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Adriyanov Kostov, BelchinColaboración PuntualChamorro Sanchez, ángelAuthorCasanovas Biern, AlbertAuthorZamora, MonicaAuthorSiso Almirall, AntoniAuthorBove Boada, AlbertAuthorBrito-Zeron PAuthorRamos-Casals, MCorresponding Author

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March 4, 2017
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Article

Influence of geolocation and ethnicity on the phenotypic expression of primary Sjögren's syndrome at diagnosis in 8310 patients: a cross-sectional study from the Big Data Sjögren Project Consortium.

Publicated to: Annals Of The Rheumatic Diseases. 76 (6): 1042-1050 - 2017-06-01 76(6), DOI: 10.1136/annrheumdis-2016-209952

Authors:

Brito-Zerón P, Acar-Denizli N, Zeher M, Rasmussen A, Seror R, Theander E, Li X, Baldini C, Gottenberg JE, Danda D, Quartuccio L, Priori R, Hernandez-Molina G, Kruize AA, Valim V, Kvarnstrom M, Sene D, Gerli R, Praprotnik S, Isenberg D, Solans R, Rischmueller M, Kwok SK, Nordmark G, Suzuki Y, Giacomelli R, Devauchelle-Pensec V, Bombardieri M, Hofauer B, Bootsma H, Brun JG, Fraile G, Carsons SE, Gheita TA, Morel J, Vollenveider C, Atzeni F, Retamozo S, Horvath IF, Sivils K, Mandl T, Sandhya P, De Vita S, Sanchez-Guerrero J, van der Heijden E, Trevisani VFM, Wahren-Herlenius M, Mariette X, Ramos-Casals M, EULAR-SS Task Force Big Data Consortium
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Affiliations

Anhui Prov Hosp, Dept Rheumatol & Immunol, Hefei, Peoples R China - Author
Brest Univ Hosp, Rheumatol Dept, Brest, France      CHU Brest - Author
Cairo Univ, Kasr Al Ainy Sch Med, Rheumatol Dept, Cairo, Egypt      Cairo University       - Author
Cathol Univ Korea, Seoul St Marys Hosp, Coll Med, Div Rheumatol, Seoul, South Korea      Seoul St. Mary's Hospital    Catholic University of Korea - Author
Christian Med Coll & Hosp, Dept Clin Immunol, Vellore, Tamil Nadu, India      Christian Medical College & Hospital (CMCH) Vellore - Author
Discipline Med Univ Adelaide, Queen Elizabeth Hosp, Dept Rheumatol, Adelaide, SA, Australia - Author
Haukeland Hosp, Dept Rheumatol, Bergen, Norway      University of Bergen    Haukeland University Hospital - Author
Hosp CIMA, Dept Med, Autoimmune Dis Unit, Barcelona, Spain - Author
Hosp Clin Barcelona, Serv Malalties Autoimmunes Sistemi, C Villarroel,170, Barcelona 08036, Spain.      Hospital Clinic de Barcelona    University of Barcelona - Author
Hosp Hebron, Dept Internal Med, Barcelona, Spain      Hospital Universitari Vall d'Hebron       - Author
Hosp Ramon & Cajal, Dept Internal Med, Madrid, Spain      Hospital Universitario Ramon y Cajal - Author
Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Immunol & Rheumatol Dept, Mexico City, DF, Mexico      Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran - Mexico - Author
Kanazawa Univ Hosp, Div Rheumatol, Kanazawa, Ishikawa, Japan      Kanazawa University - Author
Karolinska Inst, Dept Med Solna, Unit Expt Rheumatol, Stockholm, Sweden      Karolinska Institutet - Author
Karolinska Univ Hosp, Stockholm, Sweden      Karolinska University Hospital    Karolinska Institutet - Author
Le Kremlin Bicetre Univ Paris Sud, Hop Univ Paris Sud, Assistance Publ Hop Paris,U1184, Ctr Immunol Viral Infect & Autoimmune Dis,INSERM, Paris, France      Assistance Publique Hopitaux Paris (APHP)    Institut National de la Sante et de la Recherche Medicale (Inserm)    Hopital Universitaire Paul-Brousse - APHP - Author
Lund Univ, Malmo Univ Hosp, Dept Rheumatol, Lund, Sweden      Lund University    Skane University Hospital       - Author
Mimar Sinan Fine Arts Univ, Fac Sci & Letters, Dept Stat, Istanbul, Turkey      Mimar Sinan Guzel Sanatlar University - Author
Oklahoma Med Res Fdn, Arthritis & Clin Immunol Res Program, 825 NE 13th St, Oklahoma City, OK 73104 USA      Oklahoma Medical Research Foundation - Author
Queen Mary Univ London, Ctr Expt Med & Rheumatol, London, England      University of London    Queen Mary University London - Author
Sapienza Univ Rome, Dept Internal Med & Med Specialties, Rheumatol Clin, Rome, Italy      Sapienza University Rome - Author
SUNY Stony Brook, Allergy & Immunol Winthrop Univ Hosp, Div Rheumatol, Mineola, NY 11501 USA      State University of New York (SUNY) System    State University of New York (SUNY) Stony Brook    Winthrop University Hospital - Author
Teaching Hosp, Dept Rheumatol, Montpellier, France - Author
Tech Univ Munich, Otorhinolaryngol Head & Neck Surg, Munich, Germany      Technical University of Munich - Author
UCL, Ctr Rheumatol, Div Med, London, England      University of London    University College London - Author
Univ Barcelona, Hosp Clin, IDIBAPS CELLEX,Sjogren Syndrome Res Grp AGAUR, ICMiD,Dept Autoimmune Dis,Lab Autoimmune Dis Jose, Barcelona, Spain      IDIBAPS    Hospital Clinic de Barcelona    University of Barcelona - Author
Univ Bergen, Dept Clin Sci, Bergen, Norway      University of Bergen - Author
Univ Debrecen, Fac Med, Div Clin Immunol, Debrecen, Hungary      University of Debrecen - Author
Univ Fed Espirito Santo, Dept Med, Vitoria, Brazil      Universidade Federal do Espirito Santo - Author
Univ Groningen, Univ Med Ctr Groningen, Dept Rheumatol & Clin Immunol, Groningen, Netherlands      University of Groningen - Author
Univ Hosp Santa Maria Misericordia, Dept Med & Biol Sci, Clin Rheumatol, Udine, Italy      Hospital Santa Maria della Misericordia - Author
Univ Laquila, Sch Med, Clin Unit Rheumatol, Laquila, Italy      University of Aquila - Author
Univ Med Ctr Utrecht, Dept Rheumatol & Clin Immunol, Utrecht, Netherlands      Utrecht University Medical Center    Utrecht University - Author
Univ Med Ctr, Dept Rheumatol, Ljubljana, Slovenia      University of Ljubljana - Author
Univ Paris VII, Assistance Publ Hop Paris, Hop Lariboisiere, Dept Med Interne, Paris, France      Hopital Universitaire Lariboisiere-Fernand-Widal - APHP    Assistance Publique Hopitaux Paris (APHP)    Universite Sorbonne Paris Cite-USPC (ComUE)    University of Paris Diderot - Author
Univ Perugia, Dept Med, Rheumatol Unit, Perugia, Italy      University of Perugia - Author
Univ Pisa, Rheumatol Unit, Pisa, Italy      University of Pisa - Author
Univ Strasbourg, Strasbourg Univ Hosp, Dept Rheumatol, Strasbourg, France      Universite de Strasbourg    CHU Strasbourg    Universites de Strasbourg Etablissements Associes - Author
Uppsala Univ, Dept Med Sci, Rheumatol, Uppsala, Sweden      Uppsala University - Author
       - Author
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Abstract

To analyse the influence of geolocation and ethnicity on the clinical presentation of primary Sjögren's syndrome (SjS) at diagnosis.The Big Data Sjögren Project Consortium is an international, multicentre registry designed in 2014. By January 2016, 20 centres from five continents were participating. Multivariable logistic regression analyses were performed.We included 7748 women (93%) and 562 men (7%), with a mean age at diagnosis of primary SjS of 53?years. Ethnicity data were available for 7884 patients (95%): 6174 patients (78%) were white, 1066 patients (14%) were Asian, 393 patients (5%) were Hispanic, 104 patients (1%) were black/African-American and 147 patients (2%) were of other ethnicities. SjS was diagnosed a mean of 7?years earlier in black/African-American compared with white patients; the female-to-male ratio was highest in Asian patients (27:1) and lowest in black/African-American patients (7:1); the prevalence of sicca symptoms was lowest in Asian patients; a higher frequency of positive salivary biopsy was found in Hispanic and white patients. A north-south gradient was found with respect to a lower frequency of ocular involvement in northern countries for dry eyes and abnormal ocular tests in Europe (OR 0.46 and 0.44, respectively) and Asia (OR 0.18 and 0.49, respectively) compared with southern countries. Higher frequencies of antinuclear antibodies (ANAs) were reported in northern countries in America (OR=1.48) and Asia (OR=3.80) while, in Europe, northern countries had lowest frequencies of ANAs (OR=0.67) and Ro/La (OR=0.69).This study provides the first evidence of a strong influence of geolocation and ethnicity on the phenotype of primary SjS at diagnosis.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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Keywords

autoimmunechineseclassificationcriteriadiseasesgeoepidemiologylupussusceptibilityAdultAgedAntibodies, antinuclearAsian peopleAutoimmune diseasesAutoimmunityBlack or african americanClass-ii genesCross-sectional studiesEpidemiologyEye diseasesFemaleHispanic or latinoHumansMaleMiddle agedPhenotypePrevalenceRegistriesSjögren's syndromeSjøgren's syndromeSpatial analysisWhite people

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal ANNALS OF THE RHEUMATIC DISEASES due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2017, it was in position 2/30, thus managing to position itself as a Q1 (Primer Cuartil), in the category Rheumatology. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 3.3. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 1.61 (source consulted: FECYT Mar 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-26, the following number of citations:

  • WoS: 106
  • Scopus: 71
  • Europe PMC: 74
  • Google Scholar: 184
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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-26:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 181.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 181 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 38.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 11 (Altmetric).
  • The number of mentions in news outlets: 2 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Argentina; Australia; Brazil; China; Egypt; France; Germany; Hungary; India; Iran; Italy; Japan; Mexico; Netherlands; Norway; Republic of Korea; Slovenia; Sweden; Turkey; United Kingdom; United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Brito Zeron, Maria del Pilar) .

the author responsible for correspondence tasks has been Ramos Casals, Manuel.

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Awards linked to the item

Supported by Grants Fondo de Investigaciones Sanitarias (MRC, INT15/00085) and 'Ajut per a la Recerca Josep Font' (PBZ, Hospital Clinic-Barcelona 2012).
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