Abstract
BackgroundRheumatoid arthritis (RA) is a systemic, inflammatory disease and its burden extends beyond joint disease. In recent years, there has been significant advances in treating joint disease but we need a greater understanding of physical and especially psychosocial comorbities to improve quality of life in RA patients. In particular, patients often report “brain fog” meaning a diminished ability to think, learn, remember and perform other mental tasks. Doctors have long recognized that patients with certain physical conditions can experience cognitive dysfunction. Limited information is available in the literature with regard to the prevalence of cognitive dysfunction and factors associated with the condtion in RA.ObjectivesTo characterize the association of disease activity with patient reported cognitive dysfunction in patients with RA overall and stratified by age.MethodsWe identified patients with RA aged ≥18 years who were enrolled in the Corrona registry who were biologic naïve at their last follow-up visit (October 2010–June 2016). We compared those who reported cognitive dysfunction (responded “yes” to the question asking if they had “problems with thinking”) to those who did not with respect to disease activity based on the Clinical Disease Activity Index (CDAI). Unadjusted and adjusted logistic regression models controlling for demographic (age, gender, race, education), comorbidity/lifestyle (diabetes, fibromyalgia, body mass index, smoking) and RA disease characteristics (disease duration, disability and prednisone dose) were conducted. We further examined whether the relationship between disease activity and cognitive dysfunction varied based on patients age (<55 vs. >55 years) testing the moderating effect using a likelihood ratio test.ResultsThere were 10,401 patients who met inclusion criteria of whom 863 (8%) reported cognitive dysfunction. Those who reported cognitive dysfunction were more likely to be women (83% vs. 73%, p<0.001), younger (62 vs. 64 years, p<0.001), disabled (24% vs. 8%, p<0.001), with moderate/high disease activity based on the CDAI (51% vs. 31%, p<0.001). In adjusted models, the likelihood of cognitive dysfunction increased with higher levels of disease activity in the total population (Table). The impact was more pronounced in those age <55 (p=0.007; Table).Total population*Age <55**Age ≥55** Disease activity OR (95% CI)* Remission111 Low2.70 (2.11–3.45)3.97 (2.34–6.75)2.42 (1.84–3.20) Moderate3.56 (2.75–4.61)5.93 (3.45–10.19)3.01 (2.24–4.05) High3.90 (2.92–5.21)7.92 (4.49–13.98)2.90 (2.04–4.12)*Adjusted for age, gender, race, disability, education, smoking status, body mass index, diabetes, fibromyalgia, disease duration and prednisone dose. **Adjusted for gender, race, disability, education, smoking status, body mass index, diabetes, fibromyalgia, disease duration and prednisone dose.ConclusionsIncreasing disease activity is associated with a higher likelihood of reporting cognitive disfunction. The effect was more pronounced in younger as opposed to older RA patients.Disclosure of InterestG. Reed Shareholder of: Corrona, LLC, Employee of: Corrona, LLC, L. Harrold Shareholder of: Corrona, LLC, Grant/research support from: Pfizer, Inc., Consultant for: Roche, Employee of: Corrona, LLC, O. Pala: None declared, J. Kremer Shareholder of: Corrona, LLC, Grant/research support from: AbbVie, Genentech, Lilly, Novartis, Pfizer, Consultant for: AbbVie, Amgen, BMS, Genentech, Lilly, Regeneron, Sanofi, Pfizer, Employee of: Corrona, LLC
