Researchers who said they discovered a new disease akin to rheumatoid arthritis, but caused by pollution, are standing by their claim despite the retraction of their paper last month.
The article, “Middle east pain syndrome is a pollution-induced new disease mimicking rheumatoid arthritis,” appeared in the Springer Nature journal Scientific Reports in November 2021. The paper has been cited once, according to Clarivate’s Web of Science, and received limited press coverage.
According to the retraction notice, “post-publication peer review by an expert has confirmed the validity” of multiple concerns raised about the study. The paper did not present data to support its claims about the presumed cause for the syndrome, didn’t “conclusively” prove that MEPS is a new disease, and the bone erosions the study claimed were a hallmark of the disease weren’t backed by scans, the notice stated. Also, a figure of the paper featured a radiograph of a patient that wasn’t part of the study.
“The Editors therefore no longer have confidence in the conclusions of this study,” the notice states.
Rafal Marszalek, the editor-in-chief of the journal, told Retraction Watch the concerns were raised by a reader. After post-publication peer review by an expert “confirmed these concerns and that they substantially impact the conclusions of the article,” it was retracted.
The lead author of the paper, Adel A. Elbeialy, a rheumatologist at Al-Azhar University in Cairo, disagreed with the retraction. He told us the journal did not respond to his objections.
In an email to Anam Akhtar, a deputy editor of Scientific Reports, Elbeialy called the decision “hurried.”
In other communications with the journal seen by Retraction Watch, Elbeialy disputed the retraction, saying the findings would be supported in future research. “Some of these papers will reach your eminent journal soon,” he said.
Elbeialy admitted that one of the figures was from a patient not included in the study, but said the authors decided to include it because of its “high resolution and suitability for printing.”
In his email to Akhtar, Elbeialy compared MEPS to COVID-19 “and its sequelae, we have to wait for other researches that explain the pathogenesis, criteria for diagnosis and proper treatment.” He also noted that rheumatoid arthritis, which the retracted paper claims is similar to Middle East Pain Syndrome, “was not understood fully from a single paper when described by Augustin Jacob Landré-Beauvais in the year 1800.”
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Regarding the radiographs that were acknowledged by the author not to represent a patient of the study, it was described as, “Plain X ray hand PA view shows mild subperiosteal bone resorption affecting radial aspects of the proximal and middle phalanges of the 2nd and 3rd fingers, terminal tuft erosions (acro-osteolysis), as well as spur-like excrescences.” There were other references to this in the text.
I think this acknowledged misrepresentation of data alone is sufficient for an article to be retracted.
Dear Colleagues,
Middle East Pain Syndrome (MEPS) is a newly identified rheumatic disease that closely resembles rheumatoid arthritis (RA). Our research suggests that MEPS arises from chronic vitamin D3 deficiency, potentially linked to prolonged exposure to heavy metal pollutants, particularly cadmium and lead.
We believe this condition is globally prevalent, but we named it after the Middle East, where it was first identified. Clinically, MEPS presents with symptoms resembling fibromyalgia and secondary hyperparathyroidism. Many patients exhibit arthritis affecting large and some small joints in a non-symmetrical pattern. Our latest findings indicate elevated levels of IL-6, IL-17, and TNF-α, alongside widespread enthesitis. If left untreated, MEPS can progress to sacroiliitis, sometimes accompanied by hidden psoriatic lesions or eczema.
Given the significance of this discovery, we advocate for a multicenter study to investigate its genetic predisposition and potential HLA associations. MEPS deserves recognition in rheumatology literature and inclusion in medical textbooks worldwide.
The first publication on MEPS appeared in Nature Scientific Reports:
https://doi.org/10.1038/s41598-024-66447-6
However, this paper was retracted three years later despite receiving over 16,000 views and six citations. The retraction was based on non-scientific reasons:
One reviewer disputed the link between chronic cadmium exposure and vitamin D3 deficiency, despite extensive supporting literature in high-impact journals.
The editors questioned a hand X-ray used in the study, arguing that its timestamp was outside the study period. We clarified that the image belonged to a study patient but was taken later for better clarity.
The retraction note can be found here:
Retraction Note: Middle East Pain Syndrome is a Pollution-Induced New Disease Mimicking Rheumatoid Arthritis
Scientific Reports, Volume 14, Article 15723 (2024)
[Retraction link]
Despite this setback, we remain committed to raising awareness about MEPS. Misdiagnosis leads to ineffective biological treatments, unnecessary healthcare costs, and potential risks for patients undergoing unsuccessful treatment trials. Therefore, we invite colleagues worldwide to collaborate on further research, multicenter studies, and additional publications to validate and expand upon our findings.
We remain searching despite the disputes and published a paper about the effect of environmental pollution on some rheumatic diseases with notice on its effect on vitamin D3 levels.
Elbeialy, A., Sawy, S.E., Elzomor, H. et al. Environmental pollution impact on the severity of some rheumatic diseases: a comparative analytical study on inflammatory and non-inflammatory samples. BMC Rheumatol 8, 50 (2024). https://doi.org/10.1186/s41927-024-00420-8
Again, we published a new paper establishing the reality of MEPS and exploring its distinction from fibromyalgia
Elhamamy, M.H., Elbeialy, A.A., Mohamed, M.S. et al. Is middle East pain syndrome (MEPS) a variant of fibromyalgia syndrome or a distinct disease?. BMC Rheumatol 9, 3 (2025). https://doi.org/10.1186/s41927-024-00428-0
Lastly, I recall the resistance faced by my esteemed mentor, Dr. Graham Hughes, when he first described Hughes Syndrome (later recognized as Antiphospholipid Syndrome). Scientific progress often meets opposition, but perseverance is key.
We look forward to your support in advancing the understanding of MEPS for the benefit of patients and the medical community.
Sincerely,
Adel A. Elbeialy, MD
Thank you for providing this information. I have raised some concerns about this new paper on PubPeer. It would be great if you could address those. Link: https://pubpeer.com/publications/026C23C4CE1E5073C0689667998B8B
One of those concerns is about the reuse of images from the now-retracted study in the new study, which was conducted at a different time and with a different patient population.
A paper that relies heavily on this now-retracted paper to support statements made has been flagged by me on PubPeer. See https://pubpeer.com/publications/7C365997852E48F75275A295F781ED
This second paper’s last author is also the journal’s Editor-in-Chief and has responded suggesting there’s no problem with the second paper because the authors could not have known this paper would be retracted in the future. While I have replied, I suspect it will be difficult to get them to act.
Funnily enough, the new paper by Elbeialy et al, cites the second paper for a source, when the second paper cited the *retracted Elbeialy et al paper* as the original source. Unless the second paper is retracted too, this unsupported “fact” can live on in the literature forever.