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Disease activity is associated with cognitive impairment in patients with rheumatoid arthritis

Clinical Rheumatology volume 38, pages 1851–1856 (2019)Cite this article

Abstract

Objective

To investigate the association between disease activity and cognitive impairment in patients with rheumatoid arthritis (RA).

Methods

A total of 464 patients from the rheumatoid arthritis registry of two academic centers, Siriraj and Phramongkutklao hospitals, were included. Demographic, clinical, and laboratory data related to disease activity and functional status were collected. 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.

Results

Most subjects (85%) were female with a mean age ± SD of 59.2 ± 11.4 years old and a median (range) educational level of 9 (4–14) years. They were long-standing RA patients (median disease duration (range) of 9.9 (5.1–16.6) years) and 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 of the patients were classified as having cognitive impairment. The patients with cognitive impairment significantly impaired in all domains, especially in visuospatial/executive, language, and abstraction. In multiple logistic regression analyses, old age (RR 3.45, 95% CI 2–6, p < 0.001), low education (RR 10.8, 95% CI 5.3–22.1, p < 0.001), and high cumulative disease activity (RR 2.2, 95% CI 1.07–4.7, p = 0.033) were independently associated with cognitive impairment.

Conclusion

High cumulative RA disease activity is associated with cognitive impairment. Therefore, treat-to-target aimed at low disease activity or remission may be beneficial for preventing cognitive decline in RA patients.

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Acknowledgements

We thank Ms. Khemajira Karaketklang for her assistance in the statistical analysis, Ms. Wanwisa Chanapai and Mrs. Phakhamon Thaweeratthakul for the data collection and management, and Ms. Ananya Srisomnuek and Ms. Wanlika Kaewkhunthong for performing the MoCA test.

Financial support

This study was supported by a Thai Rheumatism Association research grant.

Author information

Affiliations

  1. Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 8th floor Asadang building, 2 Wanglang road, Bangkok-noi, Bangkok, 10700, Thailand

    Wanruchada Katchamart

  2. Division of Rheumatology, Department of Medicine, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand

    Pongthorn Narongroeknawin & Sumapa Chaiamnauy

  3. Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Nattharadee Phutthinart

  4. Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Varalak Srinonprasert

  5. Division of Geriatric Medicine, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Weerasak Muangpaisan

Authors
  1. Wanruchada Katchamart
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  2. Pongthorn Narongroeknawin
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  5. Weerasak Muangpaisan
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  6. Sumapa Chaiamnauy
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Corresponding author

Correspondence to Wanruchada Katchamart.

Ethics declarations

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and adhered to the principles outlined in the Guideline for Good Clinical Practice International Conference on Harmonization (ICH) Tripartite Guideline (January 1997). The study protocol was approved by local ethics committees, the Siriraj Institutional Review Board and the Institutional Review Board of the Royal Thai Army Medical Department.

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Cite this article

Katchamart, W., Narongroeknawin, P., Phutthinart, N. et al. Disease activity is associated with cognitive impairment in patients with rheumatoid arthritis. Clin Rheumatol 38, 1851–1856 (2019). https://doi.org/10.1007/s10067-019-04488-3

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  • DOI: https://doi.org/10.1007/s10067-019-04488-3

Keywords

  • Cognitive impairment
  • DAS28
  • Disease activity
  • HAQ
  • MoCA
  • Rheumatoid arthritis