Cognitive Impairments in Patients with Rheumatoid Arthritis and Comorbid Anxiety and Depressive Disorders: Outcomes of the Five-Year Prospective Study.

Abstract

The aim of this study was to assess the baseline rates and five-years outcomes of mild cognitive impairments (MCIs) in patients with rheumatoid arthritis (RA) and comorbid anxiety and depressive disorders (ADDs) receiving traditional synthetic disease-modifying antirheumatic drugs (csDMARDs) alone or in combination with biologic DMARDs (bDMARDs) and/or adequate psychopharmacotherapy (PPT), as well as to assess the factors associated with MCI after five years. A total of 128 RA patients were enrolled, ADDs were diagnosed in 123 (96.1%) patients by a licensed psychiatrist. Severity of depression and anxiety was evaluated with Montgomery-Asberg and Hamilton Anxiety scales. CIs were diagnosed during clinical and psychological examination using the battery of pathopsychological and projective techniques. CI outcomes were considered favourable in cases with no CI diagnosed throughout the study and in cases of CI reversal. PPT was offered, 52 (42.3%) patients agreed. Patients were  divided into the following treatment groups: сsDMARDs (n = 39), сsDMARDs + PPT (n = 43), сsDMARDs + bDMARDs (n = 32), and сsDMARDs + bDMARDs + PPT (n = 9). Multivariable logistic regression was performed to determine factors associated with CI after five years. MCIs were diagnosed in the majority of RA patients (73.2%), including logical thinking impairments (51.2%) and memory deficit (67.5%). At a 5-year endpoint, 74 patients were included. Total CI rates in no-PPT groups increased from 69 to 85.7% (p = 0.024) and was higher compared to PPT groups (р = 0.021, 85.7% vs 62.5%, RR 1.37). Patients with favourable CI outcomes had lower major depression prevalence and baseline Montgomery-Asberg scores, major improvement in depression symptoms, and higher rates of ADD remission after five years. Baseline DAS28 (OR 1.29, p < 0.001) was positively associated and remission of ADD negatively associated with MCI after five years (OR 0.25, p = 0.03), R² = 0.48, p < 0.001. ADDs and MCIs are highly prevalent in RA patients. While CIs tend to persist and worsen over time, PPT is associated with lower CI rates in long-term perspective. Personalized PPT with antidepressants and neuroleptics may show potential to lessen the rates of MCIs in RA patients with ADDs.