{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:28:08Z","timestamp":1786980488900,"version":"build-2736575974"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Guangdong Hospital of Traditional Chinese Medicine","award":["YN2022QN09"],"award-info":[{"award-number":["YN2022QN09"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Rheumatol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n This study aimed to explore the relationship between rheumatoid arthritis (RA) and hyperuricemia among adults.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n All the data were from the National Health and Nutrition Examination Survey (NHANES 1997\u20132018) database. Linear regression, logistic regression, and restricted cubic spline (RCS) analyses were used to investigate the association between RA and hyperuricemia. Subgroup analysis and interaction tests were conducted to assess the influence of various subgroups on their association.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n This study included 41,460 patients, among whom 2603 had RA. The RA group had higher uric acid levels compared with the non-RA group (\n P<\/jats:italic>\n \u2009<\u20090.001). Linear regression showed that RA was significantly related to uric acid levels among several adjusted models (all\n P<\/jats:italic>\n \u2009<\u20090.05). Logistic regression analysis also indicated the independent association between RA and hyperuricemia in a positive relationship (\n P<\/jats:italic>\n \u2009<\u20090.05). Subgroup analysis revealed significant association in the subgroups of females, age\u2009\u2265\u200960\u00a0years, non-Hispanics, individuals with hypertension and antihypertensive drugs use, and those with BMI\u2009\u2265\u200930\u00a0kg\/m\n 2<\/jats:sup>\n (all\n P<\/jats:italic>\n \u2009<\u20090.05). The interaction test showed that there was no interaction effect between baseline features and RA (all interaction\n P<\/jats:italic>\n \u2009>\u20090.05). RCS analysis further found that the course of RA, rather than the age of diagnosis, was related to hyperuricemia (\n P<\/jats:italic>\n \u2009<\u20090.05). Furthermore, we found that the association between RA and hyperuricemia was mainly observed in populations with 15\u201330-year course of RA (\n P<\/jats:italic>\n \u2009<\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n RA was associated with hyperuricemia and their association was still stable even after adjusting for several variables, suggesting that uric acid levels should be routinely tested to detect hyperuricemia at an early stage in patients with RA.\n \n \n \n \n \n Key Points<\/jats:bold>\n <\/jats:td>\n <\/jats:tr>\n \n \n \u2022\n Revealing association between rheumatoid arthritis (RA) and hyperuricemia risk: This study initially explored the association between RA and hyperuricemia, finding that RA was positively related to the higher uric acid levels and hyperuricemia risk<\/jats:italic>\n .\u2022\n Reflecting the role of RA course on their association: Our study found that their association was mainly observed in population with RA course of 15\u201330 years<\/jats:italic>\n .\n <\/jats:td>\n <\/jats:tr>\n <\/jats:tbody>\n <\/jats:table>\n <\/jats:table-wrap>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s10067-025-07386-z","type":"journal-article","created":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T01:05:53Z","timestamp":1741223153000},"page":"1759-1767","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Association between rheumatoid arthritis and hyperuricemia among adults: a cross-sectional study based on NHANES data"],"prefix":"10.1007","volume":"44","author":[{"given":"Chanjing","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yushun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8504-0727","authenticated-orcid":false,"given":"Xuran","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,6]]},"reference":[{"issue":"6","key":"7386_CR1","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1038\/s41584-020-0413-5","volume":"16","author":"G Nygaard","year":"2020","unstructured":"Nygaard G, Firestein GS (2020) Restoring synovial homeostasis in rheumatoid arthritis by targeting fibroblast-like synoviocytes. Nat Rev Rheumatol 16(6):316\u2013333. https:\/\/doi.org\/10.1038\/s41584-020-0413-5","journal-title":"Nat Rev Rheumatol"},{"key":"7386_CR2","doi-asserted-by":"publisher","first-page":"1051082","DOI":"10.3389\/fimmu.2022.1051082","volume":"13","author":"D Wu","year":"2022","unstructured":"Wu D, Luo Y, Li T, Zhao X, Lv T, Fang G et al (2022) Systemic complications of rheumatoid arthritis: focus on pathogenesis and treatment. Front Immunol 13:1051082. https:\/\/doi.org\/10.3389\/fimmu.2022.1051082","journal-title":"Front Immunol"},{"key":"7386_CR3","doi-asserted-by":"publisher","first-page":"102400","DOI":"10.1016\/j.jaut.2019.102400","volume":"110","author":"HU Scherer","year":"2020","unstructured":"Scherer HU, Haupl T, Burmester GR (2020) The etiology of rheumatoid arthritis. J Autoimmun 110:102400. https:\/\/doi.org\/10.1016\/j.jaut.2019.102400","journal-title":"J Autoimmun"},{"key":"7386_CR4","doi-asserted-by":"publisher","first-page":"859400","DOI":"10.3389\/fimmu.2022.859400","volume":"13","author":"C Yang","year":"2022","unstructured":"Yang C, Li D, Teng D, Zhou Y, Zhang L, Zhong Z et al (2022) Epigenetic regulation in the pathogenesis of rheumatoid arthritis. Front Immunol 13:859400. https:\/\/doi.org\/10.3389\/fimmu.2022.859400","journal-title":"Front Immunol"},{"key":"7386_CR5","doi-asserted-by":"publisher","unstructured":"Liu B, Wang J, Li YY, Li KP, Zhang Q (2023) The association between systemic immune-inflammation index and rheumatoid arthritis: evidence from NHANES 1999\u20132018. Arthritis Res Ther 25(1). https:\/\/doi.org\/10.1186\/s13075-023-03018-6","DOI":"10.1186\/s13075-023-03018-6"},{"key":"7386_CR6","doi-asserted-by":"publisher","unstructured":"Chen L, Sun Q, Peng S, Tan T, Mei G, Chen H et al (2021) Associations of blood and urinary heavy metals with rheumatoid arthritis risk among adults in NHANES, 1999\u20132018. Chemosphere 289(0). https:\/\/doi.org\/10.1016\/j.chemosphere.2021.133147","DOI":"10.1016\/j.chemosphere.2021.133147"},{"key":"7386_CR7","doi-asserted-by":"publisher","unstructured":"Ni Y, Cao Y, Qiu Y, Li Y (2024) Association between dietary retinol intake and rheumatoid arthritis based on NHANES database. BMC Public Health 24(1). https:\/\/doi.org\/10.1186\/s12889-024-19620-5","DOI":"10.1186\/s12889-024-19620-5"},{"key":"7386_CR8","doi-asserted-by":"publisher","unstructured":"Hussein M, Farag YM, Sonis S (2022) Differential associations of rheumatoid arthritis and periodontitis or tooth loss: a cross-sectional study. J Clin Periodontol 50(3). https:\/\/doi.org\/10.1111\/jcpe.13757","DOI":"10.1111\/jcpe.13757"},{"key":"7386_CR9","doi-asserted-by":"publisher","unstructured":"Zhan Y, Yang Z, Liu Y, Zhan F, Lin S (2023) Interaction between rheumatoid arthritis and mediterranean diet on the risk of cardiovascular disease for the middle aged and elderly from National Health and Nutrition Examination Survey (NHANES). BMC Public Health 23(1). https:\/\/doi.org\/10.1186\/s12889-023-15478-1","DOI":"10.1186\/s12889-023-15478-1"},{"key":"7386_CR10","doi-asserted-by":"publisher","unstructured":"Wright HL, Lyon M, Chapman EA, Moots RJ, Edwards SW (2021) Rheumatoid arthritis synovial fluid neutrophils drive inflammation through production of chemokines, reactive oxygen species, and neutrophil extracellular traps. Front Immunol 11(0). https:\/\/doi.org\/10.3389\/fimmu.2020.584116","DOI":"10.3389\/fimmu.2020.584116"},{"key":"7386_CR11","doi-asserted-by":"publisher","unstructured":"Zinellu A, Mangoni AA (2023) A systematic review and meta-analysis of the association between uric acid and allantoin and rheumatoid arthritis. Antioxidants (Basel) 12(8). https:\/\/doi.org\/10.3390\/antiox12081569","DOI":"10.3390\/antiox12081569"},{"issue":"1","key":"7386_CR12","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1186\/s12889-024-17883-6","volume":"24","author":"S Jiang","year":"2024","unstructured":"Jiang S, Wang Y, Wang Z, Xu Y, Li X, Sun M et al (2024) Bisphenol A and its alternatives bisphenol S and F exposure with serum uric acid levels, hyperuricemia, and gout prevalence among US adults: a nationally representative cross-sectional study. BMC Public Health 24(1):370. https:\/\/doi.org\/10.1186\/s12889-024-17883-6","journal-title":"BMC Public Health"},{"key":"7386_CR13","doi-asserted-by":"publisher","first-page":"791983","DOI":"10.3389\/fimmu.2021.791983","volume":"12","author":"M Zhang","year":"2021","unstructured":"Zhang M, Zhu X, Wu J, Huang Z, Zhao Z, Zhang X et al (2021) Prevalence of hyperuricemia among chinese adults: findings from two nationally representative cross-sectional surveys in 2015\u201316 and 2018\u201319. Front Immunol 12:791983. https:\/\/doi.org\/10.3389\/fimmu.2021.791983","journal-title":"Front Immunol"},{"key":"7386_CR14","doi-asserted-by":"publisher","first-page":"1098683","DOI":"10.3389\/fimmu.2023.1098683","volume":"14","author":"T Lei","year":"2023","unstructured":"Lei T, Qian H, Yang J, Hu Y (2023) The exposure to volatile organic chemicals associates positively with rheumatoid arthritis: a cross-sectional study from the NHANES program. Front Immunol 14:1098683. https:\/\/doi.org\/10.3389\/fimmu.2023.1098683","journal-title":"Front Immunol"},{"key":"7386_CR15","doi-asserted-by":"publisher","first-page":"1236401","DOI":"10.3389\/fendo.2023.1236401","volume":"14","author":"Y Ding","year":"2023","unstructured":"Ding Y, Xu Z, Zhou X, Luo Y, Xie R, Li Y (2023) Association between weight-adjusted-waist index and the risk of hyperuricemia in adults: a population-based investigation. Front Endocrinol (Lausanne) 14:1236401. https:\/\/doi.org\/10.3389\/fendo.2023.1236401","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"1","key":"7386_CR16","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s41927-021-00236-w","volume":"6","author":"Q Cai","year":"2022","unstructured":"Cai Q, Pesa J, Wang R, Fu AZ (2022) Depression and food insecurity among patients with rheumatoid arthritis in NHANES. BMC Rheumatol 6(1):6. https:\/\/doi.org\/10.1186\/s41927-021-00236-w","journal-title":"BMC Rheumatol"},{"key":"7386_CR17","doi-asserted-by":"publisher","first-page":"223","DOI":"10.2147\/OARRR.S418814","volume":"15","author":"D Alkhudir","year":"2023","unstructured":"Alkhudir D, Al-Herz A, Saleh K, Alawadhi A, Al-Kandari W, Hasan E et al (2023) Is serum uric acid level associated with disease activity in rheumatoid arthritis patients. Open Access Rheumatol 15:223\u2013230. https:\/\/doi.org\/10.2147\/OARRR.S418814","journal-title":"Open Access Rheumatol"},{"key":"7386_CR18","doi-asserted-by":"publisher","first-page":"305","DOI":"10.2147\/OARRR.S331488","volume":"13","author":"D Nada","year":"2021","unstructured":"Nada D, Gaber R, Mahmoud AS, Elkhouly R, Alashkar D (2021) Hyperuricemia among Egyptian rheumatoid arthritis patients. Is it an association or an inflammatory marker? A cross-sectional observational study. Open Access Rheumatol 13:305\u201314. https:\/\/doi.org\/10.2147\/OARRR.S331488","journal-title":"Open Access Rheumatol"},{"issue":"7","key":"7386_CR19","doi-asserted-by":"publisher","first-page":"499","DOI":"10.7326\/0003-4819-143-7-200510040-00009","volume":"143","author":"HK Choi","year":"2005","unstructured":"Choi HK, Mount DB, Reginato AM, American College of P, American Physiological S (2005) Pathogenesis of gout. Ann Intern Med 143(7):499\u2013516. https:\/\/doi.org\/10.7326\/0003-4819-143-7-200510040-00009","journal-title":"Ann Intern Med"},{"issue":"6","key":"7386_CR20","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1038\/cmi.2011.35","volume":"8","author":"DP Chen","year":"2011","unstructured":"Chen DP, Wong CK, Tam LS, Li EK, Lam CW (2011) Activation of human fibroblast-like synoviocytes by uric acid crystals in rheumatoid arthritis. Cell Mol Immunol 8(6):469\u2013478. https:\/\/doi.org\/10.1038\/cmi.2011.35","journal-title":"Cell Mol Immunol"},{"issue":"7081","key":"7386_CR21","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1038\/nature04516","volume":"440","author":"F Martinon","year":"2006","unstructured":"Martinon F, Petrilli V, Mayor A, Tardivel A, Tschopp J (2006) Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 440(7081):237\u2013241. https:\/\/doi.org\/10.1038\/nature04516","journal-title":"Nature"},{"issue":"11","key":"7386_CR22","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1038\/nrrheum.2017.155","volume":"13","author":"AK So","year":"2017","unstructured":"So AK, Martinon F (2017) Inflammation in gout: mechanisms and therapeutic targets. Nat Rev Rheumatol 13(11):639\u2013647. https:\/\/doi.org\/10.1038\/nrrheum.2017.155","journal-title":"Nat Rev Rheumatol"},{"issue":"2","key":"7386_CR23","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1136\/annrheumdis-2013-204067","volume":"74","author":"CF Kuo","year":"2015","unstructured":"Kuo CF, Grainge MJ, See LC, Yu KH, Luo SF, Valdes AM et al (2015) Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan. Ann Rheum Dis 74(2):369\u2013374. https:\/\/doi.org\/10.1136\/annrheumdis-2013-204067","journal-title":"Ann Rheum Dis"},{"key":"7386_CR24","doi-asserted-by":"publisher","unstructured":"Mangoni AA, Wiese MD, Woodman RJ, Sotgia S, Zinellu A, Carru C et al (2004) Methotrexate, blood pressure and arterial function in rheumatoid arthritis: study protocol. Future Cardiol 1\u201313. https:\/\/doi.org\/10.1080\/14796678.2024.2411167","DOI":"10.1080\/14796678.2024.2411167"},{"issue":"2","key":"7386_CR25","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1002\/art.41417","volume":"73","author":"KD Deane","year":"2021","unstructured":"Deane KD, Holers VM (2021) Rheumatoid arthritis pathogenesis, prediction, and prevention: an emerging paradigm shift. Arthritis Rheumatol 73(2):181\u2013193. https:\/\/doi.org\/10.1002\/art.41417","journal-title":"Arthritis Rheumatol"},{"issue":"2","key":"7386_CR26","doi-asserted-by":"publisher","first-page":"201","DOI":"10.31138\/mjr.33.2.201","volume":"33","author":"AG Semb","year":"2022","unstructured":"Semb AG, Ikdahl E, Kerola AM, Wibetoe G, Sexton J, Crowson CS et al (2022) A clinical audit of cardiovascular risk factors and disease in patients with rheumatoid arthritis - SURF-RA. Mediterr J Rheumatol 33(2):201\u201317. https:\/\/doi.org\/10.31138\/mjr.33.2.201","journal-title":"Mediterr J Rheumatol"},{"key":"7386_CR27","doi-asserted-by":"publisher","first-page":"1421328","DOI":"10.3389\/fmed.2024.1421328","volume":"11","author":"S Corrao","year":"2024","unstructured":"Corrao S, Calvo L, Giardina A, Cangemi I, Falcone F, Argano C (2024) Rheumatoid arthritis, cardiometabolic comorbidities, and related conditions: need to take action. Front Med (Lausanne) 11:1421328. https:\/\/doi.org\/10.3389\/fmed.2024.1421328","journal-title":"Front Med (Lausanne)"},{"key":"7386_CR28","doi-asserted-by":"publisher","unstructured":"Hermann S, Palmowski A, Hermann KG, Muche B, L\u00e9pr\u00eatre N, Alexander T et al (2021) Elevated uric acid is associated with a low bone mineral density in pre- but not post-menopausal women with rheumatoid arthritis: a pilot study. Rheumatol Int 0. https:\/\/doi.org\/10.1007\/s00296-024-05655-9","DOI":"10.1007\/s00296-024-05655-9"},{"issue":"2","key":"7386_CR29","doi-asserted-by":"publisher","first-page":"e0246416","DOI":"10.1371\/journal.pone.0246416","volume":"16","author":"M Ma","year":"2021","unstructured":"Ma M, Wang L, Huang W, Zhong X, Li L, Wang H et al (2021) Meta-analysis of the correlation between serum uric acid level and carotid intima-media thickness. PLoS One 16(2):e0246416. https:\/\/doi.org\/10.1371\/journal.pone.0246416","journal-title":"PLoS One"},{"issue":"1","key":"7386_CR30","doi-asserted-by":"publisher","first-page":"9901","DOI":"10.1038\/s41598-024-60427-6","volume":"14","author":"Y Miyajima","year":"2024","unstructured":"Miyajima Y, Karashima S, Mizoguchi R, Kawakami M, Ogura K, Ogai K et al (2024) Prediction and causal inference of hyperuricemia using gut microbiota. Sci Rep 14(1):9901. https:\/\/doi.org\/10.1038\/s41598-024-60427-6","journal-title":"Sci Rep"},{"key":"7386_CR31","doi-asserted-by":"publisher","unstructured":"Ding N, He L, Li C, Su Y (2022) Uric acid and blood pressure in NHANES dated from 2009 to 2018: a cross-sectional research. Nutr Metab Cardiovasc Dis 32(11). https:\/\/doi.org\/10.1016\/j.numecd.2022.08.017","DOI":"10.1016\/j.numecd.2022.08.017"},{"key":"7386_CR32","doi-asserted-by":"publisher","unstructured":"Tan MY, Mo CY, Li F, Zhao Q (2023) The association between serum uric acid and hypertriglyceridemia: evidence from the national health and nutrition examination survey (2007\u20132018). Front Endocrinol (Lausanne) 14(0). https:\/\/doi.org\/10.3389\/fendo.2023.1215521","DOI":"10.3389\/fendo.2023.1215521"},{"key":"7386_CR33","doi-asserted-by":"publisher","unstructured":"Xu J, Jia Y, Mao Z, Wei X, Qiu T, Hu M (2023) Association between serum uric acid, hyperuricemia and periodontitis: a cross-sectional study using NHANES data. BMC Oral Health 23(1). https:\/\/doi.org\/10.1186\/s12903-023-03320-4","DOI":"10.1186\/s12903-023-03320-4"},{"key":"7386_CR34","doi-asserted-by":"publisher","unstructured":"Nehme R, Nahas PC, de Oliveira EP (2023) Association between serum uric acid and muscle strength in older adults with or without gout diagnosis: NHANES 2011\u20132014. Aging Clin Exp Res 35(9). https:\/\/doi.org\/10.1007\/s40520-023-02462-3","DOI":"10.1007\/s40520-023-02462-3"},{"key":"7386_CR35","doi-asserted-by":"publisher","unstructured":"Hu M, Wang Y, Xu W, Bai J, Tang X (2024) The impact of serum uric acid on psoriasis: NHANES 2005\u20132014 and Mendelian randomization. Front Genet 15(0). https:\/\/doi.org\/10.3389\/fgene.2024.1334781","DOI":"10.3389\/fgene.2024.1334781"}],"container-title":["Clinical Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-025-07386-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10067-025-07386-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-025-07386-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T09:54:30Z","timestamp":1750413270000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10067-025-07386-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,6]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["7386"],"URL":"https:\/\/doi.org\/10.1007\/s10067-025-07386-z","relation":{},"ISSN":["0770-3198","1434-9949"],"issn-type":[{"value":"0770-3198","type":"print"},{"value":"1434-9949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,6]]},"assertion":[{"value":"23 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 February 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Ethics Committee of Guangdong Hospital of Traditional Chinese Medicine deemed that this research is based on open-source data, so the need for ethics approval was waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors report no conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}