RA disease activity linked to cognitive impairment
medwireNews: Rheumatoid arthritis (RA) patients with high disease activity are more likely to have cognitive impairment than those with less active disease, researchers report.
Wanruchada Katchamart (Mahidol University, Bangkok, Thailand) and colleagues used RA registries from two Thai hospitals to analyze data from 464 individuals with longstanding RA (median disease duration 9.9 years) over a median follow-up of 5.2 years. Patients were aged an average of 59.2 years, 85% were women, and mean cumulative DAS28 score – calculated from the sum of DAS28 measurements divided by the total number of clinical visits – was 3.5 points.
Overall, participants scored an average of 21.31 points on the Thai version of the Montreal Cognitive Assessment (MoCA-T), and 70% were classified as having cognitive impairment based on a score of less than 25.00 points.
As reported in Clinical Rheumatology, patients with an average cumulative DAS28 score of more than 2.6 points, indicating high disease activity, were significantly more likely to have cognitive impairment than those with lower levels of disease activity, with a relative risk (RR) of 2.23 after adjustment for factors including smoking, alcohol consumption, depression, anxiety, and comorbidities.
These findings suggest “that chronic active inflammation in RA may lead to significant cognitive impairment, in addition to traditional risk factors,” speculate the researchers.
“Therefore, treat-to-target aimed at low disease activity or remission may be beneficial for preventing or attenuating cognitive decline in RA patients, in addition to preventing joint damage and functional disability,” they add.
Katchamart and colleagues caution, however, that their study was limited by the lack of testing for baseline cognitive function before the onset of RA, meaning that “cognitive impairment found in some patients may not directly relate to RA disease activity if they had cognitive impairment prior to the onset of RA.” There was also no control group without RA, and the study did not account for some reported risk factors for cognitive impairment including hypothyroidism and anemia.
Nonetheless, they point out that “this is the first study [investigating the association between RA disease activity and cognitive impairment] that uses longitudinal data to represent cumulative disease activity.”
The team also demonstrated that older age (>60 years) and an education level of less than 6 years were significantly associated with the presence of cognitive impairment, with adjusted RRs of 3.45 and 10.80, respectively.
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