Background/Purpose: Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis in adults. Extra-articular manifestations of RA can occur in about 40% of patients, either in the beginning or during the course of their disease. Recent studies have suggested that RA may have an important relation in the development of cognitive and neurological dysfunction. However, the bond between RA and the brain is still uncertain. The purpose of this study was to assess the frequency and the clinical predictors of cognitive impairment in rheumatoid arthritis (RA) patients.

Methods: A cross-sectional and case-control study was performed including consecutive RA patients seen in a rheumatology outpatient clinic of referral tertiary hospital. The control group included 100 healthy subjects. We registered clinical and demographic data including age, sex, level of education, time of disease, time of diagnosis, drugs in use, cardiovascular risk factors and other comorbidities. Functional capacity was assessed using the Health Assessment Questionnaire (HAQ). Neurological appraisal was made with standardized questionnaires: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and the Hospital Anxiety and Depression (HAD). Analysis of the data was performed using qui-square and t-tests and a multivariate analysis (SPSS 22.0). Significance level was set as <0.05.

Results: We included 200 patients (166 were female) with a mean age of 57.4 (±11.4) years; Among these patients, 163 (81.5%) used corticosteroids, 148 (74%) methotrexate, 16 (8%) sulfasalazine, 91 (45.5%) leflunomide, 35 (17.5%) chloroquine and 57 (28.5%) biologic therapy. The mean age of RA diagnosis was 43.0 (±13.6) years. In both univariate and multivariate analysis, compared to the control group, patients with RA presented significant lower MMSE (21.9±3.9) and MoCA (17.0±4.4) scores (p<0.05). Adjusting for level of education, just 61 and 50 patients presented normal MMSE and MoCA scores (p<0.01), respectively. Cognitive decline was associated with higher HAQ scores (functional outcome due to RA) and prolonged time of disease (p<0.05). No correlation was found between sex, disease-modifying antirheumatic drugs, rheumatoid factor, C-reactive protein levels and the neurological impairment. The mean HAD score was 17.7 (±7.7) and anxiety and depression were more prevalent in RA p atients than in control group (p<0.01).

Conclusion: Patients with rheumatoid arthritis may present with cognitive decline and dementia as extra-articular manifestations of the disease. Neurological impairment is usually disregarded and might be under-diagnosed in RA patients. Future studies are necessary in order to better understand the relationship between RA and the brain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cognitive-impairment-in-rheumatoid-arthritis-patients-a-case-control-study/