Impact of disease activity on patient-reported subjective cognitive decline in patients with rheumatoid arthritis

Abstract

Aim: To evaluate the association of disease activity with patient-reported subjective cognitive decline (SCD) in patients with rheumatoid arthritis (RA) stratified by age. Methods: A cross-sectional analysis using data from the CorEvitas RA registry was utilized. The clinical disease activity index (CDAI) was used along with patient-reported problems thinking, age, and gender. The association of CDAI with patient-reported SCD was estimated using logistic regression models adjusted for sociodemographic characteristics, comorbidities, RA disease characteristics, and medication use. Additional models estimated and tested the moderating effect of patient age (< 55 years vs. ≥ 55 years). Results: A total of 3,041 out of 33,537 patients (9.1%), reported SCD with a mean CDAI of 16.2 [standard deviation (SD): 12.5] vs. 10.1 (SD: 10.8) in those who did not. The adjusted odds ratio (OR) for low, moderate, and severe disease activity vs. remission was 2.17 [95% confidence intervals (CI): 1.88–2.50], 3.25 (95% CI: 2.82–3.75), and 3.84 (95% CI: 3.29–4.48) respectively. Age had a moderating effect with the association of disease activity and self-reported SCD more prevalent in those aged < 55 years. The ORs for low, moderate, and severe disease activity were 3.37, 5.59, and 5.76 respectively for age < 55 vs. 1.90, 2.67, and 3.37 respectively for age ≥ 55 (P = 0.0001). The patient global component of CDAI displayed the highest OR of risk for SCD broken out by quartiles (1, 1.62, 2.80, and 4.55). Conclusions: Increasing disease activity is associated with a higher likelihood of patient-reported SCD. The effect was more pronounced in younger RA patients and patients with a higher patient global score.