serhal"
                            1 => "M&#46;N&#46; Lwin"
                            2 => "C&#46; Holroyd"
                            3 => "C&#46;J&#46; Edwards"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.autrev.2020.102528"
                      "Revista" => array:5 [
                        "tituloSerie" => "Autoimmun Rev&#46;"
                        "fecha" => "2020"
                        "volumen" => "19"
                        "paginaInicial" => "102528"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32234572"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rheumatoid arthritis in the elderly in the era of tight control"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Soubrier"
                            1 => "Z&#46; Tatar"
                            2 => "M&#46; Couderc"
                            3 => "S&#46; Mathieu"
                            4 => "J&#46;J&#46; Dubost"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40266-013-0122-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Drugs Aging&#46;"
                        "fecha" => "2013"
                        "volumen" => "30"
                        "paginaInicial" => "863"
                        "paginaFinal" => "869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24105334"
                            "web" => "Medline"
                          ]
                        ]
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