We identified participants who were newly diagnosed with RA using the International Classification of Diseases, tenth Revision, Clinical Modification (ICD-10-CM), codes (M05.x, M06.x) plus any dispensing of DMARDs during the identification period from January 2010 to December 2017 (n = 286,148; 23 (link)). Disease-modifying anti-rheumatic drugs (DMARDs) in the current study included all of conventional synthetic DMARDs (e.g., methotrexate, hydroxychloroquine, leflunomide, sulfasalazine, tacrolimus, cyclosporine, D-penicillamine, bucillamine, and azathioprine), biological DMARDs (e.g., adalimumab, etanercept, infliximab, golimumab, rituximab, abatacept, and tocilizumab), and targeted synthetic DMARD (e.g., tofacitinib). Those who had not completed a health checkup within 2 years before the diagnosis of RA, those with any missing data, those with age < 20 years, and those with a history of ESRD before the diagnosis of RA were excluded. We additionally excluded the subjects who were diagnosed with ESRD or who died within 1 year after the diagnosis of RA, for the diagnostic accuracy of RA. For comparison between the subjects with and without RA, we selected the control group (without RA) by age-sex exact matching, and included five times as many subjects as RA cohort. Patients with RA who were not matched with controls without RA were further excluded.
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