The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA BIONAND Platform), Málaga, Spain.
UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain.
RMD Open. 2024 Jul 23;10(2):e004422. doi: 10.1136/rmdopen-2024-004422.
To evaluate cognitive function in patients with rheumatoid arthritis (RA) and inflammatory activity.
We performed a cross-sectional study of a cohort of patients with RA initiating their first biological treatment due to moderate-to-high inflammation and a healthy control group (no inflammatory diseases) matched for age, sex and educational level. All participants underwent a comprehensive neuropsychological assessment, with cognitive impairment defined as a Montreal Cognitive Assessment (MoCA) score<26. Additional assessments included various cognitive tests (STROOP, forward and backward digit spans), anxiety and depression scales (Hospital Anxiety and Depression Scale), quality of life measures (Quality of Life-Rheumatoid Arthritis) and average inflammatory activity according to the 28-joint Disease Activity Score (DAS28)-C-reactive protein (CRP) into high activity (DAS28≥3.2) and low activity (DAS28<3.2) groups, also CRP levels and interleukin 6 (IL-6) levels were measured using an ELISA.
The study population comprised 140 participants, 70 patients with RA and 70 controls. Patients more frequently experienced cognitive impairment than controls (60% vs 40%; p=0.019) and had lower mean (SD) values in the MoCA (23.6 (3.9) vs 25.1 (3.4); p=0.019. As for subtests of the MoCA, involvement was more marked in patients than in controls for the visuospatial-executive (p=0.030), memory (p=0.026) and abstraction (p=0.039) domains. Additionally, patients scored lower on executive function, as assessed by the backward digit span test (4.0 (1.7) vs 4.7 (1.9); p=0.039). Cognitive impairment is associated with age and a lower educational level in the general population, and among patients with RA with educational level, obesity and average inflammatory activity (DAS28, CRP, and IL-6).
Patients with RA with high inflammatory activity are more susceptible to cognitive impairment, which specifically affects the domains of visuospatial, memory, abstraction and executive function.
评估类风湿关节炎（RA）患者的认知功能与炎症活动。
我们进行了一项横断面研究，纳入了一组因中重度炎症而首次接受生物治疗的 RA 患者和一组年龄、性别和教育程度相匹配的健康对照组（无炎症性疾病）。所有参与者都接受了全面的神经心理学评估，使用蒙特利尔认知评估（MoCA）评分<26 来定义认知障碍。其他评估包括各种认知测试（斯特鲁普、顺背和倒背数字广度）、焦虑和抑郁量表（医院焦虑和抑郁量表）、生活质量量表（类风湿关节炎生活质量量表），以及根据 28 关节疾病活动评分（DAS28）-C 反应蛋白（CRP）评估的平均炎症活动，分为高活动组（DAS28≥3.2）和低活动组（DAS28<3.2），还使用 ELISA 法测量 CRP 水平和白细胞介素 6（IL-6）水平。
研究人群包括 140 名参与者，70 名 RA 患者和 70 名对照组。与对照组相比，患者更频繁地出现认知障碍（60%比 40%；p=0.019），且 MoCA 的平均（SD）值更低（23.6（3.9）比 25.1（3.4）；p=0.019）。在 MoCA 的子测试中，患者的视空间执行能力（p=0.030）、记忆能力（p=0.026）和抽象能力（p=0.039）更差。此外，患者在数字倒背测试（4.0（1.7）比 4.7（1.9）；p=0.039）中的执行功能得分更低。在一般人群中，认知障碍与年龄和较低的教育程度相关，在有教育程度的 RA 患者中，与认知障碍相关的因素包括肥胖和平均炎症活动（DAS28、CRP 和 IL-6）。
炎症活动水平高的 RA 患者更容易出现认知障碍，具体表现为视空间、记忆、抽象和执行功能等领域受损。
