Mena-Vázquez Natalia, Ortiz-Márquez Fernando, Ramirez-García Teresa, Gillis-Onieva Celia, Cabezudo-García Pablo, García-Studer Aimara, Mucientes Arkaitz, Lisbona-Montañez Jose Manuel, Borregón-Garrido Paula, Ruiz-Limón Patricia, Manrique-Arija Sara, Cano-García Laura, Serrano-Castro Pedro Jesús, Fernández-Nebro Antonio
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.
Front Med (Lausanne). 2025 Apr 11;12:1561140. doi: 10.3389/fmed.2025.1561140. eCollection 2025.
To evaluate cognitive improvement in patients with rheumatoid arthritis (RA) after 6 months of treatment with tumor necrosis factor (TNF) inhibitors, analyze associated factors, and determine the percentage of patients achieving cognitive improvement.
This was a single-center prospective observational study conducted over 12 months on 70 RA patients initiating their first biologic disease-modifying antirheumatic drug (bDMARD) with a TNF inhibitor. Cognitive function was assessed at baseline and after 6 months using validated neuropsychological tests, including the Montreal Cognitive Assessment (MoCA) for global cognitive function, the digit span forward and backward tests for attention and working memory, and the Stroop-W, Stroop-C, and Stroop-CW tests for executive function and processing speed. Patient-reported outcomes were assessed using the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life-Rheumatoid Arthritis Scale-II (QOL-RA II). Clinical variables, disease activity measured by the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP), inflammatory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and patient-reported outcomes were recorded. Associations with average CRP and Health Assessment Questionnaire (HAQ) scores were analyzed throughout the follow-up period. Cognitive improvement was defined as a ≥20% increase in MoCA test scores. Logistic regression was performed to identify factors associated with improvement.
A total of 70 patients (mean age, 56.2 years; 81.4% female) were included. After 6 months, patients showed significant cognitive improvement in a validated questionnaire, namely, the Montreal Cognitive Assessment (MoCA test 23.1 ± 3.6 to 24.1 ± 3.3; = 0.001), particularly in the executive and memory domains. Significant improvements were also observed in the digit span forward test ( = 0.003), digit span backward test ( = 0.021), Stroop-W test ( = 0.040), Stroop-C test ( = 0.014), and Stroop-CW test ( = 0.035). Improvements in the MoCA were associated with educational level ( = 2.628; < 0.001), average CRP ( = -0.154; = 0.002), and average HAQ ( = -0.303; = 0.022). Similar associations were found for the other tests.
TNF inhibitor therapy in RA patients is associated with significant cognitive improvement, particularly in executive function and memory. These findings highlight the potential cognitive benefits of effective RA treatment and underscore the importance of addressing modifiable risk factors to enhance patient quality of life.
评估类风湿关节炎（RA）患者接受肿瘤坏死因子（TNF）抑制剂治疗6个月后的认知改善情况，分析相关因素，并确定认知改善患者的百分比。
这是一项单中心前瞻性观察性研究，对70例开始使用TNF抑制剂作为第一种生物改善病情抗风湿药物（bDMARD）的RA患者进行了为期12个月的研究。在基线和6个月后使用经过验证的神经心理学测试评估认知功能，包括用于整体认知功能的蒙特利尔认知评估（MoCA）、用于注意力和工作记忆的顺背和倒背数字广度测试，以及用于执行功能和处理速度的Stroop-W、Stroop-C和Stroop-CW测试。使用医院焦虑抑郁量表（HADS）和类风湿关节炎生活质量量表-II（QOL-RA II）评估患者报告的结局。记录临床变量、基于C反应蛋白的28关节疾病活动评分（DAS28-CRP）测量的疾病活动、包括C反应蛋白（CRP）和红细胞沉降率（ESR）在内的炎症标志物以及患者报告的结局。在整个随访期间分析与平均CRP和健康评估问卷（HAQ）评分的相关性。认知改善定义为MoCA测试分数增加≥20%。进行逻辑回归以确定与改善相关的因素。
共纳入70例患者（平均年龄56.2岁；81.4%为女性）。6个月后，患者在经过验证的问卷即蒙特利尔认知评估中显示出显著的认知改善（MoCA测试从23.1±3.6提高到24.1±3.3；P = 0.001），特别是在执行功能和记忆领域。在顺背数字广度测试（P = 0.003）、倒背数字广度测试（P = 0.021）、Stroop-W测试（P = 0.040）、Stroop-C测试（P = 0.014）和Stroop-CW测试（P = 0.035）中也观察到显著改善。MoCA的改善与教育水平（P = 2.628；P < 0.001）、平均CRP（P = -0.154；P = 0.002）和平均HAQ（P = -0.303；P = 0.022）相关。其他测试也发现了类似的相关性。
RA患者的TNF抑制剂治疗与显著的认知改善相关，特别是在执行功能和记忆方面。这些发现突出了有效RA治疗潜在的认知益处，并强调了应对可改变的危险因素以提高患者生活质量的重要性。
