Risk factors for dementia in RA patients discovered

For patients with rheumatoid arthritis (RA), swelling of large joints, rheumatoid nodules, hypertension, cardiovascular (CV) disease, and depression were recognised risk factors for dementia. The analysis of a Minnesotan cohort found an about 2-fold elevated risk of dementia in case those factors were present.

What are the risk factors for developing dementia in patients with RA? The goal of a population-based inception cohort study conducted by a group of Mayo Clinic investigators was to elucidate this question [1]. “Our recent studies from population-based cohorts in Olmsted County have shown that even though the overall risk of dementia is increased in patients with RA as compared with the non-RA population, there has been a decline in its incidence in recent decades coinciding with improved control of RA,” Prof. Elena Myasoedova (Mayo Clinic, MN, USA) reported in her presentation. The study included 886 patients ≥50 years who resided in Minnesota and were diagnosed with RA between 1980 and 2014. Follow-up was performed until the end of 2019. For the attribution of incident dementia, at least 2 ICD codes for dementia had to be present ≥30 days apart. Two different Cox proportional hazard models were fitted with model 1 adjusting for age, sex, and year of RA incidence. The other model also included CV risk factors as well as any CV disease.

The mean age of the cohort was 65 years, nearly two thirds were women, and the median follow-up was 8.5 years. During this time, 103 cases of incident dementia occurred. After RA was diagnosed, the risk for dementia rose gradually (2–3% over 5 years). “Similar to the general population, age was one of the risk factors that has been noticed, and older age of RA incidence was associated with a higher incidence of dementia,” Prof. Myasoedova reported. Furthermore, the presence of rheumatoid nodules at baseline and swelling of large joints or anxiety at any time carried an around 2-fold risk-augmentation for dementia. Depression at baseline or ever was an even stronger risk factor with a hazard ratio (HR) between 2.23 and 2.76 depending on timing and model. “Out of the CV risk factors, hypertension stood out for association with dementia,” Prof. Myasoedova remarked. The HRs for baseline hypertension were 1.84 (model 1) and 2.79 (model 2). Among the CV events, baseline heart failure (HR 2.72 and 2.89) and ever ischaemic stroke (HR 3.16 and 3.28) were especially linked to dementia in RA patients in both models. Among the factors that were not associated with dementia were sex, race, education, and RA disease characteristics.

“In summary, clinically active disease as well as hypertension, CV events, depression, and anxiety increased the risk of dementia among patients with RA. Among CV events, ischaemic stroke and heart failure were particularly associated with the risk of dementia,” Prof. Myasoedova concluded.  Further studies in this space including the impact of non-steroidal anti-inflammatory drugs (NSAIDs), conventional synthetic, biologic, and targeted synthetic disease-modifying antirheumatic drugs (DMARDs)  will add to this emerging story.

1. Kodishala C, et al. Active rheumatoid arthritis and associated comorbidities increase risk of dementia: a population-based cohort study. OP0134, EULAR 2022 Congress, 1–4 June, Copenhagen, Denmark.

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Posted on 21 July, 2022