Rheumatology research in Arab countries
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* Ali S. M. Jawad
* Georges El Hasbani
* Imad Uthman

*To the Editor*

We welcome the publication by Almuhaidib et al1 mapping the landscape of medical research in Arab countries. This would enthuse the academic health institutions in the Arab world to invest more in research as there is room for improvement. Research will lead eventually to better care for patients and gets us nearer precision and personalized medical care.

We examined the number of publications in the field of rheumatology originating from institutions within Arab countries between 2017 and 2021 and cited by PubMed/MEDLINE.2 Publications with authors from multiple nations were excluded. Publications were then categorized by type, including randomized controlled trials (RCTs), cohort studies, cross-sectional studies, systematic reviews, narrative reviews, and case reports. The review also used data from the World Bank to evaluate the gross domestic product (GDP) and total population of various Arab nations in order to calculate a ratio of publications to GDP and publications to population in individual countries (Table 1).

View this table:
[Table 1.](http://smj.org.sa/content/45/5/542/T1)

Table 1. 
- Ratio of publications to gross domestic product (GDP) and publications to population in the top 10 countries.

Qatar had the highest ratio of publications per population (P/P) 6.48, but only published 16 articles with no RCTs between 2017 and 2021. Tunisia had the second highest P/P ratio, 6.45, with 77 publications but mostly case reports and some cross sectional studies. Lebanon, with 38 publications, was third with a P/P ratio of 5.76, with the majority of published works consisted of narrative reviews with no published RCTs. Many publications from Lebanon were excluded because of collaborations with groups from other nations. Case-control studies represented the majority of the 282 publications from Egypt, followed by cross sectional studies. There were 23 clinical trials. With 81 publications, Saudi Arabia lead the Arabian Gulf in Rheumatology research but none of the publications were RCTs. Most of the studies were cross-sectional studies, followed by cohort studies. Kuwait, Bahrain and United Arab Emirates had very similar number of publications, publications per GDP and P/P ratios. Although Iraq had a low P/P ratio, 0.61, 4 publications were RCTs.

We did not find any publications from Comoros, Djibouti, Libya, Mauritania, Palestine and Somalia.

Our results mirror the findings of Almuhaidib et al1 more investment and wider involvement is needed in medical research. More RCTs and collaboration with institutions outside the Arab world are essential to advance research and ultimately improve patients care. Quality improvement programmes and clinical audits in every specialty and health care management are also important to advance quality care to patients.3,4

***Reply from the Author***

**No reply was received from the Author.**

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## References

1.  1.Almuhaidib S, Alqahtani R, Alotaibi HF, Saeed A, Alnasrallah S, Alshamsi F, et al. Mapping the landscape of medical research in the Arab world countries. Saudi Med J 2024; 45: 387–396
    
    [Abstract/FREE Full Text](http://smj.org.sa/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic21qIjtzOjU6InJlc2lkIjtzOjg6IjQ1LzQvMzg3IjtzOjQ6ImF0b20iO3M6MTg6Ii9zbWovNDUvNS81NDIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. El Hasbani, Jawad A, and Uthman I. Rheumatology research output in the Arab world: despite the challenges. Rheumatismo 2022; 74: 103–106.
    
    

3.  3.Jones B, Vaux E, Olsson-Brown A. How to get started in quality improvement BMJ 2019; 364: k5408.
    
    [FREE Full Text](http://smj.org.sa/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjE4OiIzNjQvamFuMTdfMTAvazU0MDgiO3M6NDoiYXRvbSI7czoxODoiL3Ntai80NS81LzU0Mi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

4.  4.Limb C, Fowler A, Gundogan B, Koshy K, Agha R. How to conduct a clinical audit and quality improvement project. Int J Surg Oncol (N Y) 2017; 2: e24.
    
    [CrossRef](http://smj.org.sa/lookup/external-ref?access_num=10.1097/IJ9.0000000000000024&link_type=DOI) 
    
    [PubMed](http://smj.org.sa/lookup/external-ref?access_num=29177218&link_type=MED&atom=%2Fsmj%2F45%2F5%2F542.atom)