RA patients can have higher risk of mild cognitive impairment


Dear Doctors: My husband has been diagnosed with rheumatoid arthritis. One of his doctors says that when someone has RA, there’s a higher risk of cognitive impairment. He also said that some of the newer medications can keep that from happening. I would like to know more about that.

Dear Reader: Rheumatoid arthritis, or RA, is an autoimmune disease. That’s when someone’s immune system malfunctions and attacks the body’s own tissues. In the case of RA, the primary target is a thin layer of cells that covers the joints, known as the synovium. This typically occurs in the smaller joints in the fingers, hands, wrists and knees. Over time, the inflammation begins to damage the surrounding tissues, as well.

Symptoms of RA include stiffness, swelling and tenderness or pain in the joints, often on both sides of the body. Additional symptoms include a sensation of warmth, localized rash or itching, low-grade fever and persistent fatigue. Left untreated, RA can interfere with balance, cause chronic pain and lead to joint deformity.

Because the inflammation of RA is ongoing, rheumatoid arthritis affects other regions of the body, as well. In some people, the disease also damages the eyes, skin, lungs, heart and blood vessels. And as your husband’s doctor has indicated, it can adversely affect mental function. This can take several forms, including mild cognitive impairment, which is the condition you are asking about.

Mild cognitive impairment, or MCI, refers to a noticeable decline in memory, concentration, focus, problem-solving, the ability to learn new information and other related intellectual capacities. With words like “cognitive” and “impairment,” this can sound alarming. But mild cognitive impairment is not the same as Alzheimer’s disease or dementia. In MCI, the symptoms are not as severe as in Alzheimer’s or dementia, and they don’t include changes to personality. Someone with MCI is able to take part in normal activities and can take care of themselves. Although the data show that having either rheumatoid arthritis or MCI increases the risk of developing dementia, it is not a certainty.

Elizabeth Ko, MD and Eve Glazier, MD

Medications for rheumatoid arthritis focus on managing inflammation. In addition to limiting damage and easing physical symptoms, they appear to aid in the mental aspects of RA, as well. A new study, which analyzed the progression of cognitive issues in 141,000 adults living with RA, suggests this is particularly true of newer medications, known as biologic agents, or biologics. This is a class of drugs engineered to interact with specific cellular targets. For RA, these new drugs target certain cells associated with causing inflammation. The goal is to alleviate symptoms and also slow progression of the disease. During the three-year study, patients who were treated with biologics developed dementia 19% less often than those taking more traditional drugs. While the study results are encouraging, they are not definitive.

All RA treatments have potential side effects, so it’s important for your husband to have an in-depth discussion with his medical team as he makes his decisions. Prompt treatment, along with appropriate lifestyle changes, can reduce the risk of joint damage and lessen the adverse effects of the disease.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)