Global Trends in Research of Gouty Arthritis Over Past Decade: A Bibliometric Analysis

The literature dataset was compiled using Thomson-Web Reuter’s of Science Core Collection (WoSCC), which provides a comprehensive and standardised set of data for export and is widely used in academia. (8). The literature search was conducted in one day (19 April 2022) to avoid deviations, taking into account the rapid update of the database. The following were the search terms: (TS=(Arthritis, Gouty) OR TS=(Gouty Arthritis) OR TS=(“Gouty Arthritis”) OR TS=(“Gout Arthritis”) OR TS=(Arthritis, Gout) OR TS=(Gout Arthritis)). Among the various types of publications, Only English-language articles and reviews were considered. In total, 2052 articles were ultimately analysed from 2012 to 2021. The results of the thorough screening may be found in Table 1.

The data for all identified articles were obtained from the SCI-expanded database and then opened in Excel 2016, including authors, affiliations, countries/regions, journals, the number of papers and citations, publication year, H-index, keywords, and references. Two writers independently browsed the qualifying papers and extracted data. The data was then analysed further using an online program (http://www.bioinformatics.com.cn/↗), VOSviewer v1.6.10.0, and CiteSpace (version 5.8.R3).

The bibliometric analysis was carried out using VOSviewer (version 1.6.10), CiteSpace (version 5.8.R3), and the web tool (https://www.bibliometrix.org↗). The number of publications and citations often used to signify bibliographic material are examples of bibliometric indicators. As the two essential viewpoints for measuring research performance, the number of publications (Np) is often used to quantify productive capacity, and the number of citations (Nc) can demonstrate impact.

The H-index is primarily used to assess researchers’ academic contributions and forecast future scientific accomplishments. The H-index unites productivity and influence by identifying a threshold that links Np and Nc. A researcher will have an H-index if they have produced H articles, each quoted at least H times. Besides, The H-Index was designed to assess personal academic performance. However, it also may now define a country’s or region’s publishing output and an institution’s or journal’s production. (9, 10)

Additionally, the Impact Factor (IF) calculated from the most recent edition of the Journal Citation Reports (JCR) is widely recognised as one of the most important indices of medical journal quality and impact. (11). The Global Citation Score (GCS) is considered the Nc of an article worldwide. It is an essential indicator of the contribution an article makes to the field of knowledge, with a high GCS indicating a high level of interest from scientists worldwide (12). The fitted polynomial model was used to forecast the yearly Np further to demonstrate the variations in the annual publishing amount. The yearly number of investigations is represented by variable f (x), and the publication year is indicated by x.

VOSviewer v1.6.10.0 is used to construct and visualise bibliometric network graphs (Leiden University, Leiden, the Netherlands). (7, 13). VOSviewer was used to perform co-citation and co-occurrence analysis in this study. The size of the nodes represented the number of publications, the thickness of the line showed the strength of the relationship, and the colours of the nodes represented distinct clusters or periods.

Cluster analysis, timeline or time zone views, references, and keywords citation bursts were all employed in CiteSpace to aid in the visual evaluation of knowledge fields and developing trends. (14). Cluster analysis enables the categorisation of references and keywords, as well as the discovery of essential study topics for GA. Bursts of keywords and references are frequently utilised to discover new research trends.

A total of 2052 articles and reviews from the previous decade were retrieved from WoSCC, including 1,672 articles and 534 reviews. The total Nc of the retrieved articles was 32,131, and the average Nc per article was 19.29. The H-index for all publications was 79.

Figure 1 depicts the geographical distribution of the total number of papers on GA research from all nations and regions. The top five nations accounted for three-quarters of the 2052 articles. China was the country with the most papers published, followed by the USA, New Zealand, England, and Netherland.

Figure 2 describes the top ten countries in terms of annual publication on GA research from 2012-to 2021. China has the most significant number of articles published in 2021(120). Followed by the USA (54) and South Korea (18). It suggests that China remains the highest number of GA research.

Figure 3A depicts the yearly Np as it relates to GA. The number of yearly papers increased from 134 in 2012 to 290 in 2021, and the Np peaked in 2021. China produces the most articles, indicating on the one hand that China is a high-yield country, and on the other hand, China pays more attention to GA research.

The polynomial-fitting curve of the yearly trend of paper publishing amount is depicted in Figure 3B. Despite minor fluctuations over ten years, there has been an overall tendency toward more articles being published, with the correlation coefficient R^{2 =} 0.9378, as shown in Figure 3B. Overall, these data imply that research on GA has been the centre of interest and has progressed rapidly.

We rated the top ten high-output countries/regions for all writers (Table 2). China published the most papers (580/28.26%), followed by the USA (535/26.07%) and New Zealand (142/6.92%). Papers from the USA were referenced 14607 times, accounting for 45.46 per cent of total citations, followed by papers from China (6422) and England (4189). Furthermore, the USA had the highest H-index (58), followed by China (38) and New Zealand (34). Compared to South Korea and Australia, France and Germany had a relatively lower Np but a much higher Nc and H-index. It may be related to APHP in France and LERU in Germany being in the top 10 institutions regarding the number of articles published. The two institutions play an essential role in expanding national influence.

Table 3 shows the top ten affiliations with the most GA-related publications. The highest Np was achieved by LERU (129). University of Auckland (101) is next, followed by the University of Otago (78). LERU had the highest Nc (4,824) and the greatest H-index (35). LERU is the University Alliance of Europe’s leading research universities and the principal advocate of promoting basic research in European universities. While Udice-French Research Universities and Assistance Publique Hopitaux Paris (APHP) in France have a little Np, they have a much higher NC than other productive colleges. Half of the affiliations were based in the USA. It suggests that more institutions in the USA are looking at gout arthritis research.

Table 4 lists the top ten most productive authors. They published 346 publications, accounting for 16.86 per cent of all articles submitted. Dalbeth, N (94). from the University of Auckland in New Zealand took first place in GA research, followed by Singh, JA (44). from Birmingham VA Med Ct and Choi, HK (34). from Harvard Med Sch in the USA. Dalbeth, N. had an extremely high Nc (3308). The work of Dalbeth N’s research has attracted more scholars’ attention. Furthermore, most of the top ten authors were mainly from the USA and New Zealand. It suggests that there are more excellent researchers in GA research in the US and New Zealand and focus on the field of GA research.

As shown in Table 5, Clinical Rheumatology (Clin Rheumatol) (72 publications, IF: 2.98) published the most studies on GA. Clin Rheumatol aims to cover all current clinical and experimental research trends involving inflammatory, metabolic, immunologic, and degenerative soft and hard connective tissue diseases. Followed by Rheumatology (61 publications, IF:7.58) and Arthritis Research and Therapy (Arthritis Res Ther) (59 publications, IF:5.156). Approximately 24% of the publications were published in the top ten academic publications (483/23.53%). Except for Clin Rheumatol (IF:2.980) and Rheumatology International (IF:2.631), all of the top ten journals had a higher IF (defined as >3.000). It suggests that Clin Rheumatol and Rheumatology International should increase the influence of journals and the quality of articles published in the future while maintaining the number of articles published.

Table 6 describes the number of publications of GA in the top Journals in Rheumatology (Arthritis and Rheumatology, Annals of the Rheumatic Diseases, Nature Reviews Rheumatology) and other journals with the high impact factors. The total Np of Nature Reviews Rheumatology (IF:20.543) is 13. The total Np of Arthritis & Rheumatology (IF:10.995) is 27, and the total Np of Annals of the Rheumatic Diseases (ARD) (19.103) is 51. Although the top journal has a relatively small number of articles on GA, However, the ARD is ranked 4th in the top ten journals in terms of the number of articles, suggesting that the research on GA has attracted some attention. The USA has the most articles in this journal, demonstrating that the USA values this journal and has an excellent scientific research base and scientific research strength.

The articles in Table 7 were listed in descending order of the total number of citations. The top ten most cited articles mainly were published between 2012 and 2016. Three articles have been cited more than 450 times, published in the Nature Genetics (IF= 38.33. title: Genome-wide association analyses identify 18 new loci associated with serum urate concentrations. type of study: Clinical Research, 491 citations). This article emphasises the significance of metabolic control of urate production and excretion, which may have implications for gout treatment and prevention. Follow by Arthritis Care &Research (IF=4.794, title: 2012 American College of Rheumatology guidelines for management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritis. Type of study: article, 484 citations), and Nature Medicine (IF=53.44. title: Aggregated neutrophil extracellular traps limit inflammation by degrading cytokines and chemokines. type of study: Basic and Clinical Research, 478 citations). Nature Medicine covers research that addresses the needs and goals of contemporary medicine. Original research ranges from new concepts in human biology and disease pathogenesis to robust preclinical bases for new therapeutic modalities and drug development. Studies related to GA were published in Nature Medicine, indicating that researchers attach great importance to the study of the pathogenesis of GA.

Figure 4 depicts the yearly number of global citations for papers having a high global citation score (GCS). The GCS of the paper written by Leung, YY. in 2012 was 128, ranking the first. In this paper, the authors referred to Colchicine’s newly described mechanism of action includes various inhibitory effects on macrophages, including inhibition of the NACHT-LRRPYD-containing protein 3 (NALP3) inflammasome. Colchicine’s therapeutic use has expanded beyond GA to include osteoarthritis, pericarditis, and atherosclerosis. (15). Followed by Schauer C. et al.’ research. His research found that aggregated NETs promote neutrophilic inflammation resolution by degrading cytokines and chemokines and disrupting neutrophil recruitment and activation. Additionally, the works of Juliana, C. et al. (16) about that NLRP3 inflammasome is involved in the pathogenesis of GA and that inhibiting NLRP3 activation has both preventive and therapeutic effects on GA have accumulated more GCS in recent years. The study of Pei, KH. et al. detailed P-Coumaric acid (P-CA) has analgesic, antipyretic, hypopigmented, anti-ulcer, anti-arthritis, antiplatelet aggregation, and anxiolytic activities. It has the potential to be utilised to treat GA. (17). Graham, GG. et al. pointed out that although paracetamol does not suppress the severe inflammation of rheumatoid arthritis and acute gout, it does reduce the less severe inflammation caused by tooth extraction and is active in a range of inflammatory tests in experimental animals. Furthermore, in Neogi T’s study, the authors thoroughly reviewed the advanced imaging literature on gout through the European League Against Rheumatism. They developed new classification criteria for gout, which increased the number of subsequent publications in the field. (18). March, L. et al. (19). summarised the worldwide and regional prevalence, disability, total burden, and costs of major musculoskeletal ailments such as knee osteoarthritis, rheumatoid arthritis, gout, etc. Taken as a whole, these documents have a significant effect on the study of GA, increasing the number of following papers on the subject. Most of the above studies focus on the mechanism and clinical treatment of GA. Figure 5 shows the 161 articles (other publications are cited more than 50 times) with high citation frequency, corresponding to Figure 4, where the nodes of articles with high GCS are relatively large and are at the core of the mesh.

Figure 6 depicts the top ten productive categories associated with GA. The most prevalent study categories were Pharmacology Pharmacy (252 papers), followed by Medicine General Internal (213 papers), Immunology (123 papers), Integrative Complementary Medicine (103 papers), and Medicine Research Experimental (95 papers). Pharmacology Pharmacy had the highest proportion of publications in terms of research categories, while Cell Biology had the lowest proportion of publications.

Co-citation networks emphasise research topics closely related to specific fields, different from global citation analysis. Given the enormous number of referenced references, a document’s minimum number of citations was 30. One hundred eighty-four references were chosen for co-citation analysis out of the 51775 mentioned by the retrieved publications. A line connecting two nodes indicates that they were referenced in the same publication, and a shorter line indicates a closer association between two publications. Furthermore, different node colours were employed to split the papers into clusters (Figure 7A). Cluster 1 (red) comprises 56 references, focusing on epidemiology, pathogenesis, and gout treatment. Cluster 2 (green) focused primarily on the clinical study of gout therapeutic drugs. Cluster 3 (blue) mainly focused on the prevalence, comorbidities and management of gout. The theme of cluster 4 (yellow) centred on the application of modern detection technology to diagnose gout. Based on the clustering, we discovered that most studies focused on the epidemiology and pathogenesis of gout. Figure 7B illustrates the most typical references in terms of burst length, burst strength, and burst time. As shown in Figure 7B, the top nine clusters of co-cited references were “nlrp3 inflammasome,” “race,” “knee osteoarthritis,” “canakinumab,” “adherence,” “mri,” “ultrasound,” “synovlocytes,” “tranilast.” Figure 7C depicts the top 20 references with the most powerful citation bursts. The Kuo CF et al. study has the highest strength (34.06). His article describes developments in the epidemiology of gout and patterns of urate-lowering therapy (ULT) in the UK general population. We also discovered that the studies of Richette, p. et al. (20) possess the higher bursts strength (29.39). In his paper, he revised the evidence-based gout management recommendations of the European League Against Rheumatism (EULAR). These recommendations are intended to educate physicians and patients about non-pharmacological and pharmacological gout therapies and the best tactics for achieving the predetermined urate target and curing the condition. In addition, So, Ak’s essay has seen a significant increase in citations. Recent developments in our understanding of positive and negative regulatory mechanisms and genetic and environmental variables that influence inflammatory responses, some of these mechanisms can be regulated, opening up new therapeutic possibilities for GA, are highlighted in his paper. (21). The above-mentioned high-strength literature has conducted relevant research on GA from a variety of perspectives, including epidemiological studies of GA, gout management recommendations, and research on the inflammatory response mechanism of GA.

Apart from search terms, VOSviewer and Citespace evaluated keywords collected from the titles and abstracts of 2052 publications. Clusters 1 (Red) primarily represented the inflammatory response mechanism to GA, as seen in Figure 8A. Cluster 2(Green) is primarily concerned with GA’s prognosis and epidemiology. Cluster 3 (blue) focused on the research on the diagnosis of GA. Cluster 4 (yellow) was mainly about the clinical research of GA. Cluster 5 (Purple) primarily focused on GA’s care and risk factors. The top frequent occurrences of keywords were “gout,” “arthritis,” “hyperuricemia,” “management,” and “inflammation,” suggesting that the research related to GA mainly focused on causes and mechanisms.

As seen in Figure 8B, VOSviewer separated the colours of all keywords into categories based on their average publication year (APY). The latest keyword was “injury” (cluster 1, APY:2019.50), followed by “nlrp3” (cluster 1, APY: 2018.95) and “pathway” (cluster 1, APY: 2018.88), both closely associated with GA. Besides, “nlrp3 inflammasome” (cluster 1, APY:2018.31) and “nf-kappa-b” (cluster 1, APY: 2018.25), as well as “expression” (cluster 1, APY: 2018. 03), were the field’s most recent hot topics. Additionally, “inflammation,” “ultrasound,” “management,” “chronic kidney disease,” and “Canakinumab” have long been a focus of research in GA, as shown in Figure 8C. Meanwhile, we discovered that the terms “pathway,” “nf kappa b,” “injury,” “receptor,” and “animal model” were the most recently trending keywords during the previous three years in Figure 8D.

The common thread in Figures 8A–D is research into the inflammatory response mechanism to GA. There will be more and more literature on the basic research of GA in the future, and more scholars will be inclined to explore the pathogenesis and treatment mechanism of GA using animal experiments. Then explore more possibilities for the treatment of GA.

The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.