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RF-2019 Classification Criteria for Systemic Lupus Erythematosus
FR-Criterios de clasificación 2019 del lupus eritematoso sistémico
L. Serra-García, P.J. Barba, D. Morgado-Carrasco
Corresponding author
Departamento de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
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Serra-García, P.J. Barba, D. Morgado-Carrasco" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Serra-García" ] 1 => array:2 [ "nombre" => "P.J." "apellidos" => "Barba" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021003720?idApp=UINPBA000044" "url" => "/00017310/0000011300000003/v2_202212210529/S0001731021003720/v2_202212210529/es/main.assets" ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => " RF-2019 Classification Criteria for Systemic Lupus Erythematosus" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T310" "paginaFinal" => "T312" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Serra-García, P.J. Barba, D. Morgado-Carrasco" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Serra-García" ] 1 => array:2 [ "nombre" => "P.J." "apellidos" => "Barba" ] 2 => array:4 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" "email" => array:1 [ 0 => "danielmorgado@yahoo.com.ar" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR-Criterios de clasificación 2019 del lupus eritematoso sistémico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with a broad spectrum of clinical and immunological manifestations, that is difficult to diagnose. The classification criteria for SLE are essential for standardization of cohorts and reproducibility of clinical trials.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In 2019, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) drew up new classification criteria for SLE<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> (EULAR/ACR-2019). These were more sensitive and specific than the 1997 criteria of the ACR (ACR-1997) and the 2012 criteria of the Systemic Lupus International Collaborating Clinics (SLICC-2012). The methodology included an initial phase comprising a systematic review of the literature,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> a Delphi exercise with 145 international experts,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> a cohort of 616 patients with recent-onset SLE, and a survey of 339 individuals with SLE. In the second phase, 19 experts used the nominal group technique to reduce the number of classification criteria to 21.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In the third phase, the criteria were separated into clinical and immunological criteria. Weighting was based on a representative sample of patients with SLE, and pairs of criteria were compared using a multicriteria decision analysis. The last phase, of refinement and validation of the criteria, was based on a validation cohort comprising 1270 individuals (696 patients with SLE and 574 controls with diseases mimicking SLE). The sensitivity and specificity of the new criteria were 96.1% and 93.4%, respectively, which represents an improvement on the ACR-1997 and SLICC-2012 criteria,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> thus enabling greater accuracy and a lower percentage of false positives and negatives.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The most relevant modification introduced by EULAR/ACR-2019 is the presence of antinuclear antibodies (ANA) at titers of ≥1/80 (measured as HEp-2 cells or equivalent) as an essential criterion, thus excluding patients with persistently negative ANA titers. This criterion is based on the results of a systematic review of 13 080 patients with SLE, in which an ANA titer ≥1/80 had 97.8% sensitivity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition, the clinical and immunological criteria were redesigned and are now subdivided into 7 clinical domains (constitutional, hematologic, neuropsychiatric, serosal, mucocutaneous, musculoskeletal, and renal) and 3 immunological domains (antiphospholipid antibodies, low complement levels, and SLE-specific antibody). Unexplained fever was included as a constitutional clinical criterion. Within each domain, the criteria are weighted with values ranging from 2 to 10 according to their relative weight in the diagnosis of SLE based on available scientific evidence. Therefore, based on the new criteria, diagnosis of SLE requires a positive ANA titer ≥1/80, a clinical criterion, and a score ≥10. The changes in weighting make it possible to classify as having SLE patients with class 3–4 lupus nephritis as the only clinical manifestation and a positive ANA titer. As for mucocutaneous criteria, even if a patient presents with various cutaneous manifestations that are typical of SLE, only that with the highest value will be scored (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Therefore, in line with the new classification, it is not possible to classify an SLE patient based only on mucocutaneous findings.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The new EULAR/ACR-2019 classification criteria for SLE are more sensitive and specific and include major modifications: positive ANA titers as an essential requirement, new clinical criteria, and changes in weighting. These are aimed at standardizing SLE cohorts and including individuals with a shorter disease course.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1590141" "palabras" => array:5 [ 0 => "Systemic lupus erythematosus" 1 => "Classification" 2 => "Antinuclear antibodies" 3 => "Cutaneous lupus erythematosus" 4 => "2019 EULAR/ACR" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: ANA, antinuclear antibody; anti-dsDNA, anti-double stranded DNA antibody; anti-β2GP1, anti-ß2 glycoprotein 1; EULAR/ACR-2019, 2019 classification of the European League Against Rheumatism and the American College of Rheumatology for SLE; SLE, systemic lupus erythematosus.</p>" "tablatextoimagen" => array:2 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">EULAR/ACR-2019</span>Entry criterion: ANA at titers<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>1/80Additive criteria: at least 1 clinical criterion and ≥<span class="elsevierStyleHsp" style=""></span>10 points<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical domains \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Constitutional \t\t\t\t\t\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">Unexplained fever<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>38.5<span class="elsevierStyleHsp" style=""></span>°C<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></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">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hematologic \t\t\t\t\t\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">LeukopeniaThrombocytopeniaAutoimmune hemolysis \t\t\t\t\t\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">344 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neuropsychiatric \t\t\t\t\t\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">DeliriumPsychosisSeizure \t\t\t\t\t\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">235 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mucocutaneous \t\t\t\t\t\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">Nonscarring alopeciaOral ulcersSubacute cutaneous or discoid lupus<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>Acute cutaneous lupus<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></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">2246 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serosal \t\t\t\t\t\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">Pleural or pericardial effusionAcute pericarditis \t\t\t\t\t\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">56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Musculoskeletal \t\t\t\t\t\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">Joint involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal \t\t\t\t\t\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">Proteinuria<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>μg/dRenal biopsy class 2 or 5 lupus nephritisRenal biopsy class 3 or 4 lupus nephritis<span class="elsevierStyleSup">d</span> \t\t\t\t\t\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">4810 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] 1 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Immunological domains</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antiphospholipid antibodies \t\t\t\t\t\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">Anticardiolipin antibodies or anti-β2GP1 antibodies or lupus anticoagulant \t\t\t\t\t\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-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complement proteins \t\t\t\t\t\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 C3 or C4Low C3 and C4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SLE-specific antibodies \t\t\t\t\t\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">Anti-dsDNA antibody or anti-Smith antibody \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The criteria are cumulative and do not need to be present simultaneously. Within each domain, only the highest-scoring criterion is counted for the total score.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Unexplained fever<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>38.3<span class="elsevierStyleHsp" style=""></span>°C is a new clinical criterion in this classification.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Definitions:</p> <p class="elsevierStyleNotepara" id="npar0020">a. Subacute cutaneous lupus: annular or papulosquamous (psoriasiform) cutaneous eruption, usually photodistributed.</p> <p class="elsevierStyleNotepara" id="npar0025">- Skin biopsy: interface vacuolar dermatitis, perivascular lymphohistiocytic infiltrate, and/or dermal mucin.</p> <p class="elsevierStyleNotepara" id="npar0030">b. Discoid lupus erythematosus:</p> <p class="elsevierStyleNotepara" id="npar0035">- Erythematous-violaceous cutaneous lesions with atrophic scarring, dyspigmentation, follicular hyperkeratosis/plugging leading to scarring alopecia on the scalp.</p> <p class="elsevierStyleNotepara" id="npar0040">- Skin biopsy: interface vacuolar dermatitis, perivascular and/or periappendageal lymphohistiocytic infiltrate. Plugs may be observed on the scalp, as may be mucin deposition in longstanding lesions.</p> <p class="elsevierStyleNotepara" id="npar0045">c. Acute cutaneous lupus:</p> <p class="elsevierStyleNotepara" id="npar0050">- Malar rash or generalized maculopapular rash.</p> <p class="elsevierStyleNotepara" id="npar0055">- Skin biopsy: interface vacuolar dermatitis, perivascular lymphohistiocytic infiltrate, often with dermal mucin. Perivascular neutrophilic infiltrate may be present early in the course.</p> <p class="elsevierStyleNotepara" id="npar0060"><span class="elsevierStyleSup">d</span>Class 3 or 4 lupus nephritis itself indicates a total score of 10. ANA<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>1/80 is sufficient to classify a patient as having SLE.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Criteria for Systemic Lupus Erythematosus According to the New 2019 Classification of the European League Against Rheumatism and the American College of Rheumatology (EULAR/ACR-2019).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Distinctions between diagnostic and classification criteria?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Aggarwal" 1 => "S. Ringold" 2 => "D. Khanna" 3 => "T. Neogi" 4 => "S.R. Johnson" 5 => "A. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2015" "volumen" => "67" "paginaInicial" => "891" "paginaFinal" => "897" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Aringer" 1 => "K. Costenbader" 2 => "D. Daikh" 3 => "R. Brinks" 4 => "M. Mosca" 5 => "R. Ramsey-Goldman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheumatol Hoboken NJ" "fecha" => "2019" "volumen" => "71" "paginaInicial" => "1400" "paginaFinal" => "1412" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of antinuclear antibodies for classifying systemic lupus erythematosus: a systematic literature review and meta-regression of diagnostic data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Leuchten" 1 => "A. Hoyer" 2 => "R. Brinks" 3 => "M. Schoels" 4 => "M. Schneider" 5 => "J. Smolen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2018" "volumen" => "70" "paginaInicial" => "428" "paginaFinal" => "438" "itemHostRev" => array:3 [ "pii" => "S1542356520316396" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multi-center delphi exercise reveals important key items for classifying systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Schmajuk" 1 => "B.F. Hoyer" 2 => "M. Aringer" 3 => "S.R. Johnson" 4 => "D.I. Daikh" 5 => "T. Dörner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2018" "volumen" => "70" "paginaInicial" => "1488" "paginaFinal" => "1494" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methods of formal consensus in classification/diagnostic criteria and guideline development" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Nair" 1 => "R. Aggarwal" 2 => "D. Khanna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2010.12.001" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2011" "volumen" => "41" "paginaInicial" => "95" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21420149" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011300000003/v2_202212210529/S0001731022001387/v2_202212210529/en/main.assets" "Apartado" => array:4 [ "identificador" => "93537" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Foro de Residentes / Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011300000003/v2_202212210529/S0001731022001387/v2_202212210529/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022001387?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
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| 2024 November | 35 | 19 | 54 |
| 2024 October | 280 | 94 | 374 |
| 2024 September | 397 | 79 | 476 |
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| 2023 September | 117 | 83 | 200 |
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