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Objective.To examine longterm visit-to-visit blood pressure (BP) variability in patients with rheumatoid arthritis (RA) versus non-RA subjects and to assess its effect on cardiovascular (CV) events and mortality in RA.Methods.Clinic BP measures were collected in a population-based incident cohort of patients with RA (1987 American College of Rheumatology criteria met between January 1, 1995, and January 1, 2008) and non-RA subjects. BP variability was defined as within-subject SD in systolic and diastolic BP.Results.The study included 442 patients with RA (mean age 55.5 yrs, 70% females) and 424 non-RA subjects (mean age 55.7 yrs, 69% females). Patients with RA had higher visit-to-visit variability in systolic BP (13.8 ± 4.7 mm Hg) than did non-RA subjects (13.0 ± 5.2 mm Hg, p = 0.004). Systolic BP variability declined after the index date in RA (p < 0.001) but not in the non-RA cohort (p = 0.73), adjusting for age, sex, and calendar year of RA. During the mean followup of 7.1 years, 33 CV events and 57 deaths occurred in the RA cohort. Visit-to-visit systolic BP variability was associated with increased risk of CV events (HR per 1 mm Hg increase in BP variability 1.12, 95% CI 1.01–1.25). Diastolic BP variability was associated with all-cause mortality in RA (HR 1.14, 95% CI 1.03–1.27), adjusting for systolic and diastolic BP, body mass index, smoking, diabetes, dyslipidemia, and use of antihypertensives.Conclusion.Patients with RA had higher visit-to-visit systolic BP variability than did non-RA subjects. There was a significant decline in systolic BP variability after RA incidence. Higher visit-to-visit BP variability was associated with adverse CV outcomes and all-cause mortality in RA.

Objective.To examine trends in the rates of serious infections among patients diagnosed with rheumatoid arthritis (RA) in 1995–2007 compared to rates previously reported from the same geographical area diagnosed 1955–1994.Methods.A population-based inception cohort of patients with RA in 1995–2007 was assembled and followed through their complete medical records until death, migration, or December 31, 2008. All serious infections (requiring hospitalization or intravenous antibiotics) were recorded. Person-year (py) methods were used to compare rates of infection.Results.Among 464 patients with incident RA in 1995–2007, 54 had ≥ 1 serious infection (178 total). These were compared to 609 patients with incident RA in 1955–1994 (290 experienced ≥ 1 serious infection; 740 total). The rate of serious infections declined from 9.6 per 100 py in the 1955–1994 cohort to 6.6 per 100 py in the 1995–2007 cohort. Serious gastrointestinal (GI) infection rates increased from 0.5 per 100 py in the 1955–1994 cohort to 1.25 per 100 py in the 1995–2007 cohort. Among patients with a history of serious infection, the rate of subsequent infection increased from 16.5 per 100 py in 1955–1994 to 37.4 per 100 py in 1995–2007. There was an increase in the rate of serious infections in patients who received biologic agents, but this did not reach significance.Conclusion.Aside from GI infections, the rate of serious infections in patients with RA has declined in recent years. However, the rate of subsequent infections was higher in recent years than previously reported.