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or a high-magnification lens &#40;&#215;200&#41;&#46; Low-magnification lenses provide a panoramic image of the microcirculation&#44; whereas high-magnification lenses enable better visualization of the capillaries and their morphological characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> The main low-magnification optical instruments are the stereomicroscope&#44; the dermatoscope&#44; and the ophthalmoscope&#46; Videocapillaroscopy provides a panoramic image and enables active visualization and magnifications of up to &#215;100&#44; &#215;200&#44; and &#215;600&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> The development of computerized systems&#44; specifically nailfold videocapillaroscopy&#44; makes it possible to visualize and analyze a single capillary&#44; and to subsequently analyze the same capillary at different time points&#44; with high reproducibility&#46; Furthermore&#44; it can digitally store images of excellent quality and provide printed reports with the Images&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> Another advantage of the videocapillaroscope is its optical probe&#44; which can be placed in direct contact with the nailfold&#44; thus enabling the study of patients with severe joint contractions&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5&#44;6</span></a> Capillaroscopy only enables visualization of capillary structure&#44; whereas with videocapillaroscopy&#44; we can observe functional and morphological changes and hemorheological dynamics&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient must be relaxed and remain seated at a temperature of 20-22&#176;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">C</span> for the 15<span class="elsevierStyleHsp" style=""></span>minutes preceding the study&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> In addition&#44; patients must refrain from smoking for 24<span class="elsevierStyleHsp" style=""></span>hours before the examination <a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>and must not undergo cosmetic procedures &#40;manicure&#44; gel or acrylic nails&#41; during the 3 weeks before the examination&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> The nailfolds must be clean&#44; without perionyxis or nail polish&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient is placed with his&#47;her hands on a surface at the level of the heart&#46; A drop of immersion oil is applied on the nailfold to increase the transparency of the skin&#46; All the fingers except the thumbs are examined&#46; Each finger must be observed at &#215;50 to examine the architecture and then at &#215;200-300 to observe the morphological characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Visualization is optimal for the folds of the fourth and fifth fingers thanks to the transparency of the skin&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Normal Capillaroscopy Pattern</span><p id="par0040" class="elsevierStylePara elsevierViewall">The periungual capillaries in a healthy person have a regular architecture in the shape of in inverted U or hairpin with a uniform distribution and diameter&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> They form a semicircle that accompanies the nail matrix with a red color over a clearer base&#44; which is known as conserved polarity&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Between 7 and 17 capillaries per linear millimeter is considered normal&#46; The capillaries have 2 branches&#8212;an afferent branch &#40;arteriole&#41; and an efferent branch &#40;venule&#41;&#8212;and a transitional zone&#46; The branches are parallel to each other&#44; without crossing over or overlapping <a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The subpapillary venous plexus can be observed in 10&#37;-30&#37; of healthy persons&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Preserved microvascular function consists of the following&#58; absence of bleeding and exudates&#44; clear visualization of structures without interference&#44; and preserved perfusion&#44; that is&#44; uninterrupted flow that is uniformly red in color in the blood column&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> There should be no megacapillaries or diffuse loss of capillaries in healthy persons&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Abnormal capillaroscopy findings are observed in up to 10&#37; of healthy persons&#59; therefore&#44; isolated abnormalities do not indicate disease&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> Capillaroscopy reveals moderate heterogeneous morphological changes in primary Raynaud phenomenon&#44; although these are not clinically signficant&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The 3 morphologically &#8220;normal&#8221; capillaroscopy patterns in healthy persons are as follows&#58; &#40;<span class="elsevierStyleItalic">1</span>&#41; the normal pattern&#44; with 2-5 U-shaped loops&#47;mm and<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2 tortuous loops&#47;mm&#59; &#40;<span class="elsevierStyleItalic">2</span>&#41; the perfect normal pattern&#44; with <span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>5 U-shaped loops&#47;mm&#59; and &#40;<span class="elsevierStyleItalic">3</span>&#41; the unusual normal pattern&#44; with at least 1 meandering or bushy loop or at least 1 microhemorrhage or with <span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4 crossed loops&#47;mm<span class="elsevierStyleSup">10</span>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the characteristics of a normal capillaroscopy pattern&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Pathological Capillaroscopy Patterns</span><p id="par0065" class="elsevierStylePara elsevierViewall">Capillary abnormalities are characterized by an increase in morphological or structural variations&#44; with an increase in the size of the capillaries and a gradual decrease in their density&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">We can identify a diverse range of individual capillary abnormalities within abnormal capillaroscopy patterns or those that are nonspecific and not associated with a specific disease&#46; Abnormalities of this type were described by Cutolo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> The most common are presented below &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The number of capillaries and their morphological characteristics make it possible to describe specific capillaroscopy patterns that can help classify disease and provide information on prognosis and outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Tortuous Pattern</span><p id="par0080" class="elsevierStylePara elsevierViewall">The tortuous pattern is characterized by meandering&#44; tortuous&#44; or corkscrew capillaries&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> In tortuous capillaries&#44; the afferent and efferent loops intersect at &#8805;2 points&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> The pattern is confirmed when the abnormality is present in at least 10&#37; of all vessels observed&#46; The superficial venous plexus is usually visible in this pattern&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">This abnormality is found mainly in rheumatoid arthritis&#44; psoriasis&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> and systemic lupus erythematosus&#44; where it is more characteristic <a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;12</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Scleroderma Pattern</span><p id="par0090" class="elsevierStylePara elsevierViewall">The scleroderma pattern is the best-defined and most specific pattern&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> It is found in systemic sclerosis &#40;80&#37;-100&#37; of patients&#41;&#44; in dermatomyositis &#40;55&#37;-100&#37;&#41;&#44; and in mixed connective tissue disease &#40;54&#37;-63&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The microvascular abnormalities of systemic sclerosis were classified by Cutolo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> into 3 different patterns&#58; the early pattern &#40;few giant capillaries&#44; few capillary hemorrhages with no evident loss of capillaries&#44; and well-preserved capillary distribution&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#59; the active pattern &#40;frequent giant capillaries&#44; frequent capillary hemorrhages&#44; and moderate loss of capillaries&#44; as well as few&#47;absent ramified capillaries&#44; with some disorganization of the capillary architecture&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Figure 5</a>&#41;&#59; and the late pattern &#40;few&#47;absent giant capillaries and microhemorrhages with severe loss of capillaries with extensive avascular areas&#44; ramified capillaries&#44; and intense disorganization&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Figure 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In patients with dermatomyositis and mixed connective tissue disease&#44; an additional finding is the presence of bushy capillaries&#44; which are ramified capillaries that are typical of neoangiogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Capillaroscopy in Rheumatic Disease</span><p id="par0105" class="elsevierStylePara elsevierViewall">The main indications for capillaroscopy are primary Raynaud phenomenon and Raynaud phenomenon secondary to rheumatic disease&#44; early detection of systemic scleroderma or sclerodermatous syndromes&#44; dermatomyositis&#44; systemic lupus erythematosus&#44; Sj&#246;gren syndrome&#44; vascular syndromes&#44; and mixed connective tissue disease&#46; The study should be performed annually&#46; In the case of rapidly progressing systemic scleroderma&#44; the study should be performed every 4-6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Raynaud Phenomenon and Systemic Sclerosis</span><p id="par0110" class="elsevierStylePara elsevierViewall">Raynaud phenomenon is thought to be an exaggerated vasospastic response to cold or emotions&#46; The classic response comprises blanching of the fingers &#40;ischemic phase&#41;&#44; bluish color &#40;deoxygenation&#41;&#44; and erythema &#40;reperfusion&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Raynaud phenomenon is the first clinical sign of abnormal systemic vascular tone&#46; Capillaroscopy makes it possible to monitor the progression of microangiopathy&#44; study severity&#44; and establish the risk of an aggressive outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> It has proven effective&#44; enabling us to distinguish between the primary form and the form that is secondary to a connective tissue disease with involvement of the microcirculation&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Secondary Raynaud phenomenon usually appears at an older age&#44; with intense&#44; asymmetric&#44; and painful episodes leading to ischemic lesions of the skin&#46; It is associated with positive specific antibody titers and capillaroscopy abnormalities&#44; revealing the presence of connective tissue diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;17</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The observation of an early scleroderma pattern in association with the presence of specific antibodies &#40;anticentromere and antitopoisomerase&#41; and Raynaud phenomenon guides the diagnosis of systemic sclerosis in the early phase&#46; An association has been observed between peripheral vascular compromise in systemic sclerosis and the active scleroderma pattern with digital ulcers&#46; The late scleroderma pattern with frequent avascular areas has been identified as a prognostic factor for mortality in patients with systemic scleroderma&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The importance and use of capillaroscopy has increased over time&#46; For example&#44; abnormal capillaroscopy findings were included in the diagnostic criteria for systemic sclerosis in 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Ingegnoli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> developed an algorithm summarizing the risk of developing systemic sclerosis in patients with abnormal capillaroscopy findings and positive specific antibody titers <a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0035">Figure 7</a>&#41;&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Mixed Connective Tissue Disease</span><p id="par0140" class="elsevierStylePara elsevierViewall">Mixed connective tissue disease affects a group of patients who present characteristics of a combination of systemic autoimmune diseases&#44; mainly lupus&#44; scleroderma&#44; and dermatomyositis&#46; The most frequent symptom is Raynaud phenomenon&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Abnormal capillaroscopy findings in mixed connective tissue disease are similar to those of scleroderma in 50&#37; of cases&#44; with frequent tortuous&#44; bushy capillaries &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Figure 8</a>&#41;&#46; Capillaroscopy has been proposed as a useful marker of activity and prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dermatomyositis</span><p id="par0150" class="elsevierStylePara elsevierViewall">Abnormal nailfold capillaroscopy findings are recorded in 70&#37; of patients with dermatomyositis&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> In more than 60&#37;-80&#37; of cases&#44; the abnormal findings are similar to those of systemic sclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> Microvascular findings are similar in classic and in paraneoplastic&#44; amyopathic&#44; and juvenile dermatomyositis&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The diagnosis of dermatomyositis is based on at least 2 of the following characteristics&#58; megacapillaries&#44; capillary loss&#44; disorganization of the capillary array&#44; bushy capillaries&#44; tortuous capillaries&#44; and hemorrhages <a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0045">Figure 9</a>&#41;&#46;</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">There is a positive correlation between the scleroderma pattern and interstitial lung disease&#46; Microthrombosis is associated with poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Systemic Lupus Erythematosus</span><p id="par0165" class="elsevierStylePara elsevierViewall">Systemic lupus erythematosus does not involve specific microvascular alterations&#46; In fact&#44; the capillaroscopy pattern is normal in 30&#37; of cases&#59; therefore&#44; normal findings do not rule out disease&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Abnormal capillaroscopy findings are more frequent in patients with systemic lupus erythematosus associated with Raynaud phenomenon&#44; anti&#8211;U1 ribonucleoprotein antibodies&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> or anticardiolipin antibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The most typical capillaroscopy abnormalities include the presence of a tortuous pattern &#40;corkscrew capillaries&#41;&#46; Other abnormalities&#44; such as capillary dilation and prominent subpapillary venous plexus&#44; have also been reported <a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0050">Figure 10</a>&#41;&#46; The presence of major capillary abnormalities points to a severe clinical course&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0050"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Rheumatoid Arthritis</span><p id="par0175" class="elsevierStylePara elsevierViewall">The presence of an extensively visible subpapillary venous plexus with capillary hemorrhages has been reported in rheumatoid arthritis&#46; The loops are usually filiform and increased in length <a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;5</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0055">Figure 11</a>&#41;&#46;</p><elsevierMultimedia ident="fig0055"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">The most noticeable abnormalities are in patients whose condition co-occurs with Raynaud phenomenon&#44; multiple joint involvement&#44; or antinuclear antibodies with positive rheumatoid factor&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">It is important to remember that many diseases involve microvascular abnormalities&#59; these range from rheumatic diseases such as Sj&#246;gren syndrome and antiphospholipid syndrome to psoriasis&#44; diabetes&#44; and hypertension&#46; The capillaroscopy patterns of each of these conditions are currently under study&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0190" class="elsevierStylePara elsevierViewall">Nailfold capillaroscopy is a rapid&#44; noninvasive&#44; safe&#44; and inexpensive technique that enables us to assess the skin microcirculation&#46; It has proven useful in the timely detection and prognosis of rheumatic diseases&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of Interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres1199768"
          "titulo" => "Abstract"
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              "identificador" => "abst0005"
            ]
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        1 => array:2 [
          "identificador" => "xpalclavsec1118210"
          "titulo" => "Keywords"
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          "identificador" => "xres1199767"
          "titulo" => "Resumen"
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            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
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        3 => array:2 [
          "identificador" => "xpalclavsec1118211"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Principles of Microcirculation"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Technique"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Normal Capillaroscopy Pattern"
        ]
        8 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Pathological Capillaroscopy Patterns"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Tortuous Pattern"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Scleroderma Pattern"
            ]
          ]
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        9 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Capillaroscopy in Rheumatic Disease"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Raynaud Phenomenon and Systemic Sclerosis"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Mixed Connective Tissue Disease"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Dermatomyositis"
            ]
            3 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Systemic Lupus Erythematosus"
            ]
            4 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Rheumatoid Arthritis"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conclusion"
        ]
        11 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conflicts of Interest"
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        12 => array:1 [
          "titulo" => "References"
        ]
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    "fechaRecibido" => "2018-05-12"
    "fechaAceptado" => "2018-10-08"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1118210"
          "palabras" => array:6 [
            0 => "Capillaroscopy"
            1 => "Cutaneous microcirculation"
            2 => "Autoimmune diseases"
            3 => "Raynaud phenomenon"
            4 => "Nailfold"
            5 => "Systemic sclerosis"
          ]
        ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1118211"
          "palabras" => array:6 [
            0 => "Capilaroscopia"
            1 => "Microcirculaci&#243;n cut&#225;nea"
            2 => "Enfermedades autoinmunes"
            3 => "Fen&#243;meno de Raynaud"
            4 => "Pliegue ungueal"
            5 => "Esclerosis sist&#233;mica"
          ]
        ]
      ]
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Capillaroscopy produces in vivo images of skin microcirculation&#46; It is a simple&#44; noninvasive tool for analyzing microvascular abnormalities and&#44; as such&#44; can be used in both adults and children&#46; Capillaroscopy has proven to be useful in many diseases&#44; but it is of particular value in Raynaud phenomenon and other autoimmune diseases&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The test is used to analyze capillaroscopic patterns in the nailfold bed of the second to fifth fingers of each hand&#46; A normal capillaroscopic pattern is characterized by the presence of 7 to 11 capillaries in a hairpin shape&#46; Pathologic patterns are characterized by morphologic and structural alterations&#44; such as ectasias&#44; giant capillaries&#44; pathologic hemorrhages&#44; avascular areas&#44; and neoangiogenesis&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In this article&#44; we review the fundamentals of capillaroscopy&#44; with an emphasis on the technique and its indications&#44; diagnostic value&#44; and use as a prognostic tool for rheumatologic disorders&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La capilaroscopia es una t&#233;cnica de estudio que permite obtener im&#225;genes directas in vivo de la microcirculaci&#243;n cut&#225;nea&#46; Constituye un m&#233;todo accesible y no invasivo para analizar las anormalidades microvasculares&#44; por lo que puede utilizarse en ni&#241;os y adultos&#46; En la actualidad se ha demostrado su utilidad en m&#250;ltiples dolencias&#44; principalmente en el fen&#243;meno de Raynaud y otras enfermedades autoinmunes&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La capilaroscopia se realiza en el lecho ungueal del segundo al quinto dedo de ambas manos con la finalidad de encontrar un patr&#243;n capilarosc&#243;pico espec&#237;fico&#46; El patr&#243;n de normalidad se caracteriza por la presencia de 7-11 capilares por mil&#237;metro dispuestos en forma de &#171;U&#187; invertida&#46; Los patrones patol&#243;gicos muestran alteraciones morfol&#243;gicas y estructurales como&#58; ectasias&#44; capilares gigantes&#44; hemorragias patol&#243;gicas&#44; &#225;reas avasculares y neoangiog&#233;nesis&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En este art&#237;culo se presentan las bases de la capilaroscopia&#44; incluyendo la t&#233;cnica&#44; las indicaciones&#44; as&#237; como la utilidad diagn&#243;stica y como factor pron&#243;stico en enfermedades reumatol&#243;gicas&#46;</p></span>"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ocampo-Garza SS&#44; Villarreal-Alarc&#243;n MA&#44; Villarreal-Trevi&#241;o AV&#44; Ocampo-Candiani J&#46; Capilaroscopia&#58; una herramienta diagn&#243;stica valiosa&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;347&#8211;352&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tortuous pattern&#46; Meandering capillaries&#59; the afferent and efferent loops intersect at <span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 points&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Active scleroderma pattern&#46; Frequent giant capillaries&#44; frequent microhemorrhages&#44; and moderate capillary loss&#44; with some disorganization of capillary architecture&#46;</p>"
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Systemic lupus erythematosus&#46; Tortuous pattern with prominent superficial venous plexus&#46;</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Modified from Chojnowski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a></p>"
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                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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics of the Capillaroscopy&nbsp;\t\t\t\t\t\t\n
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                  \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">Normal Pattern&nbsp;\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">Skin transparency and visibility&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">Transparent&#44; capillaries visible&nbsp;\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">Pericapillary edema&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">Absent&nbsp;\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">Subpapillary venous plexus&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">Visible in 10&#37;-30&#37; of healthy people&nbsp;\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">Capillary morphology&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">U-shaped&nbsp;\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">Tortuosity&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">5&#37; of healthy people&nbsp;\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">Giant or dilated capillaries&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">Absent&nbsp;\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">Ramified capillaries&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">Absent&nbsp;\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">Neoangiogenesis&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">Absent&nbsp;\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">Avascular areas&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">Absent&nbsp;\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">Capillary density&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">7-17&#47;mm&nbsp;\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
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                  \t\t\t\t">Hemorrhages&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">Normally absent&#44; may be present after trauma&nbsp;\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
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                  \t\t\t\t">Vascular flow&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">Dynamic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Characteristics of a Normal Capillaroscopy Pattern&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
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              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Capillaroscopic patterns in rheumatic diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Cortes"
                            1 => "M&#46; Cutolo"
                          ]
                        ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Reumatol Port"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "29"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17450762"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0110"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of capillaroscopy in differentiation of primary and secondary Raynaud&#39;s phenomenon in rheumatic diseases&#58; a review of the literature and two case reports"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;N&#46; Lambova"
                            1 => "U&#46; M&#252;ller-Ladner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00296-009-1019-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatol Int"
                        "fecha" => "2009"
                        "volumen" => "29"
                        "paginaInicial" => "1263"
                        "paginaFinal" => "1271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19547979"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0115"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Capilaroscopia en las unidades de reumatolog&#237;a&#46; Usos y aplicaciones"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "X&#46; Juanola"
                            1 => "E&#46; Sirvent"
                            2 => "D&#46; Reina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Reum"
                        "fecha" => "2004"
                        "volumen" => "31"
                        "paginaInicial" => "514"
                        "paginaFinal" => "520"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "4"
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                0 => array:2 [
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Practical Dermatology
Capillaroscopy: A Valuable Diagnostic Tool
Capilaroscopia: una herramienta diagnóstica valiosa
S.S. Ocampo-Garzaa, M.A. Villarreal-Alarcónb, A.V. Villarreal-Treviñob, J. Ocampo-Candiania,
Autor para correspondencia
jocampo2000@yahoo.com.mx

Corresponding author.
a Departamento de Dermatología, Hospital Universitario Dr. José E. González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México
b Departamento de Reumatología, Hospital Universitario Dr. José E. González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Capillaroscopy is a technique based on direct&#44; in vivo imaging of skin microcirculation&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> It provides an accessible&#44; noninvasive means of analyzing microvascular abnormalities in patients with rheumatic conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> Capillaroscopy has proven useful in diseases such as systemic sclerosis&#44; Sj&#246;gren syndrome&#44; rheumatoid arthritis&#44; dermatomyositis&#44; systemic lupus erythematosus&#44; and&#44; in particular&#44; Raynaud phenomenon&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Microcirculation can be studied using several methods&#44; 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as well as to eliminate carbon dioxide and waste products&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The vasculature and microcirculation consist of the smallest vessels in the body&#44; namely&#44; arterioles&#44; capillaries&#44; and venules&#46; The capillaries are composed of an arterial branch&#44; a capillary loop&#44; and a venous branch&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> The arterial branch is narrower than the venous branch by a ratio of 1&#58;1&#46;2-1&#46;5&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> This pattern is found in all the organs of the body except the liver&#44; the spleen&#44; and the bone marrow&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Technique</span><p id="par0025" class="elsevierStylePara elsevierViewall">Capillaroscopy can be performed using a low-magnification lens &#40;&#215;20&#41; or a high-magnification lens &#40;&#215;200&#41;&#46; Low-magnification lenses provide a panoramic image of the microcirculation&#44; whereas high-magnification lenses enable better visualization of the capillaries and their morphological characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> The main low-magnification optical instruments are the stereomicroscope&#44; the dermatoscope&#44; and the ophthalmoscope&#46; Videocapillaroscopy provides a panoramic image and enables active visualization and magnifications of up to &#215;100&#44; &#215;200&#44; and &#215;600&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> The development of computerized systems&#44; specifically nailfold videocapillaroscopy&#44; makes it possible to visualize and analyze a single capillary&#44; and to subsequently analyze the same capillary at different time points&#44; with high reproducibility&#46; Furthermore&#44; it can digitally store images of excellent quality and provide printed reports with the Images&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> Another advantage of the videocapillaroscope is its optical probe&#44; which can be placed in direct contact with the nailfold&#44; thus enabling the study of patients with severe joint contractions&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5&#44;6</span></a> Capillaroscopy only enables visualization of capillary structure&#44; whereas with videocapillaroscopy&#44; we can observe functional and morphological changes and hemorheological dynamics&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient must be relaxed and remain seated at a temperature of 20-22&#176;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">C</span> for the 15<span class="elsevierStyleHsp" style=""></span>minutes preceding the study&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> In addition&#44; patients must refrain from smoking for 24<span class="elsevierStyleHsp" style=""></span>hours before the examination <a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>and must not undergo cosmetic procedures &#40;manicure&#44; gel or acrylic nails&#41; during the 3 weeks before the examination&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> The nailfolds must be clean&#44; without perionyxis or nail polish&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient is placed with his&#47;her hands on a surface at the level of the heart&#46; A drop of immersion oil is applied on the nailfold to increase the transparency of the skin&#46; All the fingers except the thumbs are examined&#46; Each finger must be observed at &#215;50 to examine the architecture and then at &#215;200-300 to observe the morphological characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Visualization is optimal for the folds of the fourth and fifth fingers thanks to the transparency of the skin&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Normal Capillaroscopy Pattern</span><p id="par0040" class="elsevierStylePara elsevierViewall">The periungual capillaries in a healthy person have a regular architecture in the shape of in inverted U or hairpin with a uniform distribution and diameter&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> They form a semicircle that accompanies the nail matrix with a red color over a clearer base&#44; which is known as conserved polarity&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Between 7 and 17 capillaries per linear millimeter is considered normal&#46; The capillaries have 2 branches&#8212;an afferent branch &#40;arteriole&#41; and an efferent branch &#40;venule&#41;&#8212;and a transitional zone&#46; The branches are parallel to each other&#44; without crossing over or overlapping <a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The subpapillary venous plexus can be observed in 10&#37;-30&#37; of healthy persons&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Preserved microvascular function consists of the following&#58; absence of bleeding and exudates&#44; clear visualization of structures without interference&#44; and preserved perfusion&#44; that is&#44; uninterrupted flow that is uniformly red in color in the blood column&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> There should be no megacapillaries or diffuse loss of capillaries in healthy persons&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Abnormal capillaroscopy findings are observed in up to 10&#37; of healthy persons&#59; therefore&#44; isolated abnormalities do not indicate disease&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> Capillaroscopy reveals moderate heterogeneous morphological changes in primary Raynaud phenomenon&#44; although these are not clinically signficant&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The 3 morphologically &#8220;normal&#8221; capillaroscopy patterns in healthy persons are as follows&#58; &#40;<span class="elsevierStyleItalic">1</span>&#41; the normal pattern&#44; with 2-5 U-shaped loops&#47;mm and<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2 tortuous loops&#47;mm&#59; &#40;<span class="elsevierStyleItalic">2</span>&#41; the perfect normal pattern&#44; with <span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>5 U-shaped loops&#47;mm&#59; and &#40;<span class="elsevierStyleItalic">3</span>&#41; the unusual normal pattern&#44; with at least 1 meandering or bushy loop or at least 1 microhemorrhage or with <span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4 crossed loops&#47;mm<span class="elsevierStyleSup">10</span>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the characteristics of a normal capillaroscopy pattern&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Pathological Capillaroscopy Patterns</span><p id="par0065" class="elsevierStylePara elsevierViewall">Capillary abnormalities are characterized by an increase in morphological or structural variations&#44; with an increase in the size of the capillaries and a gradual decrease in their density&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">We can identify a diverse range of individual capillary abnormalities within abnormal capillaroscopy patterns or those that are nonspecific and not associated with a specific disease&#46; Abnormalities of this type were described by Cutolo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> The most common are presented below &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The number of capillaries and their morphological characteristics make it possible to describe specific capillaroscopy patterns that can help classify disease and provide information on prognosis and outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Tortuous Pattern</span><p id="par0080" class="elsevierStylePara elsevierViewall">The tortuous pattern is characterized by meandering&#44; tortuous&#44; or corkscrew capillaries&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> In tortuous capillaries&#44; the afferent and efferent loops intersect at &#8805;2 points&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> The pattern is confirmed when the abnormality is present in at least 10&#37; of all vessels observed&#46; The superficial venous plexus is usually visible in this pattern&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">This abnormality is found mainly in rheumatoid arthritis&#44; psoriasis&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> and systemic lupus erythematosus&#44; where it is more characteristic <a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;12</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Scleroderma Pattern</span><p id="par0090" class="elsevierStylePara elsevierViewall">The scleroderma pattern is the best-defined and most specific pattern&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> It is found in systemic sclerosis &#40;80&#37;-100&#37; of patients&#41;&#44; in dermatomyositis &#40;55&#37;-100&#37;&#41;&#44; and in mixed connective tissue disease &#40;54&#37;-63&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The microvascular abnormalities of systemic sclerosis were classified by Cutolo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> into 3 different patterns&#58; the early pattern &#40;few giant capillaries&#44; few capillary hemorrhages with no evident loss of capillaries&#44; and well-preserved capillary distribution&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#59; the active pattern &#40;frequent giant capillaries&#44; frequent capillary hemorrhages&#44; and moderate loss of capillaries&#44; as well as few&#47;absent ramified capillaries&#44; with some disorganization of the capillary architecture&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Figure 5</a>&#41;&#59; and the late pattern &#40;few&#47;absent giant capillaries and microhemorrhages with severe loss of capillaries with extensive avascular areas&#44; ramified capillaries&#44; and intense disorganization&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Figure 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In patients with dermatomyositis and mixed connective tissue disease&#44; an additional finding is the presence of bushy capillaries&#44; which are ramified capillaries that are typical of neoangiogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Capillaroscopy in Rheumatic Disease</span><p id="par0105" class="elsevierStylePara elsevierViewall">The main indications for capillaroscopy are primary Raynaud phenomenon and Raynaud phenomenon secondary to rheumatic disease&#44; early detection of systemic scleroderma or sclerodermatous syndromes&#44; dermatomyositis&#44; systemic lupus erythematosus&#44; Sj&#246;gren syndrome&#44; vascular syndromes&#44; and mixed connective tissue disease&#46; The study should be performed annually&#46; In the case of rapidly progressing systemic scleroderma&#44; the study should be performed every 4-6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Raynaud Phenomenon and Systemic Sclerosis</span><p id="par0110" class="elsevierStylePara elsevierViewall">Raynaud phenomenon is thought to be an exaggerated vasospastic response to cold or emotions&#46; The classic response comprises blanching of the fingers &#40;ischemic phase&#41;&#44; bluish color &#40;deoxygenation&#41;&#44; and erythema &#40;reperfusion&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Raynaud phenomenon is the first clinical sign of abnormal systemic vascular tone&#46; Capillaroscopy makes it possible to monitor the progression of microangiopathy&#44; study severity&#44; and establish the risk of an aggressive outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> It has proven effective&#44; enabling us to distinguish between the primary form and the form that is secondary to a connective tissue disease with involvement of the microcirculation&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Secondary Raynaud phenomenon usually appears at an older age&#44; with intense&#44; asymmetric&#44; and painful episodes leading to ischemic lesions of the skin&#46; It is associated with positive specific antibody titers and capillaroscopy abnormalities&#44; revealing the presence of connective tissue diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;17</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The observation of an early scleroderma pattern in association with the presence of specific antibodies &#40;anticentromere and antitopoisomerase&#41; and Raynaud phenomenon guides the diagnosis of systemic sclerosis in the early phase&#46; An association has been observed between peripheral vascular compromise in systemic sclerosis and the active scleroderma pattern with digital ulcers&#46; The late scleroderma pattern with frequent avascular areas has been identified as a prognostic factor for mortality in patients with systemic scleroderma&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The importance and use of capillaroscopy has increased over time&#46; For example&#44; abnormal capillaroscopy findings were included in the diagnostic criteria for systemic sclerosis in 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Ingegnoli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> developed an algorithm summarizing the risk of developing systemic sclerosis in patients with abnormal capillaroscopy findings and positive specific antibody titers <a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0035">Figure 7</a>&#41;&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Mixed Connective Tissue Disease</span><p id="par0140" class="elsevierStylePara elsevierViewall">Mixed connective tissue disease affects a group of patients who present characteristics of a combination of systemic autoimmune diseases&#44; mainly lupus&#44; scleroderma&#44; and dermatomyositis&#46; The most frequent symptom is Raynaud phenomenon&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Abnormal capillaroscopy findings in mixed connective tissue disease are similar to those of scleroderma in 50&#37; of cases&#44; with frequent tortuous&#44; bushy capillaries &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Figure 8</a>&#41;&#46; Capillaroscopy has been proposed as a useful marker of activity and prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dermatomyositis</span><p id="par0150" class="elsevierStylePara elsevierViewall">Abnormal nailfold capillaroscopy findings are recorded in 70&#37; of patients with dermatomyositis&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> In more than 60&#37;-80&#37; of cases&#44; the abnormal findings are similar to those of systemic sclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> Microvascular findings are similar in classic and in paraneoplastic&#44; amyopathic&#44; and juvenile dermatomyositis&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The diagnosis of dermatomyositis is based on at least 2 of the following characteristics&#58; megacapillaries&#44; capillary loss&#44; disorganization of the capillary array&#44; bushy capillaries&#44; tortuous capillaries&#44; and hemorrhages <a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0045">Figure 9</a>&#41;&#46;</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">There is a positive correlation between the scleroderma pattern and interstitial lung disease&#46; Microthrombosis is associated with poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Systemic Lupus Erythematosus</span><p id="par0165" class="elsevierStylePara elsevierViewall">Systemic lupus erythematosus does not involve specific microvascular alterations&#46; In fact&#44; the capillaroscopy pattern is normal in 30&#37; of cases&#59; therefore&#44; normal findings do not rule out disease&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Abnormal capillaroscopy findings are more frequent in patients with systemic lupus erythematosus associated with Raynaud phenomenon&#44; anti&#8211;U1 ribonucleoprotein antibodies&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> or anticardiolipin antibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The most typical capillaroscopy abnormalities include the presence of a tortuous pattern &#40;corkscrew capillaries&#41;&#46; Other abnormalities&#44; such as capillary dilation and prominent subpapillary venous plexus&#44; have also been reported <a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0050">Figure 10</a>&#41;&#46; The presence of major capillary abnormalities points to a severe clinical course&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0050"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Rheumatoid Arthritis</span><p id="par0175" class="elsevierStylePara elsevierViewall">The presence of an extensively visible subpapillary venous plexus with capillary hemorrhages has been reported in rheumatoid arthritis&#46; The loops are usually filiform and increased in length <a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;5</span></a>&#40;<a class="elsevierStyleCrossRef" href="#fig0055">Figure 11</a>&#41;&#46;</p><elsevierMultimedia ident="fig0055"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">The most noticeable abnormalities are in patients whose condition co-occurs with Raynaud phenomenon&#44; multiple joint involvement&#44; or antinuclear antibodies with positive rheumatoid factor&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">It is important to remember that many diseases involve microvascular abnormalities&#59; these range from rheumatic diseases such as Sj&#246;gren syndrome and antiphospholipid syndrome to psoriasis&#44; diabetes&#44; and hypertension&#46; The capillaroscopy patterns of each of these conditions are currently under study&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0190" class="elsevierStylePara elsevierViewall">Nailfold capillaroscopy is a rapid&#44; noninvasive&#44; safe&#44; and inexpensive technique that enables us to assess the skin microcirculation&#46; It has proven useful in the timely detection and prognosis of rheumatic diseases&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of Interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres1199768"
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        1 => array:2 [
          "identificador" => "xpalclavsec1118210"
          "titulo" => "Keywords"
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          "identificador" => "xres1199767"
          "titulo" => "Resumen"
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            0 => array:1 [
              "identificador" => "abst0010"
            ]
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        3 => array:2 [
          "identificador" => "xpalclavsec1118211"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Principles of Microcirculation"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Technique"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Normal Capillaroscopy Pattern"
        ]
        8 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Pathological Capillaroscopy Patterns"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Tortuous Pattern"
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            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Scleroderma Pattern"
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          ]
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        9 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Capillaroscopy in Rheumatic Disease"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Raynaud Phenomenon and Systemic Sclerosis"
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            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Mixed Connective Tissue Disease"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Dermatomyositis"
            ]
            3 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Systemic Lupus Erythematosus"
            ]
            4 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Rheumatoid Arthritis"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conclusion"
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        11 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conflicts of Interest"
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        12 => array:1 [
          "titulo" => "References"
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    "fechaRecibido" => "2018-05-12"
    "fechaAceptado" => "2018-10-08"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1118210"
          "palabras" => array:6 [
            0 => "Capillaroscopy"
            1 => "Cutaneous microcirculation"
            2 => "Autoimmune diseases"
            3 => "Raynaud phenomenon"
            4 => "Nailfold"
            5 => "Systemic sclerosis"
          ]
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1118211"
          "palabras" => array:6 [
            0 => "Capilaroscopia"
            1 => "Microcirculaci&#243;n cut&#225;nea"
            2 => "Enfermedades autoinmunes"
            3 => "Fen&#243;meno de Raynaud"
            4 => "Pliegue ungueal"
            5 => "Esclerosis sist&#233;mica"
          ]
        ]
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Capillaroscopy produces in vivo images of skin microcirculation&#46; It is a simple&#44; noninvasive tool for analyzing microvascular abnormalities and&#44; as such&#44; can be used in both adults and children&#46; Capillaroscopy has proven to be useful in many diseases&#44; but it is of particular value in Raynaud phenomenon and other autoimmune diseases&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The test is used to analyze capillaroscopic patterns in the nailfold bed of the second to fifth fingers of each hand&#46; A normal capillaroscopic pattern is characterized by the presence of 7 to 11 capillaries in a hairpin shape&#46; Pathologic patterns are characterized by morphologic and structural alterations&#44; such as ectasias&#44; giant capillaries&#44; pathologic hemorrhages&#44; avascular areas&#44; and neoangiogenesis&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In this article&#44; we review the fundamentals of capillaroscopy&#44; with an emphasis on the technique and its indications&#44; diagnostic value&#44; and use as a prognostic tool for rheumatologic disorders&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La capilaroscopia es una t&#233;cnica de estudio que permite obtener im&#225;genes directas in vivo de la microcirculaci&#243;n cut&#225;nea&#46; Constituye un m&#233;todo accesible y no invasivo para analizar las anormalidades microvasculares&#44; por lo que puede utilizarse en ni&#241;os y adultos&#46; En la actualidad se ha demostrado su utilidad en m&#250;ltiples dolencias&#44; principalmente en el fen&#243;meno de Raynaud y otras enfermedades autoinmunes&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La capilaroscopia se realiza en el lecho ungueal del segundo al quinto dedo de ambas manos con la finalidad de encontrar un patr&#243;n capilarosc&#243;pico espec&#237;fico&#46; El patr&#243;n de normalidad se caracteriza por la presencia de 7-11 capilares por mil&#237;metro dispuestos en forma de &#171;U&#187; invertida&#46; Los patrones patol&#243;gicos muestran alteraciones morfol&#243;gicas y estructurales como&#58; ectasias&#44; capilares gigantes&#44; hemorragias patol&#243;gicas&#44; &#225;reas avasculares y neoangiog&#233;nesis&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En este art&#237;culo se presentan las bases de la capilaroscopia&#44; incluyendo la t&#233;cnica&#44; las indicaciones&#44; as&#237; como la utilidad diagn&#243;stica y como factor pron&#243;stico en enfermedades reumatol&#243;gicas&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ocampo-Garza SS&#44; Villarreal-Alarc&#243;n MA&#44; Villarreal-Trevi&#241;o AV&#44; Ocampo-Candiani J&#46; Capilaroscopia&#58; una herramienta diagn&#243;stica valiosa&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;347&#8211;352&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Normal pattern&#46; Regular architecture with uniform distribution and diameter and hairpin or U shape&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tortuous pattern&#46; Meandering capillaries&#59; the afferent and efferent loops intersect at <span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 points&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Early scleroderma pattern&#46; Few giant capillaries&#44; with no evidence of capillary loss and well-preserved capillary array&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Active scleroderma pattern&#46; Frequent giant capillaries&#44; frequent microhemorrhages&#44; and moderate capillary loss&#44; with some disorganization of capillary architecture&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Late pattern in scleroderma&#46; Few&#47;absent giant capillaries and microhemorrhages&#44; extensive avascular areas&#44; ramified capillaries&#44; and intense disorganization&#46;</p>"
        ]
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Algorithm summarizing the risk of developing systemic sclerosis in patients with secondary Raynaud phenomenon&#46; ANA indicates antinuclear antibodies&#59; SS&#44; systemic sclerosis&#46;</p>"
        ]
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        "identificador" => "fig0040"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Dermatomyositis&#46; Megacapillaries&#44; bushy capillaries&#44; and capillary loss with disorganization of the capillary array&#46;</p>"
        ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Systemic lupus erythematosus&#46; Tortuous pattern with prominent superficial venous plexus&#46;</p>"
        ]
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Rheumatoid arthritis&#46; Nonspecific alterations&#58; filiform&#44; elongated loops&#44; with a visible vascular plexus&#46;</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Modified from Chojnowski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a></p>"
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                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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics of the Capillaroscopy&nbsp;\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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal Pattern&nbsp;\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">Skin transparency and visibility&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">Transparent&#44; capillaries visible&nbsp;\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">Pericapillary edema&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">Absent&nbsp;\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">Subpapillary venous plexus&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">Visible in 10&#37;-30&#37; of healthy people&nbsp;\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">Capillary morphology&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">U-shaped&nbsp;\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">Tortuosity&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">5&#37; of healthy people&nbsp;\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">Giant or dilated capillaries&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">Absent&nbsp;\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">Ramified capillaries&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">Absent&nbsp;\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">Neoangiogenesis&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">Absent&nbsp;\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">Avascular areas&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">Absent&nbsp;\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">Capillary density&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">7-17&#47;mm&nbsp;\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">Hemorrhages&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">Normally absent&#44; may be present after trauma&nbsp;\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">Vascular flow&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">Dynamic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Characteristics of a Normal Capillaroscopy Pattern&#46;</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Cortes"
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                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "link" => array:1 [
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                            "web" => "Medline"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                          "etal" => false
                          "autores" => array:2 [
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                          ]
                        ]
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                  "host" => array:1 [
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                      "Revista" => array:6 [
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              "referencia" => array:1 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Capilaroscopia en las unidades de reumatolog&#237;a&#46; Usos y aplicaciones"
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              "referencia" => array:1 [
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                  "contribucion" => array:1 [
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                  "host" => array:1 [
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                      "autores" => array:1 [
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                          "etal" => false
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                            1 => "A&#46; Felis-Giemza"
                            2 => "M&#46; Olesi&#324;ska"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5114/reum.2016.60215"
                      "Revista" => array:6 [
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                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Cutolo"
                            1 => "A&#46; Sulli"
                            2 => "V&#46; Smith"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.berh.2013.03.001"
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                        "tituloSerie" => "Best Pract Res Clin Rheumatol"
                        "fecha" => "2013"
                        "volumen" => "27"
                        "paginaInicial" => "237"
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              "identificador" => "bib0135"
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