Inflammation From Rheumatoid Arthritis Linked to Cognitive Issues

The latest results, gleaned from 70 people with RA and an equal amount without, show that inflammatory activity caused by RA is linked to specific cognitive impairments including diminished memory, concentration, and visual and spatial awareness.

“[The] findings underscore the importance of early detection and monitoring of cognitive function in patients with RA, especially those with ongoing inflammatory activity,” wrote lead study author Natalie Mena-Vazquez, MD, and her collaborators at the Biomedical Research Institute of Malaga in Spain. “Clinicians can use this information to educate patients with RA about potential cognitive challenges associated with their condition, offering appropriate support and resources to optimize their quality of life.”

A Clearer Picture of RA’s Impact on the Mind

Those with rheumatoid arthritis had the condition for an average of 10.5 years. Although most were taking conventional RA drug treatment, about three-quarters of participants still had ongoing moderate to high levels of systemic inflammation due to their disease, as measured by protein levels and joint inflammation.

All participants completed cognitive assessments, which measured attention span, language comprehension, abstract thinking, recall, and visual and spatial processing, along with memory, concentration, and inhibition.

Based on those measures, cognitive impairment was observed in 60 percent of participants with RA, compared with 40 percent of volunteers without RA.

Marissa Blum, MD, a professor of clinical medicine at the Lewis Katz School of Medicine at Temple University and a rheumatologist at Temple University Hospital in Philadelphia, notes that these results build on a growing body of work examining the prevalence of mental impairment in people with rheumatoid arthritis.

“Inflammation is an important driver of cognitive impairment,” says Dr. Blum, who was not involved in the study. “Future research will hopefully examine ways to mitigate inflammation to prevent this most serious complication.”

Factors That May Make Matters Worse

When looking deeper into issues that might affect brain health, the researchers highlighted that people with RA who had obesity were most likely to have cognitive impairment. They had a risk level that was almost 6 times higher compared with those without obesity.

“Obesity predisposes individuals to sleep apnea, which has been linked to cognitive impairment,” says Rajat Bhatt, MD, a rheumatologist in Richmond, Texas, who is affiliated with Memorial Hermann Health System Health. “The inflammatory activity seen in obese individuals — potentially exacerbated by unhealthy dietary choices — further complicates the relationship between obesity and cognitive health.”

Individuals consistently experiencing inflammation were also more prone to troubles involving their mental capabilities. Inflammatory activity throughout the course of the disease was associated with double the risk of cognitive impairment compared with more sporadic inflammation.

Older age and lower educational attainment were also linked to greater odds of having cognitive problems.

“Research is still evolving around this topic, but it is thought that higher amounts of educational attainment help build up a ‘cognitive reserve’ that allows the brain to be more resilient,” says Blum.

Additionally, the study authors observed poorer physical health and more depression among the rheumatoid arthritis participants compared with the disease-free volunteers. About 13 percent of those with RA were assessed as having depression, compared with 3 percent of the controls.

Dr. Bhatt, who was not involved in the research, stresses that the study is observational, and isolating the specific contribution of RA to cognitive impairment is challenging.

“It is essential to approach these findings with caution and consider the broader context of each patient's health status and lifestyle factors,” he says.