The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO — A number of potential modifiable risk factors for preventing cognitive dysfunction among patients with rheumatoid arthritis (RA) have been suggested, with physical activity shown to be protective against difficulties in concentration and word retrieval, according to the results of a large, nationwide prospective cohort study presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, in Chicago, Illinois.

The investigators explored the ways in which clinical and functional modifiable risk factors such as inactivity and obesity contribute to cognitive decline in the setting of a chronic inflammatory disorder such as RA. They obtained data on joint examinations, serologies, and detailed psychological, clinical, functional, and exercise outcomes over the course of 10 years in an academic cohort of patients with long-standing RA. Self-reported memory, concentration, and word finding difficulties were evaluated annually using questionnaires, and graded from “never” to “often.”

A total of 1219 patients with RA were evaluated. The mean participant age was 56.5 years; 82% of the patients were women, and 58% had a college education. At the first study visit, 10.4% (127 of 1219) of the participants said that poor memory, poor concentration, or word finding difficulties affected them “often.” Among these indicators of cognitive function, only the perception of memory difficulties increased significantly over time (P =.006).

Patients with RA were significantly less likely to develop word finding difficulties (P <.0001 and impaired concentration (P =.0002) if they met the US Department of Health and Human Services physical activity recommendations. Concentration worsened among patients with RA who were women (P =.03), who had higher Disease Activity Score 28-joint count-C-reactive protein scores (P =.04), and who had higher Mental Health Inventory depression scores (P =.05). 

Patients with RA who were receiving anti-tumor necrosis factor (TNF) therapy were less likely to develop worsened memory complaints. Sleep, body mass index, and use of medications such as methotrexate and corticosteroids were all not independently associated with worsening in any of the cognitive measures.

The investigators concluded that clinical factors such as anti-TNF use and lower disease activity decrease the risk for worsened memory and concentration in patients with RA over time. Meeting the US Department of Health and Human Services guidelines for physical activity appears to be protective against worsening concentration and word retrieval among these individuals.

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Reference

Shadick NA, Iannaccone CK, Katz P, et al. The impact of exercise and clinical factors on perceived cognitive function in patients with rheumatoid arthritis: results from a prospective cohort study. Presented at: ACR/ARHP 2018 Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 2986.

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