Research ArticleArticle
The Burden of Gout and Its Attributable Risk Factors in the Middle East and North Africa Region, 1990 to 2019
Fatemeh Amiri, Ali-Asghar Kolahi, Seyed Aria Nejadghaderi, Maryam Noori, Alireza Khabbazi, Mark J. M. Sullman, Jay S. Kaufman, Gary S. Collins and Saeid Safiri
The Journal of Rheumatology September 2022, jrheum.220425; DOI: https://doi.org/10.3899/jrheum.220425
Fatemeh Amiri
This work was supported by The Bill and Melinda Gates Foundation, who were not involved in any way in the preparation of this manuscript, and who also funded the Global Burden of Disease study. The Tabriz University of Medical Sciences (grant no. 68766) and Shahid Beheshti University of Medical Sciences (grant no. 28705) also supported the present report. F. Amiri, MD, Student Research Committee, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; A.A. Kolahi, MD, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; S.A. Nejadghaderi, MD, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, and Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; M. Noori, MD, Student Research Committee, School of Medicine, Iran University of Medical Sciences, and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; A. Khabbazi, MD, Connective Tissue Diseases Research Center, and Department of Internal Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; M.J.M. Sullman, PhD, Department of Life and Health Sciences, and Department of Social Sciences, University of Nicosia, Nicosia, Cyprus; J.S. Kaufman, PhD, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; G.S. Collins, PhD, Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; S. Safiri, PhD, Connective Tissue Diseases Research Center, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Safiri, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email: safiris@tbzmed.ac.ir; saeidsafiri@gmail.com. Or Dr. A.A. Kolahi, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kolahi@sbmu.ac.ir. Accepted for publication August 3, 2022.
Ali-Asghar Kolahi
This work was supported by The Bill and Melinda Gates Foundation, who were not involved in any way in the preparation of this manuscript, and who also funded the Global Burden of Disease study. The Tabriz University of Medical Sciences (grant no. 68766) and Shahid Beheshti University of Medical Sciences (grant no. 28705) also supported the present report. F. Amiri, MD, Student Research Committee, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; A.A. Kolahi, MD, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; S.A. Nejadghaderi, MD, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, and Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; M. Noori, MD, Student Research Committee, School of Medicine, Iran University of Medical Sciences, and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; A. Khabbazi, MD, Connective Tissue Diseases Research Center, and Department of Internal Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; M.J.M. Sullman, PhD, Department of Life and Health Sciences, and Department of Social Sciences, University of Nicosia, Nicosia, Cyprus; J.S. Kaufman, PhD, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; G.S. Collins, PhD, Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; S. Safiri, PhD, Connective Tissue Diseases Research Center, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Safiri, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email: safiris@tbzmed.ac.ir; saeidsafiri@gmail.com. Or Dr. A.A. Kolahi, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kolahi@sbmu.ac.ir. Accepted for publication August 3, 2022.
Seyed Aria Nejadghaderi
This work was supported by The Bill and Melinda Gates Foundation, who were not involved in any way in the preparation of this manuscript, and who also funded the Global Burden of Disease study. The Tabriz University of Medical Sciences (grant no. 68766) and Shahid Beheshti University of Medical Sciences (grant no. 28705) also supported the present report. F. Amiri, MD, Student Research Committee, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; A.A. Kolahi, MD, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; S.A. Nejadghaderi, MD, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, and Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; M. Noori, MD, Student Research Committee, School of Medicine, Iran University of Medical Sciences, and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; A. Khabbazi, MD, Connective Tissue Diseases Research Center, and Department of Internal Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; M.J.M. Sullman, PhD, Department of Life and Health Sciences, and Department of Social Sciences, University of Nicosia, Nicosia, Cyprus; J.S. Kaufman, PhD, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; G.S. Collins, PhD, Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; S. Safiri, PhD, Connective Tissue Diseases Research Center, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Safiri, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email: safiris@tbzmed.ac.ir; saeidsafiri@gmail.com. Or Dr. A.A. Kolahi, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kolahi@sbmu.ac.ir. Accepted for publication August 3, 2022.
Maryam Noori
This work was supported by The Bill and Melinda Gates Foundation, who were not involved in any way in the preparation of this manuscript, and who also funded the Global Burden of Disease study. The Tabriz University of Medical Sciences (grant no. 68766) and Shahid Beheshti University of Medical Sciences (grant no. 28705) also supported the present report. F. Amiri, MD, Student Research Committee, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; A.A. Kolahi, MD, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; S.A. Nejadghaderi, MD, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, and Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; M. Noori, MD, Student Research Committee, School of Medicine, Iran University of Medical Sciences, and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; A. Khabbazi, MD, Connective Tissue Diseases Research Center, and Department of Internal Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; M.J.M. Sullman, PhD, Department of Life and Health Sciences, and Department of Social Sciences, University of Nicosia, Nicosia, Cyprus; J.S. Kaufman, PhD, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; G.S. Collins, PhD, Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; S. Safiri, PhD, Connective Tissue Diseases Research Center, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Safiri, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email: safiris@tbzmed.ac.ir; saeidsafiri@gmail.com. Or Dr. A.A. Kolahi, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kolahi@sbmu.ac.ir. Accepted for publication August 3, 2022.
Alireza Khabbazi
This work was supported by The Bill and Melinda Gates Foundation, who were not involved in any way in the preparation of this manuscript, and who also funded the Global Burden of Disease study. The Tabriz University of Medical Sciences (grant no. 68766) and Shahid Beheshti University of Medical Sciences (grant no. 28705) also supported the present report. F. Amiri, MD, Student Research Committee, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; A.A. Kolahi, MD, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; S.A. Nejadghaderi, MD, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, and Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; M. Noori, MD, Student Research Committee, School of Medicine, Iran University of Medical Sciences, and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; A. Khabbazi, MD, Connective Tissue Diseases Research Center, and Department of Internal Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; M.J.M. Sullman, PhD, Department of Life and Health Sciences, and Department of Social Sciences, University of Nicosia, Nicosia, Cyprus; J.S. Kaufman, PhD, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; G.S. Collins, PhD, Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; S. Safiri, PhD, Connective Tissue Diseases Research Center, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Safiri, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email: safiris@tbzmed.ac.ir; saeidsafiri@gmail.com. Or Dr. A.A. Kolahi, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kolahi@sbmu.ac.ir. Accepted for publication August 3, 2022.
Mark J. M. Sullman
This work was supported by The Bill and Melinda Gates Foundation, who were not involved in any way in the preparation of this manuscript, and who also funded the Global Burden of Disease study. The Tabriz University of Medical Sciences (grant no. 68766) and Shahid Beheshti University of Medical Sciences (grant no. 28705) also supported the present report. F. Amiri, MD, Student Research Committee, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; A.A. Kolahi, MD, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; S.A. Nejadghaderi, MD, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, and Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; M. Noori, MD, Student Research Committee, School of Medicine, Iran University of Medical Sciences, and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; A. Khabbazi, MD, Connective Tissue Diseases Research Center, and Department of Internal Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; M.J.M. Sullman, PhD, Department of Life and Health Sciences, and Department of Social Sciences, University of Nicosia, Nicosia, Cyprus; J.S. Kaufman, PhD, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; G.S. Collins, PhD, Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; S. Safiri, PhD, Connective Tissue Diseases Research Center, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Safiri, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email: safiris@tbzmed.ac.ir; saeidsafiri@gmail.com. Or Dr. A.A. Kolahi, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kolahi@sbmu.ac.ir. Accepted for publication August 3, 2022.
Jay S. Kaufman
This work was supported by The Bill and Melinda Gates Foundation, who were not involved in any way in the preparation of this manuscript, and who also funded the Global Burden of Disease study. The Tabriz University of Medical Sciences (grant no. 68766) and Shahid Beheshti University of Medical Sciences (grant no. 28705) also supported the present report. F. Amiri, MD, Student Research Committee, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; A.A. Kolahi, MD, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; S.A. Nejadghaderi, MD, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, and Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; M. Noori, MD, Student Research Committee, School of Medicine, Iran University of Medical Sciences, and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; A. Khabbazi, MD, Connective Tissue Diseases Research Center, and Department of Internal Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; M.J.M. Sullman, PhD, Department of Life and Health Sciences, and Department of Social Sciences, University of Nicosia, Nicosia, Cyprus; J.S. Kaufman, PhD, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; G.S. Collins, PhD, Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; S. Safiri, PhD, Connective Tissue Diseases Research Center, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Safiri, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email: safiris@tbzmed.ac.ir; saeidsafiri@gmail.com. Or Dr. A.A. Kolahi, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kolahi@sbmu.ac.ir. Accepted for publication August 3, 2022.
Gary S. Collins
This work was supported by The Bill and Melinda Gates Foundation, who were not involved in any way in the preparation of this manuscript, and who also funded the Global Burden of Disease study. The Tabriz University of Medical Sciences (grant no. 68766) and Shahid Beheshti University of Medical Sciences (grant no. 28705) also supported the present report. F. Amiri, MD, Student Research Committee, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; A.A. Kolahi, MD, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; S.A. Nejadghaderi, MD, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, and Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; M. Noori, MD, Student Research Committee, School of Medicine, Iran University of Medical Sciences, and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; A. Khabbazi, MD, Connective Tissue Diseases Research Center, and Department of Internal Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; M.J.M. Sullman, PhD, Department of Life and Health Sciences, and Department of Social Sciences, University of Nicosia, Nicosia, Cyprus; J.S. Kaufman, PhD, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; G.S. Collins, PhD, Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; S. Safiri, PhD, Connective Tissue Diseases Research Center, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Safiri, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email: safiris@tbzmed.ac.ir; saeidsafiri@gmail.com. Or Dr. A.A. Kolahi, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kolahi@sbmu.ac.ir. Accepted for publication August 3, 2022.
Saeid Safiri
This work was supported by The Bill and Melinda Gates Foundation, who were not involved in any way in the preparation of this manuscript, and who also funded the Global Burden of Disease study. The Tabriz University of Medical Sciences (grant no. 68766) and Shahid Beheshti University of Medical Sciences (grant no. 28705) also supported the present report. F. Amiri, MD, Student Research Committee, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; A.A. Kolahi, MD, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; S.A. Nejadghaderi, MD, Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, and Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; M. Noori, MD, Student Research Committee, School of Medicine, Iran University of Medical Sciences, and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; A. Khabbazi, MD, Connective Tissue Diseases Research Center, and Department of Internal Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; M.J.M. Sullman, PhD, Department of Life and Health Sciences, and Department of Social Sciences, University of Nicosia, Nicosia, Cyprus; J.S. Kaufman, PhD, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; G.S. Collins, PhD, Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; S. Safiri, PhD, Connective Tissue Diseases Research Center, and Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Safiri, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email: safiris@tbzmed.ac.ir; saeidsafiri@gmail.com. Or Dr. A.A. Kolahi, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kolahi@sbmu.ac.ir. Accepted for publication August 3, 2022.
Abstract
Objective This study reported the burden of gout and its attributable risk factors in the Middle East and North Africa (MENA) region between 1990 and 2019 by age, sex, and sociodemographic index (SDI).
Methods Data on the prevalence, incidence, and years lived with disability (YLD) due to gout were obtained from the Global Burden of Disease 2019 study for the 21 countries in the MENA region, from 1990 to 2019.
Results In 2019, the regional age-standardized point prevalence and annual incidence rates of gout were 509.1 and 97.7 per 100,000 population, which represent a 12% and 11.1% increase since 1990, respectively. Moreover, in 2019 the regional age-standardized YLD rate was 15.8 per 100,000 population, an 11.7% increase since 1990. In 2019, Qatar and Afghanistan had the highest and lowest age-standardized YLD rates, respectively. Regionally, the age-standardized point prevalence of gout increased with age up to the oldest age group, and it was more prevalent among males in all age groups. In addition, there was an overall positive association between SDI and the burden of gout between 1990 and 2019. In 2019, high BMI (46.1%) was the largest contributor to the burden of gout in the MENA region.
Conclusion There were large intercountry variations in the burden of gout, but in general, it has increased in MENA over the last 3 decades. This increase is in line with the global trends of gout. However, the age-standardized YLD rate change was higher in MENA than at the global level.
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In this issue
The Journal of Rheumatology
Vol. 50, Issue 1
1 Jan 2023
The Burden of Gout and Its Attributable Risk Factors in the Middle East and North Africa Region, 1990 to 2019
Fatemeh Amiri, Ali-Asghar Kolahi, Seyed Aria Nejadghaderi, Maryam Noori, Alireza Khabbazi, Mark J. M. Sullman, Jay S. Kaufman, Gary S. Collins, Saeid Safiri
The Journal of Rheumatology Sep 2022, jrheum.220425; DOI: 10.3899/jrheum.220425
The Burden of Gout and Its Attributable Risk Factors in the Middle East and North Africa Region, 1990 to 2019
Fatemeh Amiri, Ali-Asghar Kolahi, Seyed Aria Nejadghaderi, Maryam Noori, Alireza Khabbazi, Mark J. M. Sullman, Jay S. Kaufman, Gary S. Collins, Saeid Safiri
The Journal of Rheumatology Sep 2022, jrheum.220425; DOI: 10.3899/jrheum.220425
