New population-based studies show increased risk of dementia and depression in RA

In work presented at the 2022 EULAR Congress, Dr. Jens Kristian Pedersen and colleagues used data from the DANBIO registry to describe the all-cause mortality risk associated with depression in patients with incident rheumatoid arthritis (RA).

The group used the first filling of a prescription for antidepressants as a proxy for depression. Among 11,071 RA patients 10% had filled prescriptions for antidepressants. Analysis showed depression was associated with more than 6-fold increased mortality risk in patients with incident RA.

Growing evidence suggests people with RA have a higher risk of developing dementia. However, the incidence of dementia among RA patients has declined in recent years. It is unknown if this reflects broader trends of dementia incidence over time, treatment advances yielding better control of RA, or other factors. Dr. Elena Myasoedova shared new findings on risk factors for incident dementia in a large inception cohort of patients with RA.

The key finding was that clinically active RA, among other risk factors, is associated with an elevated risk of dementia. The cumulative incidence of dementia increased by 2–3% every 5 years after the diagnosis of RA, and older age at RA incidence was consistently associated with risk of dementia.

Presence of rheumatoid nodules, large joint swelling, hypertension, heart failure, and depression at baseline or during the first year after RA incidence were significantly associated with risk of dementia. Large joint swelling, any cardiovascular or cerebrovascular disease (particularly heart failure and ischemic stroke), anxiety, and depression at any time increased the risk of dementia. Studies are ongoing to evaluate the role of systemic inflammation and its interactions with other risk factors on the risk of cognitive decline in patients with RA.

Dr. Yeonghee Eun also shared data on the association between dementia and RA, based on a study in a large population-based cohort.

Results showed that RA patients had a 1.2-times higher risk of dementia than controls. This included both Alzheimer's disease and vascular dementia. In a stratified analysis according to age, gender, lifestyle factors, and comorbidities, the association between RA and dementia was consistently found. The authors note that appropriate evaluation of dementia is required when cognitive impairment occurs in RA patients.