Case and Research Letters
Mixed Connective Tissue Disease in a Patient With Castleman Disease and Hodgkin Lymphoma: Excellent Clinical Response to Rituximab
Enfermedad mixta del tejido conectivo en el contexto de enfermedad de Castleman y linfoma Hodgkin con excelente respuesta clínica a rituximab
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Rash eritematovioláceo en la cara y el cuello, sin afectación de las zonas no fotoexpuestas como los párpados inferiores y la zona submentoniana; además se observa alopecia debida a quimioterapia. b. Pápulas de Gottron sobre las articulaciones metacarpofalángicas e interfalángicas. c. Edema en las plantas de ambos pies. d. Edema en las palmas y dedos «en salchicha».</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "T. Gracia-Cazaña, C. Delgado-Beltrán, M.A. Concellón, M.A. Fuertes" "autores" => array:4 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Gracia-Cazaña" ] 1 => array:2 [ "nombre" => "C." 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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "846" "paginaFinal" => "848" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Exploramos correctamente a los pacientes? ¿Qué nos está pasando?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 788 "Ancho" => 900 "Tamanyo" => 121487 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of the primary tumor in the patient with lymph node metastases in the left groin. A dark, kerotic pigmented lesion measuring 1.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm can be seen, with the Hutchinson sign, on the ball of the left little toe.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Ivars, P. Redondo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Ivars" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Redondo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015002847" "doi" => "10.1016/j.ad.2015.05.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015002847?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002632?idApp=UINPBA000044" "url" => "/15782190/0000010600000010/v1_201512060022/S1578219015002632/v1_201512060022/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219015002619" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.10.001" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1210" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2015;106:841-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 766 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 532 "PDF" => 189 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Acral Nodular Lesion Following Trauma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "841" "paginaFinal" => "843" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión nodular acral tras traumatismo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1750 "Ancho" => 575 "Tamanyo" => 87785 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nodule in contact with soft tissue. No bone involvement is observed on the radiograph.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Martínez-Leboráns, A. Martínez-Aparicio, V. Alegre de Miguel" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Martínez-Leboráns" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Martínez-Aparicio" ] 2 => array:2 [ "nombre" => "V." 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Gracia-Cazaña, C. Delgado-Beltrán, M.A. Concellón, M.A. Fuertes" "autores" => array:4 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Gracia-Cazaña" "email" => array:1 [ 0 => "tamara_gracia@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Delgado-Beltrán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.A." "apellidos" => "Concellón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M.A." "apellidos" => "Fuertes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de Barbastro, Huesca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Clínico Lozano Blesa, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Lozano Blesa, Zaragoza, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Hematología, Hospital Clínico Lozano Blesa, Zaragoza, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad mixta del tejido conectivo en el contexto de enfermedad de Castleman y linfoma Hodgkin con excelente respuesta clínica a rituximab" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 731 "Ancho" => 900 "Tamanyo" => 203216 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Basal layer vacuolization and thickening of the basement membrane (periodic acid-Schiff ×20).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Castleman disease (CD), or angiofollicular lymphoid hyperplasia, is characterized by a process of reactive hyperplasia affecting the immune system. The condition can, therefore, give rise to a clinical picture similar to that of either a connective tissue disease or an autoimmune disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> We report a case of Castleman disease and Hodgkin lymphoma in a patient who developed a mixed connective tissue disease (MCTD).</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 49-year-old man, who had recently been diagnosed with Hodgkin lymphoma and multicentric Castleman disease and was being treated with adriamycin, bleomycin, vinblastine, and dacarbazine. He was referred to our department when he developed skin lesions and photosensitivity in association with Raynaud's phenomenon and muscle weakness a month after completing chemotherapy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed the following: erythematous-violaceous coloration on sun-exposed areas, elbows, and knees; edema of the palms and soles; and erythematous scaly papules on the dorsal surfaces of the interphalangeal and metacarpophalangeal joints of the hands consistent with Gottron papules (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Capillaroscopy demonstrated disorganization of the capillary bed, loss of normal capillary distribution, and a few thrombosed giant capillaries.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Two of the explorations performed yielded significant results: an electroneurogram evidenced sensory-motor polyneuropathy; and autoimmune tests revealed antinuclear antibodies (titers of 1:1280), anti-Smith antibodies, and anti-U1 ribonucleoprotein (U1-RNP) (titers > 1:1.600). The results of other autoantibody tests were negative. Histological study of biopsied samples of skin and muscle tissue from the arm revealed vacuolization of the basal layer and thickening of the basement membrane as well as a positive periodic acid-Schiff stain (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and signs of inflammatory myositis. These findings led to a diagnosis of MCTD associated with Castleman disease and Hodgkin lymphoma. In view of the reported association between Castleman disease and the human immunodeficiency virus and the human herpesvirus 8, serology was performed to screen for these viruses, with negative results in both cases. The negative result for the human herpesvirus 8 was confirmed by a polymerase chain reaction assay in peripheral blood, in which no viral load was detected.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Initial treatment with corticosteroids and antimalarials had little effect on the symptoms of MCTD, but subsequent treatment with rituximab achieved remission of both MCTD and Castleman disease. The regimen used was 375<span class="elsevierStyleHsp" style=""></span>mg/m<span class="elsevierStyleSup">2</span> administered intravenously once a week for 4 weeks, with a repeat cycle after 6 months, in combination with methylprednisolone 7.5<span class="elsevierStyleHsp" style=""></span>mg/d (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">MCTD was first described in 1972 as a disorder characterized by a combination of the clinical features of systemic lupus erythematosus, systemic scleroderma, polymyositis/dermatomyositis, and rheumatoid arthritis in the presence of high titers of anti-U1-RNP.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> The most common clinical manifestations include Raynaud's phenomenon, swollen hands, fingers with a sausage appearance, joint pain, and muscle weakness. The cutaneous manifestations include features consistent with a dermatomyositis-like or systemic lupus erythematosus-like photosensitivity, ulcers, Sjogren syndrome, and urticarial vasculitis, although no specific or pathognomonic clinical finding has been identified.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnostic criteria proposed by Alarcón-Segovia et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> have a sensitivity of 100%. For a confirmed diagnosis, the patient must fulfill the serologic criteria (anti-U1-RNP autoantibodies with a titer in hemagglutination of > 1:1600) and at least 3 of the clinical criteria, which are swollen hands, synovitis, myositis, Raynaud's phenomenon, and acrosclerosis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">There have been several reports of patients with Castleman disease presenting autoimmune manifestations, with more cases of hemolytic anemia and fewer of connective tissue disease. The onset of autoimmune manifestations has been reported as occurring both before and after the onset of Castleman disease. To date, only 3 cases of MCTD associated with Castleman disease have been reported in the literature. Nanki et al<span class="elsevierStyleItalic">.</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> reported the case of a 60-year woman with multicentric Castleman disease and EMTC in which pharmacological remission was achieved following treatment with melphalan; Chrispal et al<span class="elsevierStyleItalic">.</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> reported associated EMTC and Castleman disease in a 16-year-old girl; and Hosaka et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> reported 3 cases of Castleman disease mimicking the features of collagen disease, one of them with symptoms typical of MCTD. No association with Hodgkin lymphoma was reported in any of these cases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the case of our patient, the treatment chosen was the anti-CD20 agent rituximab because an increased mean survival has been reported in patients with Castleman disease on rituximab-based therapies, although there is less experience on the use of this therapy in EMTC.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> Remission of the clinical manifestations of subacute lupus has been reported in patients with MCTD as well as improvement in refractory thrombocytopenia and Raynaud's phenomenon; the only adverse effect reported in these patients treated with rituximab was 1 case of severe ischemia.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">9–11</span></a> The therapeutic mechanism of rituximab involves depletion of CD20 positive cells, which are its therapeutic target. CD20 positive cells are directly or indirectly responsible for the dysregulated production of interleukin-6 and other cytokines.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In this case it appears that 3 diseases may be related. Overproduction of interleukin 6 by Reed-Sternberg cells and histiocytes in Hodgkin lymphoma has been demonstrated, and this abnormal immune state is responsible for the association between Hodgkin lymphoma and Castleman disease.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> The resulting proinflammatory cytokine microenvironment may trigger an exaggerated immune response, leading to a loss of tolerance and the development of an autoimmune disease.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gracia-Cazaña T, Delgado-Beltrán C, Concellón MA, Fuertes MA. Enfermedad mixta del tejido conectivo en el contexto de enfermedad de Castleman y linfoma Hodgkin con excelente respuesta clínica a rituximab. Actas Dermosifiliogr. 2015;106:843–846.</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" => 1339 "Ancho" => 1500 "Tamanyo" => 307174 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Erythematous-violaceous rash on the face and neck, which spares areas not exposed to sunlight, such as the lower eyelids and the submental area; alopecia due to chemotherapy also observed. B, Gottron papules on the metacarpophalangeal and interphalangeal joints. C, Edema in the soles of both feet. D, Swollen palms and sausage fingers.</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" => 731 "Ancho" => 900 "Tamanyo" => 203216 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Basal layer vacuolization and thickening of the basement membrane (periodic acid-Schiff ×20).</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" => 667 "Ancho" => 1500 "Tamanyo" => 169649 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Resolution of the facial rash following treatment with rituximab. B, Appearance of hands after treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic connective tissue disease complicated by Castleman's disease: Report of a case and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. De Marchi" 1 => "S. de Vita" 2 => "M. Fabris" 3 => "C.A. Scott" 4 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 5 | 22 |
| 2024 October | 93 | 58 | 151 |
| 2024 September | 123 | 33 | 156 |
| 2024 August | 156 | 85 | 241 |
| 2024 July | 131 | 46 | 177 |
| 2024 June | 128 | 61 | 189 |
| 2024 May | 93 | 37 | 130 |
| 2024 April | 126 | 43 | 169 |
| 2024 March | 131 | 47 | 178 |
| 2024 February | 187 | 56 | 243 |
| 2024 January | 252 | 53 | 305 |
| 2023 December | 378 | 30 | 408 |
| 2023 November | 491 | 30 | 521 |
| 2023 October | 545 | 36 | 581 |
| 2023 September | 475 | 35 | 510 |
| 2023 August | 496 | 33 | 529 |
| 2023 July | 469 | 64 | 533 |
| 2023 June | 465 | 33 | 498 |
| 2023 May | 525 | 46 | 571 |
| 2023 April | 402 | 36 | 438 |
| 2023 March | 512 | 40 | 552 |
| 2023 February | 399 | 30 | 429 |
| 2023 January | 350 | 40 | 390 |
| 2022 December | 257 | 61 | 318 |
| 2022 November | 280 | 43 | 323 |
| 2022 October | 368 | 33 | 401 |
| 2022 September | 272 | 27 | 299 |
| 2022 August | 307 | 49 | 356 |
| 2022 July | 275 | 46 | 321 |
| 2022 June | 347 | 37 | 384 |
| 2022 May | 383 | 55 | 438 |
| 2022 April | 461 | 50 | 511 |
| 2022 March | 452 | 63 | 515 |
| 2022 February | 412 | 42 | 454 |
| 2022 January | 432 | 40 | 472 |
| 2021 December | 255 | 54 | 309 |
| 2021 November | 223 | 49 | 272 |
| 2021 October | 284 | 71 | 355 |
| 2021 September | 216 | 49 | 265 |
| 2021 August | 210 | 36 | 246 |
| 2021 July | 152 | 38 | 190 |
| 2021 June | 164 | 50 | 214 |
| 2021 May | 138 | 29 | 167 |
| 2021 April | 213 | 73 | 286 |
| 2021 March | 112 | 39 | 151 |
| 2021 February | 94 | 42 | 136 |
| 2021 January | 84 | 23 | 107 |
| 2020 December | 54 | 37 | 91 |
| 2020 November | 49 | 28 | 77 |
| 2020 October | 52 | 21 | 73 |
| 2020 September | 37 | 14 | 51 |
| 2020 August | 37 | 26 | 63 |
| 2020 July | 36 | 23 | 59 |
| 2020 June | 40 | 33 | 73 |
| 2020 May | 26 | 31 | 57 |
| 2020 April | 30 | 27 | 57 |
| 2020 March | 38 | 31 | 69 |
| 2020 February | 3 | 6 | 9 |
| 2020 January | 6 | 7 | 13 |
| 2019 December | 6 | 7 | 13 |
| 2019 November | 4 | 12 | 16 |
| 2019 October | 0 | 11 | 11 |
| 2019 September | 1 | 10 | 11 |
| 2019 August | 4 | 7 | 11 |
| 2019 July | 7 | 3 | 10 |
| 2019 June | 4 | 11 | 15 |
| 2019 May | 7 | 45 | 52 |
| 2019 April | 16 | 1 | 17 |
| 2019 March | 4 | 3 | 7 |
| 2019 February | 5 | 0 | 5 |
| 2019 January | 9 | 0 | 9 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 16 | 0 | 16 |
| 2018 October | 60 | 0 | 60 |
| 2018 September | 7 | 0 | 7 |
| 2018 April | 0 | 4 | 4 |
| 2018 March | 3 | 5 | 8 |
| 2018 February | 163 | 13 | 176 |
| 2018 January | 94 | 9 | 103 |
| 2017 December | 161 | 9 | 170 |
| 2017 November | 59 | 9 | 68 |
| 2017 October | 50 | 11 | 61 |
| 2017 September | 32 | 12 | 44 |
| 2017 August | 43 | 8 | 51 |
| 2017 July | 23 | 13 | 36 |
| 2017 June | 34 | 22 | 56 |
| 2017 May | 35 | 10 | 45 |
| 2017 April | 30 | 29 | 59 |
| 2017 March | 29 | 21 | 50 |
| 2017 February | 82 | 17 | 99 |
| 2017 January | 19 | 16 | 35 |
| 2016 December | 41 | 31 | 72 |
| 2016 November | 51 | 24 | 75 |
| 2016 October | 32 | 29 | 61 |
| 2016 September | 0 | 3 | 3 |
| 2016 August | 1 | 1 | 2 |
| 2016 July | 2 | 2 | 4 |
| 2016 June | 2 | 1 | 3 |
| 2016 May | 0 | 1 | 1 |
| 2016 April | 0 | 4 | 4 |
| 2016 March | 0 | 1 | 1 |
| 2016 January | 0 | 1 | 1 |
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