Type 2 diabetes (T2D) represents a growing public health challenge affecting more than 460 million people worldwide, with poor glucose control resulting in the development of micro- and macrovascular complications. On the other hand, many patients with chronic inflammatory rheumatic diseases exhibit insulin resistance and comorbid diabetes, as well as an increased risk for developing cardiovascular disease. A growing body of evidence suggests that chronic low-grade inflammation plays a central role in the pathophysiology of T2D and diabetes-related vascular complications. As such, T2D has increasingly been regarded as an inflammatory disease. Therefore, therapeutic strategies targeting inflammation and with proven efficacy in alleviating rheumatic disease activity, improving glucose control, and reducing cardiovascular risk are highly desirable interventions for patients with T2D and inflammatory rheumatic diseases.

Disease-modifying antirheumatic drugs (DMARDs) are a class of immunomodulatory and immunosuppressive agents used for treatment of several inflammatory rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, psoriatic arthritis, and ankylosing spondylitis, among others. DMARDs are classified into different categories, including conventional synthetic DMARDs (such as methotrexate, hydroxychloroquine, sulfasalazine and leflunomide), targeted synthetic DMARDs (including phosphodiesterase inhibitors and kinase inhibitors), and biologic DMARDs (including TNF inhibitors and biologics targeting other cytokines, such as IL-1 and IL-6). Emerging evidence indicates that different DMARDs display antihyperglycemic properties by virtue of their well-established anti-inflammatory and immunomodulatory effects, although the exact mechanisms of action are still not entirely clear. A number of observational and short-term intervention studies have demonstrated that DMARDs may improve glucose control or even reduce the risk for developing diabetes in patients with inflammatory rheumatic diseases with and without diabetes, respectively. However, concerns exist regarding the long-term use of these drugs due to the lack of long-term safety data in diabetic patients.

Therefore, the purpose of this Special Issue is to collate articles that help to better elucidate the exact mechanisms of action underlying the antihyperglycemic properties of different DMARDs, as well as their potential role as antidiabetic drugs and their impact on cardiovascular risk in patients with inflammatory rheumatic diseases and comorbid diabetes. This Special Issue will have relevant implications for the acquisition of more evidence-based data on the safety and efficacy profile of different DMARDs in the context of inflammatory rheumatic diseases and T2D. Original research and review articles are welcome.

Potential topics include but are not limited to the following:

• In vitro or in vivo studies elucidating the molecular mechanisms underlying the antihyperglycemic properties of different DMARDs, including their effects on systemic and islet inflammation, beta-cell function, insulin secretion, and insulin sensitivity
• Clinical studies investigating the potential role of different DMARDs in preventing T2D among patients with inflammatory rheumatic diseases
• Clinical studies assessing the potential role of different DMARDs as antidiabetic medications in patients with inflammatory rheumatic diseases and comorbid T2D
• Clinical studies evaluating the impact of different DMARDs on parameters of metabolic dysfunction, cardiovascular risk, and diabetes-related vascular complications in patients with inflammatory rheumatic diseases and comorbid T2D