RA: Several risk factors identified for incident dementia

Cohort study data detected factors linked to a risk amplification for dementia development in patients with rheumatoid arthritis.

Rheumatoid nodules at baseline and swelling of large joints or anxiety carried an around 2-fold risk-augmentation for dementia

A population-based inception cohort study investigated potential risk factors for dementia in patients with RA1. The study included 886 patients ≥50 years who resided in Minnesota, USA, 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 cardiovascular (CV) risk factors as well as any CV disease.

The mean age of the cohort was 65 years, nearly 2 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 incidence was associated with a higher incidence of dementia,” Dr Elena Myasoedova (Mayo Clinic, MN, USA) 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,” Dr Myasoedova remarked. The HRs for baseline hypertension were 1.84 (model 1) and 2.79 (model 2). Among the CV disease events, especially baseline heart failure (HR 2.72 and 2.89) and ever ischaemic stroke (HR 3.16 and 3.28) were linked to dementia in RA patients in both models. Among the factors that did not have an association with dementia were: sex, race, education, and RA disease characteristics.

“In summary, clinically active RA as well as hypertension, cardiovascular disease events, depression and anxiety increased the risk of dementia among patients with rheumatoid arthritis. Among cardiovascular disease events, ischaemic stroke and heart failure were particularly associated with the risk of dementia,” Dr Myasoedova concluded.

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