DEMENTIA risk is decreased among patients with rheumatoid arthritis who are treated with biologic disease-modifying antirheumatic drugs (DMARD), a new study has found. Inflammation plays a pivotal role in various chronic diseases, including both rheumatoid arthritis (RA) and dementia. TNF, a key inflammatory cytokine, has been implicated in the pathogenesis of both conditions; thus, researchers aimed to investigate the association between DMARD use in RA treatment and incidence of dementia.
The team conducted a systematic review and meta-analysis of electronic databases including PubMed, EMBASE, and Cochrane Library. Overall, 14 studies involving 940,422 patients with RA were included, and findings from these studies were summarised using pooled risk ratios (RR) with confidence intervals (CI) of 95%.
The pooled RR for developing dementia was 0.76 (95% CI: 0.72–0.80) in patients receiving biological DMARDs, compared to those on conventional synthetic DMARDs. Specifically, both TNF inhibitors and non-TNF biologics were associated with a 24% reduction in dementia risk. Subgroup analysis revealed varying effects among different types of TNF inhibitors, with etanercept demonstrating the lowest relative risk (RR: 0.58; 95% CI: 0.53–0.65) and infliximab demonstrating the highest (RR: 0.80; 95% CI: 0.72–0.88). However, no significant effect on dementia incidence was found in patients receiving conventional synthetic DMARDs overall, except for sulfasalazine, which was associated with a slight increase in risk (RR: 1.27; 95% CI: 1.06–1.50).
The findings suggest that biological DMARDs for RA may be associated with a significant decrease in dementia risk, whereas no protective effect was observed with conventional synthetic DMARDs. Further controlled clinical trials focusing on TNF inhibitors are warranted to assess their potential neuroprotective effects. These results highlight the potential dual benefits of biological DMARD therapy in managing both RA and dementia risk, underscoring the importance of personalised treatment approaches in chronic inflammatory conditions.
Reference
Xie W et al. Association between disease-modifying antirheumatic drugs for rheumatoid arthritis and risk of incident dementia: a systematic review with meta-analysis. RMD Open. 2024;10(1):e004016.
