Scientometric analysis and mapping of scientific articles on Behcet s disease

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1 International Journal of Rheumatic Diseases 2013; 16: ORIGINAL ARTICLE Scientometric analysis and mapping of scientific articles on Behcet s disease Farhad SHAHRAM, 1 Ahmad-Reza JAMSHIDI, 1 Armin HIRBOD-MOBARAKEH, 2,3 Gholamreza HABIBI, 4 Amir MARDANI 4 and Marjan GHAEMI 4 1 Behcet s Disease Unit,Rheumatology Research Center, 2 Molecular Immunology Research Center and Department of Immunology, School of Medicine, 3 Students Scientific Research Center,Tehran University of Medical Sciences, and 4 Farzan Scientometric Group, Farzan Clinical Research Institute, Tehran, Iran Abstract Background: Behcßet s disease (BD) is a systemic vasculitis disease with oral and genital aphthous ulceration, uveitis, skin manifestations, arthritis and neurological involvement. Many investigators have published articles on BD in the last two decades since introduction of diagnosis criteria by the International Study Group for Behcßet s Disease in However, there is no scientometric analysis available for this increasing amount of literature. Methods: A scientometric analysis method was used to achieve a view of scientific articles about BD which were published between 1990 and 2010, by data retrieving from ISI Web of Science. The specific features such as publication year, language of article, geographical distribution, main journal in this field, institutional affiliation and citation characteristics were retrieved and analyzed. International collaboration was analyzed using Intcoll and Pajek softwares. Results: There was a growing trend in the number of BD articles from 1990 to The number of citations to BD literature also increased around 5.5-fold in this period. The countries found to have the highest output were Turkey, Japan, the USA and England; the first two universities were from Turkey. Most of the top 10 journals publishing BD articles were in the field of rheumatology, consistent with the subject areas of the articles. There was a correlation between the citations per paper and the impact factor of the publishing journal. Conclusion: This is the first scientometric analysis of BD, showing the scientometric characteristics of ISI publications on BD. Key words: Behcßet s disease, citation, scientometric analysis, web of science. INTRODUCTION Behcßet s disease (BD) is a chronic inflammatory and multisystemic disorder classified as a systemic vasculitis occurring most commonly in young adults. Manifestations include recurrent oral and genital aphthous ulceration, uveitis, skin manifestations, arthritis and neurological involvement. 1,2 It is prevalent in Japan, Correspondence: Professor Marjan Ghaemi, Farzan Scientometric Group, Farzan Clinical Research Institute, PO Box: , Tehran, Iran. swt_f@yahoo.com the Middle East and some Mediterranean countries with a prevalence of per population, and is attributed to the high prevalence of human leukocyte antigen (HLA)-B51 in these regions and some environmental factors. 2 5 Hippocrates described primary descriptions of symptoms resembling BD in some of his works. 6 In 1930, the first official report of BD as a triad of recurrent oral, genital aphthous ulcerations and iritis was reported by Adamantiades during the annual meeting of the Medical Association of Athens. 7 Since 1930, BD has been a focus of active research concerning genetics, immunol The Authors International Journal of Rheumatic Diseases 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd

2 F. Shahram et al. ogy, molecular biology, diagnosis, and treatment. 8 Recent investigations have made significant progress in the etiology and pathogenesis of BD. 9 The introduction of diagnosis criteria by the International Study Group For BD in has drawn the attention of clinicians and researchers to BD. 11 Many investigators, particularly in the last two decades, have published articles on BD. However, there is still no scientometric analysis despite this increasing amount of literature. Scientometric analyses are increasingly used for evaluation processes, carrier decisions and assignment of funds. 12 Moreover, scientometric analyses are helpful for learning the history and current status of a study field. The scientometric method brings us a reliable way to map external and internal features of a scientific field by tracing the core production or citation, the content or quality of articles, and motivations of the researchers in the form of published literature. 13,14 The aim of this study was to perform an analysis of articles on BD, published from 1990 to 2010, using scientometric methods. METHODS Data source Thomson Reuters (formerly ISI) Web of Knowledge ( was chosen because it is one of the major sources for scientometric, citation and other academic impact information of scientific articles. 15 The data on prevalence of disease in separate countries was also gathered from various articles. 2,9,16 20 The impact factors of the journals were retrieved from the Journal Citation Report. The specific features such as publication year, language of article, geographical distribution, and main journal in the field, institutional affiliation and citations were retrieved from ISI Web of Science and analyzed using the Analyze function provided by the ISI database. Intcoll software ( leydesdorff.net/software/intc) was used for considering the international collaboration between countries of the authors origins. The bibliography retrieved from Web of Science database was imported to Intcoll. Results from Intcoll were imported to Pajek software ( and then visualized. All other statistical analyses were performed using the SPSS (version 13) (SPSS Inc., Chicago, IL, US). The correlation between the citation per paper and the impact factor of the publishing journal was analyzed using Pearson s test. Spearman s test was used to determine the correlation between number of articles published by a country and total citations and average citations to them. Search strategies Utilizing the controlled vocabulary, medical subject heading (MeSH) used by the National Library of Medicine (NLM) to index PubMed contents, the search strategy adopted was as follows: Behcet s disease* OR Behcet s syndrome* OR Behcet disease* OR Behcet syndrome* OR Behcets-disease* OR Behcets-syndrome*. The sign * is a wildcard which can take any value. Our literature search covered the papers published during All retrieved documents, including original articles, review articles, case reports, letters and meeting abstracts were included in the analysis. RESULT Publication trend Between the years 1990 and 2010, a total of 5780 articles in the field of BD were indexed in the ISI Web of Science database. The literature about BD gradually rose from 97 articles in 1990 to 533 in 2010 with two major peaks in 2003 and 2008 (Fig. 1). In 2003, the increase on the preceding year (2002) was 175%, and in 2008 the increase on 2007 was 139%. More than 50% of the articles published in 2003 were included in the textbook Adamantiades-Behcßet s Disease (CC Zouboulis, ed., Springer, Heidelberg, 2003, ISBN ), which included the proceedings of the 10th International Conference on Behcet s Disease held in 2002 in Berlin and was an issue of the Advances of Experimental and Medical Biology Series (also cited as: Adv Exp Med Biol 2003; 528). Further analysis using ISI web of science revealed that about 95% of the papers published in the year 2003, were presented at the 10th International Conference on Behcet s Disease. In the year 2008 the proportion of contributions from Iran increased from 2.3% to 7.2%. Most of the papers in this year were published in Clinical and Experimental Rheumatology journal as meeting abstracts which were in the field of rheumatology. Geographical distribution and institution profile The 5780 articles originated from 82 different countries which makes an average of 70 articles per country. Turkey with the highest prevalence of BD ( per population), 17,18 contributed about 26% of the BD articles and had an average citation per paper (C/P) of 9.4. Also Japan with the high prevalence of 13.4 per population, stands the second in number of papers followed by the USA (Table 1). 186 International Journal of Rheumatic Diseases 2013; 16:

3 Scientific articles on BD Figure 1 Time-trend to number of articles published in the field of Behcet s disease from 1990 to Table 1 Prevalence of Behcet s disease (BD) and geographical distribution of the scientific papers about BD Country No. of articles % Prevalence (per inhabitants) Total citations Average citations per item Turkeys Japan USA England France Germany South Korea Italy Spain Tunisia Israel Iran Greece Morocco Netherlands Saudi Arabia China England with 403 articles (6.9%) ranked fourth in number of articles and the first with 20.5 in C/P. France with 311 articles and a C/P of ranked fifth in regard to number of articles. Iran had the highest level of international collaboration with other countries (Fig. 2). There was a very good correlation between number of articles published by countries (countries publishing > 1% of articles) and total citations to these articles. (r = 0.875, P = 0.001) but there was no significant correlation between number of articles and average citations. In accordance with top countries, the top two institutions contributing to BD publications were from Turkey. Istanbul School of Medicine ranked first with 328 articles (5.66%) followed by Hacettepe University and Yonsei University with 142 articles (2.45%) and 115 articles (1.98%), respectively (Table 2). Dr. Hasan Yazici from Istanbul University with 192 articles, Sebahattin Yurdakul from University of Istanbul with 104 articles, Shigeaki Ohno from Hokkaido University School of Medicine with 100 articles, Vedat Hamuryudan with 94 articles and Fereydoun Davatchi with 88 articles had the maximum number of articles in this field (Table 3). Article profile There were 3235 original articles (55.9%), 968 meeting abstracts (16.7%) and 585 letters (10.1%) among all International Journal of Rheumatic Diseases 2013; 16:

4 F. Shahram et al. Figure 2 International collaboration between countries of Behcet s disease articles origins. The size of the arrows is equivalent with the number of collaboration between two countries. Table 2 Top 10 institutions with regards to Behcet s disease (BD) articles published in the field of BD for the period Institution name No. of articles % Country Istanbul University Turkey Hacettepe University Turkey Yonsei University South Korea Yokohama City Japan University Ankara University Turkey Tehran University of Iran Medical Sciences University Athens Greece Tel Aviv University Israel Marmara University Turkey St Marianna University Japan documents. Review articles constituted only about 7% of all articles. The top subject area with 1794 articles (31%) was rheumatology, followed by ophthalmology with 621 articles (10.7%). In total, BD articles were in eight languages. The most articles were in English (91.3%) followed by French (4.6%) and German (1.6%). Only 29 articles (0.5%) were in Turkish. Top 10 journals Table 4 shows the top 10 journals publishing BD articles. Among journals publishing BD articles, the Journal of Clinical and Experimental Rheumatology with 564 articles (9.75%) ranked first with a 5-year impact factor of The next journal in the list was Arthritis and Rheumatism with a 5-year impact factor of Citation profile In total, 5780 articles on BD since 1990 were cited times by the end of The average citation per article was The average citation per year was and the H-index for all these articles was 78. About 34% of these articles remained uncited throughout the years. Figure 3 shows the trend of citations between 1990 and In total, 33 articles had 100 or more citations. The top 10 articles which were cited the most during the years are shown in Table 5. Table 6 lists the journals publishing the most cited articles (more than 100 citations). Journal of Rheumatology with five of these top cited articles (15%) ranked first, followed by Arthritis and Rheumatism and Lancet with four (12%) and three (9%) articles, respectively. Considering the number of citations per top-cited papers, Lancet had citations per article and ranked first. New England Journal of Medicine with two articles and 384 citations per article and Immunology Today with one article and 256 citations per article ranked second and third, respectively. There was a correlation between the citation per paper and the impact factor of the publishing journal (r = 0.685, P = 0.001). DISCUSSION The present study is the first scientometric analysis of BD. A systematic view of BD papers helps us to gain a deeper understanding of BD. The results showed a continuous increasing trend in the number of BD publications. We found an association between prevalence of the disease and a country s contribution to BD literature, although there are countries with lower prevalence of 188 International Journal of Rheumatic Diseases 2013; 16:

5 Scientific articles on BD Table 3 Top 10 authors with most number of articles Authors No. of articles % Country Institutes Hasan Yazici Turkey Istanbul University Sebahattin Yurdakul Turkey Istanbul University Shigeaki Ohno Japan Hokkaido University Vedat Hamuryudan Turkey Cerrahpasßa Medical Faculty Fereydoun Davatchi Iran Tehran University of Medical Science Haner Direskeneli Turkey Marmara University Medical School Ahmet gul Turkey Istanbul University Farhad Shahram Iran Tehran University of Medical Science Bertrand Wechsler France H^opital Pitie-Salp^etriere Dongsik Bang Korea Ajou University School of Medicine Table 4 Top 10 journals publishing articles on Behcet s disease for the period Journal No. of articles % 5-year impact factor Clinical and Experimental Rheumatology Arthritis and Rheumatism Annals of the Rheumatic Diseases Clinical Rheumatology Journal of Rheumatology Advances in Experimental Medicine and Biology Rheumatology International Rheumatology Investigative Ophthalmology & Visual Science Revue De Medecine Interne BD and high contributions, like USA and England, or high prevalence but lower contributions, like Spain, Saudi Arabia and Israel. We could not find any data on BD prevalence in some of the countries, especially The Netherland and Greece, with high citations per paper. Only 29 countries had an international collaboration with other countries in this field. Despite the low number of articles, Iran had the most collaboration with other countries. In fact, Iran had collaborative articles with all other countries, mostly with USA, England, Australia and Canada. Collaboration with other countries was limited to less than three countries. The first three institutions with the most BD papers were from Turkey, although Turkish was the fifth most common language in BD literature. The majority of articles being in English may be due to the widespread use of English as the first language of science or as a result of the fact that most indexed journals by ISI are in English. Approximately 31% of articles considered BD from the aspect of rheumatology. Ophthalmology was the aspect of view of more than 10% of articles. Ocular involvement, a major symptom of the BD clinical triad, usually occurring within the first 2 3 years of disease onset, is present in approximately 53.7% of patients. 21,22 Most of the top 10 journals publishing BD articles were in the field of rheumatology, consistent with the subject areas of the articles. In this list, Clinical and Experimental Rheumatology, Arthritis and Rheumatism and Annals of the Rheumatic Diseases, alone published almost 18% of BD articles. An analysis of top-cited articles revealed that most of them were published before the year 2001, simply because older articles were available for a longer period, and the new ones have not had time to be cited. For example, Criteria for diagnosis of Behcet s disease: International Study Group for Behcßet s Disease is the title of the most highly cited paper, which was published in 1990 in Lancet and is the joint work of seven countries. The number of citations to BD literature increased from 1990 to 2010 by around 5.5-fold, indicating the growing interest of the medical world in this topic. The top 10 journals (with the highest number of BD papers) published 35% of the top-cited articles. General journals with nine top-cited articles published more than 25% of the top-cited articles, which means BD has attracted the attention of all medical professions. There was a correlation between citation per paper and the impact of the publishing journals; this may be due to the higher quality of papers that are published in the high-impact journals or due to more numbers of readers for these journals. International Journal of Rheumatic Diseases 2013; 16:

6 F. Shahram et al. Figure 3 Time-trend of citations to the publications on Behcet s disease between 1990 and Table 5 Citation and characteristics of top 10 most cited papers on Behcet s disease Title Year Country Journal 5-year impact factor Criteria for diagnosis of Behcet s disease 1990 France- Iran-Japan- Tunisia-USA- England-Turkey No. times cited Lancet Current concepts Behcet s disease 1999 Japan New England Journal of Medicine Vascular involvement in Behcet s disease 1992 Turkey Journal of Rheumatology Triplet repeat polymorphism in the 1997 Japan- Switzerland Proceedings of the National transmembrane region of the MICA gene: A strong association of six GCT repetitions with Behcet disease - France Academy of Sciences of the United States of America A controlled trial of azathioprine in 1990 Turkey-England New England Journal Behcets syndrome of Medicine Behcet s disease 1998 USA-Greece Seminars In Arthritis and Rheumatism Effect of infliximab on 2001 Greece Lancet sight-threatening panuveitis in Behcet s disease Clinical patterns of neurological involvement in Behcet s disease 1999 Turkey Brain Thalidomide in the treatment of the mucocutaneous lesions of the Behcet syndrome Overproduction of monocytederived TNF-a, interleukin 6, 8 and increased neutrophil superoxide generation in Behcet s disease 1998 Turkey-Germany Annals of Internal Medicine 1993 Turkey Journal of Rheumatology CONCLUSION This was the first scientometric analysis of Behcet s disease, which tried to show the characteristics of BD literature. One of the possible limitations of this study was its focus on ISI indexed publications in evaluation of publication trends, which may lead to exclusion of a number of papers published during this period. The study revealed considerable growth in scientific production and citations to BD articles in the last two decades 190 International Journal of Rheumatic Diseases 2013; 16:

7 Scientific articles on BD Table 6 Journals where top-cited articles (> 100 citations) were published Name of journal No. of top-cited articles 5-Year impact factor Citations per paper Lancet New England Journal of Medicine Proceedings of the National Academy of Sciences of the United States of America Annals of Internal Medicine Seminars In Arthritis and Rheumatism British Journal of Ophthalmology Journal of Rheumatology Brain Nature Medicine American Journal of Ophthalmology Blood Infection and Immunity Neurology Medicine Human Pathology Annals of the Rheumatic Diseases Progress In Retinal and Eye Research Journal of Neurology Arthritis and Rheumatism Rheumatic Disease Clinics of North America which reflects the growing scientific interest in BD, including the regions with most prevalence of BD, as well as in developed countries. FINANCIAL DISCLOSURE The authors have no financial disclosure to clarify. REFERENCES 1 Ideguchi H, Suda A, Takeno M, Ueda A, Ohno S, Ishigatsubo Y (2011) Behcet disease: evolution of clinical manifestations. Medicine (Baltimore) 90 (2), Sakane T, Takeno M, Suzuki N, Inaba G (1999) Behcet s disease. N Engl J Med 341 (17), Zouboulis CC (1999) Epidemiology of Adamantiades- Behcet s disease. Ann Med Interne (Paris) 150(6), Shahram F, Davatchi F, Nadji A, et al. (2003) HLA-B51 frequency in Iranian patients with Behcet s disease. Adv Exp Med Biol 528, Atalay A, Yildiz-Demirtepe S, Tatlipinar S, et al. (2008) HLA-B51 gene and its expression in association with Behcet s Disease in Denizli Province of Turkey. Mol Biol Rep 35 (3), Feigenbaum A (1956) Description of Behcet s syndrome in the Hippocratic third book of endemic diseases. Br J Ophthalmol 40 (6), Behcet H, Matteson EL (1937) On relapsing, aphthous ulcers of the mouth, eye and genitalia caused by a virus. Clin Exp Rheumatol 28(4 Suppl.60), S Dilsen N (1996) History and development of Behcet s disease. Rev Rheum Engl Ed 63 (7 8), Hirohata S, Kikuchi H (2003) Behcet s disease. Arthritis Res Ther 5 (3), International Study Group for Behcet s Disease (1990) Criteria for diagnosis of Behcet s disease. Lancet 335 (8697), O Neill TW, Rigby AS, Silman AJ, Barnes C (1994) Validation of the International Study Group criteria for Behcet s disease. Br J Rheumatol 33 (2), Eshraghi M, Habibi G, Rahim MB, et al. (2011) Bibliometric analysis of lung transplantation research articles. Thorac Cardiovasc Surg 59 (2), Groneberg-Kloft B, Dinh QT, Scutaru C, et al. (2009) Cough as a symptom and a disease entity: scientometric analysis and density-equalizing calculations. J Investig Allergol Clin Immunol 19 (4), Estabrooks CA, Winther C, Derksen L (2004) Mapping the field: a bibliometric analysis of the research utilization literature in nursing. Nurs Res 53 (5), Sevinc A (2004) Web of science: a unique method of cited reference searching. J Natl Med Assoc 96 (7), Zamani F, Shahram F, Shakeri R, et al. (2009) Prevalence of celiac disease among patients with Behcet s disease in Iran. Dig Dis Sci 54 (8), International Journal of Rheumatic Diseases 2013; 16:

8 F. Shahram et al. 17 Davatchi F, Shahram F, Chams-Davatchi C, et al. (2010) Behcet s disease: from East to West. Clin Rheumatol 29 (8), Kaklamani VG, Vaiopoulos G, Kaklamanis PG (1998) Behcet s Disease. Semin Arthritis Rheum 27 (4), Tuzun Y, Yurdakul S, Cem Mat M, et al. (1996) Epidemiology of Behcet s syndrome in Turkey. Int J Dermatol 35 (9), Davatchi F, Jamshidi AR, Banihashemi AT, et al. (2008) WHO-ILAR COPCORD Study (Stage 1, Urban Study) in Iran. J Rheumatol 35 (7), Yazici HYS, Hamuryudan V (eds) (1998) Behcßet s Syndrome, 2nd edn. Mosby, London. 22 Disease ITftRoICfBs (2008) Clinical manifestations of Behcet s Disease. The ITR-ICBD report. Clin Exp Rheumatol 26, S International Journal of Rheumatic Diseases 2013; 16:

Behcet's Disease in Bahrain, Clinical and HLA Findings

Bahrain Medical Bulletin, Vol.23, No., March 200 Behcet's Disease in Bahrain, Clinical and HLA Findings Reda Ali Ebrahim, MD, FRCP* Raed Al Alawi, MD** Eman Farid, MD,PhD*** Objective: To study the clinical