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Objective.Patients with rheumatoid arthritis (RA) who also have diabetes mellitus (DM) might have worse clinical outcomes and adverse events compared to patients with RA who do not have DM. We evaluated the effects of DM on Health Assessment Questionnaire (HAQ) changes and outpatient infection rates in patients with RA.Methods.Using the American College of Rheumatology’s Rheumatology Informatics System for Effectiveness (RISE) electronic health record–based registry, we identified patients with RA who had ≥ 1 rheumatologist visit with a HAQ measured in 2016 (index visit), ≥ 1 previous visit, and a subsequent outcome visit with the same HAQ measured at 12 months (± 3 months). We identified DM by diagnosis codes, medications, or laboratory values. Outpatient infection was defined by diagnosis codes or antiinfective medications. We calculated mean HAQ change and incidence rate (IR) of outpatient infections among patients with and without DM. Generalized linear models and Cox regression were used to calculate the adjusted mean HAQ change and HRs.Results.We identified 3853 RA patients with DM and 18,487 without DM. The mean HAQ change between index and outcome visit among patients with DM was 0.03 and without DM was 0.002 (P< 0.01). We identified 761 outpatient infections for patients with DM with an IR of 22.6 (95% CI 21.0–24.2) per 100 person-years and 3239 among patients without DM with an IR of 19.8 (95% CI 19.1–20.5). The adjusted HR of outpatient infections among patients with DM was 0.99 (95% CI 0.91–1.07), compared to patients without DM.Conclusion.Patients with RA with concomitant DM had greater worsening, or less improvement, in their functional status, suggesting additional interventions may be needed for RA patients with DM to optimize treatment and management of other comorbidities.

Objective.Methotrexate (MTX) has been associated with reduced risk for cardiovascular disease (CVD) events among patients with rheumatoid arthritis (RA) not exposed to biologic disease-modifying antirheumatic drugs (bDMARDs). The effect of concomitant MTX on CVD risk among RA patients initiating bDMARDs remains unknown.Methods.A retrospective cohort study was conducted to assess the effect of MTX on CVD risk using 2006–2015 Medicare claims data for patients with RA initiating bDMARD. The main exposure was current use of MTX, updated in a time-varying fashion. The primary outcome was a composite of incident myocardial infarction (MI), stroke, and fatal CVD. Secondary outcomes were each event that comprised the primary outcome. Incidence rates (IR) and 95% CI were calculated using Poisson regression. Associations between MTX and risk of CVD were assessed using Cox regression.Results.A total of 88,255 bDMARD initiations and 1861 CVD events were included in this study. Mean age was 64.6 (12.3) years, 84.0% were female, and 68.2% were non-Hispanic White. The crude IRs (95% CI) for CVD were 17.9 (16.9–18.8) and 12.1 (11.1–13.2) per 1000 patient-years among MTX unexposed and exposed, respectively. The multivariable adjusted HR (95% CI) for CVD events associated with MTX was 0.76 (0.68–0.85). Multivariable adjusted HRs were 0.78 (0.66–0.91), 0.74 (0.62–0.88), 0.77 (0.68–0.86), and 0.82 (0.73–0.93) for MI, stroke, MI or stroke, and a composite CVD outcome, respectively. Results were robust in sensitivity and subgroup analyses.Conclusion.Among patients with RA receiving biologics, concomitant MTX use was associated with a 24% lower risk for CVD events.

Objective.The protection duration of herpes zoster (HZ) vaccination is unclear among patients with autoimmune (AI) diseases.Methods.Using 2006–2013 Medicare data, HZ vaccinated patients with AI were matched 1:2 to unvaccinated HZ. Incidence rates (IR) and adjusted risk ratios over time were calculated using Poisson regression.Results.Of 59,627 vaccinated patients, crude IR increased from 0.75/100 person-years during the first year post-vaccination to 1.25 during the seventh year. Vaccinated patients had a significantly lower risk of HZ compared with the unvaccinated through 5 years.Conclusion.HZ vaccination was significantly protective only for about 5 years among patients with AI.