Case and Research Letters
Pulmonary and Lymph Node Sarcoidosis Associated With Anti-Tumor Necrosis Factor Therapy in a Patient With Psoriasis: A New Case of This Paradoxical Phenomenon
Sarcoidosis pulmonar y ganglionar en un paciente con psoriasis durante terapia anti-TNF alfa: nuevo caso de fenómeno paradójico
L. Padilla-España
, S. Habicheyn-Hiar, M. de Troya
Corresponding author
Servicio de Dermatología, Hospital Costa del Sol, Marbella, Spain
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Padilla-España, S. Habicheyn-Hiar, M. de Troya" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Padilla-España" "email" => array:1 [ 0 => "laupadesp@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Habicheyn-Hiar" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "de Troya" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Costa del Sol, Marbella, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoidosis pulmonar y ganglionar en un paciente con psoriasis durante terapia anti-TNF alfa: nuevo caso de fenómeno paradójico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 975 "Tamanyo" => 142482 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography, axial cuts: Multiple nodules forming masses were observed in the mediastinum, at both hila, and in the left supraclavicular fossa, in addition to nodular pulmonary involvement.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 43-year-old man with a history of mild perinatal anoxic encephalopathy, obesity since childhood, and severe plaque psoriasis diagnosed at 28 years of age, not controlled by topical treatments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Prior to starting systemic treatment, the patient presented multiple infiltrated and desquamating erythematous plaques, particularly affecting the lumbosacral region and legs, with a psoriasis area severity index (PASI)<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>15. However, there was no nail or joint involvement. Given the patient's degree of dependence and the lack of response to previous systemic treatments with acitretin and methotrexate, it was decided to start biological therapy, and additional tests were therefore requested, including complete blood count, biochemistry, urinary sediment, chest x-ray, and a tuberculin test, all of which were negative or normal. Treatment was then started with etanercept 50<span class="elsevierStyleHsp" style=""></span>mg administered subcutaneously once a week, after performing the induction course, obtaining a good clinical response and achieving a PASI of 75% at 10 weeks.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite normal laboratory results during the anti-tumor necrosis factor (TNF) therapy and for 2 years of follow-up, a persistent moderate leucopenia was later detected in serial blood tests, and a chest x-ray, serology, and evaluation by the hematology department were therefore requested. A detailed medical history did not detect associated systemic symptoms.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The chest x-ray revealed a parahilar mass consistent with the high-resolution computed tomography findings of multiple mediastinal, parahilar, and supraclavicular lymph nodes and multiple pulmonary nodules (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Given the possibility of a lymphoproliferative disease, mediastinoscopy was performed to take a lymph node biopsy. Histology showed chronic noncaseating granulomatous inflammation with a negative Ziehl-Neelsen stain and negative polymerase chain reaction test for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Based on these findings, a diagnosis of pulmonary and lymph node sarcoidosis was made and the anti-TNF treatment was interrupted. Given the absence of respiratory symptoms, we took a conservative approach, with clinical and radiological follow-up of the patient.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Six months after withdrawing the anti-TNF treatment because of the diagnosis of sarcoidosis, we observed a radiological improvement (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) with a marked decrease in the size of the lymphadenopathies, and a complete blood count within normal limits.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The ever wider off-label use of anti-TNF drugs in the fields of rheumatology and dermatology and in autoinflammatory diseases in other specialist fields explains the increase in the incidence of paradoxical phenomena in recent years.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> These are exacerbations or the new appearance of inflammatory conditions that usually respond to the use of anti-TNF therapy,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> such as psoriasiform rashes,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> uveitis, and the onset of other granulomatous diseases (Crohn disease and sarcoidosis). Controversy continues over the etiologic and pathogenic mechanisms underlying these phenomena, although it has been suggested that TNF inhibition may provoke a dysregulation of the compensatory proinflammatory cascade.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Fewer than 50 cases of pulmonary sarcoidosis induced by anti-TNF treatment have been reported in the literature, and the disease was only confirmed histologically in 27.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> The majority of cases have developed in patients with rheumatic inflammatory diseases, particularly rheumatoid arthritis (15%), followed by the spondyloarthropathies (7%) and psoriatic arthritis (4%). The most widely used TNF inhibitor was etanercept (52%), folowed by infliximab (30%) and adalimumab (18%). The diagnosis of sarcoidosis was made after a mean treatment duration of 23 months.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> In all cases the treatment was interrupted and glucocorticoid therapy was administered in half of the patients; the clinical course of the sarcoidosis was satisfactory, with complete resolution in the majority of cases (89%).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The development of pulmonary sarcoidosis in patients treated with TNF inhibitors for psoriasis without joint involvement is rarer or, at least, it has not been reported as frequently in the literature. Ours is the second reported case induced by etanercept.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Differences in dosage and the follow-up of patients on TNF inhibitor treatment in rheumatology compared with those with exclusively cutaneous pathology could be the reason for this difference.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although the etiological and pathogenic mechanisms remain unclear, it has been suggested that TNF inhibition could alter the expression of certain cytokines, such as interleukin (IL) 2, IL-18, and interferon-γ. Although all anti-TNF drugs act by blocking this proinflammatory cytokine, there are major differences both in their structure and in their pharmacokinetic and pharmacodynamic characteristics. The higher incidence of sarcoidosis with etanercept compared with other anti-TNF agents may be because this drug shows binding limited to transmembrane TNF, leaving the monomeric soluble form unbound, and it does not cause cell lysis, meaning that TNF inhibition would not be sufficient to prevent the formation of granulomas.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Ever more dermatologic diseases may benefit from the use of anti-TNF agents; the disease that has typically been described is psoriasis,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> but the efficacy of this agent has recently been reported in other inflammatory diseases such as hidradenitis suppurativa and pyoderma gangrenosum. Paradoxical phenomena, in particular sarcoidosis, have been appearing with increasing frequency during treatment with anti-TNF agents, and dermatologists must therefore take this possible complication into account and ensure early recognition.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Padilla-España L, Habicheyn-Hiar S, de Troya M. Sarcoidosis pulmonar y ganglionar en un paciente con psoriasis durante terapia anti-TNF alfa: nuevo caso de fenómeno paradójico. Actas Dermosifiliogr. 2015;106:760–762.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 975 "Tamanyo" => 142482 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography, axial cuts: Multiple nodules forming masses were observed in the mediastinum, at both hila, and in the left supraclavicular fossa, in addition to nodular pulmonary involvement.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 257153 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Noncaseating chronic granulomatous inflammation in the transbronchial biopsy. Hematoxylin-eosin, original magnification x200.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 975 "Ancho" => 975 "Tamanyo" => 100008 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography showing a significant reduction in the pulmonary nodules and parahiliar lymph nodes 6 months after diagnosis and the interruption of anti-TNF treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Tong" 1 => "N. Manolios" 2 => "G. Howe" 3 => "D. Spencer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intern Med J." "fecha" => "2012" "volumen" => "42" "paginaInicial" => "89" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22389903" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of cutaneous sarcoidosis during treatment with tumour necrosis alpha factor antagonists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Lamrock" 1 => "P. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-0960.2011.00845.x" "Revista" => array:6 [ "tituloSerie" => "Australas J Dermatol." "fecha" => "2012" "volumen" => "53" "paginaInicial" => "87" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22571555" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ustekinumab treatment of TNF antagonist-induced paradoxical psoriasis flare in a patient with psoriatic arthritis: case report and review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Puig" 1 => "C.E. Morales-Múnera" 2 => "A. López-Ferrer" 3 => "C. Geli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000339864" "Revista" => array:6 [ "tituloSerie" => "Dermatology." "fecha" => "2012" "volumen" => "225" "paginaInicial" => "14" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22890275" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etanercept-induced cutaneous and pulmonary sarcoid-like granulomas resolving with adalimumab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.M. Burns" 1 => "P.J. Green" 2 => "S. Pasternak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2011.01795.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol." "fecha" => "2012" "volumen" => "39" "paginaInicial" => "289" "paginaFinal" => "293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21899592" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The development of sarcoidosis on antitumour necrosis factor therapy: a paradox" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.E. Pink" 1 => "A. Fonia" 2 => "C.H. Smith" 3 => "J.N. Barker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2010.09843.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol." "fecha" => "2010" "volumen" => "163" "paginaInicial" => "648" "paginaFinal" => "649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20456350" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung sarcoidosis induced by TNF antagonists in rheumatoid arthritis: a case presentation and a literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Gifre" 1 => "V. Ruiz-Esquide" 2 => "A. Xaubet" 3 => "J.A. Gómez-Puerta" 4 => "M.V. Hernández" 5 => "R. Sanmartí" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2010.05.011" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol." "fecha" => "2011" "volumen" => "47" "paginaInicial" => "208" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20638761" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary sarcoidosis associated with etanercept therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.E. Farah" 1 => "M.D. Shay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1592/phco.27.10.1446" "Revista" => array:6 [ "tituloSerie" => "Pharmacotherapy." "fecha" => "2007" "volumen" => "27" "paginaInicial" => "1446" "paginaFinal" => "1448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17896899" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis as an adverse effect of tumor necrosis factor inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Cathcart" 1 => "N. Sami" 2 => "B. Elewski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Drugs Dermatol." "fecha" => "2012" "volumen" => "11" "paginaInicial" => "609" "paginaFinal" => "612" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22527429" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor necrosis factor and granuloma biology: explaining the differential infection risk of etanercept and infliximab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.S. Wallis" 1 => "S. Ehlers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2005.01.009" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum." "fecha" => "2005" "volumen" => "34" "paginaInicial" => "34" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15852254" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of psoriasis in Spain in the age of biologics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Ferrándiz" 1 => "J.M. Carrascosa" 2 => "M. Toro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2013.12.008" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2014" "volumen" => "105" "paginaInicial" => "504" "paginaFinal" => "509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24569109" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000009/v1_201511040157/S157821901500253X/v1_201511040157/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000009/v1_201511040157/S157821901500253X/v1_201511040157/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901500253X?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 6 | 12 |
| 2024 October | 89 | 38 | 127 |
| 2024 September | 101 | 20 | 121 |
| 2024 August | 105 | 57 | 162 |
| 2024 July | 86 | 27 | 113 |
| 2024 June | 91 | 38 | 129 |
| 2024 May | 76 | 25 | 101 |
| 2024 April | 71 | 27 | 98 |
| 2024 March | 61 | 37 | 98 |
| 2024 February | 63 | 31 | 94 |
| 2024 January | 61 | 39 | 100 |
| 2023 December | 63 | 20 | 83 |
| 2023 November | 71 | 24 | 95 |
| 2023 October | 59 | 23 | 82 |
| 2023 September | 62 | 25 | 87 |
| 2023 August | 49 | 22 | 71 |
| 2023 July | 58 | 36 | 94 |
| 2023 June | 68 | 34 | 102 |
| 2023 May | 77 | 31 | 108 |
| 2023 April | 49 | 27 | 76 |
| 2023 March | 47 | 30 | 77 |
| 2023 February | 47 | 26 | 73 |
| 2023 January | 29 | 31 | 60 |
| 2022 December | 50 | 43 | 93 |
| 2022 November | 41 | 35 | 76 |
| 2022 October | 24 | 21 | 45 |
| 2022 September | 16 | 35 | 51 |
| 2022 August | 29 | 31 | 60 |
| 2022 July | 20 | 55 | 75 |
| 2022 June | 29 | 39 | 68 |
| 2022 May | 52 | 34 | 86 |
| 2022 April | 63 | 45 | 108 |
| 2022 March | 76 | 65 | 141 |
| 2022 February | 55 | 29 | 84 |
| 2022 January | 65 | 38 | 103 |
| 2021 December | 39 | 29 | 68 |
| 2021 November | 58 | 54 | 112 |
| 2021 October | 93 | 44 | 137 |
| 2021 September | 60 | 38 | 98 |
| 2021 August | 76 | 17 | 93 |
| 2021 July | 28 | 32 | 60 |
| 2021 June | 34 | 45 | 79 |
| 2021 May | 39 | 21 | 60 |
| 2021 April | 75 | 71 | 146 |
| 2021 March | 58 | 22 | 80 |
| 2021 February | 62 | 30 | 92 |
| 2021 January | 35 | 25 | 60 |
| 2020 December | 33 | 21 | 54 |
| 2020 November | 36 | 22 | 58 |
| 2020 October | 43 | 23 | 66 |
| 2020 September | 26 | 17 | 43 |
| 2020 August | 24 | 20 | 44 |
| 2020 July | 28 | 28 | 56 |
| 2020 June | 28 | 32 | 60 |
| 2020 May | 28 | 35 | 63 |
| 2020 April | 25 | 19 | 44 |
| 2020 March | 26 | 28 | 54 |
| 2020 February | 3 | 14 | 17 |
| 2020 January | 4 | 13 | 17 |
| 2019 December | 0 | 5 | 5 |
| 2019 November | 0 | 3 | 3 |
| 2019 October | 3 | 2 | 5 |
| 2019 September | 0 | 1 | 1 |
| 2019 August | 0 | 4 | 4 |
| 2019 July | 4 | 18 | 22 |
| 2019 June | 0 | 22 | 22 |
| 2019 May | 2 | 68 | 70 |
| 2019 April | 2 | 35 | 37 |
| 2019 March | 0 | 16 | 16 |
| 2019 February | 2 | 7 | 9 |
| 2019 January | 1 | 6 | 7 |
| 2018 December | 0 | 4 | 4 |
| 2018 November | 3 | 7 | 10 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 5 | 0 | 5 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 24 | 4 | 28 |
| 2018 January | 30 | 6 | 36 |
| 2017 December | 37 | 9 | 46 |
| 2017 November | 18 | 6 | 24 |
| 2017 October | 27 | 3 | 30 |
| 2017 September | 31 | 7 | 38 |
| 2017 August | 22 | 9 | 31 |
| 2017 July | 24 | 7 | 31 |
| 2017 June | 28 | 10 | 38 |
| 2017 May | 31 | 10 | 41 |
| 2017 April | 28 | 8 | 36 |
| 2017 March | 10 | 10 | 20 |
| 2017 February | 15 | 10 | 25 |
| 2017 January | 11 | 6 | 17 |
| 2016 December | 23 | 17 | 40 |
| 2016 November | 40 | 23 | 63 |
| 2016 October | 27 | 18 | 45 |
| 2016 September | 0 | 8 | 8 |
| 2016 July | 1 | 1 | 2 |
| 2016 June | 3 | 1 | 4 |
| 2016 May | 2 | 5 | 7 |
| 2016 April | 0 | 6 | 6 |
| 2016 March | 0 | 3 | 3 |
| 2016 February | 0 | 1 | 1 |
| 2016 January | 0 | 4 | 4 |
| 2015 December | 0 | 2 | 2 |
| 2015 November | 0 | 6 | 6 |
Show all
