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Infliximab no tratamento da sarcoidose - Experiência de um hospital central
Infliximab for treating sarcoidosis patients, Portuguese experience
M. Aguiar
, N. Marçal, A.C. Mendes, A. Bugalho de Almeida
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Serviço de Pneumologia 1, Hospital de Santa Maria, CHLN, EPE, Lisboa, Portugal
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"apellidos" => "Pontes da Mata" ] ] ] ] ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215911700198?idApp=UINPBA00004E" "url" => "/08732159/0000001700000002/v2_201509070838/S0873215911700198/v2_201509070838/pt/main.assets" ] "pt" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Série de casos</span>" "titulo" => "Infliximab no tratamento da sarcoidose - Experiência de um hospital central" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "85" "paginaFinal" => "93" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Aguiar, N. Marçal, A.C. Mendes, A. Bugalho de Almeida" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Aguiar" "email" => array:1 [ 0 => "m_aguiar@netcabo.pt" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Marçal" ] 2 => array:2 [ "nombre" => "A.C." "apellidos" => "Mendes" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Bugalho de Almeida" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Serviço de Pneumologia 1, Hospital de Santa Maria, CHLN, EPE, Lisboa, Portugal" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Autor para correspondência." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Infliximab for treating sarcoidosis patients, Portuguese experience" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-11-27" "fechaAceptado" => "2010-10-02" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec566812" "palabras" => array:2 [ 0 => "Sarcoidose" 1 => "Infliximab" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec566813" "palabras" => array:2 [ 0 => "Sarcoidosis" 1 => "Infliximab" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Apesar de tratamento agressivo e atempado, a Sarcoidose pode ser, por vezes, uma doença progressiva e bastante debilitante. O papel do factor de necrose tumoral (TNF)-α na génese dos granulomas é ambíguo. Por um lado a sua presença é necessária para a formação e manutenção da inflamação granulomatosa, sendo, portanto, o seu antagonista utilizado com sucesso no tratamento de doentes com sarcoidose; por outro lado e para outras situações, há referência do aparecimento dessa patologia em doentes submetidos a Infliximab.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O Infliximab foi por nós utilizado no tratamento de doentes com sarcoidose que não apresentavam resposta à corticoterapia ou a outras terapêuticas convencionais ou que desenvolviam efeitos secundários inaceitáveis a essa terapêutica. A dose inicial foi de 5<span class="elsevierStyleHsp" style=""></span>mg/Kg de peso e as doses subsequentes foram administradas na 2.<span class="elsevierStyleSup">a</span> semana, na 6.<span class="elsevierStyleSup">a</span> semana e depois, durante o período de um ano de 8 em 8 semanas.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dez doentes com diagnóstico de sarcoidose por biopsia, iniciaram terapêutica com este fármaco. Destes cinco eram homens e cinco mulheres, com uma idade média de 47,1 anos, variando a idade entre 28 e 63 anos. Três doentes apresentavam sintomas graves do sistema nervoso central, dois, cirrose hepática, uma inflamação granulomatosa da glândula lacrimal já submetida a múltiplas cirurgias, uma com envolvimento pulmonar extenso (estádio III), uma, com lúpus pérnio desfigurante e dois, com nódulos cutâneos desfigurantes. Oito doentes apresentavam mais do que um local de doença. Todos os doentes completaram pelo menos sete ciclos de tratamento. Em quatro doentes a dose de corticóides ou de outra terapêutica imunosupressora foi suspensa, em três foi reduzida, e apenas em uma doente foi necessário juntar corticóides à terapêutica com Infliximab. Cinco doentes apresentaram uma melhoria significativa. Um dos doentes com sintomas neurológicos apresentou resolução total, enquanto que a segunda melhorou substancialmente o seu deficit visual permitindo que voltasse a ler. Dois doentes suspenderam terapêutica, uma por falta de melhoria dos sintomas neurológicos e outra por aparecimento de pneumonia organizativa durante o tratamento com Infliximab. Três doentes desenvolveram anticorpos anti-histonas durante o tratamento.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O Infliximab parece ser eficaz no tratamento de doentes com sarcoidose refractária ou que desenvolvem efeitos secundários ao regime terapêutico habitual de corticóides ou outros agentes imunosupressivos. No entanto é necessário manter uma vigilância apertada destes doentes para identificar rapidamente efeitos secundários que possam surgir.</p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Despite aggressive treatment, sarcoidosis may be debilitating and progressive. The role of tumor necrosis factor (TNF)-α in the genesis of granulomas is ambiguous. It has proven to be critical in the formation and maintenance of granulomatous inflammation and its antagonist, Infliximab, has therefore been used with success in the treatment of patients with sarcoidosis. There are, however, reports of onset of sarcoidosis in patients in treatment for other conditions and that had no outbursts before submission to this therapy.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We used Infliximab in the treatment of patients with sarcoidosis who either didn’t respond to corticosteroids and other conventional drugs or developed unacceptable side effects to these drugs. The initial dose was 5<span class="elsevierStyleHsp" style=""></span>mg/Kg body weight and subsequent doses were given at weeks 2, 4 and then every other 8 weeks for a total period of one year.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We treated ten patients with biopsy proven sarcoidosis, five men and five women, with a mean age of 47.1 years ranging from 28 to 63 years of age. Three patients had severe neurological symptoms, two had hepatic cirrhosis, one had granulomatous inflammation of the lachrymal gland and had already been submitted to many surgeries, one had extensive pulmonary involvement (stage III), one had disfiguring lupus pernio and two presented disabling cutaneous nodules. In four patients the dosage of corticosteroids or other immunosuppressive drugs was suspended, in three the dosage was reduced and in one, corticosteroids were added to the Infliximab therapy. In five of the patients there was a significant improvement. One of the patients with neurological symptoms displayed a complete recovery, while another had significant improvement of vision deficit enabling her to read again. Two patients withdrew from therapy, one due to lack of improvement of neurological symptoms and the other due to the onset of organizing pneumonia spawned by Infliximab. Two patients developed anti-histone antibodies during treatment.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Infliximab seems effective in treating patients who are either refractory or develop side effects to a standard regimen of corticosteroids and immunosuppressive agents. These patients, treated with Infliximab, should be under tight surveillance in order to quickly identify possible secondary effects.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of Infliximab in treating selected patients with sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Saleh" 1 => "S. Ghodsian" 2 => "V. Yakaimova" 3 => "J. Henderson" 4 => "O.P. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2006.02.017" "Revista" => array:6 [ "tituloSerie" => "Respiratory Medicine" "fecha" => "2006" "volumen" => "100" "paginaInicial" => "2053" "paginaFinal" => "2059" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16935484" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor necrosis factor-alpha inhibitor treatment for sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Callejas-Rubio" 1 => "L. López-Pérez" 2 => "N. Ortego-Centeno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Therapeutics and Clinical Risk Management" "fecha" => "2008" "volumen" => "4" "paginaInicial" => "1305" "paginaFinal" => "1313" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19337437" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary sarcoidosis; a disorder mediated by excess T-helper lymphocyte activity at sites of disease activity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Hunninghake" 1 => "R. Crystal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198108203050804" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1981" "volumen" => "305" "paginaInicial" => "429" "paginaFinal" => "432" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6454846" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current concepts of the pathogenesis of sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Thomas" 1 => "G. Hunninghake" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/arrd.1987.135.3.747" "Revista" => array:6 [ "tituloSerie" => "Am Rev Respir Dis" "fecha" => "1987" "volumen" => "135" "paginaInicial" => "747" "paginaFinal" => "760" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3103505" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor a for Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.R. Targan" 1 => "S.R. Hanauer" 2 => "S.J.H. van Deventer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199710093371502" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1997" "volumen" => "337" "paginaInicial" => "1029" "paginaFinal" => "1035" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9321530" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Canadian rheumatology association consensus on the use of antitumor necrosis factor-alpha directed therapies in the treatment of spondyloarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Maksymowch" 1 => "R. Inman" 2 => "D. Gladman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2003" "volumen" => "30" "paginaInicial" => "1356" "paginaFinal" => "1363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12784417" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infliximab improves signs and symptoms of psoriatic arthritis: results of the IMPACT 2 trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Antoni" 1 => "G. Krueger" 2 => "K. de Vlam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2004.032268" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2005" "volumen" => "64" "paginaInicial" => "1150" "paginaFinal" => "1157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15677701" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of sarcoidosis with Infliximab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.D. Doty" 1 => "J.E. Mazur" 2 => "M.A. Judson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.127.3.1064" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2005" "volumen" => "127" "paginaInicial" => "1064" "paginaFinal" => "1071" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15764796" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infliximab in refractory sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Baughman" 1 => "E. Lower" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sarcoidosis Vasc Diffuse Lung Dis" "fecha" => "2001" "volumen" => "18" "paginaInicial" => "70" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11354550" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Refractory sarcoidosis responding to Infliximab" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Roberts" 1 => "D. Wilkes" 2 => "R. Burgett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2003" "volumen" => "124" "paginaInicial" => "2028" "paginaFinal" => "2031" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14605086" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Refractory neurosarcoidosis responding to Infliximab" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Pettersen" 1 => "D. Zochodne" 2 => "R. Bell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2002" "volumen" => "59" "paginaInicial" => "1660" "paginaFinal" => "1661" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12451224" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor-alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.N. Maini" 1 => "F.C. Breedveld" 2 => "J.R. Kalden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1529-0131(199809)41:9<1552::AID-ART5>3.0.CO;2-W" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1998" "volumen" => "41" "paginaInicial" => "1552" "paginaFinal" => "1563" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9751087" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low dose methotrexate suppresses antiglobulin responses and potentiates efficacy of a chimeric monoclonal anti-TNF-a antibody (cA2) given repeatedly in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Maini" 1 => "F. Breedveld" 2 => "J. Kalden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1997" "volumen" => "40" "numero" => "Suppl" "paginaInicial" => "126" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infections associated with tumor necrosis factor-a antagonists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.F. Crum" 1 => "E.R. Lederman" 2 => "M.R. Wallace" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Medicine" "fecha" => "2005" "volumen" => "84" "paginaInicial" => "291" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16148729" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histoplasmosis after treatment with anti-tumor necrosis factor-a therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.L. Wood" 1 => "C.A. Hage" 2 => "K.S. Knox" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200206-563OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2003" "volumen" => "167" "paginaInicial" => "1279" "paginaFinal" => "1282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12615627" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary sarcoidosis in a patient with ankylosing spondylitis treated with Infliximab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Almodóvar" 1 => "M. Izquierdo" 2 => "P. Zarco" 3 => "F. Javier Quirós" 4 => "R. Mazzucchelli" 5 => "B. Steen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2007" "volumen" => "25" "paginaInicial" => "99" "paginaFinal" => "101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17417999" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful long-term management of refractory cutaneous and upper airway sarcoidosis with periodic Infliximab infusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Rosen" 1 => "C. Doherty" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18328208" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac sarcoidosis responding to monotherapy with Infliximab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Uthman" 1 => "Z. Touma" 2 => "M. Khoury" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-007-0614-1" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "2001" "paginaFinal" => "2003" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17394036" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Refractory neurosarcoidosis responsive to Infliximab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Kobylecki" 1 => "S. Shaunak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pract Neurol" "fecha" => "2007" "volumen" => "7" "paginaInicial" => "112" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17430876" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of infliximab in cutaneous sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.H. Meyerle" 1 => "A. Shorr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Drugs Dermatol" "fecha" => "2003" "volumen" => "2" "paginaInicial" => "413" "paginaFinal" => "414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12884466" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "pt" "url" => "/08732159/0000001700000002/v2_201509070838/S0873215911700204/v2_201509070838/pt/main.assets" "Apartado" => array:4 [ "identificador" => "9560" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Série de casos" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001700000002/v2_201509070838/S0873215911700204/v2_201509070838/pt/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215911700204?idApp=UINPBA00004E" "pdfAlternativo" => array:1 [ 0 => array:3 [ "idioma" => "pt" "documentoPdf" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/file/08732159/addon/S0873215911700204/S300/pt/320v17n02a90002031pdf001_2.pdf" "portada" => "320v17n02a90002031pdf001_2.png" ] ] ]
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ISSN: 08732159Original language: Portuguese
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