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array:22 [ "pii" => "S0025775322000835" "issn" => "00257753" "doi" => "10.1016/j.medcli.2022.02.003" "estado" => "S300" "fechaPublicacion" => "2022-07-08" "aid" => "5927" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2022;159:57" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:18 [ "pii" => "S0025775322000859" "issn" => "00257753" "doi" => "10.1016/j.medcli.2022.02.004" "estado" => "S300" "fechaPublicacion" => "2022-07-08" "aid" => "5928" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2022;159:56" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen médica</span>" "titulo" => "Filariasis orbitaria" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "56" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Orbital filariasis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 883 "Ancho" => 1500 "Tamanyo" => 161494 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Sánchez-Vela, Marta Garrido-Marín, Bernardo F. Sánchez-Dalmau" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Sánchez-Vela" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Garrido-Marín" ] 2 => array:2 [ "nombre" => "Bernardo F." "apellidos" => "Sánchez-Dalmau" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775322000859?idApp=UINPBA00004N" "url" => "/00257753/0000015900000001/v1_202206300527/S0025775322000859/v1_202206300527/es/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in medicine</span>" "titulo" => "Mechanic's hand: Tip of the iceberg in evolving connective tissue disorders" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "57" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Aiman Perween Afsar, Latika Gupta" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Aiman Perween" "apellidos" => "Afsar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Latika" "apellidos" => "Gupta" "email" => array:1 [ 0 => "drlatikagupta@gmail.com" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Maulana Azad Medical College, New Delhi, India" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "City Hospital Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manos de mecánico: La punta del <span class="elsevierStyleItalic">iceberg</span> en la evolución de los trastornos del tejido conectivo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 479 "Ancho" => 1740 "Tamanyo" => 154280 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 39-year-old female diagnosed with rheumatoid arthritis presented to the outpatient clinic with mechanic's hands (MH) on both thumbs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) and left forefinger (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) raising suspicion for undiagnosed anti-synthetase syndrome (ASSD). However, muscle strength and chest examination were normal and HRCT chest ruled out silent ILD (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Labs suggested positive anti-CCP antibodies (44.3 units), rheumatoid factor (107 units), and high C-reactive protein (6.95<span class="elsevierStyleHsp" style=""></span>mg/L), while hand radiographs depicted erosive arthritis and juxta-articular osteopenia. On myositis profile, anti-PM/Scl antibodies were positive.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">MH are thought to indicate a diagnosis of ASSD, although the organ involvement at the outset may be limited, with progression to the full spectrum of the syndrome in 25–50% of patients per year. However, recent research suggests that MH may not be a sine qua non for ASSD, rather way more common in other connective tissue diseases (CTDs). Notably, patients with anti-PM/Scl-positive CTDs may often exhibit MH. Furthermore, anti-PM/Scl positive myositis is known to share pathogenetic and genetic predispositions with ASSD.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore, cases with seropositive arthritis with the classic radiograph picture may have underlying undiagnosed CTD with future prognostic implications.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 479 "Ancho" => 1740 "Tamanyo" => 154280 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000015900000001/v1_202206300527/S0025775322000835/v1_202206300527/en/main.assets" "Apartado" => array:4 [ "identificador" => "93344" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imágenes médicas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015900000001/v1_202206300527/S0025775322000835/v1_202206300527/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775322000835?idApp=UINPBA00004N" ]
