Rheumatoid arthritis (RA) is a chronic inflammatory condition that affects millions worldwide, potentially increasing the risk of developing dementia, a condition with significant social and economic impact. The link between RA and dementia suggests that inflammation plays a crucial role in both conditions. This has led scientists to explore whether medications used to treat RA, known as disease-modifying antirheumatic drugs (DMARDs), could also influence the risk of developing dementia.
A comprehensive review of existing research, involving nearly a million RA patients, discovered intriguing insights. The study found that patients treated with biological DMARDs (bDMARDs), which are advanced therapies targeting specific components of the immune system, had a notably lower risk of developing dementia compared to those on conventional synthetic DMARDs (csDMARDs), which are traditional medications used to treat RA. Specifically, the risk reduction was about 24% for those on TNF inhibitors, a type of bDMARD, and similarly for other non-TNF biologics.
Interestingly, different types of TNF inhibitors showed varying levels of effectiveness in reducing dementia risk, with etanercept being the most effective, followed by adalimumab and infliximab. This suggests that not all bDMARDs are equal in their potential neuroprotective effects. However, the study found no significant reduction in dementia risk for RA patients taking csDMARDs, like methotrexate or hydroxychloroquine, except for sulfasalazine, which was associated with an increased risk of dementia.
These findings highlight the possibility that bDMARDs, especially TNF inhibitors, might offer protective benefits against dementia in RA patients. This has important implications for selecting RA treatments for patients at high risk of dementia and suggests a new avenue for research into dementia prevention and treatment. Further clinical trials are needed to explore the neuroprotective potential of TNF inhibitors and other bDMARDs, potentially opening up new strategies for combating dementia.
Xie W et al. RMD Open. 2024