A second paper on a contested pain disease is under investigation after sleuths raised questions about the methodology and possible fabrication of data.
Last year, Scientific Reports retracted a paper comparing the condition, which the authors dubbed Middle East Pain Syndrome, to rheumatoid arthritis for failing to establish a clear distinction between the two ailments.
The new article, published in January in BMC Rheumatology with two overlapping authors, compares MEPS to fibromyalgia, claiming it is distinct for its “hand tufts spur-like excrescences.”
A sleuth raised concerns about the new paper to BMC Rheumatology in a February 8 email. In the email, the sleuth, who asked us not to identify them due to “security issues,” critiqued the cross-sectional design and the study’s lack of a control group, and said bone spurs can occur in other diseases, like hyperparathyroidism and osteoarthritis.
Barbara Kensen, associate editor of BMC Rheumatology, told us in an email the journal is “aware of concerns regarding this paper and are investigating them thoroughly.”
Among the issues raised, the sleuth noted the researchers had reused the ethical approval number provided by the affiliated university, Al-Azhar Faculty of Medicine for Girls Ethics Committee at the Egyptian Ministry of Health, from the retracted study. These concerns were also shared on PubPeer by commenter Actinopolyspora biskrensis in March.
Actinopolyspora also noted Reference 3 in the BMC article was a self-citation of a “20 year-old abstract from a poster presentation” claiming exposure to cadmium and lead from fried snacks, fizzy drinks and smoking could contribute to MEPS. However, in the BMC paper, the reference is included for “cadmium polluted underground water.”
The BMC paper includes a figure from the retracted paper, which was published in 2021. As Actinopolyspora noted, because the study was conducted in 2023 and 2024, “the images in this paper cannot be from patients included in this study.”
Adel Elbeialy, a rheumatologist at Al-Azhar University in Cairo and the corresponding author of both the retracted Scientific Reports and BMC articles, responded to the criticism in the same thread on PubPeer. He noted the poster abstract reference was incorrect.
He also said the researchers “forgot to include the ID number” for the ethics approval, but that the number referenced by the comments “is not study-specific but rather serves as the institutional IRB registration code assigned to our faculty.” He also included a picture of the ethics paperwork.
Elbeialy justified the re-use of the image, saying the cohort in the BMC study is the same group of patients “analyzed across multiple research projects.” He also defended referencing the retracted paper: “our study does not rely on it for the specific claim in question,” he wrote on PubPeer. However, he offered to remove the reference as part of a “Correction plan.”
Elbeialy told us by email he hadn’t yet heard from the journal regarding the investigation.
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As I mentioned in my PubPeer comments, I’m suspicious about the re-use of the radiographs. If the authors had 400 MEPS patients in the first (now-retracted study) and another 40 MEPS patients in the BMJ study, why don’t they have a greater selection of radiographs? Perhaps this the only image that shows the spurs?
One other comment I made on the BMJ paper was moderated out, although I’m not sure of the reason. In that comment I believe I noted that the authors seemed to be using a backdoor method to cite the retracted paper in their new BMJ paper. See https://pubpeer.com/publications/7C365997852E48F75275A295F781ED. Rafieian et al, Journal of Parathyroid Disease (2022). Rafieian repeatedly cites the retracted paper, and in my opinion, if these sections were excised, the Rafieian paper would fall apart.
Sadly, the last author of the Rafieian paper is the editor-in-charge of the Journal of Parathyroid Disease, and in a reply in the PubPeer thread he explains that he sees no need to correct or retract his paper. Dr. Elbeialy can safely cite the Rafieian paper for all the things he wishes to retrieve from the dumpster in his retracted paper.
Oops… I meant BMC, not BMJ.
Dear Cheshire
Thank you for your comments and for your diligence in reviewing our work. I would like to clarify a few points regarding your concerns:
1. Radiograph Selection:
The radiographs included in our study were chosen to best illustrate the presence of spurs in MEPS patients. While our patient cohort was large, not all radiographs were of publishable quality. The selected images represent the most characteristic findings. However, if needed, we can provide additional anonymized radiographs for further verification.
2. Citation of the Retracted Paper:
Our intention was never to circumvent the retraction process. Any references to previous studies, including Rafieian et al., were cited to provide relevant background information rather than to validate findings from a retracted publication. If there are concerns regarding the citations, we are open to discussing appropriate revisions or clarifications.
3. Journal Policy & Editorial Oversight:
The editorial decisions of the Journal of Parathyroid Disease are beyond our control. However, we have strictly adhered to ethical publication guidelines in our manuscript. If there are specific concerns about citation practices, we are open to addressing them transparently.
We appreciate your engagement in this discussion and are committed to maintaining the highest research integrity standards. Please let us know if further clarification or additional data is required.
Best regards,
Dr. Adel Elbeialy
[email protected]
[Al-Azhar University Faculty of Medicine, Egypt]
Dear Dr. ElBeialy,
I would like to respectfully raise several concerns regarding your recent work. Firstly, the duplication of the same image constitutes clear plagiarism, and the use of a retracted reference raises serious questions about the integrity of the methodology and intent.
Moreover, your study is based on a cross-sectional design, yet it proposes specific diagnostic criteria for a disease without appropriate validation, which is methodologically unsound. The assumption that spurs are exclusive to MEPS is inaccurate and contradicts existing literature and clinical understanding.
It is also concerning that in your earlier, now retracted, publication, you proposed a set of criteria, and in your subsequent paper, additional components such as capillaroscopy and enthesitis were introduced. This evolving and inconsistent definition suggests a lack of clarity and raises doubts about the scientific rigor behind your proposed criteria. One might reasonably speculate that a third paper would expand the criteria even further to encompass a broad range of unrelated rheumatologic conditions.
I urge a more cautious and evidence-based approach in defining disease criteria to ensure the credibility and reproducibility of your findings.
Sincerely,
PA
Thank you for responding. I think PubPeer is a better forum for continuing this discussion and I have responded to you there.