Cognitive Impairment Is Associated with Disease Activity in Patients with Rheumatoid Arthritis

Wanruchada Katchamart¹, Pongthorn Narongroeknawin², Nattharadee Phutthinart³, Vararak Srinonprasert⁴, Weerasak Muangpaisan⁵ and Sumapa Chaiamnuay², ¹Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, ²Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand, ³Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University,, Bangkok, Thailand, ⁴Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, ⁵Division of Geriatric Medicine, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, Bangkok, Thailand

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Cognitive dysfunction and rheumatoid arthritis (RA), Disease Activity

Session Information

Date: Sunday, October 21, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster I: Comorbidities

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Intact cognitive function is important for executing several tasks on day-to-day basis in people with chronic diseases, including rheumatoid arthritis (RA). A number of studies have reported a high prevalence of cognitive impairment in patients with RA. Chronic systemic inflammation in RA may play an important role in the pathogenesis of cognitive impairment, in addition to the traditional risk factors. Our objective was to investigate the association between disease activity and cognitive impairment in patients with RA.

Methods: All patients who were of Thai nationality, aged of 18 years old or older, diagnosed of RA according to the ACR 1987 revised criteria for the classification of RA or the 2010 Rheumatoid arthritis classification criteria, literate, and had at least a visit of follow-up were included in this study. A total of 464 patients from the RA registry of 2 academic centers, Siriraj and Phramongkutklao hospital were included. Demographics, clinical and laboratory data related to disease activity (Disease activity score 28 or DAS28), functional status (Health assessment questionnaire or HAQ) were collected. Cumulative disease activity of DAS28 was calculated by the sum of serial measurement of DAS28 divided by the total times of clinic visits from first to last measurement. Cognitive function was assessed using the Thai version of the Montreal cognitive assessment (MoCA-T). Subjects were classified as cognitively impaired if they scored less than 25, a cutoff point validated in Thai population. Univariate and multivariate analyses were performed to identify factors associated with cognitive impairment.

Results: Most subjects (85%) were female with the mean age ± SD of 59.2 ± 11.4 years old and median (range) educational level of 9 (4-14) years. The median duration of follow-up (range) was 5.2 (2.2-5.9) years. They were long-standing RA [median disease duration (range) of 9.9 (5.1-16.6) year], had moderate cumulative disease activity [mean DAS28 ± SD of 3.5 ± 0.81], and mild functional impairment [median HAQ (range) 0.5 (0.13-1.10)]. Seventy percent was classified as having cognitive impairment. Patients with cognitive impairment significantly impaired in all domains, especially in visuospatial/executive, language, and abstraction. In multiple logistic regression analyses, old age (> 60 years) [RR 3.43, 95% CI 2-5.9, p < 0.001], low education (< 6 years) [RR 9.9, 95%CI 4.9-19.9, p < 0.001], and high cumulative disease activity (mean DAS28 > 2.6) [RR 2.2, 95%CI 1.04-4.4, p = 0.038] were independently associated with cognitive impairment.

Conclusion: Besides traditional risk factors, high cumulative RA disease activity is associated with cognitive impairment. Therefore, treat-to-target aiming at low disease activity or remission may be beneficial for preventing cognitive decline in RA patients.

Multiple logistic regression analysis to identify factor related to cognitive impairment in RA

Factors	RR	95%CI	P-value
Age > 60 years	3.43	2.01 – 5.86	< 0.001
Smoking	1.75	0.75 – 4.09	0.197
Education < 6 years	9.88	4.91 – 19.86	< 0.001
Unemployment	1.11	0.67 – 1.86	0.678
DAS28 > 2.6	2.15	1.04 – 4.42	0.038
HAQ > 0.5	1.05	0.65 – 1.69	0.857
Anxiety	2.29	0.92 – 5.69	0.075

Disclosure: W. Katchamart, None; P. Narongroeknawin, None; N. Phutthinart, None; V. Srinonprasert, None; W. Muangpaisan, None; S. Chaiamnuay, None.

To cite this abstract in AMA style:

Katchamart W, Narongroeknawin P, Phutthinart N, Srinonprasert V, Muangpaisan W, Chaiamnuay S. Cognitive Impairment Is Associated with Disease Activity in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/cognitive-impairment-is-associated-with-disease-activity-in-patients-with-rheumatoid-arthritis/. Accessed .

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