Dear Doctors: My husband has been diagnosed with rheumatoid arthritis. One of his doctors says that when someone has RA, there’s a higher risk of cognitive impairment and that some of the newer medications can keep that from happening. I would like to know more.
Answer: Rheumatoid arthritis, or RA, is an autoimmune disease.
That’s when someone’s immune system malfunctions and attacks the body’s own tissues.
With RA, the primary target is a thin layer of cells that covers the joints, known as the synovium. This typically occurs in the smaller joints in the fingers, hands, wrists and knees. Over time, the inflammation begins to damage the surrounding tissues.
Symptoms include stiffness, swelling and tenderness or pain in the joints, often on both sides of the body. Additional symptoms include a sensation of warmth, rash or itching, low-grade fever and persistent fatigue.
Left untreated, RA can interfere with balance, cause chronic pain and lead to joint deformity.
Because the inflammation is ongoing, rheumatoid arthritis affects other regions of the body, too. The disease can damage the eyes, skin, lungs, heart and blood vessels and, as your husband’s doctor has indicated, can adversely affect mental function. This can take several forms, including mild cognitive impairment, which is the condition you are asking about.
Mild cognitive impairment, or MCI, refers to a noticeable decline in memory, concentration, focus, problem-solving, the ability to learn new information and other intellectual capacities.
This can sound alarming. But mild cognitive impairment is not the same as Alzheimer’s disease or dementia. MCI symptoms aren’t as severe as in Alzheimer’s or dementia, and they don’t include changes to personality. People with MCI can take part in normal activities and take care of themselves.
Having rheumatoid arthritis or MCI increases the risk of developing dementia, but it isn’t a certainty.
Medications for rheumatoid arthritis focus on managing inflammation. They appear to aid in the mental aspects of RA, too. A study that analyzed the progression of cognitive issues in 141,000 adults with RA suggests this is particularly true with newer medications, known as biologic agents, or biologic, a class of drugs engineered to interact with specific cellular targets.
For RA, these new drugs target certain cells associated with causing inflammation. The goal is to alleviate symptoms and also slow progression of the disease.
All RA treatments have potential side effects. But prompt treatment and appropriate lifestyle changes can reduce the risk of joint damage and lessen RA’s adverse effects.
Dr. Eve Glazier and Dr Elizabeth Ko are internists at UCLA Health.
