Clinical and subclinical neuropsychiatric abnormalities in rheumatoid arthritis patients

Cognitive impairment in patients with rheumatoid arthritis: A systematic review and meta-analysis

OBJECTIVE

An increasing number of studies have demonstrated cognitive impairment in patients with rheumatoid arthritis (RA). The literature indicates many factors play an important role in this clinical problem, such as the severity of depressive symptoms and the treatment used. The aim of this study was to systematically review studies comparing cognitive functioning between healthy participants and RA patients and to determine both the severity and potential moderators of cognitive impairment.

METHODS

For this purpose, 16 studies that fulfilled all selection criteria were carefully selected. Altogether, 921 patients with RA (812 women and 109 men) and 700 controls participated in these studies. Due to the inability to perform a network meta-analysis, it was decided to determine the effect sizes for studies which used the same measurement methods.

RESULTS

The analysis demonstrated greater impairment of cognitive functioning in patients with RA than in healthy controls, with effect sizes ranging from small to large, depending on the assessment method used in the study.

CONCLUSIONS

The study pinpoints potential biases, lack of replication, and inconsistencies in reporting data as possible confounding factors and suggests further recommendations for assessment methods, research directions and clinical implications.

CLINICAL TRIAL REGISTRATION

Not applicable.

Evaluation of cognitive function in systemic sclerosis patients: a pilot study

OBJECTIVE

To investigate cognitive dysfunction in adult patients with systemic sclerosis (SSc) who had no known clinical neurological manifestations and to relate it with other disease severity parameters.

METHODS

In the present study, 20 SSc consecutive female patients, who met the 2013 American College of Rheumatology SSc criteria, were compared with 20 healthy age-, gender-, and educational status-matched volunteer hospital workers. Mean age and duration of illness were 41.8 ± 12.52 and 6.9 ± 5.4 years respectively. Mini-Mental State Examination (MMSE), Wechsler Adult Intelligence scale (WAIS-III), and P300 component of event-related potentials (ERPs) were used to evaluate cognitive function in SS subjectively and objectively respectively.

RESULTS

Sixty-five percent (13 out of 20) of SSc patients had MMSE score < 25, and cognitive impairment. Despite the lack of clinically apparent neurological manifestations, SSc patients had significantly low MMSE score, high Deterioration Index (DI), and prolonged P300 latency compared with that of the control group (P = 0.0001; 0.010 and 0.008 respectively). A significant positive association was found between (DI) and the Medsger severity vascular score (r = 0.518; P = 0.012).There were few differences between limited and diffuse SSc.

CONCLUSIONS

To our knowledge, few studies highlighted that subclinical cognitive impairment can occur in the course of SSc disease. Early diagnosis of cognitive impairment should be investigated either subjectively (using psychometrics tests as MMSE or WAIS-III) or objectively using P300 evoked related potentials. Medsger severity vascular score seems to be closely related to cognitive impairment.Key points• Cognitive impairment can be associated with Medsger Vascular severity score and the duration of illness.• Further larger studies will be needed to estimate the effect of disease activity on cognitive function, to further delineate the differences between limited and diffuse SSc in this area, and to understand the underlying pathophysiological mechanisms causing cognitive impairment in patients with SSc.• To investigate impaired cognitive function in patients with SSc, even in the absence of clinically apparent neurological and vascular disease.

Psychological affection in rheumatoid arthritis patients in relation to disease activity

Rheumatoid arthritis (RA) is a common, systemic autoimmune disease characterized by persistent symmetric polyarthritis (synovitis). Anxiety and depression are common among patients with RA, compared to the general population and have been associated with increased pain, fatigue, physical disability and health care costs, and an overall reduced health-related quality of life. The aim of the present study was to assess the relation between psychological factors (anxiety and depression) and disease activity (and severity) parameters in RA patients.This national, single-center, cross-sectional study recruited over 6 months 25 patients with RA diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria, and 25 healthy control individuals. All participants were subjected to the clinical and laboratory evaluation of disease activity and psychological assessment according to the International Classification of Mental and Behavioral Disorders tenth revision. Significance and regression analyses were performed to determine disease activity and severity predictors.80% of RA patients had depression and 52% anxiety symptoms, while only 8% of healthy controls reported mild depression (P < .001). Data also found highly significant correlation between depressive symptoms and RA disease activity (P < .05).Psychiatric manifestations are common in RA and they strongly correlate with severity of the disease.