Rheumatoid Arthritis & Cognitive Impairment Link

Researchers evaluated the cognitive function of individuals with rheumatoid arthritis (RA) who continue to experience inflammation in a recent study that was published in RMD Open.

Context
Rheumatoid arthritis (RA) is a persistent inflammatory disease that causes synovitis in the joints, leading to joint degradation and impaired function. Patients typically experience cognitive and neurological problems.

We still don’t fully grasp how systemic inflammation affects cognitive function, despite progress in understanding the etiology of RA. Prior studies have demonstrated cognitive impairment in RA patients; however, it is unclear how inflammatory activity in RA relates to cognitive performance.

About the study
Researchers assessed cognitive performance in rheumatoid arthritis patients starting biological treatment in this cross-sectional study, looking into connections between inflammation, psychosocial variables, and life quality and cognitive impairment in RA.

Researchers recruited 16-year-old individuals with RA diagnosed according to 2010 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria between June 2022 and June 2023. Despite receiving standard synthetic disease-modifying antirheumatic drug (csDMARD) treatment, eligible people exhibited moderate-severe inflammation as measured by the 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR) and had not had biological treatment beforehand. Individuals with rheumatic illnesses unrelated to RA or those with past neurological problems unrelated to the development of RA were eliminated by the researchers.

Age, gender, and educational level were matched between RA patients who had begun biological therapy for moderate-to-severe inflammation and healthy controls who did not have inflammatory illness. When determining cognitive impairment, participants underwent thorough neuropsychological evaluations based on Montreal Cognitive Assessment (MoCA) scores less than 26. The Stroop cognitive test, the Hospital Anxiety and Depression Scale (HADS), the Quality of Life-RA Scale II (QOL-RA II), and the 28-joint Disease Activity Score (DAS28)-C-reactive protein (CRP) levels were among the additional assessments. The DAS28 score was divided into two categories: low activities (score below 3.2) and high activities (score 3.2 and above).

The team calculated the odds ratios (OR) for analysis using multivariable logistic regressions. Race, birthdate, and comorbidities like alcoholism, smoking, arterial hypertension, obesity, diabetes mellitus, dyslipidemia, and history of cardiovascular disease were among the study variables. In addition, the researchers noted the length of the condition, the date of diagnosis, the beginning of symptoms, rheumatoid factor (RF), the anti-cyclic citrullinated peptide (anti-CCP) antibody, interleukin 6 (IL-6), scores from the Spanish version of the Health Assessment Questionnaire (HAQ), and erosions.

In summary
According to the study, individuals with RA who have elevated inflammatory activity are at a higher risk of developing cognitive impairments encompassing memory, visuospatial, executive function, and abstraction. The impairment is linked to overweight, age, and a lower educational attainment level.

In order to lower the risk of cognitive impairment, the study emphasizes the importance of developing novel therapeutic approaches and controlling inflammation and comorbidities early in RA management. A comprehensive approach that takes into account both clinical and psychosocial variables is necessary for managing rheumatoid arthritis. For people with RA, early diagnosis and cognitive function monitoring are essential.

For more information: Impact of inflammation on cognitive function in patients with highly inflammatory rheumatoid arthritis, RMD Open, https://doi.org/10.1136/rmdopen-2024-004422