Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that causes pain, swelling, and stiffness in the joints. It can also cause fatigue and the underlying inflammation can affect other body systems. Dementia is a symptom of brain damage, which can be caused by several different diseases, for example, Alzheimer’s. Symptoms include memory loss, difficulty concentrating, confusion, and mood swings. It is not known what causes all types of dementia, but it is believed that some of the damage could be caused by other underlying diseases. Heart failure occurs when the heart becomes weak or stiff and is unable to pump blood around the body properly. People with heart failure can be out of breath even at rest, feel very tired and have swollen ankles or legs.
Heart failure is one of the most common cardiovascular conditions in people with RA and previous studies have suggested that people with RA are twice as likely to develop it. heart attack as people in the general population without RA. For dementia, previous studies have obtained mixed results on the pattern of cognitive impairment and dementia in people with RA compared to the general population, with some showing increased probabilities, while others show the opposite. In addition, existing studies have not evaluated trends in the incidence of dementia either color not seeing if the risks have changed over time.
Two groups at the Mayo Clinic in the United States have conducted population-based studies in Minnesota to assess the incidence of dementia or heart failure over time in people with RA and compared to the general population.
Vanessa Kronzer and colleagues assessed the incidence of dementia over time in people with RA and compared it with that observed in the general population. Data were collected from the medical history of 895 people diagnosed with RA between 1980 and 2009. All individuals were tracked until death, migration, or December 31, 2019 to see if they developed dementia. The cumulative incidence of 10 years of dementia in people diagnosed during the 1980s, 1990s, and 2000s was 12.7%, 7.2%, and 6.2%, respectively, showing a clear decline and cumulative incidence. of markedly lower dementia in people diagnosed with RA in the 2000s with the 1980s. For 880 people in the general population without RA, the cumulative incidence of 10 years of dementia in the 1980s, 1990s, and 2000s was 9 , 3%, 5.0% and 7.1%, respectively. Overall, the risk of dementia in patients with RA was significantly higher than in people without RA. When subdivided by decades, the risk of dementia in people diagnosed with RA was higher than comparators who were not RA in the 1980s and 1990s, but not in the 2000s.
Elena Myasoedova and her colleagues used the same methods to analyze heart failure trends in 905 people diagnosed with RA between 1980 and 2009 and followed until death, migration, or December 31, 2019. The cumulative incidence of 10 years of heart failure in people diagnosed with RA in the 1980s, 1990s, and 2000s was 8.5%, 10.8%, and 7.1%, respectively. These results show that there were no differences in the incidence of heart failure between the 1990s and 2000s compared with the 1980s. For 903 people in the general population without RA during the same time period, the incidence of heart failure cardiac was 7.4%, 7.5% and 7.3%. heart failure in people with and without RA, people diagnosed with RA in the 2000s did not have an excessive risk of heart failure compared to general population. This finding contrasts with twice the excess risk observed in people diagnosed with RA in the 1980s and a 1.5-fold increase in the 1990s.
Further studies should investigate these associations and analyze the role of inflammation, autoimmunity, and antirheumatic treatments in the risk of dementia and heart failure.
Kronzer V, et al. Trends in the onset of dementia in patients with rheumatoid arthritis: a population-based cohort study, 1980-2009. Presented at EULAR 2021. Abstract OP0216.
Myasoedova E, et al. Decreased excessive risk of heart failure in patients with rheumatoid arthritis in recent years. Presented at EULAR 2021. Abstract OP0102.
Provided by the European Alliance of Associations for Rheumatology
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