Rheumatoid Arthritis Research in India: A Scientometric Assessment of Publications during 2007-2016

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system-which normally protects its health by attacking foreign substances like bacteria and viruses-mistakenly attacks the joints. This creates inflammation that causes the tissue that lines the inside of joints (the synovium) to thicken, resulting in swelling and pain in and around the joints. The synovium makes a fluid that lubricates joints and helps them move smoothly. Rheumatoid arthritis most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles. The joint effect is usually symmetrical. That means if one knee or hand if affected, usually the other one is, too. Because RA also can affect body systems, such as the cardiovascular or respiratory systems, it is called a systemic disease. Systemic means “entire body” [1]. RA affects about 24.5 million people as of 2015 [2]. This is between 0.5 and 1% of adults in the developed world with 5 and 50 per 100,000 people newly developing the condition each year [3] Onset is most frequent during middle age and women are affected 2.5 times as frequently as men [4]. In 2013, it resulted in 38,000 deaths up from 28,000 deaths in 1990 [5].


Literature Review
Only one study has so far been conducted in the past on quantitative analysis of arthritis research. Lewison & Devey [7] used bibliometric methods to evaluate the magnitude and quality of publications in arthritis research in the UK and also compared this with that of other countries. Outputs from 13 countries between 1988 and 1995 were analyzed by number, research level (from clinical to basic) and potential impact on other researchers (from low to high). The UK has a strong presence in arthritis research and the highest relative commitment of all the countries studied. Papers with funding acknowledgements were of significantly higher impact and less clinical than those without. Only one literature review is available on rheumatoid arthritis research in India. Here Handa et al. [8] provided a literature review of observational studies published from 1985 to 2012 and this review identified twentyeight studies. Of the 28 studies, seven described the descriptive epidemiology of RA, 14 described comorbidities and extra-articular manifestations, nine described the functioning abilities and quality of life among patients, and 10 provided information on treatments. Since no Indian bibliometric study was available in this area, as a result we decided to undertake the present study.

Objectives
The main objectives of this study are to study the performance of India's rheumatoid arthritis research during 2007-16, based on publications output covered in Scopus database. In particular, the study focuses on the following objectives: i.
To study the growth India's research output in rheumatoid arthritis research and its citation impact ; ii.
To study the India's international collaboration share and share of leading collaborating countries iii. To study the Indian research output by broad subject areas iv. To study the publication productivity and citation impact of top 15 most productive organizations and authors v.
To study the modes of communication and identification of most productive journals and (v) to study the characteristics of top 12 highly cited papers.

Methodology
The study retrieved and downloaded 10-yearpublication data of the Indian output in rheumatoid arthritis research from the Scopus database (http://www.scopus.com) covering the period 2007-16. Keywords, such as "rheumatoid arthritis'' were searched in "keyword tag" or '' Ärticle Title tag'' for period 2007-16 within "date range tag". This became our main search string. When the main search string was restricted to "India tag", we were able to get publication data on India, which consisted of 1744 publications. Using analytical commands or tags available in Scopus database, such as "subject area tag", "country tag", "source title tag", "journal title name" and "affiliation tag", we were able to get data/information on the distribution of publications output by subject, collaborating countries, author-wise, organization-wise and journal-wise, etc. For citation data, citations to publications were also collected from date of publication till July 2017.

Profile of top 15 most productive Indian organizations
In Indian rheumatoid arthritis research, the productivity of 15 most productive Indian organizations varied from 18 to 87 publications and together they contributed 29.87% (521) publication share and 37.92% (6107) citation share to its cumulative publications output during 2007-16. The scientometric profile of these 15 organizations is presented in ( Table 4)

Profile of top 15 most productive authors
In the field of Indian rheumatoid arthritis research, the research productivity of top 15 most productive authors varied from 13 to 60 publications. Together they contributed 18.23% (318) Indian publication share and 22.36% (3601) citation share during 2007-16. The scientometric profile of these 15authors is presented in (Table 5). Five authors registered publications output above the group average of 21.

Highly cited papers
A total of 12highly cited papers were identified which received citations from 101 to 1138 during 2007-16. These 12papers together received 3405 citations, which averaged to 283.78 citations per paper. Of the 12 high cited papers, 7 were reviews and 5 articles. Seven out of 12 high cited papers involve collaboration (2 national collaborative and 5 international collaborative).These 12 Concludes that rheumatology has been a neglected subspecialty in India. A staggering patient load, a severely inadequate number of trained rheumatology specialists, therapeutic nihilism and limited advocacy are some of the critical challenges that confront rheumatology care, and possibly explain the high rates of reliance on complementary and alternative medicines in India. To address the many problems with rheumatology care in India, curricular reforms, capacity building, patient education and political support are sorely needed.