Rheumatoid Arthritis Linked to Neuropsychiatric Symptoms

Neuropsychiatric manifestations are quite common in rheumatoid arthritis (RA), according to a comprehensive review published in Autoimmunity Reviews.¹ Though most commonly known for its destructive effects on joints, RA can also affect the central nervous system (CNS), spine, and brain.

“Neuropsychiatric manifestations — especially mood disorders and headache — are frequently observed in RA,”lead author Andrei Joaquim, MD, from the Department of Neurology at State University of Campinas (UNICAMP) in São Paolo, Brazil, told Clinical Pain Advisor.

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“It is of paramount importance for neurologist and rheumatologist to understand the nuances of neurological symptoms in RA patients for a proper diagnosis and an adequate treatment,” write Dr. Joaquim and colleague Simone Appenzeller, MD.

Accordingly, Drs. Joaquim and Appenzeller searched the medical literature for studies on neuropsychiatric manifestations of RA, categorizing them according to central or peripheral nervous system involvement (Table).¹ The most common symptoms and their probable etiology were included in the review. 

Mood Disorders and Cognitive Impairment

The most common symptom observed in RA patients was headache, potentially resulting from the disease process, treatment, or comorbid conditions unrelated to RA.

Depression and anxiety were likewise common, affecting up to 40% of patients. The prevalence of depression was higher than that of the general population (risk ratio [RR] = 2.06; 95% confidence interval [CI], 1.73-2.44, P < 0.001), but comparable to that observed in other chronic or disabling diseases.

Anxiety was reported in 21% to 70% of RA patients, often occurring in conjunction with depression. Depression was linked to a higher risk for suicide and mortality, while anxiety was associated with increased sensitivity to pain and suffering.

Patients with RA also appeared to have higher rates of cognitive dysfunction than the general population, particularly in areas of visual-spatial perception and planning. Cognitive dysfunction was associated with impaired functional ability, reduced quality of life, and poor medication adherence.  

Potential risk factors for cognitive dysfunction in RA patients included low education (odds ratio [OR] = 6.18; 95% CI, 1.6-23.87), low income (OR =7.12; 95% CI, 1.35-37.51), use of oral glucocorticoids (OR = 2.92; 95% CI, 1.05-8.12), and increased cardiovascular disease (CVD) risk factors (OR per risk factor = 1.61; 95% CI 1.19-2.17).