Decline in excess risk of dementia and heart failure in patients with rheumatoid arthritis

Priscilla Lynch provides a round-up of some of the most topical research presented at this year’s EULAR Congress, which took place virtually from 2-5 June

Data released at the 2021 EULAR Congress show a substantial decline in the risk of both dementia and heart failure in people with RA onset in the 2000s as compared to 1980s – coinciding with the advent of novel biologic treatments for RA. 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 heart failure as people in the general population without RA.

For dementia, previous studies have delivered mixed results about the pattern of cognitive impairment and dementia in people with RA compared to the general population – with some showing increased odds, while others show the reverse. Vanessa Kronzer and colleagues, Mayo Clinic, US, assessed the incidence of dementia over time in people with
RA and compared it to that seen in the general population. Medical record data were collected for 895 people diagnosed with RA between 1980 and 2009. All individuals were followed until death, migration, or 31 December 2019 to see if they went on to develop dementia.

The 10-year cumulative incidence of dementia in people diagnosed during the 1980s, 1990s, and 2000s was 12.7 per cent, 7.2 per cent, and 6.2 per cent, respectively – showing a clear decline and markedly lower cumulative incidence of dementia for people diagnosed with RA in the 2000s compared with the 1980s. For 880 people in the general population without RA, the 10-year cumulative incidence of dementia in the 1980s, 1990s, and 2000s was 9.3 per cent, 5.0 per cent, and 7.1 per cent, respectively.

Overall, the risk of dementia in RA patients was significantly higher than in people without RA. When subdivided by decade, the risk of dementia in people diagnosed with RA was higher than non-RA comparators in the 1980s and 1990s – but not the 2000s. Elena Myasoedova and colleagues used the same methods to look at the trends of heart failure in 905 people diagnosed with RA between 1980 and 2009, and followed until death, migration, or 31 December 2019.

The 10-year cumulative incidence of heart failure in people diagnosed with RA in the 1980s, 1990s, and 2000s was 8.5 per cent, 10.8 per cent, and 7.1 per cent, respectively. These results show there was no difference in incidence of heart failure in the 1990s and 2000s compared to the 1980s. For 903 people in the general population without RA over the same time period the incidence of heart failure was 7.4 per cent, 7.5 per cent, and 7.3 per cent. When comparing the risk of heart failure in people with and without RA, those diagnosed with RA in the 2000s had no excess risk of heart failure compared to the general population.

This finding is in contrast to the two-fold excess risk seen in people diagnosed with RA in the 1980s, and around 1.5-fold increased risk in 1990s. Further studies should investigate these associations and look at the role of inflammation, autoimmunity, and anti-rheumatic treatments in the risk of dementia and heart failure, the study authors said.