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Enlace permanente de la investigaciónConcomitant onset of systemic lupus erythematosus and disseminated histoplasmosis: a case-based review / Alicia Inés Hidrón Botero
Título : Concomitant onset of systemic lupus erythematosus and disseminated histoplasmosis: a case-based review Tipo de documento : documento electrónico Autores : Alicia Inés Hidrón Botero, Fecha de publicación : 2021 Títulos uniformes : Rheumatology International Idioma : Inglés (eng) Palabras clave : Capsulatum Histoplasma Histoplasmosis Systemic lupus erythematosus Resumen : Introduction: Concomitant infections during the debut or relapse of systemic lupus erythematosus are a common scenario, due to multiple mechanisms including the use of immunosuppressive drugs and autoimmunity per se. Invasive fungal infections are rare in systemic lupus erythematosus and are associated with profound immunosuppressed states. Disseminated histoplasmosis in patients with lupus has rarely been reported and the concomitant presentation of both entities is exceptional.Methods: We describe a case and performed a literature review in order to identify all case reports. A literature search was carried out using in PubMed/MEDLINE, EMBASE and Google Scholar (the first 200 relevant references) bibliographic databases. All available inclusion studies from January 1968 through July 2020. All data were tabulated, and outcomes were cumulatively analyzed.Results: Thirty-one additional cases were identified. Disseminated histoplasmosis was the most common clinical presentation and most cases have been reported in patients with a prior diagnosis of lupus in the setting of moderate to high steroid dose use, usually in combination with some other immunosuppressant. Description at systemic lupus disease onset was only reported in 3 cases with a high associated mortality. In our patient, severe disease activity, significant immunosuppression, malnutrition and multi-organ compromise conditioned the patient's fatal outcome. Conclusion: Histoplasmosis can closely mimic activity of lupus. Thus, early clinical recognition is important since a delay in diagnosis and treatment can lead to fatal outcomes. Mención de responsabilidad : Peinado-Acevedo Juan Sebastián, Varela Diana-Cristina, Hidrón Alicia Referencia : Rheumatol Int. 2021 Sep;41(9):1673-1680. DOI (Digital Object Identifier) : 10.1007/s00296-020-04739-6 PMID : 33150492 En línea : https://link.springer.com/article/10.1007/s00296-020-04739-6 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5180 Concomitant onset of systemic lupus erythematosus and disseminated histoplasmosis: a case-based review [documento electrónico] / Alicia Inés Hidrón Botero, . - 2021.
Obra : Rheumatology International
Idioma : Inglés (eng)
Palabras clave : Capsulatum Histoplasma Histoplasmosis Systemic lupus erythematosus Resumen : Introduction: Concomitant infections during the debut or relapse of systemic lupus erythematosus are a common scenario, due to multiple mechanisms including the use of immunosuppressive drugs and autoimmunity per se. Invasive fungal infections are rare in systemic lupus erythematosus and are associated with profound immunosuppressed states. Disseminated histoplasmosis in patients with lupus has rarely been reported and the concomitant presentation of both entities is exceptional.Methods: We describe a case and performed a literature review in order to identify all case reports. A literature search was carried out using in PubMed/MEDLINE, EMBASE and Google Scholar (the first 200 relevant references) bibliographic databases. All available inclusion studies from January 1968 through July 2020. All data were tabulated, and outcomes were cumulatively analyzed.Results: Thirty-one additional cases were identified. Disseminated histoplasmosis was the most common clinical presentation and most cases have been reported in patients with a prior diagnosis of lupus in the setting of moderate to high steroid dose use, usually in combination with some other immunosuppressant. Description at systemic lupus disease onset was only reported in 3 cases with a high associated mortality. In our patient, severe disease activity, significant immunosuppression, malnutrition and multi-organ compromise conditioned the patient's fatal outcome. Conclusion: Histoplasmosis can closely mimic activity of lupus. Thus, early clinical recognition is important since a delay in diagnosis and treatment can lead to fatal outcomes. Mención de responsabilidad : Peinado-Acevedo Juan Sebastián, Varela Diana-Cristina, Hidrón Alicia Referencia : Rheumatol Int. 2021 Sep;41(9):1673-1680. DOI (Digital Object Identifier) : 10.1007/s00296-020-04739-6 PMID : 33150492 En línea : https://link.springer.com/article/10.1007/s00296-020-04739-6 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5180 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001626 AC-2020-120 Archivo digital Producción Científica Artículos científicos Disponible
Título : Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study Tipo de documento : documento electrónico Autores : Ruth María Eraso Garnica, Fecha de publicación : 2021 Títulos uniformes : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Glucocorticoids Immunosuppressants Opportunistic infections Systemic lupus erythematosus Tuberculosis Resumen : Objective: To identify factors associated with active tuberculosis (TB) in patients with systemic lupus erythematosus (SLE). Methods: We performed a retrospective case-control study in two tertiary care teaching hospitals in Medellín, Colombia. From January 2007 to December 2017, a total of 268 patients with SLE were included. SLE patients with TB (cases) were matched 1:3 with SLE patients without TB (controls) by disease duration and the date of the hospitalization in which the diagnosis of TB was made (index date of cases) to the nearest available rheumatology hospitalization in the matched controls (± 2 years). Conditional univariable and multivariable logistic regression analyses were performed. Results: Sixty-seven cases and 201 controls were assessed. Only pulmonary TB occurred in 46.3%, only extrapulmonary TB in 16.4% and disseminated TB in 37.3% of cases. Multivariable logistic regression analysis showed that lymphopenia (OR, 2.91; 95% CI 1.41-6.03; P = 0.004), 12-month cumulative glucocorticoid dose ≥ 1830 mg (OR, 2.74; 95% CI 1.26-5.98; P = 0.011), and having been treated with ≥ 2 immunosuppressants during the last 12 months (OR, 2.81; 95% CI 1.16-6.82; P = 0.022) were associated with TB after adjusting for age, sex, ethnicity, disease duration, disease activity, and comorbidity index. A trend towards an association of kidney transplantation with TB was also found (OR, 3.77; 95% CI 0.99-14.30; P = 0.051). Conclusion: Among SLE patients, cumulative glucocorticoid dose, lymphopenia, and the use of ≥ 2 immunosuppressants during the last 12 months were associated with active TB infection. Key Points • Among SLE patients, a cumulative dose of glucocorticoids equivalent to 5 mg/day of prednisone during the last 12 months is independently associated with the development of TB. • The use of two or more immunosuppressants during the last 12 months is also a risk factor for TB infection development is SLE patients. • Lymphopenia is predominant in SLE patients with TB, being especially profound in those with disseminated TB. • Renal transplant recipients with SLE also have an elevated risk of TB. Mención de responsabilidad : Luis Alonso González-Naranjo, Jaime Alberto Coral-Enríquez, Mauricio Restrepo-Escobar, Carlos Horacio Muñoz-Vahos, Daniel Jaramillo-Arroyave, Adriana Lucía Vanegas-García, Ruth Eraso, Gloria Vásquez & Fabián Jaimes Referencia : Clin Rheumatol. 2021 Jan;40(1):181-191. DOI (Digital Object Identifier) : 10.1007/s10067-020-05225-x PMID : 32529420 En línea : https://link.springer.com/article/10.1007%2Fs10067-020-05225-x Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5753 Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study [documento electrónico] / Ruth María Eraso Garnica, . - 2021.
Obra : Clinical Rheumatology
Idioma : Inglés (eng)
Palabras clave : Glucocorticoids Immunosuppressants Opportunistic infections Systemic lupus erythematosus Tuberculosis Resumen : Objective: To identify factors associated with active tuberculosis (TB) in patients with systemic lupus erythematosus (SLE). Methods: We performed a retrospective case-control study in two tertiary care teaching hospitals in Medellín, Colombia. From January 2007 to December 2017, a total of 268 patients with SLE were included. SLE patients with TB (cases) were matched 1:3 with SLE patients without TB (controls) by disease duration and the date of the hospitalization in which the diagnosis of TB was made (index date of cases) to the nearest available rheumatology hospitalization in the matched controls (± 2 years). Conditional univariable and multivariable logistic regression analyses were performed. Results: Sixty-seven cases and 201 controls were assessed. Only pulmonary TB occurred in 46.3%, only extrapulmonary TB in 16.4% and disseminated TB in 37.3% of cases. Multivariable logistic regression analysis showed that lymphopenia (OR, 2.91; 95% CI 1.41-6.03; P = 0.004), 12-month cumulative glucocorticoid dose ≥ 1830 mg (OR, 2.74; 95% CI 1.26-5.98; P = 0.011), and having been treated with ≥ 2 immunosuppressants during the last 12 months (OR, 2.81; 95% CI 1.16-6.82; P = 0.022) were associated with TB after adjusting for age, sex, ethnicity, disease duration, disease activity, and comorbidity index. A trend towards an association of kidney transplantation with TB was also found (OR, 3.77; 95% CI 0.99-14.30; P = 0.051). Conclusion: Among SLE patients, cumulative glucocorticoid dose, lymphopenia, and the use of ≥ 2 immunosuppressants during the last 12 months were associated with active TB infection. Key Points • Among SLE patients, a cumulative dose of glucocorticoids equivalent to 5 mg/day of prednisone during the last 12 months is independently associated with the development of TB. • The use of two or more immunosuppressants during the last 12 months is also a risk factor for TB infection development is SLE patients. • Lymphopenia is predominant in SLE patients with TB, being especially profound in those with disseminated TB. • Renal transplant recipients with SLE also have an elevated risk of TB. Mención de responsabilidad : Luis Alonso González-Naranjo, Jaime Alberto Coral-Enríquez, Mauricio Restrepo-Escobar, Carlos Horacio Muñoz-Vahos, Daniel Jaramillo-Arroyave, Adriana Lucía Vanegas-García, Ruth Eraso, Gloria Vásquez & Fabián Jaimes Referencia : Clin Rheumatol. 2021 Jan;40(1):181-191. DOI (Digital Object Identifier) : 10.1007/s10067-020-05225-x PMID : 32529420 En línea : https://link.springer.com/article/10.1007%2Fs10067-020-05225-x Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5753 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001648 AC-2021-004 Archivo digital Producción Científica Artículos científicos Disponible
Título : Predictive models of infection in patients with systemic lupus erythematosus: A systematic literature review Tipo de documento : documento electrónico Autores : Paula Andrea Granda Carvajal, Fecha de publicación : 2021 Títulos uniformes : Lupus Idioma : Inglés (eng) Palabras clave : Systemic lupus erythematosus clinical prediction models infection prognosis systematic literature review Resumen : Introduction: Having reliable predictive models of prognosis/the risk of infection in systemic lupus erythematosus (SLE) patients would allow this problem to be addressed on an individual basis to study and implement possible preventive or therapeutic interventions. Objective: To identify and analyze all predictive models of prognosis/the risk of infection in patients with SLE that exist in medical literature. Methods: A structured search in PubMed, Embase, and LILACS databases was carried out until May 9, 2020. In addition, a search for abstracts in the American Congress of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual meetings' archives published over the past eight years was also conducted. Studies on developing, validating or updating predictive prognostic models carried out in patients with SLE, in which the outcome to be predicted is some type of infection, that were generated in any clinical context and with any time horizon were included. There were no restrictions on language, date, or status of the publication. To carry out the systematic review, the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) guideline recommendations were followed. The PROBAST tool (A Tool to Assess the Risk of Bias and Applicability of Prediction Model Studies) was used to assess the risk of bias and the applicability of each model. Results: We identified four models of infection prognosis in patients with SLE. Mostly, there were very few events per candidate predictor. In addition, to construct the models, an initial selection was made based on univariate analyses with no contraction of the estimated coefficients being carried out. This suggests that the proposed models have a high probability of overfitting and being optimistic. Conclusions: To date, very few prognostic models have been published on the infection of SLE patients. These models are very heterogeneous and are rated as having a high risk of bias and methodological weaknesses. Despite the widespread recognition of the frequency and severity of infections in SLE patients, there is no reliable predictive prognostic model that facilitates the study and implementation of personalized preventive or therapeutic measures.Protocol registration number: PROSPERO CRD42020171638. Mención de responsabilidad : Mauricio Restrepo-Escobar, Paula A Granda-Carvajal, Daniel C Aguirre, Johanna Hernández-Zapata, Gloria M Vásquez, Fabián Jaimes Referencia : Lupus. 2021 Mar;30(3):421-430. DOI (Digital Object Identifier) : 10.1177/0961203320983462 PMID : 33407048 En línea : https://journals.sagepub.com/doi/10.1177/0961203320983462 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5763 Predictive models of infection in patients with systemic lupus erythematosus: A systematic literature review [documento electrónico] / Paula Andrea Granda Carvajal, . - 2021.
Obra : Lupus
Idioma : Inglés (eng)
Palabras clave : Systemic lupus erythematosus clinical prediction models infection prognosis systematic literature review Resumen : Introduction: Having reliable predictive models of prognosis/the risk of infection in systemic lupus erythematosus (SLE) patients would allow this problem to be addressed on an individual basis to study and implement possible preventive or therapeutic interventions. Objective: To identify and analyze all predictive models of prognosis/the risk of infection in patients with SLE that exist in medical literature. Methods: A structured search in PubMed, Embase, and LILACS databases was carried out until May 9, 2020. In addition, a search for abstracts in the American Congress of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual meetings' archives published over the past eight years was also conducted. Studies on developing, validating or updating predictive prognostic models carried out in patients with SLE, in which the outcome to be predicted is some type of infection, that were generated in any clinical context and with any time horizon were included. There were no restrictions on language, date, or status of the publication. To carry out the systematic review, the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) guideline recommendations were followed. The PROBAST tool (A Tool to Assess the Risk of Bias and Applicability of Prediction Model Studies) was used to assess the risk of bias and the applicability of each model. Results: We identified four models of infection prognosis in patients with SLE. Mostly, there were very few events per candidate predictor. In addition, to construct the models, an initial selection was made based on univariate analyses with no contraction of the estimated coefficients being carried out. This suggests that the proposed models have a high probability of overfitting and being optimistic. Conclusions: To date, very few prognostic models have been published on the infection of SLE patients. These models are very heterogeneous and are rated as having a high risk of bias and methodological weaknesses. Despite the widespread recognition of the frequency and severity of infections in SLE patients, there is no reliable predictive prognostic model that facilitates the study and implementation of personalized preventive or therapeutic measures.Protocol registration number: PROSPERO CRD42020171638. Mención de responsabilidad : Mauricio Restrepo-Escobar, Paula A Granda-Carvajal, Daniel C Aguirre, Johanna Hernández-Zapata, Gloria M Vásquez, Fabián Jaimes Referencia : Lupus. 2021 Mar;30(3):421-430. DOI (Digital Object Identifier) : 10.1177/0961203320983462 PMID : 33407048 En línea : https://journals.sagepub.com/doi/10.1177/0961203320983462 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5763 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001688 AC-2021-014 Archivo digital Producción Científica Artículos científicos Disponible
Título : Development and Internal Validation of a Prediction Model to Estimate the Probability of Needing Aggressive Immunosuppressive Therapy With Cytostatics in de Novo Lupus Nephritis Patients Otros títulos : Desarrollo y validación interna de un modelo de predicción para estimar la probabilidad de requerir inmunosupresión intensiva con citostáticos en pacientes con nefritis lúpica de novo Tipo de documento : documento electrónico Autores : Mauricio Restrepo Escobar, ; Paula Andrea Granda Carvajal, ; Fabián Alberto Jaimes Barragán, Fecha de publicación : 2019 Títulos uniformes : Reumatología Clínica Idioma : Inglés (eng) Palabras clave : Systemic lupus erythematosus lupus nephritis immunosuppression multivariate analysis decision support techniques logistic models Resumen : Objective: To develop a multivariable clinical prediction model for the requirement of aggressive immunosuppression with cytostatics, based on simple clinical record data and lab tests. The model is defined in accordance with the result of the kidney biopsies. Methods: Retrospective study conducted with data from patients 16 years and older, with SLE and nephritis with less than 6 months of evolution. An initial bivariate analysis was conducted to select the variables to be included in a multiple logistic regression model. Goodness of fit was evaluated using a Hosmer–Lemeshow test (H–L) and the discrimination capacity of the model by means of the area under the ROC (AUC) curve. Results: Data from 242 patients was gathered; of these, 18.2% (n = 44) did not need an addition of cytostatics according to the findings of their kidney biopsies. The variables included in the final model were 24-h proteinuria, diastolic blood pressure, creatinine, C3 complement and the interaction of hematuria with leukocyturia in urinary sediment. The model showed excellent discrimination (AUC = 0.929; 95% CI = 0.894–0.963) and adequate calibration (H–L, P = .959). Conclusion: In recent-onset LN patients, the decision to use or not to use intensive immunosuppressive therapy could be performed based on our prediction model as an alternative to kidney biopsies. Mención de responsabilidad : Mauricio Restrepo-Escobar, Paula Andrea Granda-Carvajal, Fabián Jaimes Referencia : Reumatol Clin. 2019 Jan - Feb;15(1):27-33. DOI (Digital Object Identifier) : 10.1016/j.reuma.2017.05.010 PMID : 28732643 En línea : https://www.reumatologiaclinica.org/en-linkresolver-development-internal-validat [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4052 Development and Internal Validation of a Prediction Model to Estimate the Probability of Needing Aggressive Immunosuppressive Therapy With Cytostatics in de Novo Lupus Nephritis Patients = Desarrollo y validación interna de un modelo de predicción para estimar la probabilidad de requerir inmunosupresión intensiva con citostáticos en pacientes con nefritis lúpica de novo [documento electrónico] / Mauricio Restrepo Escobar, ; Paula Andrea Granda Carvajal, ; Fabián Alberto Jaimes Barragán, . - 2019.
Obra : Reumatología Clínica
Idioma : Inglés (eng)
Palabras clave : Systemic lupus erythematosus lupus nephritis immunosuppression multivariate analysis decision support techniques logistic models Resumen : Objective: To develop a multivariable clinical prediction model for the requirement of aggressive immunosuppression with cytostatics, based on simple clinical record data and lab tests. The model is defined in accordance with the result of the kidney biopsies. Methods: Retrospective study conducted with data from patients 16 years and older, with SLE and nephritis with less than 6 months of evolution. An initial bivariate analysis was conducted to select the variables to be included in a multiple logistic regression model. Goodness of fit was evaluated using a Hosmer–Lemeshow test (H–L) and the discrimination capacity of the model by means of the area under the ROC (AUC) curve. Results: Data from 242 patients was gathered; of these, 18.2% (n = 44) did not need an addition of cytostatics according to the findings of their kidney biopsies. The variables included in the final model were 24-h proteinuria, diastolic blood pressure, creatinine, C3 complement and the interaction of hematuria with leukocyturia in urinary sediment. The model showed excellent discrimination (AUC = 0.929; 95% CI = 0.894–0.963) and adequate calibration (H–L, P = .959). Conclusion: In recent-onset LN patients, the decision to use or not to use intensive immunosuppressive therapy could be performed based on our prediction model as an alternative to kidney biopsies. Mención de responsabilidad : Mauricio Restrepo-Escobar, Paula Andrea Granda-Carvajal, Fabián Jaimes Referencia : Reumatol Clin. 2019 Jan - Feb;15(1):27-33. DOI (Digital Object Identifier) : 10.1016/j.reuma.2017.05.010 PMID : 28732643 En línea : https://www.reumatologiaclinica.org/en-linkresolver-development-internal-validat [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4052 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD000652 AC-2017-041 Archivo digital Producción Científica Artículos científicos Disponible
Título : Antiphospholipid antibodies, steroid dose, arterial hypertension, relapses, and late-onset predict organ damage in a population of Colombian patients with systemic lupus erythematosus Tipo de documento : documento electrónico Autores : Luis Fernando Pinto Peñaranda, ; Carolina Muñoz Grajales, ; Mónica Zuluaga Quintero, ; Andrés Felipe Echeverri García, ; Javier Darío Márquez Hernández, Fecha de publicación : 2018 Títulos uniformes : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Organ damage SLICC/ACR SDI systemic lupus erythematosus Resumen : Organ damage predicts mortality, increased accrual of detriment, and poor quality of life in systemic lupus erythematosus patients. The objective of this study is to determine the damage-free survival and its predictive factors in a population of Colombian subjects. The method used in this study is the retrospective follow-up of a cohort; damage was measured with SLICC/ACR index. Predictors of impairment were assessed by logistic regression and survival analysis. One hundred sixty-one individuals were included; 28.9% suffered damage, primarily neuropsychiatric, renal, and vascular. Arterial hypertension, antiphospholipid antibodies, prednisone dose, and number of relapses were all predictors of detriment. Onset after age 50 and daily prednisone dose higher than 7.5 mg determined earlier occurrence of damage. Mención de responsabilidad : Luis F Pinto-Peñaranda, C Muñoz-Grajales, A F Echeverri Garcia, C J Velásquez-Franco, M A Mesa-Navas, M Zuluaga Quintero, S Herrera-Uribe, J D Márquez-Hernández Referencia : Clin Rheumatol. 2018 Apr;37(4):949-954. DOI (Digital Object Identifier) : 10.1007/s10067-017-3927-8 PMID : 29204758 En línea : https://link.springer.com/article/10.1007%2Fs10067-017-3927-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4200 Antiphospholipid antibodies, steroid dose, arterial hypertension, relapses, and late-onset predict organ damage in a population of Colombian patients with systemic lupus erythematosus [documento electrónico] / Luis Fernando Pinto Peñaranda, ; Carolina Muñoz Grajales, ; Mónica Zuluaga Quintero, ; Andrés Felipe Echeverri García, ; Javier Darío Márquez Hernández, . - 2018.
Obra : Clinical Rheumatology
Idioma : Inglés (eng)
Palabras clave : Organ damage SLICC/ACR SDI systemic lupus erythematosus Resumen : Organ damage predicts mortality, increased accrual of detriment, and poor quality of life in systemic lupus erythematosus patients. The objective of this study is to determine the damage-free survival and its predictive factors in a population of Colombian subjects. The method used in this study is the retrospective follow-up of a cohort; damage was measured with SLICC/ACR index. Predictors of impairment were assessed by logistic regression and survival analysis. One hundred sixty-one individuals were included; 28.9% suffered damage, primarily neuropsychiatric, renal, and vascular. Arterial hypertension, antiphospholipid antibodies, prednisone dose, and number of relapses were all predictors of detriment. Onset after age 50 and daily prednisone dose higher than 7.5 mg determined earlier occurrence of damage. Mención de responsabilidad : Luis F Pinto-Peñaranda, C Muñoz-Grajales, A F Echeverri Garcia, C J Velásquez-Franco, M A Mesa-Navas, M Zuluaga Quintero, S Herrera-Uribe, J D Márquez-Hernández Referencia : Clin Rheumatol. 2018 Apr;37(4):949-954. DOI (Digital Object Identifier) : 10.1007/s10067-017-3927-8 PMID : 29204758 En línea : https://link.springer.com/article/10.1007%2Fs10067-017-3927-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4200 Reserva
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