Lung involvement in rheumatologic diseases in children

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Pagán, A.J. Huertas, V. Iraola, H. Pinto, R. Martínez, M. Ramírez, M.D. Martos, J. Carnés" "autores" => array:8 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "Pagán" ] 1 => array:2 [ "nombre" => "A.J." "apellidos" => "Huertas" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Iraola" ] 3 => array:2 [ "nombre" => "H." "apellidos" => "Pinto" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Martínez" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Ramírez" ] 6 => array:2 [ "nombre" => "M.D." "apellidos" => "Martos" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Carnés" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054611001261?idApp=UINPBA00004N" "url" => "/03010546/0000004000000002/v1_201304101104/S0301054611001261/v1_201304101104/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S030105461100156X" "issn" => "03010546" "doi" => "10.1016/j.aller.2011.02.012" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "289" "copyright" => "SEICAP" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Allergol Immunopathol (Madr). 2012;40:81-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2218 "formatos" => array:3 [ "EPUB" => 6 "HTML" => 1767 "PDF" => 445 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "T-cell proliferation by surface molecules expression on polymorphonuclear neutrophils stimulated with IL-4 in superantigen presence" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "81" "paginaFinal" => "87" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2062 "Ancho" => 3243 "Tamanyo" => 138547 ] ] "descripcion" => array:1 [ "en" => "Changes in HLA class II (A), CD80 (B) and CD86 (C) expression on unstimulated and IL-4 stimulated PMN. Statistical analysis showed that, there is a significant difference between IL-4 stimulated cells and unstimulated cells, P<0.05." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B.K.A. Abdel-Salam" "autores" => array:1 [ 0 => array:2 [ "nombre" => "B.K.A." "apellidos" => "Abdel-Salam" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030105461100156X?idApp=UINPBA00004N" "url" => "/03010546/0000004000000002/v1_201304101104/S030105461100156X/v1_201304101104/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Lung involvement in rheumatologic diseases in children" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "88" "paginaFinal" => "91" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Quezada, S. Ramos, M. Garcia, X. Norambuena, D. Pavon" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Quezada" "email" => array:1 [ 0 => "aquezada@med.uchile.cl" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Ramos" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Garcia" ] 3 => array:2 [ "nombre" => "X." "apellidos" => "Norambuena" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Pavon" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "University of Chile, Santiago de Chile, Chile" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionLung function tests have been used for the diagnosis, monitoring and treatment evaluation of a number of chronic lung diseases in children, such as asthma, cystic fibrosis, and interstitial pneumonitis. For each of these methods, there are standard procedures and reference values adjusted to normal population by age, sex, and height.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a> Rheumatic diseases are a group of immunologically mediated inflammatory disorders associated with a large variety of affected organs.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>There are few descriptions of lung injuries in children with rheumatic disease, which incidentally may be affecting all its components such as airways, vessels, parenchyma, pleura, and respiratory muscles.<a class="elsevierStyleCrossRefs" href="#bib0020">4–9</a> Juvenile idiopathic arthritis, systemic lupus erythematosus, juvenile dermatomyositis, and systemic sclerosis are the most frequent rheumatic illnesses associated with lung compromise.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2,4,5</a>This impairment can be related to the illness itself, drugs used in treatment, or secondary to infections between others.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a>In adults, rheumatoid arthritis has been associated with mild restrictive defects, diffuse interstitial lung diseases, pulmonary vasculitis, and bronchiolitis obliterans. These alterations have also been observed in juvenile idiopathic arthritis.<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a>In childhood, lung impairment can be found in active diseases even in the absence of abnormalities in chest radiographs or in lung function tests such as diffusing capacity, lung volumes, low forced ventilatory flows and saturation in exercise.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>ObjectiveTo describe the lung function test and radiological findings in children in treatment for at least one year from diagnosis of some rheumatic disease stable in the preceding six months.MethodsStudy populationFourteen patients attending the Immunology Department of Exequiel Gonzalez Cortes Children's Hospital (Santiago, Chile) were enrolled: 11 diagnosed with juvenile idiopathic arthritis (JIA) of different clinical form (three systemic, two oligoarticular, two polyarticular, and four enthesitis-related arthritis) according to the International League Association for Rheumatology classification<a class="elsevierStyleCrossRef" href="#bib0060">12</a>; two diagnosed with systemic lupus erythematosus (SLE) according to American Rheumatology Academic criteria updated by Hochberg<a class="elsevierStyleCrossRef" href="#bib0065">13</a>; and one diagnosed with juvenile dermatomyositis (JDM) according to Pearson criteria modified by Bohan and Peter.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Age of onset and history of treatment were recorded. None had history of chronic lung disease before the onset of the rheumatic disease.Lung functionIn all patients spirometry was obtained using a Med Graphics Breeze V 3.7 spirometer, and the best values of at least three technically well-performed flow-volume curves were used. Reference values of Gutierrez for Chilean populations of healthy children 4–18 years were applied<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and range 80–120% for reference values were considered normal.Carbon monoxide diffusing capacity of lung (DLCO) and DLCO/alveolar volume (VA) were determined using a standardised single-breath technique (Master Screen Body V 4.3 Jaeger). Reference values from Zapletal for populations of healthy children aged 4–18 years were used<a class="elsevierStyleCrossRef" href="#bib0075">15</a> and range 80–120% for reference values were considered normalBlood arterial gases at rest and exercise were performed in the subjects before and after a run on a treadmill for three minutes after reaching submaximal heart rate. Reference values of Graef were used.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>In two cases with signs of hypoventilation, strength of respiratory muscles was assessed by measuring maximum static respiratory mouth pressures with a tube mouthpiece attached to pressure gauge. The absolute peak pressure for inspiratory effort (Pi max) was recorded and compared with reference values of Szeinberg.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> This test is used in our country as part of the evaluation of lung involvement in children with neuromuscular diseases.Radiology testChest radiography and chest high resolution computed tomography (HRCT) were interpreted by two blinded radiologists.The protocol was approved by the local Ethics Committee and written consent for participation in the study was obtained from their parents.Statistical analysesAll variables were presented as means±SD. The results from the lung function test were expressed as a percentage of reference values.Epi Info 6.0 and Stata 10.0 were used for data analysis. Percentages and Fisher exact test were used for qualitative nominal variables such as gender differences. T student test was applied for gauge variation with mean and standard deviation and average comparison.ResultsFourteen children were included (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Mean age was 13 years (range 7–18 years), nine females. Duration of disease was 4±2.8 years (range 1–11 years). Among these 14 children: nine had normal results in all lung function and radiologic tests (diagnoses JIA 8, JDM 1). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> details the treatment being received at time of study. Seven JIA patients were receiving methotrexate, as well as low doses of prednisone in four; two lupus patients were treated with cyclophosphamide pulses plus prednisone during pulmonary evaluations.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>In four cases (28.6%, SLE 2, JIA 2) we found abnormal test (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). One patient with SLE showed forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1) lower than reference values compatible with restrictive defects; in this case, the other lung function test and radiology test were abnormal too. She had reduction in DLCO and evidence of hypoventilation in blood arterial gases at rest and exercise, and the value of maximal inspiratory pressure (Pi max) was lower than the reference values. In the other SLE patient we found signs of hypoventilation in the blood arterial gases at rest and exercise. In this case the other lung function test was normal and the Pi max could not be performed by the child. One JIA with enthesitis-related clinical form (E-A) patient had reduction in DLCO and hypoventilation signs in blood arterial gas at rest and post exercise. In this case the maximal inspiratory pressure (Pi max) values were lower than the reference. One AIJ with systemic clinical form patient had hypoxemia in blood arterial gases at rest and low DLCO.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Radiological testIn two patients chest radiography and chest HRCT abnormalities were demonstrated: two SLE patients had pleural compromise. One of them was associated with sub-segmental atelectasis. One JIA case had an asymptomatic sub-pleural nodule but this observation was considered a normal finding because the other functional respiratory tests were also normal.We found no statistically significant risk factors for pulmonary injuries, probably due to the small number of cases.DiscussionIn our study, one third (4/14) of the patients had any grade of abnormalities in the lung function test and/or radiologist test even when they did not show clinical respiratory symptoms in the last six months. It is also remarkable that there were no respiratory clinical symptoms shown in four patients.In SLE patients, alterations compatible with early interstitial lung disease in DLCO were found without anomalies on HRCT at this stage. The hypoventilation found in two SLE patients is described in adult patients as a compromise of inspiratory muscles function associated with diaphragmatic dysfunction on the basis of the demonstration of decreased inspiratory muscles strength in eleven SLE patients for Wilcox.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> On the other hand, Laroche et al.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> failed to demonstrate diaphragm weakness. In children this alteration has also been described, but the origin is not yet clear.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3,20–25</a> We cannot rule out the possible side effects of corticosteroids used over long periods in the respiratory muscles weakness, even though we find no evidence for this statement. On the other hand the assessment of inspiratory muscles in children receiving steroid treatment for long periods has been not studied, so probably if this test was done routinely information could be gathered about this possibility.Lung compromise in children is infrequent in different following trials reporting 14–31% of pulmonary illness. The most common alteration is pleural compromise with pleural effusion in 12%; the interstitial pneumonitis had been considered a less common alteration with reports of between 1% and 14%.<a class="elsevierStyleCrossRefs" href="#bib0130">26,27</a>Lilleby et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> in a study including 46 SLE patients found abnormal DLCO in 26% as the most frequently abnormal lung function test and in one case this was associated to restrictive ventilatory pattern.The low frequency of HRCT abnormalities in relation to the DLCO test's alteration was also reported by Lilleby.The alterations in two JIA cases were compatible with early interstitial lung diseases, the most common features observed in adults with rheumatic disorders. However Knook at al.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> found no alteration in DLCO in 31 patients with juvenile idiopathic arthritis.Due to the small number of children studied, we were unable to assess the potential impact of drugs on lung function describes for methotrexate, non-steroidal anti-inflammatory drugs or corticosteroids, especially in adults.<a class="elsevierStyleCrossRefs" href="#bib0010">2,5,28</a> In this series, one JIA with systemic form had been in treatment for the last two years with methotrexate and methylprednisolone and the other JIA with E-A form received non-steroidal anti-inflammatory intermittent treatment during 20 months and methotrexate for 17 months.Although some bias could be attributable to small size and the heterogeneous population studied, the consecutive inclusion and prospective detailed pulmonary investigations with blinded review of test seem sufficient strength to us to guarantee the main conclusions.We suggest the routine evaluation of pulmonary function in all patients with rheumatic diseases at least once a year, even in the absence of respiratory symptoms, in order to detect early alteration, optimise the treatment and prevent possible related complications.Conflict of interestThe authors declare no potential conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres86084" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Objective" 3 => "Methods" 4 => "Results" 5 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec74247" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Objective" ] 4 => array:3 [ "identificador" => "sec0015" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Lung function" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Radiology test" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analyses" ] ] ] 5 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Radiological test" ] ] ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-12-17" "fechaAceptado" => "2011-02-14" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec74247" "palabras" => array:6 [ 0 => "Children" 1 => "Juvenile arthritis" 2 => "Juvenile dermatomyositis" 3 => "Lung" 4 => "Lupus" 5 => "Rheumatic diseases" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundLung involvement in rheumatologic disease in children has been described with low frequency. ObjectiveTo describe the lung function test and the radiological findings in a group of paediatric patients with rheumatologic diseases. MethodsDescriptive study. Pulmonary function was evaluated with spirometry, carbon monoxide diffusing capacity, blood arterial gas at rest and post exercise in addition to chest radiography and high resolution computed tomography were performed in children with rheumatologic disease. ResultsOf the fourteen patients studied: 11 were diagnosed with juvenile idiopathic arthritis (JIA), two with systemic lupus erythematosus (SLE), and one with juvenile dermatomyositis (JDM). Mean age: 13 years (range 7–18 years). Nine females, duration of disease 4±2.8 years (range 1–11 years). Four patients had any grade of abnormalities in one or more lung function tests and/or radiological test. ConclusionWe recommend routine checks of pulmonary function in all patients with rheumatologic diseases even in the absence of respiratory symptoms." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "JIA=juvenile idiopathic arthritis; S=systemic; O=oligoarticular; P=polyarticular; E-A=enthesitis-related; SLE=systemic lupus erythematosus; JDM=juvenile dermatomyositis." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">JIA S \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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">JIA O \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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">JIA P \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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">JIA E-A \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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">SLE \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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">JDM \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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Female \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">64.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Age years \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 (range 7–18) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Duration of disease years \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±2.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165430.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the study population." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "JIA=juvenile idiopathic arthritis; S=systemic; O=oligoarticular; P=polyarticular; E-A=enthesitis-related; SLE=systemic lupus erythematosus; JDM=juvenile dermatomyositis." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Number of cases \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Methotrexate \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Prednisone \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Azathioprine \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Non-steroidal anti-inflamatory \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">JIA S \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">JIA O \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">JIA P \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">JIA E-A \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">SLE \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">JDM \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165428.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Current pharmacological treatment." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "JIA=juvenile idiopathic arthritis; S=systemic; E-A=enthesitis-related; SLE=systemic lupus erythematosus; FVC=forced vital capacity; DL=diffusion lung; VA=ventilation alveolar; DLCO=diffusion lung carbon monoxide; R–E=rest–exercise; HRCT=high resolution computed tomography." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Spirometry \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">DLCO \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Blood arterial gases R–E \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">HRCT \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \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">F \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">SLE \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">Restrictive FVC 40% \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">Low DL/VA 20% \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">Hypoventilation \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">Subpleural thickness subsegmental atelectasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \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">F \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">SLE \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">Normal FVC 103% \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">Normal DL/VA 98% \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">Hypoventilation \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">Normal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \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">F \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">JIA S \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">Normal FVC 95% \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">Low DL/VA 55% \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">Hypoxemia \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">Cisural and subpleural thickness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \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">M \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">JIA E-A \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">Normal FCV 92.5% \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">Low DL/VA 76% \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">Hypoventilation \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">Normal \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165429.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results of abnormal lung function 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Original article

A. Quezada

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aquezada@med.uchile.cl

Corresponding author.

, S. Ramos, M. Garcia, X. Norambuena, D. Pavon

University of Chile, Santiago de Chile, Chile

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which incidentally may be affecting all its components such as airways&#44; vessels&#44; parenchyma&#44; pleura&#44; and respiratory muscles&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a> Juvenile idiopathic arthritis&#44; systemic lupus erythematosus&#44; juvenile dermatomyositis&#44; and systemic sclerosis are the most frequent rheumatic illnesses associated with lung compromise&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This impairment can be related to the illness itself&#44; drugs used in treatment&#44; or secondary to infections between others&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In adults&#44; rheumatoid arthritis has been associated with mild restrictive defects&#44; diffuse interstitial lung diseases&#44; pulmonary vasculitis&#44; and bronchiolitis obliterans&#46; These alterations have also been observed in juvenile idiopathic arthritis&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In childhood&#44; lung impairment can be found in active diseases even in the absence of abnormalities in chest radiographs or in lung function tests such as diffusing capacity&#44; lung volumes&#44; low forced ventilatory flows and saturation in exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Objective</span><p id="par0030" class="elsevierStylePara elsevierViewall">To describe the lung function test and radiological findings in children in treatment for at least one year from diagnosis of some rheumatic disease stable in the preceding six months&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study population</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fourteen patients attending the Immunology Department of Exequiel Gonzalez Cortes Children&#39;s Hospital &#40;Santiago&#44; Chile&#41; were enrolled&#58; 11 diagnosed with juvenile idiopathic arthritis &#40;JIA&#41; of different clinical form &#40;three systemic&#44; two oligoarticular&#44; two polyarticular&#44; and four enthesitis-related arthritis&#41; according to the International League Association for Rheumatology classification<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#59; two diagnosed with systemic lupus erythematosus &#40;SLE&#41; according to American Rheumatology Academic criteria updated by Hochberg<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#59; and one diagnosed with juvenile dermatomyositis &#40;JDM&#41; according to Pearson criteria modified by Bohan and Peter&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Age of onset and history of treatment were recorded&#46; None had history of chronic lung disease before the onset of the rheumatic disease&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Lung function</span><p id="par0040" class="elsevierStylePara elsevierViewall">In all patients spirometry was obtained using a Med Graphics Breeze V 3&#46;7 spirometer&#44; and the best values of at least three technically well-performed flow-volume curves were used&#46; Reference values of Gutierrez for Chilean populations of healthy children 4&#8211;18 years were applied<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and range 80&#8211;120&#37; for reference values were considered normal&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Carbon monoxide diffusing capacity of lung &#40;DLCO&#41; and DLCO&#47;alveolar volume &#40;VA&#41; were determined using a standardised single-breath technique &#40;Master Screen Body V 4&#46;3 Jaeger&#41;&#46; Reference values from Zapletal for populations of healthy children aged 4&#8211;18 years were used<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and range 80&#8211;120&#37; for reference values were considered normal</p><p id="par0050" class="elsevierStylePara elsevierViewall">Blood arterial gases at rest and exercise were performed in the subjects before and after a run on a treadmill for three minutes after reaching submaximal heart rate&#46; Reference values of Graef were used&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In two cases with signs of hypoventilation&#44; strength of respiratory muscles was assessed by measuring maximum static respiratory mouth pressures with a tube mouthpiece attached to pressure gauge&#46; The absolute peak pressure for inspiratory effort &#40;Pi max&#41; was recorded and compared with reference values of Szeinberg&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> This test is used in our country as part of the evaluation of lung involvement in children with neuromuscular diseases&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Radiology test</span><p id="par0060" class="elsevierStylePara elsevierViewall">Chest radiography and chest high resolution computed tomography &#40;HRCT&#41; were interpreted by two blinded radiologists&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The protocol was approved by the local Ethics Committee and written consent for participation in the study was obtained from their parents&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analyses</span><p id="par0070" class="elsevierStylePara elsevierViewall">All variables were presented as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46; The results from the lung function test were expressed as a percentage of reference values&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Epi Info 6&#46;0 and Stata 10&#46;0 were used for data analysis&#46; Percentages and Fisher exact test were used for qualitative nominal variables such as gender differences&#46; T student test was applied for gauge variation with mean and standard deviation and average comparison&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Fourteen children were included &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Mean age was 13 years &#40;range 7&#8211;18 years&#41;&#44; nine females&#46; Duration of disease was 4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8 years &#40;range 1&#8211;11 years&#41;&#46; Among these 14 children&#58; nine had normal results in all lung function and radiologic tests &#40;diagnoses JIA 8&#44; JDM 1&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> details the treatment being received at time of study&#46; Seven JIA patients were receiving methotrexate&#44; as well as low doses of prednisone in four&#59; two lupus patients were treated with cyclophosphamide pulses plus prednisone during pulmonary evaluations&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In four cases &#40;28&#46;6&#37;&#44; SLE 2&#44; JIA 2&#41; we found abnormal test &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; One patient with SLE showed forced vital capacity &#40;FVC&#41; and forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>s &#40;FEV<span class="elsevierStyleInf">1</span>&#41; lower than reference values compatible with restrictive defects&#59; in this case&#44; the other lung function test and radiology test were abnormal too&#46; She had reduction in DLCO and evidence of hypoventilation in blood arterial gases at rest and exercise&#44; and the value of maximal inspiratory pressure &#40;Pi max&#41; was lower than the reference values&#46; In the other SLE patient we found signs of hypoventilation in the blood arterial gases at rest and exercise&#46; In this case the other lung function test was normal and the Pi max could not be performed by the child&#46; One JIA with enthesitis-related clinical form &#40;E-A&#41; patient had reduction in DLCO and hypoventilation signs in blood arterial gas at rest and post exercise&#46; In this case the maximal inspiratory pressure &#40;Pi max&#41; values were lower than the reference&#46; One AIJ with systemic clinical form patient had hypoxemia in blood arterial gases at rest and low DLCO&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Radiological test</span><p id="par0090" class="elsevierStylePara elsevierViewall">In two patients chest radiography and chest HRCT abnormalities were demonstrated&#58; two SLE patients had pleural compromise&#46; One of them was associated with sub-segmental atelectasis&#46; One JIA case had an asymptomatic sub-pleural nodule but this observation was considered a normal finding because the other functional respiratory tests were also normal&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">We found no statistically significant risk factors for pulmonary injuries&#44; probably due to the small number of cases&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">In our study&#44; one third &#40;4&#47;14&#41; of the patients had any grade of abnormalities in the lung function test and&#47;or radiologist test even when they did not show clinical respiratory symptoms in the last six months&#46; It is also remarkable that there were no respiratory clinical symptoms shown in four patients&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In SLE patients&#44; alterations compatible with early interstitial lung disease in DLCO were found without anomalies on HRCT at this stage&#46; The hypoventilation found in two SLE patients is described in adult patients as a compromise of inspiratory muscles function associated with diaphragmatic dysfunction on the basis of the demonstration of decreased inspiratory muscles strength in eleven SLE patients for Wilcox&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> On the other hand&#44; Laroche et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> failed to demonstrate diaphragm weakness&#46; In children this alteration has also been described&#44; but the origin is not yet clear&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;20&#8211;25</span></a> We cannot rule out the possible side effects of corticosteroids used over long periods in the respiratory muscles weakness&#44; even though we find no evidence for this statement&#46; On the other hand the assessment of inspiratory muscles in children receiving steroid treatment for long periods has been not studied&#44; so probably if this test was done routinely information could be gathered about this possibility&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Lung compromise in children is infrequent in different following trials reporting 14&#8211;31&#37; of pulmonary illness&#46; The most common alteration is pleural compromise with pleural effusion in 12&#37;&#59; the interstitial pneumonitis had been considered a less common alteration with reports of between 1&#37; and 14&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Lilleby et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> in a study including 46 SLE patients found abnormal DLCO in 26&#37; as the most frequently abnormal lung function test and in one case this was associated to restrictive ventilatory pattern&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The low frequency of HRCT abnormalities in relation to the DLCO test&#39;s alteration was also reported by Lilleby&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The alterations in two JIA cases were compatible with early interstitial lung diseases&#44; the most common features observed in adults with rheumatic disorders&#46; However Knook at al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> found no alteration in DLCO in 31 patients with juvenile idiopathic arthritis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Due to the small number of children studied&#44; we were unable to assess the potential impact of drugs on lung function describes for methotrexate&#44; non-steroidal anti-inflammatory drugs or corticosteroids&#44; especially in adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5&#44;28</span></a> In this series&#44; one JIA with systemic form had been in treatment for the last two years with methotrexate and methylprednisolone and the other JIA with E-A form received non-steroidal anti-inflammatory intermittent treatment during 20 months and methotrexate for 17 months&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Although some bias could be attributable to small size and the heterogeneous population studied&#44; the consecutive inclusion and prospective detailed pulmonary investigations with blinded review of test seem sufficient strength to us to guarantee the main conclusions&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">We suggest the routine evaluation of pulmonary function in all patients with rheumatic diseases at least once a year&#44; even in the absence of respiratory symptoms&#44; in order to detect early alteration&#44; optimise the treatment and prevent possible related complications&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare no potential conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres86084"
          "titulo" => array:6 [
            0 => "Abstract"
            1 => "Background"
            2 => "Objective"
            3 => "Methods"
            4 => "Results"
            5 => "Conclusion"
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        1 => array:2 [
          "identificador" => "xpalclavsec74247"
          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Objective"
        ]
        4 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Study population"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Lung function"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Radiology test"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Statistical analyses"
            ]
          ]
        ]
        5 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Results"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Radiological test"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-12-17"
    "fechaAceptado" => "2011-02-14"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec74247"
          "palabras" => array:6 [
            0 => "Children"
            1 => "Juvenile arthritis"
            2 => "Juvenile dermatomyositis"
            3 => "Lung"
            4 => "Lupus"
            5 => "Rheumatic diseases"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lung involvement in rheumatologic disease in children has been described with low frequency&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the lung function test and the radiological findings in a group of paediatric patients with rheumatologic diseases&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Descriptive study&#46; Pulmonary function was evaluated with spirometry&#44; carbon monoxide diffusing capacity&#44; blood arterial gas at rest and post exercise in addition to chest radiography and high resolution computed tomography were performed in children with rheumatologic disease&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Of the fourteen patients studied&#58; 11 were diagnosed with juvenile idiopathic arthritis &#40;JIA&#41;&#44; two with systemic lupus erythematosus &#40;SLE&#41;&#44; and one with juvenile dermatomyositis &#40;JDM&#41;&#46; Mean age&#58; 13 years &#40;range 7&#8211;18 years&#41;&#46; Nine females&#44; duration of disease 4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8 years &#40;range 1&#8211;11 years&#41;&#46; Four patients had any grade of abnormalities in one or more lung function tests and&#47;or radiological test&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We recommend routine checks of pulmonary function in all patients with rheumatologic diseases even in the absence of respiratory symptoms&#46;</p>"
      ]
    ]
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">JIA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>juvenile idiopathic arthritis&#59; S<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>systemic&#59; O<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>oligoarticular&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>polyarticular&#59; E-A<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>enthesitis-related&#59; SLE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>systemic lupus erythematosus&#59; JDM<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>juvenile dermatomyositis&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">JIA S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">JIA O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">JIA P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">JIA E-A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">SLE&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">JDM&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&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">Female&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">64&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Age years&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;range 7&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Duration of disease years&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<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab165430.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the study population&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">JIA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>juvenile idiopathic arthritis&#59; S<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>systemic&#59; O<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>oligoarticular&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>polyarticular&#59; E-A<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>enthesitis-related&#59; SLE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>systemic lupus erythematosus&#59; JDM<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>juvenile dermatomyositis&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Number of cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Methotrexate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Prednisone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Cyclophosphamide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Azathioprine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Non-steroidal anti-inflamatory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">JIA S&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">JIA O&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">JIA P&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">JIA E-A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">SLE&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">JDM&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab165428.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Current pharmacological treatment&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">JIA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>juvenile idiopathic arthritis&#59; S<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>systemic&#59; E-A<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>enthesitis-related&#59; SLE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>systemic lupus erythematosus&#59; FVC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>forced vital capacity&#59; DL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>diffusion lung&#59; VA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>ventilation alveolar&#59; DLCO<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>diffusion lung carbon monoxide&#59; R&#8211;E<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>rest&#8211;exercise&#59; HRCT<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>high resolution computed tomography&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Spirometry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">DLCO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Blood arterial gases R&#8211;E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">HRCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&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">F&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">SLE&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">Restrictive FVC 40&#37;&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">Low DL&#47;VA 20&#37;&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">Hypoventilation&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">Subpleural thickness subsegmental atelectasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&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">F&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">SLE&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">Normal FVC 103&#37;&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">Normal DL&#47;VA 98&#37;&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">Hypoventilation&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">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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">F&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">JIA S&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">Normal FVC 95&#37;&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">Low DL&#47;VA 55&#37;&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">Hypoxemia&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">Cisural and subpleural thickness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&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">M&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">JIA E-A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal FCV 92&#46;5&#37;&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">Low DL&#47;VA 76&#37;&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">Hypoventilation&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">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                          "etal" => false
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Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2011.02.009

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	1	3
2024 October	26	13	39
2024 September	33	11	44
2024 August	37	12	49
2024 July	21	18	39
2024 June	23	4	27
2024 May	20	8	28
2024 April	23	9	32
2024 March	33	8	41
2024 February	26	11	37
2024 January	28	9	37
2023 December	23	4	27
2023 November	30	18	48
2023 October	27	13	40
2023 September	24	15	39
2023 August	27	6	33
2023 July	13	9	22
2023 June	20	4	24
2023 May	18	12	30
2023 April	14	7	21
2023 March	13	22	35
2023 February	8	6	14
2023 January	11	8	19
2022 December	11	5	16
2022 November	11	8	19
2022 October	15	8	23
2022 September	21	17	38
2022 August	13	24	37
2022 July	14	10	24
2022 June	8	11	19
2022 May	7	10	17
2022 April	16	12	28
2022 March	12	19	31
2022 February	9	15	24
2022 January	33	12	45
2021 December	11	21	32
2021 November	9	19	28
2021 October	11	41	52
2021 September	7	21	28
2021 August	3	9	12
2021 July	7	10	17
2021 June	12	12	24
2021 May	16	11	27
2021 April	17	16	33
2021 March	13	12	25
2021 February	6	14	20
2021 January	9	14	23
2020 December	1	3	4
2020 November	0	4	4
2020 October	0	4	4
2020 July	0	3	3
2020 May	0	11	11
2020 April	0	8	8
2020 March	0	7	7
2020 February	0	7	7
2020 January	0	2	2
2019 December	0	2	2
2019 November	0	1	1
2019 October	0	4	4
2019 September	0	2	2
2019 August	0	3	3
2019 July	0	8	8
2019 June	0	6	6
2019 May	0	44	44
2019 April	0	13	13
2019 March	0	3	3
2019 February	0	3	3
2019 January	0	1	1
2018 December	0	6	6
2018 July	0	1	1
2018 February	2	3	5
2018 January	1	4	5
2017 December	1	1	2
2017 November	4	3	7
2017 October	3	6	9
2017 September	5	15	20
2017 August	6	6	12
2017 July	5	6	11
2017 June	11	17	28
2017 May	12	12	24
2017 April	12	9	21
2017 March	10	50	60
2017 February	14	6	20
2017 January	10	10	20
2016 December	11	8	19
2016 November	7	8	15
2016 October	36	4	40
2016 September	13	14	27
2016 August	11	7	18
2016 July	5	1	6
2016 June	16	17	33
2016 May	4	4	8
2016 April	8	30	38
2016 March	17	18	35
2016 February	12	17	29
2016 January	9	16	25
2015 December	5	17	22
2015 November	5	17	22
2015 October	16	22	38
2015 September	4	12	16
2015 August	9	9	18
2015 July	13	16	29
2015 June	3	13	16
2015 May	5	4	9
2015 April	8	11	19
2015 March	6	10	16
2015 February	17	3	20
2015 January	17	5	22
2014 December	22	10	32
2014 November	13	5	18
2014 October	17	5	22
2014 September	23	8	31
2014 August	10	3	13
2014 July	6	2	8
2014 June	6	7	13
2014 May	7	3	10
2014 April	1	4	5
2014 March	24	16	40
2014 February	32	13	45
2014 January	26	8	34
2013 December	25	7	32
2013 November	17	7	24
2013 October	35	11	46
2013 September	29	13	42
2013 August	40	10	50
2013 July	42	10	52
2013 June	20	4	24
2013 May	29	5	34
2013 April	17	10	27
2013 March	20	5	25
2013 February	21	6	27
2013 January	13	3	16
2012 December	8	2	10
2012 November	2	3	5
2012 October	1	1	2
2012 September	1	1	2
2012 March	472	0	472

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