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interdisciplinar&#44; entre los servicios de Reumatolog&#237;a y Neumolog&#237;a&#44; para la valoraci&#243;n conjunta de afectaci&#243;n pulmonar en enfermedades sist&#233;micas inmunomediadas&#44; integrada en la unidad de EPID del centro&#44; acreditada por la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41; como unidad interdisciplinar de alta complejidad&#46; Esto permite una recogida de datos estructurada que consigue estudiar la dimensi&#243;n total de esta enfermedad en nuestra zona&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es estimar la prevalencia de EPID sintom&#225;tica&#44; sus patrones radiol&#243;gicos en la AR y las caracter&#237;sticas de los pacientes que desarrollan s&#237;ntomas respiratorios&#44; en el &#225;rea sanitaria de un hospital de tercer nivel&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio observacional longitudinal prospectivo entre el 2007 y el 2018 en la consulta interdisciplinar de Reumatolog&#237;a y Neumolog&#237;a del HULP&#46; El protocolo fue aprobado por el comit&#233; &#233;tico de investigaci&#243;n del HULP&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Poblaci&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluy&#243; a los pacientes del &#225;rea y los estudiados en el servicio de Reumatolog&#237;a que cumpl&#237;an los criterios de AR de 1987 o de 2010<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8&#44;9</span></a> y que hubieran sido remitidos a la consulta interdisciplinar de Reumatolog&#237;a y Neumolog&#237;a con sospecha de EPID por s&#237;ntomas &#40;tos&#44; disnea&#41;&#44; signos &#40;auscultaci&#243;n patol&#243;gica&#41; o alteraci&#243;n en prueba de imagen&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Definici&#243;n de caso y recogida de datos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se defini&#243; 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El procedimiento para la espirometr&#237;a lenta y forzada es el descrito por SEPAR<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a>&#46; Como valores de referencia se utilizaron los propuestos por la <span class="elsevierStyleItalic">Global Lung Initiative</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a>&#46; La capacidad de difusi&#243;n de mon&#243;xido de carbono &#40;DLCO&#41; se midi&#243; con el mismo equipo con la t&#233;cnica de respiraci&#243;n &#250;nica y se corrigi&#243; en funci&#243;n de la hemoglobina&#44; con los valores de referencia propuestos por Cotes<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a>&#46; La funci&#243;n pulmonar se consider&#243; anormal si la CVF o la DLCO eran menores del 80&#37;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de EPID fue mediante TCAR&#59; el protocolo incluy&#243; un topograma para determinar los l&#237;mites del volumen que se deb&#237;a adquirir en inspiraci&#243;n m&#225;xima&#44; en sentido cr&#225;neo caudal&#46; Tambi&#233;n se obtuvieron cortes en espiraci&#243;n a nivel de cayado y a la entrada de las venas pulmonares&#44; para valorar el atrapamiento a&#233;reo&#46; Se utiliz&#243; un equipo de TC 16 detectores SOMATON EMOTION 16 &#40;Siemens Medical Solutions&#44; Erlangen&#44; Alemania&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Los par&#225;metros de irradiaci&#243;n se ajustaron de forma convencional con respecto a las caracter&#237;sticas morfol&#243;gicas de cada paciente&#58; 120 kV&#44; con corriente del tubo de 160<span class="elsevierStyleHsp" style=""></span>mA&#46; El grosor de corte empleado fue 0&#44;75<span class="elsevierStyleHsp" style=""></span>mm&#44; con un incremento de reconstrucci&#243;n de 0&#44;5<span class="elsevierStyleHsp" style=""></span>mm&#44; una relaci&#243;n de paso en el barrido espiral &#40;pitch&#41; de 0&#44;8<span class="elsevierStyleHsp" style=""></span>mm y un grosor de colimaci&#243;n de 0&#44;6<span class="elsevierStyleHsp" style=""></span>mm&#46; Se utilizaron 2<span class="elsevierStyleHsp" style=""></span>algoritmos de reconstrucci&#243;n est&#225;ndar &#40;filtro B 41 para valoraci&#243;n de partes blandas y filtro B 90 de alta resoluci&#243;n para mejor evaluaci&#243;n del par&#233;nquima pulmonar&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Las im&#225;genes fueron interpretadas por 2<span class="elsevierStyleHsp" style=""></span>radi&#243;logos de la secci&#243;n de t&#243;rax de nuestro hospital&#44; expertos en enfermedad intersticial&#44; del equipo multidisciplinar de EPID&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se analizaron los datos sociodemogr&#225;ficos y cl&#237;nicos&#44; las PFR y los patrones radiol&#243;gicos&#46; La descripci&#243;n de la muestra se llev&#243; a cabo mediante medidas de tendencia central y de dispersi&#243;n para variables cuantitativas&#44; as&#237; como tablas de frecuencias y distribuci&#243;n de porcentajes para las cualitativas&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tras la descripci&#243;n de la muestra de an&#225;lisis&#44; se estim&#243; la prevalencia poblacional de EPID sintom&#225;tica en AR en los casos pertenecientes al &#225;rea de referencia del HULP&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Para el estudio de prevalencia de EPID se manej&#243; como denominador todas las AR aportadas por los centros de salud del &#225;rea vivos en octubre del 2018 y como numerador&#44; aquellos que presentaban EPID sintom&#225;tica&#46; Para calcular las prevalencias&#44; y su intervalo de confianza &#40;IC&#41; del 95&#37;&#44; se asumi&#243; una distribuci&#243;n de Poisson&#46; Los resultados se expresaron de forma global y por estratos de edad y sexo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En los pacientes con EPID se estableci&#243; la frecuencia de los distintos patrones de afectaci&#243;n radiol&#243;gica clasificados como&#58; neumon&#237;a intersticial usual &#40;NIU&#41;&#59; probable NIU&#59; s&#237;ndrome combinado enfisema-fibrosis &#40;SCEF&#41;&#59; neumon&#237;a intersticial no espec&#237;fica &#40;NINE&#41;&#59; neumon&#237;a organizada &#40;NO&#41;&#59; neumon&#237;a intersticial linfoide &#40;NIL&#41; y otros&#46; Para ello se utiliz&#243; la clasificaci&#243;n de neumon&#237;as intersticiales idiop&#225;ticas de la European Respiratory Society &#40;ERS&#41; y la American Respiratory Society del 2013&#44; y las recomendaciones de fibrosis pulmonar idiop&#225;tica realizadas conjuntamente por la American Thoracic Society&#44; la European Respiratory Society&#44; la Japanese Respiratory Society y la Latin American Thoracic Society<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Se crearon y compararon los siguientes grupos de patrones&#58; &#40;NIU &#43; probable NIU&#41; vs&#46; &#40;NINE&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Comparamos las caracter&#237;sticas sociodemogr&#225;ficas y cl&#237;nicas&#44; y las PFR basal entre ambos grupos mediante pruebas de contraste de hip&#243;tesis para variables continuas &#40;t de Student o U de Mann-Whitney&#44; seg&#250;n su distribuci&#243;n&#41; y categ&#243;ricas &#40;chi al cuadrado&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se registraron 2&#46;729 casos de AR en el &#225;rea&#44; que supone una prevalencia de AR del 0&#44;62&#37;&#44; dentro de lo esperado&#46; El registro de AR-EPID sintom&#225;tica inclu&#237;a a 92 pacientes&#44; se eliminaron 2<span class="elsevierStyleHsp" style=""></span>&#40;una artritis idiop&#225;tica juvenil y una neumoconiosis&#41;&#46; De los 90 incluidos&#44; 69 pertenec&#237;an al &#225;rea del HULP y 47 segu&#237;an vivos en la fecha del estudio&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La prevalencia poblacional de AR-EPID sintom&#225;tica del &#225;rea del HULP se estim&#243; en un 1&#44;72&#37; &#40;IC del 95&#37;&#58; 1&#44;26-2&#44;29&#41;&#46; Por sexos&#44; fue mayor en varones &#40;3&#44;11&#37; vs&#46; 1&#44;23&#37;&#41;&#44; por grupos de edad&#44; el valor m&#225;s elevado se obtuvo en los menores de 55 a&#241;os respecto a los mayores de esta edad &#40;2&#44;20&#44; IC del 95&#37;&#58; 1&#44;28-3&#44;52 vs&#46; 1&#44;53&#44; IC del 95&#37;&#58; 1&#44;03-2&#44;19&#41;&#46; Si bien&#44; para el sexo los IC no solapan&#44; lo cual indica que la diferencia es estad&#237;sticamente significativa&#44; esto no ocurre con la edad y la diferencia observada puede deberse al azar &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra la descripci&#243;n de los 90 pacientes con AR y EPID de nuestra serie&#46; La edad media al diagn&#243;stico de la AR fue 57&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;3 a&#241;os y 49 &#40;48&#44;9&#37;&#41; eran mujeres&#46; La mayor&#237;a&#44; FR y ACPA positivos&#44; el 16&#37; fumadores y un 45&#37; exfumadores&#46; La afectaci&#243;n articular fue la sintomatolog&#237;a de inicio en 80 casos &#40;90&#37;&#41;&#44; con una mediana de tiempo transcurrido entre el inicio de los s&#237;ntomas articulares y respiratorios de 9&#44;9 a&#241;os&#46; En la visita basal el 23&#37; presentaba tos&#59; el 58&#37;&#44; disnea&#59; el 15&#44;2&#37;&#44; tos y disnea&#44; y el 66&#37;&#44; crepitantes&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">El patr&#243;n radiol&#243;gico m&#225;s frecuente fue NIU &#40;31&#37;&#41;&#44; seguido de NINE &#40;22&#37;&#41;&#44; el SCEF &#40;13&#37;&#41;&#44; el patr&#243;n inespec&#237;fico &#40;10&#37;&#41; y la NO y NIL &#40;6&#44;7&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En cuanto la distribuci&#243;n por sexo&#44; la NINE fue m&#225;s frecuente en mujeres &#40;34&#37; vs&#46; 13&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41; y el SCEF solo apareci&#243; en varones &#40;26&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Respecto a la edad&#44; se observ&#243; mayor frecuencia de NINE en los &#60;<span class="elsevierStyleHsp" style=""></span>55 a&#241;os &#40;32&#37; vs&#46; 14&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41; y el SCEF en el grupo de mayor edad &#40;20&#37; vs&#46; 5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; La NIU tambi&#233;n fue m&#225;s frecuente en mayores de 55 a&#241;os &#40;39&#37; vs&#46; 22&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;08&#41; pero no alcanz&#243; significaci&#243;n estad&#237;stica &#40;SE&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Al comparar por grupos radiol&#243;gicos&#44; NIU &#43; probable NIU frente NINE &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#44; la edad media al diagn&#243;stico en el grupo con NIU &#43; probable NIU era 64&#44;2 frente a 52&#44;3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#41; y la NINE fue m&#225;s frecuente en mujeres &#40;70 vs&#46; 51&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;186&#41; pero no alcanz&#243; SE &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;18&#41;&#46; Al comparar el patr&#243;n NINE con NIU &#43; probable NIU se observ&#243; que el t&#237;tulo de FR era mayor en pacientes con NINE &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;020&#41;&#46; Respecto a la DLCO y la CVF&#44; no encontramos diferencias significativas&#44; probablemente por el tama&#241;o de la muestra &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">En nuestro estudio se ha estimado una prevalencia de EPID en AR que es menor de la descrita en otras series<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a>&#44; confirm&#225;ndose que esta enfermedad es m&#225;s frecuente en fumadores y pacientes con FR y ACPA positivos y que la NIU es el patr&#243;n m&#225;s frecuente&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Aunque el estudio es de un solo centro&#44; se trata de un &#225;rea representativa amplia en la que los pacientes con AR son derivados en su casi totalidad a Reumatolog&#237;a &#40;con una prevalencia de AR del 0&#44;62 &#91;IC del 95&#37;&#58; 0&#44;60-0&#44;64&#93; seg&#250;n datos propios&#44; que cuadra con la estimada para la poblaci&#243;n general&#41;&#46; Adem&#225;s&#44; los pacientes atendidos en la consulta interdisciplinar provienen tanto de la consulta de Reumatolog&#237;a del hospital como de los centros de especialidades&#44; por lo que incluyen pacientes con AR con todo el espectro de gravedad de la enfermedad&#46; Por &#250;ltimo&#44; sus caracter&#237;sticas cl&#237;nicas son muy similares a las de otras series&#44; lo que apoya su representatividad&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La prevalencia de EPID en pacientes con AR var&#237;a del 1 al 67&#44;3&#37;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a>&#46; Estas diferencias no son sorprendentes&#44; por la gran cantidad de definiciones&#44; pruebas diagn&#243;sticas utilizadas<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a>&#44; criterios<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> e incluso debido al an&#225;lisis estad&#237;stico utilizado&#44; no reflejado siempre en los art&#237;culos<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a>&#46; La prevalencia es del 1 al 6&#37; si se utiliza radiograf&#237;a de t&#243;rax y del 5 al 67&#44;3&#37; si se realiza TCAR<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Hay que considerar que&#44; aunque la proporci&#243;n de pacientes con AR-EPID por TCAR es llamativa&#44; solo se considera cl&#237;nicamente significativa en el 5-10&#37;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a>&#46; Esto debe tenerse en cuenta&#44; ya que existe una brecha significativa entre el gran n&#250;mero de individuos asintom&#225;ticos con cambios pulmonares radiol&#243;gicos o funcionales y el de pacientes que finalmente desarrollar&#225; una EPID cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&#46; Kelly et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> realizaron un estudio en pacientes sintom&#225;ticos y diagnosticados por TCAR y obtuvieron un resultado del 2-3&#37; y&#44; en un trabajo que inclu&#237;a a pacientes con pleuritis o EPID&#44; Bartels et al&#46; publicaron unos resultados del 2&#37; en 1985 y del 4&#37; en el 2006<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En Espa&#241;a los &#250;nicos datos que disponemos de prevalencia de EPID en AR son los de la cohorte EMECAR<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a>&#44; con una prevalencia de 3&#44;7&#37; &#40;IC del 95&#37;&#58; 2&#44;4-5&#41;&#46; En este estudio los criterios de clasificaci&#243;n consist&#237;an en existencia de patr&#243;n restrictivo o hallazgos en TCAR indicativos de EPID&#44; pero sin hacer referencia a la cl&#237;nica&#46; Aunque recientemente se han publicado estudios descriptivos de AR-EPID en nuestro pa&#237;s<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;7</span></a>&#44; no hemos localizado otros trabajos que estimaran su prevalencia&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La prevalencia de AR-EPID sintom&#225;tica en nuestra &#225;rea es del 1&#44;72&#37; &#40;IC del 95&#37;&#58; 1&#44;26-2&#44;29&#41;&#44; comparable con los resultados de EMECAR<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> y con los del trabajo de Kelly et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Nuestro trabajo solo incluye a pacientes con s&#237;ntomas respiratorios en los que hemos confirmado EPID mediante TCAR&#46; Esto supone que nuestro estudio puede subestimar la prevalencia de AR-EPID&#46; Adem&#225;s&#44; el hecho de no seleccionar solo a pacientes con AR grave tambi&#233;n puede ser una explicaci&#243;n de esta baja prevalencia&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En la AR&#44; la afectaci&#243;n pulmonar es la primera manifestaci&#243;n en el 10-20&#37; de los pacientes<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#44; datos que coinciden con nuestros resultados&#44; donde 10 pacientes &#40;10&#37;&#41; iniciaron con cl&#237;nica respiratoria&#46; El inicio de la afectaci&#243;n pulmonar en la AR habitualmente ocurre hacia los 50-60 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> y la edad se considera un factor de riesgo de desarrollo de EPID&#46; Por otro lado&#44; la edad al diagn&#243;stico de AR tambi&#233;n se ha relacionado con EPID<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&#46; En nuestra serie&#44; la edad media al diagn&#243;stico de la AR fue 57 a&#241;os&#46; Llama la atenci&#243;n que la prevalencia de EPID sea m&#225;s elevada en menores de 55 a&#241;os que en los mayores&#44; si bien estas diferencias no son estad&#237;sticamente significativas&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Se ha descrito que&#44; adem&#225;s de la edad&#44; el tabaquismo&#44; el FR y los ACPA positivos&#44; especialmente a t&#237;tulos altos&#44; los antecedentes familiares de AR y ser var&#243;n son factores de riesgo de desarrollo de EPID en la AR<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#44;25-27</span></a>&#46; En nuestra serie&#44; el 61&#37; de los pacientes ten&#237;a antecedentes de tabaquismo y m&#225;s del 80&#37; ten&#237;a FR y ACPA positivos a t&#237;tulos altos&#44; lo cual cuadra con lo esperado&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En las enfermedades sist&#233;micas inmunomediadas el patr&#243;n NINE es el m&#225;s frecuente excepto en la AR&#44; donde es el NIU<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a>&#46; En nuestro trabajo&#44; es m&#225;s frecuente la NIU &#40;31&#44;1&#37;&#41;&#44; seguida de NINE &#40;22&#44;2&#37;&#41;&#44; con un patr&#243;n similar a otras publicaciones&#44; con cifras entorno al 40-60&#37; para NIU y al 11-30&#37; para NINE<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a>&#46; Cada vez hay m&#225;s datos que confirman que los pacientes con AR y patr&#243;n NIU tienen un fenotipo diferente que los pacientes con patrones no NIU&#46; La NIU es m&#225;s frecuente en varones&#44; mayores&#44; fumadores<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#44; mientras que el patr&#243;n NINE es casi 3<span class="elsevierStyleHsp" style=""></span>veces m&#225;s frecuente en mujeres<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a>&#46; Como en otros trabajos&#44; los pacientes con NIU o probable NIU son m&#225;s mayores al diagn&#243;stico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#41;&#44; son hombres con m&#225;s frecuencia &#40;48&#44;5 vs&#46; 30&#37;&#41; y existe m&#225;s el antecedente de tabaquismo que en el grupo NINE &#40;53&#44;1 vs&#46; 40&#37;&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los estudios sobre EPID en las enfermedades autoinmunes no han tenido en cuenta su coexistencia con enfisema&#44; por lo que no se conoce la frecuencia de SCEF en estas enfermedades<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a>&#46; En nuestro estudio&#44; el 13&#44;3&#37; de los pacientes muestran patr&#243;n de SCEF&#46; Tambi&#233;n hemos podido comprobar que se trata de pacientes con un fenotipo especial&#59; en nuestro trabajo todos eran varones&#44; fumadores y mayores de 55 a&#241;os&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Este trabajo tiene algunas limitaciones&#46; En la estratificaci&#243;n por edad hemos empleado la aportada por los registros de Atenci&#243;n Primaria&#44; lo que puede suponer una limitaci&#243;n&#44; dado que el l&#237;mite de 55 a&#241;os es distinto de otras series y no permite comparaciones<span class="elsevierStyleBold">&#46;</span> Si bien el trabajo se ha llevado a cabo en un solo centro&#44; pensamos que la muestra es suficientemente representativa para que estos datos puedan ser extrapolables a otras zonas&#46; La fortaleza fundamental de este estudio es que los pacientes se han reclutado desde una consulta interdisciplinar&#44; en la que existe una protocolizaci&#243;n del diagn&#243;stico y seguimiento&#44; con lo que se han conseguido unos datos muy uniformes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusiones</span><p id="par0175" class="elsevierStylePara elsevierViewall">Con este estudio unic&#233;ntrico hemos analizado la prevalencia de AR-EPID sintom&#225;tica en nuestra &#225;rea&#44; la cual est&#225; por debajo del 2&#37;&#44; mucho menor de la descrita en otros trabajos&#44; probablemente en relaci&#243;n con las definiciones utilizadas&#46; As&#237; mismo&#44; hemos descrito que en nuestro medio el patr&#243;n NIU es el m&#225;s frecuente en pacientes con AR&#44; seguido del NINE y analizado por primera vez la prevalencia de SCEF en la AR&#44; que alcanza el 13&#37;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Financiaci&#243;n</span><p id="par0180" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de inter&#233;s relacionado directa o indirectamente con los contenidos del manuscrito&#46;</p></span></span>"
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    "fechaRecibido" => "2020-08-06"
    "fechaAceptado" => "2021-01-31"
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            0 => "Prevalencia"
            1 => "Artritis reumatoide"
            2 => "Enfermedad pulmonar intersticial difusa"
            3 => "Patrones radiol&#243;gicos"
            4 => "Factores de riesgo"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En Espa&#241;a&#44; los estudios epidemiol&#243;gicos de prevalencia de enfermedad pulmonar intersticial difusa &#40;EPID&#41; en artritis reumatoide &#40;AR&#41; son escasos y limitados&#46; Nuestro objetivo fue estimar la prevalencia de EPID sintom&#225;tica en AR y sus caracter&#237;sticas en nuestra &#225;rea&#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">Se dise&#241;&#243; un estudio observacional longitudinal prospectivo en la consulta interdisciplinar de Reumatolog&#237;a y Neumolog&#237;a&#44; en el que incluimos AR con s&#237;ntomas respiratorios y EPID confirmada por tomograf&#237;a computarizada de alta resoluci&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De las 2&#46;729 personas con AR de nuestra &#225;rea&#44; 47 presentaban EPID sintom&#225;tica&#44; estim&#225;ndose una prevalencia de EPID sintom&#225;tica en AR del 1&#44;72&#37; &#40;intervalo de confianza del 95&#37;&#58; 1&#44;26-2&#44;29&#41; con una edad al diagn&#243;stico de AR de 57&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;3 a&#241;os&#46; Fue m&#225;s frecuente en hombres&#44; el 60&#44;6&#37; ten&#237;a antecedente de tabaquismo y el 84&#44;3 y el 84&#44;7&#37; factor reumatoide y anticuerpos antip&#233;ptidos c&#237;clicos citrulinados&#44; respectivamente&#46; El patr&#243;n m&#225;s frecuente fue neumon&#237;a intersticial usual &#40;NIU&#41; en 28 &#40;31&#44;1&#37;&#41;&#44; la neumon&#237;a intersticial no espec&#237;fica &#40;NINE&#41; fue m&#225;s frecuente en mujeres y el s&#237;ndrome combinado enfisema-fibrosis &#40;SCEF&#41; exclusivamente en hombres&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En este estudio hemos analizado la prevalencia de AR-EPID sintom&#225;tica en nuestra &#225;rea&#44; la cual est&#225; por debajo de lo esperado&#44; probablemente en relaci&#243;n con las definiciones utilizadas&#46; As&#237; mismo&#44; hemos descrito que el patr&#243;n NIU es el m&#225;s frecuente en la AR&#44; seguido del NINE y analizado por primera vez la prevalencia de SCEF en la AR&#44; que alcanza el 13&#37;&#46;</p></span>"
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            "identificador" => "abst0010"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In Spain&#44; epidemiological studies of the prevalence of diffuse interstitial lung disease &#40;ILD&#41; in rheumatoid arthritis &#40;RA&#41; are limited&#46; Our objective was to estimate the prevalence of symptomatic ILD in RA and its characteristics in our area&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In our hospital&#39;s interdisciplinary rheumatology and pulmonology clinic&#44; a prospective longitudinal observational study was designed in which we included RA with respiratory symptoms and ILD confirmed by high resolution computed tomography&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 2&#44;729 people with RA in our area&#44; 47 had symptomatic ILD&#44; estimating a prevalence of symptomatic ILD in RA of 1&#46;72&#37; &#40;95&#37; CI 1&#46;26 - 2&#46;29&#41; with an age at diagnosis of RA of 57&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;3 years&#46; It was more frequent in men&#44; 60&#46;6&#37; had a history of smoking&#44; and 84&#46;3&#37; and 84&#46;7&#37; had rheumatoid factor &#40;RF&#41; and anti-cyclic citrullinated peptide &#40;Anti-CCP&#41; antibodies&#44; respectively&#46; The most frequent pattern was usual interstitial pneumonitis &#40;UIP&#41;&#44; appearing in 28 &#40;31&#46;1&#37;&#41;&#46; Nonspecific interstitial pneumonia &#40;NSIP&#41; was more frequent in women&#44; while the combined pulmonary fibrosis-emphysema &#40;CPFE&#41; syndrome presented exclusively in men&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We have analysed the prevalence of symptomatic RA-ILD in our area&#44; which is lower than expected&#44; probably in relation to the definitions used&#46; We have also described that the UIP pattern is the most frequent in RA in our environment&#44; followed by the NSIP&#46; Lastly&#44; we have analysed the prevalence of CPFE in RA&#44; which reaches 13&#37;&#44; for the first time&#46;</p></span>"
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                  \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">Edad al diagn&#243;stico&#44; m</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE &#40;a&#241;os&#41;</span>&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">90&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">57&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;3&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">FR positivo&#44; n &#40;&#37;&#41;</span>&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">89&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">75 &#40;84&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">T&#237;tulo FR&#44; m</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
                  \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">89&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">688&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;184&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">ACPA positivo&#44; n &#40;&#37;&#41;</span>&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">85&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 &#40;84&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">T&#237;tulo ACPA&#44; m</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
                  \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">85&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&#46;011&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;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"><span class="elsevierStyleItalic">Tabaquismo&#44; n &#40;&#37;&#41;</span>&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">89&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"><span class="elsevierStyleHsp" style=""></span>No fumador&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;39&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Exfumador&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;44&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Fumador&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;15&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">Sintomatolog&#237;a inicial&#44; n &#40;&#37;&#41;</span>&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">90&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"><span class="elsevierStyleHsp" style=""></span>Articular&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;89&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Pulmonar&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">Tiempo s&#237;ntomas articular-pulm&#243;n &#40;a&#241;os&#41;&#44; m</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
                  \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">80&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">11&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">Tiempo s&#237;ntomas pulm&#243;n-articular &#40;a&#241;os&#41;&#44; m</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
                  \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">10&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;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4&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">S&#237;ntomas y signos pulmonares&#44; n &#40;&#37;&#41;</span>&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">86&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"><span class="elsevierStyleHsp" style=""></span>Sin tos ni disnea&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;33&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Tos o disnea&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;51&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Tos y disnea&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;15&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Crepitantes&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">86&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">57 &#40;66&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">DLCO &#37; &#40;primera determinaci&#243;n&#41;&#44; m</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
                  \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">69&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;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;21&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">CVF &#37; &#40;primera determinaci&#243;n&#41;&#44; m</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
                  \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">69&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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                  """
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                  \t\t\t\t">Neumon&#237;a intersticial linfoide&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">0&#44;186&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\ttable-entry\n
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                  \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  " 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"><span class="elsevierStyleItalic">ACPA positivo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;82&#44;8&#41;&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">20 &#40;100&#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">0&#44;070&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">T&#237;tulo ACPA</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">624 &#40;56-1&#46;256&#41;&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">1&#46;350 &#40;312-1&#46;812&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;179&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  " 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\ttop\n
                  \t\t\t\t">&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;652&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>Exfumador&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">14 &#40;43&#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">6 &#40;30&#44;0&#41;&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="" 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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fumador&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">3 &#40;9&#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">2 &#40;10&#44;0&#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"><span class="elsevierStyleItalic">DLCO &#40;primera&#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">0&#44;73 &#40;0&#44;59-0&#44;91&#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;68 &#40;0&#44;54-0&#44;82&#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;526&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
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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;85 &#40;0&#44;77-0&#44;95&#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;94 &#40;0&#44;78-1&#44;09&#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;282&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">N&#243;dulos reumatoides&#44; n &#40;&#37;&#41;</span>&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 &#40;13&#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">1 &#40;5&#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">0&#44;636&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">S&#237;ndrome Sj&#246;gren secundario&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;10&#44;0&#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;10&#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">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
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                  \t\t\t\t"><span class="elsevierStyleItalic">T&#250;nel carpiano&#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
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ORIGINAL
Prevalencia y características clínicas de la enfermedad pulmonar intersticial difusa sintomática en la artritis reumatoide en una población española
Prevalence and clinical characteristics of symptomatic diffuse interstitial lung disease in rheumatoid arthritis in a Spanish population
M.G. Bonilla Hernána,
Autor para correspondencia
gemabonilla@ser.es

Autor para correspondencia.
, L. Gómez-Carrerab, M. Fernández-Velilla Peñac, R. Álvarez-Sala Waltherb, A. Balsaa
a Servicio de Reumatología, Hospital Universitario La Paz, Idipaz, Ciberes; Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
b Servicio de Neumología, Hospital Universitario La Paz, Idipaz, Ciberes; Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
c Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Idipaz, Ciberes; Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
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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 sist&#233;mica&#44; caracterizada por la inflamaci&#243;n cr&#243;nica de las articulaciones&#44; con su consecuente destrucci&#243;n&#44; deformidad e incapacidad<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#44; con manifestaciones extraarticulares que contribuyen a la morbimortalidad<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a>&#46; El pulm&#243;n es lugar habitual de afectaci&#243;n extraarticular&#44; cuya manifestaci&#243;n m&#225;s frecuente es la enfermedad pulmonar intersticial difusa &#40;EPID&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#46; Hasta un 58&#37; de los pacientes con AR pueden tener afectaci&#243;n pulmonar&#44; que se asocia con la mortalidad en un 10-20&#37; de casos<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Es de gran inter&#233;s conocer la prevalencia de la AR con EPID &#40;AR-EPID&#41; cl&#237;nica&#44; sus factores de riesgo y su forma de presentaci&#243;n&#46; En Espa&#241;a&#44; los estudios epidemiol&#243;gicos de prevalencia de AR-EPID son escasos y limitados<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a>&#44; y los estudios descriptivos de la afectaci&#243;n pulmonar incluyen pocos pacientes con AR<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En 2007 se inici&#243; en el Hospital Universitario La Paz &#40;HULP&#41; de Madrid una consulta pionera&#44; interdisciplinar&#44; entre los servicios de Reumatolog&#237;a y Neumolog&#237;a&#44; para la valoraci&#243;n conjunta de afectaci&#243;n pulmonar en enfermedades sist&#233;micas inmunomediadas&#44; integrada en la unidad de EPID del centro&#44; acreditada por la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41; como unidad interdisciplinar de alta complejidad&#46; Esto permite una recogida de datos estructurada que consigue estudiar la dimensi&#243;n total de esta enfermedad en nuestra zona&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es estimar la prevalencia de EPID sintom&#225;tica&#44; sus patrones radiol&#243;gicos en la AR y las caracter&#237;sticas de los pacientes que desarrollan s&#237;ntomas respiratorios&#44; en el &#225;rea sanitaria de un hospital de tercer nivel&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio observacional longitudinal prospectivo entre el 2007 y el 2018 en la consulta interdisciplinar de Reumatolog&#237;a y Neumolog&#237;a del HULP&#46; El protocolo fue aprobado por el comit&#233; &#233;tico de investigaci&#243;n del HULP&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Poblaci&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluy&#243; a los pacientes del &#225;rea y los estudiados en el servicio de Reumatolog&#237;a que cumpl&#237;an los criterios de AR de 1987 o de 2010<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8&#44;9</span></a> y que hubieran sido remitidos a la consulta interdisciplinar de Reumatolog&#237;a y Neumolog&#237;a con sospecha de EPID por s&#237;ntomas &#40;tos&#44; disnea&#41;&#44; signos &#40;auscultaci&#243;n patol&#243;gica&#41; o alteraci&#243;n en prueba de imagen&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Definici&#243;n de caso y recogida de datos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se defini&#243; EPID sintom&#225;tica si presentaba tos&#44; disnea o crepitantes en la auscultaci&#243;n pulmonar en un paciente con una tomograf&#237;a computarizada de alta resoluci&#243;n &#40;TCAR&#41; diagn&#243;stica de EPID&#46; Se excluy&#243; a pacientes con s&#237;ndrome de superposici&#243;n o con otras causas posibles de EPID&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se recogieron variables sociodemogr&#225;ficas y cl&#237;nicas&#44; tabaquismo&#44; tratamientos recibidos por la AR&#44; s&#237;ntomas respiratorios &#40;tos y disnea&#41;&#44; presencia de crepitantes&#44; t&#237;tulo de factor reumatoide &#40;FR&#41; y anticuerpos antip&#233;ptidos c&#237;clicos citrulinados &#40;ACPA&#41;&#44; pruebas de funci&#243;n respiratoria &#40;PFR&#41; y patrones radiol&#243;gicos por TCAR&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para las PFR se emple&#243; un equipo MasterLab-body 6&#46;0 &#40;Viasys&#44; Wuerzburg&#44; Alemania&#41;&#44; siguiendo las recomendaciones de la ATS&#47;ERS para la calibraci&#243;n y procedimientos de medida<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46; El procedimiento para la espirometr&#237;a lenta y forzada es el descrito por SEPAR<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a>&#46; Como valores de referencia se utilizaron los propuestos por la <span class="elsevierStyleItalic">Global Lung Initiative</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a>&#46; La capacidad de difusi&#243;n de mon&#243;xido de carbono &#40;DLCO&#41; se midi&#243; con el mismo equipo con la t&#233;cnica de respiraci&#243;n &#250;nica y se corrigi&#243; en funci&#243;n de la hemoglobina&#44; con los valores de referencia propuestos por Cotes<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a>&#46; La funci&#243;n pulmonar se consider&#243; anormal si la CVF o la DLCO eran menores del 80&#37;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de EPID fue mediante TCAR&#59; 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las PFR y los patrones radiol&#243;gicos&#46; La descripci&#243;n de la muestra se llev&#243; a cabo mediante medidas de tendencia central y de dispersi&#243;n para variables cuantitativas&#44; as&#237; como tablas de frecuencias y distribuci&#243;n de porcentajes para las cualitativas&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tras la descripci&#243;n de la muestra de an&#225;lisis&#44; se estim&#243; la prevalencia poblacional de EPID sintom&#225;tica en AR en los casos pertenecientes al &#225;rea de referencia del HULP&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Para el estudio de prevalencia de EPID se manej&#243; como denominador todas las AR aportadas por los centros de salud del &#225;rea vivos en octubre del 2018 y como numerador&#44; aquellos que presentaban EPID sintom&#225;tica&#46; Para calcular las prevalencias&#44; y su intervalo de confianza &#40;IC&#41; del 95&#37;&#44; se asumi&#243; una distribuci&#243;n de Poisson&#46; Los resultados se expresaron de forma global y por estratos de edad y sexo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En los pacientes con EPID se estableci&#243; 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&#40;NIU &#43; probable NIU&#41; vs&#46; &#40;NINE&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Comparamos las caracter&#237;sticas sociodemogr&#225;ficas y cl&#237;nicas&#44; y las PFR basal entre ambos grupos mediante pruebas de contraste de hip&#243;tesis para variables continuas &#40;t de Student o U de Mann-Whitney&#44; seg&#250;n su distribuci&#243;n&#41; y categ&#243;ricas &#40;chi al cuadrado&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se registraron 2&#46;729 casos de AR en el &#225;rea&#44; que supone una prevalencia de AR del 0&#44;62&#37;&#44; dentro de lo esperado&#46; El registro de AR-EPID sintom&#225;tica inclu&#237;a a 92 pacientes&#44; se eliminaron 2<span class="elsevierStyleHsp" style=""></span>&#40;una artritis idiop&#225;tica juvenil y una neumoconiosis&#41;&#46; De los 90 incluidos&#44; 69 pertenec&#237;an al &#225;rea del HULP y 47 segu&#237;an vivos en la fecha del estudio&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La prevalencia poblacional de AR-EPID sintom&#225;tica del &#225;rea del HULP se estim&#243; en un 1&#44;72&#37; &#40;IC del 95&#37;&#58; 1&#44;26-2&#44;29&#41;&#46; Por sexos&#44; fue mayor en varones &#40;3&#44;11&#37; vs&#46; 1&#44;23&#37;&#41;&#44; por grupos de edad&#44; el valor m&#225;s elevado se obtuvo en los menores de 55 a&#241;os respecto a los mayores de esta edad &#40;2&#44;20&#44; IC del 95&#37;&#58; 1&#44;28-3&#44;52 vs&#46; 1&#44;53&#44; IC del 95&#37;&#58; 1&#44;03-2&#44;19&#41;&#46; Si bien&#44; para el sexo los IC no solapan&#44; lo cual indica que la diferencia es estad&#237;sticamente significativa&#44; esto no ocurre con la edad y la diferencia observada puede deberse al azar &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra la descripci&#243;n de los 90 pacientes con AR y EPID de nuestra serie&#46; La edad media al diagn&#243;stico de la AR fue 57&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;3 a&#241;os y 49 &#40;48&#44;9&#37;&#41; eran mujeres&#46; La mayor&#237;a&#44; FR y ACPA positivos&#44; el 16&#37; fumadores y un 45&#37; exfumadores&#46; La afectaci&#243;n articular fue la sintomatolog&#237;a de inicio en 80 casos &#40;90&#37;&#41;&#44; con una mediana de tiempo transcurrido entre el inicio de los s&#237;ntomas articulares y respiratorios de 9&#44;9 a&#241;os&#46; En la visita basal el 23&#37; presentaba tos&#59; el 58&#37;&#44; disnea&#59; el 15&#44;2&#37;&#44; tos y disnea&#44; y el 66&#37;&#44; crepitantes&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">El patr&#243;n radiol&#243;gico m&#225;s frecuente fue NIU &#40;31&#37;&#41;&#44; seguido de NINE &#40;22&#37;&#41;&#44; el SCEF &#40;13&#37;&#41;&#44; el patr&#243;n inespec&#237;fico &#40;10&#37;&#41; y la NO y NIL &#40;6&#44;7&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En cuanto la distribuci&#243;n por sexo&#44; la NINE fue m&#225;s frecuente en mujeres &#40;34&#37; vs&#46; 13&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41; y el SCEF solo apareci&#243; en varones &#40;26&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Respecto a la edad&#44; se observ&#243; mayor frecuencia de NINE en los &#60;<span class="elsevierStyleHsp" style=""></span>55 a&#241;os &#40;32&#37; vs&#46; 14&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41; y el SCEF en el grupo de mayor edad &#40;20&#37; vs&#46; 5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; La NIU tambi&#233;n fue m&#225;s frecuente en mayores de 55 a&#241;os &#40;39&#37; vs&#46; 22&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;08&#41; pero no alcanz&#243; significaci&#243;n estad&#237;stica &#40;SE&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Al comparar por grupos radiol&#243;gicos&#44; NIU &#43; probable NIU frente NINE &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#44; la edad media al diagn&#243;stico en el grupo con NIU &#43; probable NIU era 64&#44;2 frente a 52&#44;3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#41; y la NINE fue m&#225;s frecuente en mujeres &#40;70 vs&#46; 51&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;186&#41; pero no alcanz&#243; SE &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;18&#41;&#46; Al comparar el patr&#243;n NINE con NIU &#43; probable NIU se observ&#243; que el t&#237;tulo de FR era mayor en pacientes con NINE &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;020&#41;&#46; Respecto a la DLCO y la CVF&#44; no encontramos diferencias significativas&#44; probablemente por el tama&#241;o de la muestra &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">En nuestro estudio se ha estimado una prevalencia de EPID en AR que es menor de la descrita en otras series<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a>&#44; confirm&#225;ndose que esta enfermedad es m&#225;s frecuente en fumadores y pacientes con FR y ACPA positivos y que la NIU es el patr&#243;n m&#225;s frecuente&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Aunque el estudio es de un solo centro&#44; se trata de un &#225;rea representativa amplia en la que los pacientes con AR son derivados en su casi totalidad a Reumatolog&#237;a &#40;con una prevalencia de AR del 0&#44;62 &#91;IC del 95&#37;&#58; 0&#44;60-0&#44;64&#93; seg&#250;n datos propios&#44; que cuadra con la estimada para la poblaci&#243;n general&#41;&#46; Adem&#225;s&#44; los pacientes atendidos en la consulta interdisciplinar provienen tanto de la consulta de Reumatolog&#237;a del hospital como de los centros de especialidades&#44; por lo que incluyen pacientes con AR con todo el espectro de gravedad de la enfermedad&#46; Por &#250;ltimo&#44; sus caracter&#237;sticas cl&#237;nicas son muy similares a las de otras series&#44; lo que apoya su representatividad&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La prevalencia de EPID en pacientes con AR var&#237;a del 1 al 67&#44;3&#37;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a>&#46; Estas diferencias no son sorprendentes&#44; por la gran cantidad de definiciones&#44; pruebas diagn&#243;sticas utilizadas<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a>&#44; criterios<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> e incluso debido al an&#225;lisis estad&#237;stico utilizado&#44; no reflejado siempre en los art&#237;culos<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a>&#46; La prevalencia es del 1 al 6&#37; si se utiliza radiograf&#237;a de t&#243;rax y del 5 al 67&#44;3&#37; si se realiza TCAR<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Hay que considerar que&#44; aunque la proporci&#243;n de pacientes con AR-EPID por TCAR es llamativa&#44; solo se considera cl&#237;nicamente significativa en el 5-10&#37;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a>&#46; Esto debe tenerse en cuenta&#44; ya que existe una brecha significativa entre el gran n&#250;mero de individuos asintom&#225;ticos con cambios pulmonares radiol&#243;gicos o funcionales y el de pacientes que finalmente desarrollar&#225; una EPID cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&#46; Kelly et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> realizaron un estudio en pacientes sintom&#225;ticos y diagnosticados por TCAR y obtuvieron un resultado del 2-3&#37; y&#44; en un trabajo que inclu&#237;a a pacientes con pleuritis o EPID&#44; Bartels et al&#46; publicaron unos resultados del 2&#37; en 1985 y del 4&#37; en el 2006<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En Espa&#241;a los &#250;nicos datos que disponemos de prevalencia de EPID en AR son los de la cohorte EMECAR<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a>&#44; con una prevalencia de 3&#44;7&#37; &#40;IC del 95&#37;&#58; 2&#44;4-5&#41;&#46; En este estudio los criterios de clasificaci&#243;n consist&#237;an en existencia de patr&#243;n restrictivo o hallazgos en TCAR indicativos de EPID&#44; pero sin hacer referencia a la cl&#237;nica&#46; Aunque recientemente se han publicado estudios descriptivos de AR-EPID en nuestro pa&#237;s<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;7</span></a>&#44; no hemos localizado otros trabajos que estimaran su prevalencia&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La prevalencia de AR-EPID sintom&#225;tica en nuestra &#225;rea es del 1&#44;72&#37; &#40;IC del 95&#37;&#58; 1&#44;26-2&#44;29&#41;&#44; comparable con los resultados de EMECAR<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> y con los del trabajo de Kelly et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Nuestro trabajo solo incluye a pacientes con s&#237;ntomas respiratorios en los que hemos confirmado EPID mediante TCAR&#46; Esto supone que nuestro estudio puede subestimar la prevalencia de AR-EPID&#46; Adem&#225;s&#44; el hecho de no seleccionar solo a pacientes con AR grave tambi&#233;n puede ser una explicaci&#243;n de esta baja prevalencia&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En la AR&#44; la afectaci&#243;n pulmonar es la primera manifestaci&#243;n en el 10-20&#37; de los pacientes<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#44; datos que coinciden con nuestros resultados&#44; donde 10 pacientes &#40;10&#37;&#41; iniciaron con cl&#237;nica respiratoria&#46; El inicio de la afectaci&#243;n pulmonar en la AR habitualmente ocurre hacia los 50-60 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> y la edad se considera un factor de riesgo de desarrollo de EPID&#46; Por otro lado&#44; la edad al diagn&#243;stico de AR tambi&#233;n se ha relacionado con EPID<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&#46; En nuestra serie&#44; la edad media al diagn&#243;stico de la AR fue 57 a&#241;os&#46; Llama la atenci&#243;n que la prevalencia de EPID sea m&#225;s elevada en menores de 55 a&#241;os que en los mayores&#44; si bien estas diferencias no son estad&#237;sticamente significativas&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Se ha descrito que&#44; adem&#225;s de la edad&#44; el tabaquismo&#44; el FR y los ACPA positivos&#44; especialmente a t&#237;tulos altos&#44; los antecedentes familiares de AR y ser var&#243;n son factores de riesgo de desarrollo de EPID en la AR<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#44;25-27</span></a>&#46; En nuestra serie&#44; el 61&#37; de los pacientes ten&#237;a antecedentes de tabaquismo y m&#225;s del 80&#37; ten&#237;a FR y ACPA positivos a t&#237;tulos altos&#44; lo cual cuadra con lo esperado&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En las enfermedades sist&#233;micas inmunomediadas el patr&#243;n NINE es el m&#225;s frecuente excepto en la AR&#44; donde es el NIU<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a>&#46; En nuestro trabajo&#44; es m&#225;s frecuente la NIU &#40;31&#44;1&#37;&#41;&#44; seguida de NINE &#40;22&#44;2&#37;&#41;&#44; con un patr&#243;n similar a otras publicaciones&#44; con cifras entorno al 40-60&#37; para NIU y al 11-30&#37; para NINE<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a>&#46; Cada vez hay m&#225;s datos que confirman que los pacientes con AR y patr&#243;n NIU tienen un fenotipo diferente que los pacientes con patrones no NIU&#46; La NIU es m&#225;s frecuente en varones&#44; mayores&#44; fumadores<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#44; mientras que el patr&#243;n NINE es casi 3<span class="elsevierStyleHsp" style=""></span>veces m&#225;s frecuente en mujeres<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a>&#46; Como en otros trabajos&#44; los pacientes con NIU o probable NIU son m&#225;s mayores al diagn&#243;stico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#41;&#44; son hombres con m&#225;s frecuencia &#40;48&#44;5 vs&#46; 30&#37;&#41; y existe m&#225;s el antecedente de tabaquismo que en el grupo NINE &#40;53&#44;1 vs&#46; 40&#37;&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los estudios sobre EPID en las enfermedades autoinmunes no han tenido en cuenta su coexistencia con enfisema&#44; por lo que no se conoce la frecuencia de SCEF en estas enfermedades<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a>&#46; En nuestro estudio&#44; el 13&#44;3&#37; de los pacientes muestran patr&#243;n de SCEF&#46; Tambi&#233;n hemos podido comprobar que se trata de pacientes con un fenotipo especial&#59; en nuestro trabajo todos eran varones&#44; fumadores y mayores de 55 a&#241;os&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Este trabajo tiene algunas limitaciones&#46; En la estratificaci&#243;n por edad hemos empleado la aportada por los registros de Atenci&#243;n Primaria&#44; lo que puede suponer una limitaci&#243;n&#44; dado que el l&#237;mite de 55 a&#241;os es distinto de otras series y no permite comparaciones<span class="elsevierStyleBold">&#46;</span> Si bien el trabajo se ha llevado a cabo en un solo centro&#44; pensamos que la muestra es suficientemente representativa para que estos datos puedan ser extrapolables a otras zonas&#46; La fortaleza fundamental de este estudio es que los pacientes se han reclutado desde una consulta interdisciplinar&#44; en la que existe una protocolizaci&#243;n del diagn&#243;stico y seguimiento&#44; con lo que se han conseguido unos datos muy uniformes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusiones</span><p id="par0175" class="elsevierStylePara elsevierViewall">Con este estudio unic&#233;ntrico hemos analizado la prevalencia de AR-EPID sintom&#225;tica en nuestra &#225;rea&#44; la cual est&#225; por debajo del 2&#37;&#44; mucho menor de la descrita en otros trabajos&#44; probablemente en relaci&#243;n con las definiciones utilizadas&#46; As&#237; mismo&#44; hemos descrito que en nuestro medio el patr&#243;n NIU es el m&#225;s frecuente en pacientes con AR&#44; seguido del NINE y analizado por primera vez la prevalencia de SCEF en la AR&#44; que alcanza el 13&#37;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Financiaci&#243;n</span><p id="par0180" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de inter&#233;s relacionado directa o indirectamente con los contenidos del manuscrito&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En Espa&#241;a&#44; los estudios epidemiol&#243;gicos de prevalencia de enfermedad pulmonar intersticial difusa &#40;EPID&#41; en artritis reumatoide &#40;AR&#41; son escasos y limitados&#46; Nuestro objetivo fue estimar la prevalencia de EPID sintom&#225;tica en AR y sus caracter&#237;sticas en nuestra &#225;rea&#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">Se dise&#241;&#243; un estudio observacional longitudinal prospectivo en la consulta interdisciplinar de Reumatolog&#237;a y Neumolog&#237;a&#44; en el que incluimos AR con s&#237;ntomas respiratorios y EPID confirmada por tomograf&#237;a computarizada de alta resoluci&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De las 2&#46;729 personas con AR de nuestra &#225;rea&#44; 47 presentaban EPID sintom&#225;tica&#44; estim&#225;ndose una prevalencia de EPID sintom&#225;tica en AR del 1&#44;72&#37; &#40;intervalo de confianza del 95&#37;&#58; 1&#44;26-2&#44;29&#41; con una edad al diagn&#243;stico de AR de 57&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;3 a&#241;os&#46; Fue m&#225;s frecuente en hombres&#44; el 60&#44;6&#37; ten&#237;a antecedente de tabaquismo y el 84&#44;3 y el 84&#44;7&#37; factor reumatoide y anticuerpos antip&#233;ptidos c&#237;clicos citrulinados&#44; respectivamente&#46; El patr&#243;n m&#225;s frecuente fue neumon&#237;a intersticial usual &#40;NIU&#41; en 28 &#40;31&#44;1&#37;&#41;&#44; la neumon&#237;a intersticial no espec&#237;fica &#40;NINE&#41; fue m&#225;s frecuente en mujeres y el s&#237;ndrome combinado enfisema-fibrosis &#40;SCEF&#41; exclusivamente en hombres&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En este estudio hemos analizado la prevalencia de AR-EPID sintom&#225;tica en nuestra &#225;rea&#44; la cual est&#225; por debajo de lo esperado&#44; probablemente en relaci&#243;n con las definiciones utilizadas&#46; As&#237; mismo&#44; hemos descrito que el patr&#243;n NIU es el m&#225;s frecuente en la AR&#44; seguido del NINE y analizado por primera vez la prevalencia de SCEF en la AR&#44; que alcanza el 13&#37;&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Antecedentes y objetivos"
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          1 => array:2 [
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            "titulo" => "Materiales y m&#233;todos"
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            "titulo" => "Conclusiones"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In Spain&#44; epidemiological studies of the prevalence of diffuse interstitial lung disease &#40;ILD&#41; in rheumatoid arthritis &#40;RA&#41; are limited&#46; Our objective was to estimate the prevalence of symptomatic ILD in RA and its characteristics in our area&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In our hospital&#39;s interdisciplinary rheumatology and pulmonology clinic&#44; a prospective longitudinal observational study was designed in which we included RA with respiratory symptoms and ILD confirmed by high resolution computed tomography&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 2&#44;729 people with RA in our area&#44; 47 had symptomatic ILD&#44; estimating a prevalence of symptomatic ILD in RA of 1&#46;72&#37; &#40;95&#37; CI 1&#46;26 - 2&#46;29&#41; with an age at diagnosis of RA of 57&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;3 years&#46; It was more frequent in men&#44; 60&#46;6&#37; had a history of smoking&#44; and 84&#46;3&#37; and 84&#46;7&#37; had rheumatoid factor &#40;RF&#41; and anti-cyclic citrullinated peptide &#40;Anti-CCP&#41; antibodies&#44; respectively&#46; The most frequent pattern was usual interstitial pneumonitis &#40;UIP&#41;&#44; appearing in 28 &#40;31&#46;1&#37;&#41;&#46; Nonspecific interstitial pneumonia &#40;NSIP&#41; was more frequent in women&#44; while the combined pulmonary fibrosis-emphysema &#40;CPFE&#41; syndrome presented exclusively in men&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We have analysed the prevalence of symptomatic RA-ILD in our area&#44; which is lower than expected&#44; probably in relation to the definitions used&#46; We have also described that the UIP pattern is the most frequent in RA in our environment&#44; followed by the NSIP&#46; Lastly&#44; we have analysed the prevalence of CPFE in RA&#44; which reaches 13&#37;&#44; for the first time&#46;</p></span>"
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            "titulo" => "Results"
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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"><span class="elsevierStyleItalic">ACPA positivo&#44; n &#40;&#37;&#41;</span>&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">85&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 &#40;84&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">T&#237;tulo ACPA&#44; m</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
                  \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">85&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&#46;011&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;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"><span class="elsevierStyleItalic">Tabaquismo&#44; n &#40;&#37;&#41;</span>&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">89&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"><span class="elsevierStyleHsp" style=""></span>No fumador&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;39&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Exfumador&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;44&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Fumador&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;15&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">Sintomatolog&#237;a inicial&#44; n &#40;&#37;&#41;</span>&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">90&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"><span class="elsevierStyleHsp" style=""></span>Articular&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;89&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Pulmonar&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">Tiempo s&#237;ntomas articular-pulm&#243;n &#40;a&#241;os&#41;&#44; m</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
                  \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">80&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">11&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">Tiempo s&#237;ntomas pulm&#243;n-articular &#40;a&#241;os&#41;&#44; m</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
                  \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">10&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;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4&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">S&#237;ntomas y signos pulmonares&#44; n &#40;&#37;&#41;</span>&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">86&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"><span class="elsevierStyleHsp" style=""></span>Sin tos ni disnea&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;33&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Tos o disnea&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;51&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Tos y disnea&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;15&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Crepitantes&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">86&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">57 &#40;66&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">DLCO &#37; &#40;primera determinaci&#243;n&#41;&#44; m</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
                  \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">69&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;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;21&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">CVF &#37; &#40;primera determinaci&#243;n&#41;&#44; m</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
                  \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">69&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;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;19&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">Inicio enfermedad-inicio tratamiento &#40;a&#241;os&#41;&#44; m</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
                  \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">86&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;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;3&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">Inicio enfermedad-inicio tratamiento &#40;meses&#41;&#44; m</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
                  \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">86&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">15&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>40&#44;5&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">Fallecimiento&#44; n &#40;&#37;&#41;</span>&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">84&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">26 &#40;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Descripci&#243;n de la muestra de pacientes con artritis reumatoide y enfermedad pulmonar intersticial difusa&#44; &#225;rea del Hospital Universitario La Paz &#40;Madrid&#41;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">NINE&#58; neumon&#237;a intersticial no espec&#237;fica&#59; NIU&#58; neumon&#237;a intersticial usual&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Global&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hombre&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&#41;&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#8805; 55 a&#241;os&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \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\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">NIU&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</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">14 &#40;30&#44;4&#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">0&#44;887&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;38&#44;8&#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">0&#44;086&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">Probable NIU&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;5&#44;6&#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;4&#44;3&#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">0&#44;673&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 &#40;6&#44;1&#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">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">NIU &#43; probable NIU&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">33 &#40;36&#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
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                  \t\t\t\t">16 &#40;34&#44;8&#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">0&#44;705&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">22 &#40;44&#44;9&#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">0&#44;076&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">S&#237;ndrome combinado enfisema-fibrosis&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">12 &#40;13&#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
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                  \t\t\t\t">12 &#40;26&#44;1&#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
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&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">10 &#40;20&#44;4&#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">0&#44;033&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">NINE&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">20 &#40;22&#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
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                  \t\t\t\t">6 &#40;13&#44;3&#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">0&#44;032&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">7 &#40;14&#44;3&#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">0&#44;048&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">Neumon&#237;a organizada&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">6 &#40;6&#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
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                  \t\t\t\t">2 &#40;4&#44;3&#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">0&#44;429&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 &#40;2&#44;0&#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">0&#44;054&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">Neumon&#237;a intersticial linfoide&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 &#40;6&#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">1 &#40;2&#44;2&#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
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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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#44;1&#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">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">Otras&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">13 &#40;14&#44;4&#41;&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">9 &#40;10&#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
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                  \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">1&#40;2&#44;3&#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
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                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
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        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Descripci&#243;n y distribuci&#243;n de patrones radiol&#243;gicos de enfermedad pulmonar intersticial difusa en artritis reumatoide &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>90&#41; global&#44; por sexo y grupo de edad</p>"
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        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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            "identificador" => "at4"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Variables continuas expresadas como mediana &#40;P<span class="elsevierStyleInf">25-75</span>&#41;&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">ACPA&#58; anticuerpos antip&#233;ptidos citrulinados&#59; CVF&#58; capacidad vital forzada&#59; DLCO&#58; capacidad de difusi&#243;n del CO&#59; FR&#58; factor reumatoide&#59; NINE&#58; neumon&#237;a intersticial no espec&#237;fica&#59; NIU&#58; neumon&#237;a intersticial usual&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">En negrita se expresan los datos estad&#237;sticamente significativos &#40;p &#60; 0&#44;05&#41;&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NINE&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#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\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">Edad al diagn&#243;stico &#40;a&#241;os&#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">64&#44;2 &#40;54&#44;0-69&#44;0&#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">52&#44;3 &#40;44&#44;8-64&#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"><span class="elsevierStyleBold">0&#44;039</span>&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"><span class="elsevierStyleItalic">Sexo mujer&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;51&#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;70&#44;0&#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;186&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">FR positivo&#44; n &#40;&#37;&#41;</span>&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">28 &#40;84&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;100&#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;144&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">T&#237;tulo FR</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">211 &#40;45-766&#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">620 &#40;236-1&#46;135&#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"><span class="elsevierStyleBold">0&#44;020</span>&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="elsevierStyleItalic">ACPA positivo&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;82&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;100&#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;070&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">T&#237;tulo ACPA</span>&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">624 &#40;56-1&#46;256&#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&#46;350 &#40;312-1&#46;812&#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;179&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
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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  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;43&#44;7&#41;&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">6 &#40;30&#44;0&#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\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;9&#44;4&#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">2 &#40;10&#44;0&#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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\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
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Evolving concepts of rheumatoid arthritis"
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                        "tituloSerie" => "Nature&#46;"
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ISSN: 00142565
Idioma original: Español
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