How to Reduce the Risk of Dementia in Patients Rheumatoid Arthritis?

In inflammatory diseases like rheumatoid arthritis (RA) there is an increased risk of developing dementia. The current treatment includes the use of Disease-modifying antirheumatic drugs (DMARDs) that decrease inflammation. The advantage with DMARDs is that unlike other medications that only temporarily ease pain and inflammation, DMARDs are able to slow the progression of RA. And this results in fewer symptoms and less damage over time.

In a recent research presented at the meeting of American College of Rheumatology it was seen that the risk for developing dementia in patients with Rheumatoid arthritis decreases if they are treated with biologic or targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) compared to patients who are treated with conventional synthetic DMARDs.

The lead author of the study, Sebastian Sattui, MD, MS, a rheumatology fellow at Hospital for Special Surgery (HSS) in New York City says, “Being on a biologic or targeted synthetic DMARD actually decreased your risk of incidence of dementia by 17% compared to patients who were on a conventional synthetic DMARD only.”

Based on the understanding that rheumatoid arthritis has much more effect than the classic clinical manifestations, the treatment of rheumatoid arthritis has become much more complex stated Dr Sattui.

Earlier studies have mentioned that inflammatory diseases like rheumatoid arthritis can increase the risk of developing dementia. The study also mentioned that TNF agents (Tumor Necrosis factor) can have a role in preventing development of dementia.

In the new study, the researchers searched the Medicare claims data from 2006 till 2017 and identified group of patient with rheumatoid arthritis which included 141,326 patients. The observed incident rate for dementia per 100 person-years patients on conventional synthetic DMARDs was 2.0 and for patients on biologic DMARD was 1.3.

After accounting for various factors like age, sex and other comorbidities, there was a 17% lower risk for dementia with biologic or targeted synthetic DMARDs than with conventional synthetic DMARDs. The decreased risk of dementia is due to decrease in inflammation and no significant differences in the different biologics are seen.

The clinicians should include this new information while considering the treatment options for the patients. Dr Sattui said, “Our work shows yet another dimension in which treatment of rheumatoid arthritis can impact the overall health and quality of life of our patients. Rheumatoid arthritis is a systemic disease and it can have cognitive implications. However, these complications seem to share similar pathways to those of articular disease, and the medications that we use to treat rheumatoid arthritis could be effective in the prevention of dementia in patients with rheumatoid arthritis. Future studies need to assess the impact of the interventions, such as the treat-to-target strategy, on the incidence of dementia in patients with rheumatoid arthritis.”

Source-Medindia