The Risk of Dementia and Heart Failure Among Rheumatoid Arthritis Patients Is Declining

Rheumatoid arthritis (RA) is often thought of as a joint-related condition. And while this disease does impact the joints, rheumatoid arthritis-related inflammation affects other areas of the body as well.

Take, for example, the heart. Rheumatoid arthritis has long been associated with heart disease, since inflammation makes it easier for plaque to form and block an artery. In fact, a 2012 review in the journal Annals of the Rheumatic Diseases found that people with RA have a 50 percent greater risk of developing cardiovascular disease than the general population.

Rheumatoid arthritis has also been connected to dementia. According to a 2020 review in the journal Cureus, RA-related inflammation can reduce blood flow to vital body organs like the brain, which in turn may increase the risk of developing dementia.

But the risk of RA patients developing these conditions may be on the decline. Recent advances in rheumatoid arthritis treatment have made it possible to slow the disease’s progression and, in turn, reduce the risk of other inflammatory-related problems, like heart disease and dementia.

Two new studies presented at EULAR 2021 Virtual Congress, the annual meeting of the European Alliance of Associations for Rheumatology, analyzed data on patients collected over nearly 30 years and came to some uplifting conclusions: Rates of heart failure and dementia among people with RA are declining.

Dementia rates among people with rheumatoid arthritis have been decreasing over the years

Both studies were conducted by researchers at the Mayo Clinic. The research on dementia used data on 895 RA patients who were diagnosed between 1980 and 2009 and followed until the end up of December 2019 (unless they passed away earlier). The researchers determined that the chance that someone with RA would develop dementia within a 10-year period was nearly 13 percent in the 1980s but only 7 percent in the 1990s — and down to 6 percent by the 2000s.

The researchers compared these findings to the rates of dementia among the general population (people without RA) during the same time period. While dementia rates were far lower among those without RA in the 1980s (9 percent for the general population versus 13 percent for RA patients), by the 2000s the risk of developing dementia was slightly higher for those without RA (7 percent  for the general population versus 6 percent for RA patients).

Whether disease-modifying RA medications can explain this improvement isn’t totally clear, though it seems likely. “More studies are needed to understand the reasons and implications of these trends,” the researchers wrote.

People with rheumatoid arthritis may have the same risk of heart failure as those without RA

The second study, which focused on heart failure — a common form of cardiovascular disease among people with RA — employed similar methods. The authors of that study used data on 905 people who were diagnosed with RA between 1980 and 2009 and were tracked until the end of 2019. They also analyzed rates of heart failure among a control group from the general population.

During the 30-year study, the risk of developing heart failure in a 10-year period for members of the general population held steady at around 7 percent. But for those with RA, there were significant changes: In the 1990s the risk was 8.5 percent, followed by an an uptick in the 1990s to 11 percent. But in the 2000s the risk had dropped to 7 percent.

In other words, people with RA initially had twice the risk of heart failure compared to those without RA, but by the 2000s they had no extra risk at all.

A press release from EULAR suggested that “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.”

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