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Inflammatory activity in rheumatoid arthritis is associated with certain cognitive impairments
Last reviewed: 02.07.2025
Inflammatory activity in the body caused by rheumatoid arthritis is linked to certain cognitive impairments, a small comparative study published in the open-access journal RMD Open has found.
These impairments include decreased ability to perceive and spatially orient, remember, think abstractly, and perform executive functions of working memory, concentration, and inhibition.
Inflammatory activity in rheumatoid arthritis is associated with a variety of systemic effects, including effects on the brain, but it is unclear which specific cognitive domains may be affected.
To find out, the researchers compared the cognitive function of 70 adults with rheumatoid arthritis (80% women, average age 56) cared for at one hospital with 70 volunteers without rheumatoid arthritis, matched for age, gender and education level.
Almost 3 in 4 patients (49; 72%) had persistent moderate to high levels of systemic inflammatory activity caused by their disease, as measured by levels of indicator proteins and the degree of joint inflammation, despite standard drug treatment. Their average disease duration was 10.5 years.
All 140 participants underwent comprehensive neurological and psychological assessments, as well as various validated cognitive tests and assessments of mood and quality of life between June 2022 and June 2023.
Specific cognitive abilities tested included the ability to process and organize visual-spatial information; naming; attention; language; abstract thinking; delayed recall; and orientation, as well as the executive functions of working memory, concentration, and inhibition.
Cognitive impairment was defined as a Montreal Cognitive Assessment (MoCA) score below 26 out of a maximum of 30 points.
Information was collected on other influencing risk factors. This included age; gender; smoking; alcohol consumption; high blood pressure; obesity; blood fat levels; diabetes; and history of heart disease/stroke.
Overall, those who had cognitive impairment tended to be older, had lower levels of education, and had more comorbidities — such as obesity, unhealthy levels of blood fats, and high blood pressure — compared with those whose cognitive function was preserved.
But the rheumatoid arthritis patients scored lower on average on the Montreal Cognitive Assessment than the volunteers (23 vs. 25) and had lower executive function scores. Cognitive impairment was reported in 60% of them, compared with 40% of the volunteers.
Significantly more patients also scored higher for anxiety and depression and had lower quality of life scores than the volunteers.
Cognitively impaired patients had more severe and persistent inflammatory activity than those patients who retained their cognitive function. And they were more likely to have symptoms of depression and impaired physical performance.
Factors associated with the greatest risk of cognitive impairment among patients were obesity (almost 6 times higher risk) and inflammatory activity throughout the disease course (about twice the risk). As in the general population, age and low education were also risk factors.
To explain their findings, the researchers point to previous suggestions that chronic inflammation, autoimmune processes, and persistent symptoms of pain and fatigue associated with rheumatoid arthritis may underlie cognitive decline.
This is an observational study, so it is impossible to draw definitive conclusions about causal factors. The researchers also acknowledge various limitations of their findings, including the lack of imaging tests to detect vascular damage associated with cognitive impairment.
But they conclude: "These results support the hypothesis that [rheumatoid arthritis] is a chronic systemic inflammatory disease that affects multiple systems, including nervous tissue... [and] the results highlight the importance of earlier and more stringent control of arthritis activity and the need for new therapeutic strategies targeting associated factors to reduce the risk of cognitive impairment in patients with rheumatoid arthritis."