Exercise Protects Cognition in Patients with Rheumatoid Arthritis

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Patients with rheumatoid arthritis who are physically active are less likely to report cognitive difficulties, say researchers recently writing in ACR Open Rheumatology.

Patients with inflammatory diseases such as rheumatoid arthritis have an increased prevalence of cognitive impairment, and perhaps Alzheimer's dementia. However, rheumatoid arthritis patients need adequate cognitive capacity, due to their complex medication management and intermittent difficulties in performance of activities of daily living. Cognitive impairment can co‐occur with markers of psychological distress in rheumatoid arthritis, and self‐reported cognitive dysfunction can be affected by symptoms of depression and fatigue. Potentially modifiable lifestyle factors such as inactivity and obesity may increase the risk for cognitive decline in the general population, but little is known about how these factors may affect patients with rheumatoid arthritis.

“We studied rheumatoid arthritis patients followed since 2003 who reported yearly on their perceived cognition to better understand the risk factors for this outcome,” wrote the authors of the study, led by Nancy A. Shadick, M.D., M.P.H., of Brigham & Women's Hospital in Boston, Mass.

This prospective cohort study included 1,219 patients with rheumatoid arthritis, with clinical and functional questionnaire data collected over 10 years, including yearly self‐reported memory, concentration, and word‐finding difficulties graded from “never” to “often.” Researchers examined the role of exercise, which was defined as those meeting the Department of Health and Human Services physical activity guidelines of 75 minutes of vigorous or 150 minutes of moderate aerobic activity per week, body mass index (BMI), sleep, depression (Mental Health Index‐Depression), DAS28‐CRP3 score, disease‐modifying antirheumatic drug and corticosteroid use from the previous year as predictors of cognitive complaints that progressed to “often” compared with the previous year.

Of the patients, 10.4 percent described either poor memory, concentration, or word‐finding difficulties as affecting them “often” at study entry. Patients (n = 1,092, mean age = 56.5 years, 82 percent female, 58 percent college educated) were less likely to report word‐finding difficulties, poor memory, and concentration as “often” if they were physically active (p = 0.0001, P = 0.01, P < 0.0001, respectively). Female patients developed more concentration complaints compared with males (P = 0.03); patients taking an anti–tumor necrosis factor therapy were less likely to complain of poor memory (P = 0.01).
Sleep, BMI, fatigue, depression, DAS28‐CRP3, methotrexate, and corticosteroid use were not independently associated with a worsening of any cognitive complaints.

“Meeting guidelines for physical activity protected against the development of frequent complaints of word finding, memory, and concentration difficulties. Taking anti‐TNF therapy was also protective for the development of worsening memory,” the authors wrote.

“Understanding what factors account for cognitive complaints is helpful in choosing who may need neuropsychological testing or brain imaging to document impairment,” the authors wrote. “If clinicians are interested in screening rheumatoid arthritis patients for early dementia and do not have the resources or time to perform neurocognitive testing, understanding the role that lifestyle and clinical factors play in the report of cognition difficulties is important.”

“Our study suggests potential modifiable risk factors for the prevention of cognitive dysfunction in rheumatoid arthritis,” the authors wrote.

REFERENCE

Nancy A. Shadick, Patricia Katz, Christine I. Iannaccone, et al. “The Impact of Exercise, Lifestyle, and Clinical Factors on Perceived Cognitive Function in Patients with Rheumatoid Arthritis: Results from a Prospective Cohort Study.” ACR Open Rheumatology. October 24, 2019. https://doi.org/10.1002/acr2.11088