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Tejón P, Belmonte MA, Lerma JJ, Lozano A. Coccydynia related to the use of a contraceptive vaginal ring. Reumatol Clin 2017; 13:42-43. [PMID: 26805547 DOI: 10.1016/j.reuma.2015.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/05/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
Coccydynia is a syndrome that rheumatologists encounter frequently in the form of tailbone pain, which is usually worse when sitting. Although the most common origin is trauma, there are several other possible causes of pain in the coccyx. We present an unusual case in which coccydynia developed shortly after the insertion of a contraceptive vaginal ring and remitted completely upon removal of this system.
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Affiliation(s)
- Patricia Tejón
- Sección de Reumatología, Hospital Universitario General de Castellón, Castellón de la Plana, Castellón, España.
| | - Miguel Angel Belmonte
- Sección de Reumatología, Hospital Universitario General de Castellón, Castellón de la Plana, Castellón, España
| | - Juan José Lerma
- Sección de Reumatología, Hospital Universitario General de Castellón, Castellón de la Plana, Castellón, España
| | - Antonio Lozano
- Sección de Reumatología, Hospital Universitario General de Castellón, Castellón de la Plana, Castellón, España
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Garcia-Palacios A, Herrero R, Belmonte MA, Castilla D, Guixeres J, Molinari G, Baños RM. Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: a randomized crossover study. Eur J Pain 2013; 18:862-72. [PMID: 24921074 DOI: 10.1002/j.1532-2149.2013.00425.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Daily diaries are a useful way of measuring fluctuations in pain-related symptoms. However, traditional diaries do not assure the gathering of data in real time, not solving the problem of retrospective assessment. Ecological momentary assessment (EMA) by means of electronic diaries helps to improve repeated assessment. However, it is important to test its feasibility in specific populations in order to reach a wider number of people who could benefit from these procedures. METHODS The present study compares the compliance and acceptability of an electronic diary running on a smartphone using a crossover design for a sample with a specific pain condition, fibromyalgia and low familiarity with technology. Forty-seven participants were randomly assigned to one of two conditions: (1) paper diary - smartphone diary and (2) smartphone diary - paper diary, using each assessment method for 1 week. RESULTS The findings of this study showed that the smartphone diary made it possible to gather more accurate and complete ratings. Besides, this method was well accepted by a sample of patients with fibromyalgia referred by a public hospital, with an important proportion of participants with low level of education and low familiarity with technology. CONCLUSIONS The findings of this study support the use of smartphones for EMA even in specific populations with a specific pain condition, fibromyalgia and with low familiarity with technology. These methods could help clinicians and researchers to gather more accurate ratings of relevant pain-related variables even in populations with low familiarity with technology.
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Botella C, Garcia-Palacios A, Vizcaíno Y, Herrero R, Baños RM, Belmonte MA. Virtual reality in the treatment of fibromyalgia: a pilot study. Cyberpsychol Behav Soc Netw 2013; 16:215-23. [PMID: 23496678 DOI: 10.1089/cyber.2012.1572] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this article is to present preliminary data on the effectiveness of virtual reality (VR) as an adjunct to cognitive behavioral therapy (CBT) in the treatment of fibromyalgia (FM). The sample comprised six women diagnosed with FM according to the American College of Rheumatology guidelines (1990). The treatment program consisted of 10 sessions of group CBT with the support of an adaptive virtual environment containing a specific content for developing relaxation and mindfulness skills. Patients were assessed at pretreatment, post-treatment, and at a 6-month follow-up for the following outcome variables: functional status related to pain, depression, a negative and positive affect, and coping skills. The results showed the long-term benefits of significantly reduced pain and depression and an increased positive affect and use of healthy coping strategies. This is the first study showing a preliminary utility of VR in treating FM.
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Affiliation(s)
- Cristina Botella
- Department Psicologia Basica, Clinica y Psicobiologia. Universitat Jaume I , Castellon, Spain
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Naranjo A, Carmona L, Gavrila D, Balsa A, Belmonte MA, Tena X, Rodríguez-Lozano C, Sanmartí R, González-Alvaro I. Prevalence and associated factors of anterior atlantoaxial luxation in a nation-wide sample of rheumatoid arthritis patients. Clin Exp Rheumatol 2004; 22:427-32. [PMID: 15301239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To estimate the prevalence of anterior atlantoaxial subluxation (AAS) in patients with rheumatoid arthritis (RA), and to analyse its association with disease markers. METHODS Cross-sectional analysis of a cohort of RA patients randomly selected from the clinical registries of 34 centres. AAS, defined as an atlantoaxial displacement in cervical spine X-rays greater than 3 mm on flexion films, was actively searched for. Bivariate and multivariate analysis was performed to examine its association with clinical, functional, and treatment variables. RESULTS AAS was found in 88 out of 736 patients with available cervical radiographs, (prevalence and 95% confidence interval [CI]: 12% [9.7-14.2]). The presence of AAS was highly associated with a Larsen score (0-150) over 50 (OR and 95% CI: 5.31 [2.68-10.55]), RA duration of more than 10 years (4.48 [2.70-7.44]), disease onset before age 50 (4.15 [2.42-7.12]), eye involvement (3.93 [1.63-9.46]), and previous RA related surgery (3.90 [2.46-6.19]). No association was found with rheumatoid factor. Multivariate analysis showed that a disease onset before the age of 50, the number of previous DMARD, and, above all, a Larsen score greater than 50 were important independent factors associated with AAS. There is a 33% increased risk for AAS every 10 units up in the Larsen score. CONCLUSION AAS is frequent in RA patients, particularly in those with markers of erosive disease.
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Affiliation(s)
- A Naranjo
- Rheumatology Department, Hospital Dr Negrín, Las Palmas, Spain.
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Balsa A, Carmona L, González-Alvaro I, Belmonte MA, Tena X, Sanmartí R. Value of Disease Activity Score 28 (DAS28) and DAS28-3 compared to American College of Rheumatology-defined remission in rheumatoid arthritis. J Rheumatol 2004; 31:40-6. [PMID: 14705217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To assess the criteria for remission based on Disease Activity Score 28 (DAS28) and DAS28-3 (excluding patients' evaluation of disease activity) compared to American College of Rheumatology (ACR) preliminary criteria in established rheumatoid arthritis (RA), and to examine the value of each ACR criterion individually. METHODS The EMECAR study was designed to assess the burden of comorbidity and inflammatory activity for RA in Spain. A random sample of 788 patients with RA from 34 Spanish centers was selected. Remission was defined by preliminary ACR criteria applied specifically and the clinical activity assessed by the DAS28 and the DAS28-3. A receiver operating characteristics curve analysis was performed to identify cutoff values with the highest usefulness in defining remission on both DAS indices. RESULTS Thirty-two patients (4.1%) were in ACR-defined remission, 62 (7.9%) if fatigue was excluded from the criteria. The frequency of any single criterion that patients in remission fulfilled: no fatigue and joint pain by anamnesis in 31 patients (96.9%); morning stiffness < 15 min in 26 (81.3%); no swelling in joints in 21 (65.6%); normal erythrocyte sedimentation rate (ESR) in 29 (90.6%); and no joint tenderness in 21 (65.6%) patients. The positive predictive value for remission of each criterion: normal ESR 6.5%; morning stiffness < 15 min 8.4%; no fatigue 8.7%; no joint tenderness 13%; no swelling in joints 15.8%; and no joint pain by anamnesis 27.7%. The DAS28 cutoff values with higher discriminatory power for remission were 3.14 (sensitivity 87%; specificity 67%) when all the ACR criteria were used, and 2.81 (sensitivity 84%; specificity 81%) when fatigue was omitted. The equivalent cutoffs for the DAS28-3 were 3.52 (sensitivity 84%; specificity 66%) and 2.95 (sensitivity 82%; specificity 83%), respectively. CONCLUSION DAS28 and DAS28-3 are good tools to define remission in established RA. No joint pain by anamnesis is the criterion with the highest value in defining remission, while normal ESR, an absence of morning stiffness, and fatigue are the least effective.
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Affiliation(s)
- Alejandro Balsa
- Rheumatology Unit, Hospital Universitario La Paz, Madrid, Spain.
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Carmona L, Hernández-García C, Vadillo C, Pato E, Balsa A, González-Alvaro I, Belmonte MA, Tena X, Sanmartí R. Increased risk of tuberculosis in patients with rheumatoid arthritis. J Rheumatol 2003; 30:1436-9. [PMID: 12858438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To quantify the risk of tuberculosis (TB) in an unselected sample of patients with rheumatoid arthritis (RA) compared to the risk in the general population. METHODS The incidence of TB in the general population of Spain was obtained from the National Network of Epidemiological Surveillance reports. The incidence of TB was ascertained from a cohort of 788 patients with RA selected randomly from the registries of 34 participating centers throughout Spain. A patient was considered a TB case only if information about disease symptoms, microorganism identification, and TB treatment were confirmed in the clinical records. The relative risk of TB in RA was calculated by dividing the standardized mean incidence of TB from 1990 to 2000 in the RA cohort by the mean incidence of TB in Spain during the same years. RESULTS The mean incidence of TB in the general population of Spain from 1990 to 2000 was 23 cases per 100,000. Seven cases of TB were identified in the RA cohort, yielding a mean annual incidence (1990-2000) of 134/100,000 patients. The incidence risk ratio of pulmonary TB in patients with RA compared to the general population is 3.68 (95% CI 2.36-5.92). CONCLUSION We found a 4-fold increased risk of TB infection in patients diagnosed with RA. These results might help to interpret the magnitude of the problem attributable to the introduction of new therapies in RA.
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Bacurau RF, Belmonte MA, Seelaender MC, Costa Rosa LF. Effect of a moderate intensity exercise training protocol on the metabolism of macrophages and lymphocytes of tumour-bearing rats. Cell Biochem Funct 2000; 18:249-58. [PMID: 11180287 DOI: 10.1002/1099-0844(200012)18:4<249::aid-cbf879>3.0.co;2-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is commonly accepted that moderate intensity exercise is beneficial to the immune system. We tested the influence of a moderate intensity training protocol (8 weeks) upon immune system function in Wistar tumour-bearing (TB) rats. The metabolism of glucose and glutamine in lymphocytes and macrophages was assessed, together with some functional parameters (hydrogen peroxide production and lymphocyte proliferative response). These substrates were chosen since they represent the most important energetic and synthetic metabolites for these cellular types. The training protocol caused a decrease of 17.4 per cent in the production of H(2)O(2) by macrophages, as well as a decrease in glucose consumption (25 per cent) and lactate production (47.1 per cent), and an increase in the production of labelled CO(2) from the oxidation of [U-(14)C]-glucose, in TB rats. The training protocol was also able to induce changes in the maximal activity of some key enzymes in the metabolism of glucose and glutamine, a reduction of hexokinase (68.8 per cent) activity and an increase in the activity of citrate synthase (10.1 per cent) in TB rats. The training protocol increased the proliferative response of lymphocytes cultivated in the absence of mitogens (75 per cent), of those cultivated in the presence of ConA (38.2 per cent) and in the presence of LPS (45.0 per cent). These cells also showed an increase in the maximal activity of some key enzymes of the glycolytic and glutaminolytic pathways. Our data demonstrated that the training protocol was able to induce an increase in aerobic utilisation of both substrates in lymphocytes and macrophages. The training protocol was also able to prevent several changes in glucose and glutamine metabolism that are normally present in sedentary TB rats. These changes in immune cell metabolism induced by the training protocol were able to increase TB rat survival.
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Affiliation(s)
- R F Bacurau
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Yago M, Belmonte MA, Olmos MJ, Beltran J, Teruel C, Segarra M. Detecting anti-SSA and anti-SSB antibodies in routine analysis: a comparison between double immunodiffusion and immunoblotting. Ann Clin Biochem 1999; 36 ( Pt 3):365-71. [PMID: 10376080 DOI: 10.1177/000456329903600310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to assess the performance of a commercially available procedure for detecting anti-Sjögren's syndrome A (anti-SSA) and anti-Sjögren's syndrome B (anti-SSB) antibodies by immunoblotting (IB) and compare it with double immunodiffusion (DID). We also studied the clinical significance of these profiles in a series of unselected anti-SSA positive patients. Serum samples from 534 patients that were positive on an immunofluorescent screening test using HEp-2 cells were analysed for anti-SSA and anti-SSB antibodies by DID and IB (Biolab Anablot System II), and the results on anti-SSA antibodies were confirmed by an enzyme-linked immunosorbent assay (ELISA). Fifty-five serum samples were found to be positive for anti-SSA antibodies. Among these, 24 were anti-SSA negative by IB but positive by DID and ELISA ('non-blotter sera'), whereas only three serum samples were anti-SSA negative by DID but positive by IB and ELISA. Of the 18 anti-SSB positive serum samples, eight were negative by DID. All the serum samples that were anti-SSB positive by DID were also positive by IB. Anti-SSB antibodies showed a significant association with eye dryness and leucopenia. Anti-52 kDa SSA antibodies were associated with anti-SSB antibodies but showed no significant association with sicca symptoms, while anti-60 kDa SSA antibodies were associated with lower rates of leucopenia. The 'non-blotter' profile showed no significant association with any clinical parameter. IB is less sensitive than DID for detecting anti-SSA antibodies but more sensitive than DID for detecting anti-SSB antibodies. The determination of anti-SSA immunoblotting profiles in patients positive for anti-SSA antibodies by DID does not significantly improve the clinical usefulness of this test. As expected, anti-SSB antibodies were associated with clinical features of Sjögren's disease. Non-blotting (probably conformational) anti-SSA antibodies did not show any further association with clinical parameters and seem to have no clinical relevance.
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Affiliation(s)
- M Yago
- Laboratory of Biochemistry, Hospital General, Castellón, Spain
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Mola S, Botia E, Belmonte MA, Bravo R, Casado A, Moreno P, Osorno M, Vega-Gama JG. [Electronic forum of Revista de neurología: 'Internet, Medicine and Neuroglia']. Rev Neurol 1998; 26:625-32. [PMID: 9796020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION In recent years Internet has drastically transformed the world of telecommunications. Questions about whether Internet and the global communication accessibility may be considered as a fundamental aspect in the medicine of today and tomorrow have been brought up. OBJECTIVE Discuss current and future applications of Internet to the field of Medicine and Neurology. METHODS Bibliographical review based on Medline and standard Web search engines. Forum sessions performed through Internet by means of Web-Chat. Forum coordination entirely performed by electronic mail. RESULTS There are several opinions regarding the influence of Internet on Medicine and Neurology. Currently, the communication and collaboration between teams is improving. It allows scientific publications on-line, improves continuous remote training and facilitates information to patients. New applications like telemedicine need more development. CONCLUSIONS Currently, Internet represents an efficient tool for collaboration, training and distribution of information in the field of Medicine and Neurology.
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Affiliation(s)
- S Mola
- Unidad de Neurología, Hospital del SVS Vega Baja, Alicante, España.
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Belmonte MA. [Statistical methods]. Med Clin (Barc) 1995; 104:397. [PMID: 7707738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
RENOIR is an expert system developed to assist the diagnosis of 37 diseases of connective tissue and inflammatory arthropathies. Precise diagnosis of rheumatic diseases implies great uncertainty and there is no gold standard with which to compare the expert system output. To overcome this problem a set of clinical cases was submitted to RENOIR and its diagnoses were compared with those of clinicians. Medical records of 81 patients with rheumatic diseases were interpreted by RENOIR and by 12 clinicians at three different expertise levels in rheumatology. Distances between the likelihoods of the 37 considered diseases provided by clinicians and RENOIR were computed as a disagreement measure. Mahalanobis distance was used to correct the collinearity between the possibilities of each pair of diseases. Using the resulting matrices of distances between experts, cluster analyses were carried out to classify RENOIR among human experts. Greater differences between RENOIR and clinicians than among clinicians themselves were not found.
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Affiliation(s)
- C Hernandez
- Departament d'Informàtica Mèdica, Institut Municipal d'Investigació Mèdica (IMIM), Universitat Autònoma de Barcelona, Spain
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Belmonte MA, García-Portales R, Doménech I, Fernández-Nebro A, Camps MT, De Ramón E. Avascular necrosis of bone in human immunodeficiency virus infection and antiphospholipid antibodies. J Rheumatol Suppl 1993; 20:1425-8. [PMID: 8230033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We describe 3 cases of human immunodeficiency virus (HIV) infected patients with antiphospholipid antibodies (aPL) in serum who developed avascular necrosis (AVN), an association that to our knowledge, has rarely been described. Given that the 3 patients had stopped their intravenous drug addiction 2 years before the clinical picture appeared, and none had any known risk factors for developing AVN, there may be an association, perhaps fortuitous, between HIV infection, the presence of aPL and the development of AVN.
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Affiliation(s)
- M A Belmonte
- Department of Internal Medicine, Regional Hospital of S.A.S., Malaga, Spain
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Costa B, Belmonte MA, Huguet R, Richart C. [Diabetologic education at a general hospital in Cataluna: methodology and short-term indicators of effectiveness]. Rev Clin Esp 1989; 185:82-90. [PMID: 2772352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In order to carry out an initial evaluation of an intrahospital diabetes education programme after its first year, the methods used are described and some previously established short term effectiveness indicators are analyzed: 1) knowledge of the theory, 2) insulinization, 3) blood glucose self testing at home, 4) metabolic control, 5) readmission in hospital, and 6) detection of chronic complications. An analysis of the previous situation was carried out resulting in a mean hospital stay of 10.8 days/patient/year during 1985, being the mean hospital stay for the general population of 8.1 days. 222 diabetic patients (63 type I and 159 type II) were included in the programme during the first year, and their cultural background, diabetes education, place of origin and participation were evaluated. 358 written tests were examined. The scores obtained after the educational sessions (75.6 +/- 17.5) were significantly higher than the initial scores (47.4 +/- 23.1; p less than 0.001). Prior the programme, 93 patients (41.9%) were on insulin. At the time of the evaluation 156 (70.2%) were on insulin treatment, of which 86 (38.7%) were on rapid insulin. Furthermore, 141 patients (66.1%) were carrying out periodic (over 10 tests/week) blood glucose determinations at home. In a 96 patient follow up group (36 type I and 60 type II) a significant improvement in baseline glucose levels (8.6 +/- 2.7 vs 12.6 +/- 4.2 mmol/l; p less than 0.001) as well as glycosylated hemoglobin levels (9.3 + 1.2% vs 11.0 + 2.0%; p greater than 0.001) was confirmed; this improvement was maintained throughout the time period considered.(ABSTRACT TRUNCATED AT 250 WORDS)
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Costa B, Belmonte MA, Callizo J, Pastor RM, Huguet R, Richart C. [Serum C4 concentration, diabetes mellitus and diabetic microangiopathy]. Med Clin (Barc) 1988; 91:728-31. [PMID: 3236916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Belmonte MA, Cequiere A, Roig-Escofet D. Severe ventricular arrhythmia after methylprednisolone pulse therapy in rheumatoid arthritis. J Rheumatol 1986; 13:477-9. [PMID: 3723518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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