AB1240 PROSPECTIVE EVALUATION OF COGNITIVE FUNCTION IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Abstract

ObjectivesProspectively evaluate changes in the cognitive function of patients with juvenile idiopathic arthritis (JIA) and associated factors.MethodsDesign and protocol: We performed a prospective cohort study with JIA patients that participated in a previous cross-sectional study (2019) to evaluate cognitive function. After 24 months, the patients were administered the same test battery previously used through an established protocol, and data was collected from their clinical histories. The neuropsychological tests were corrected by a neurologist and neuropsychologist.Study population: Inclusion criteria: Patients aged ≥16 years with JIA classified according to the criteria of ILAR 2001. Patients with inflammatory or rheumatic diseases other than JIA, previous neurological disease not associated with the course of JIA, and patients with scores lower than the normal in the manual skill test were excluded. Outcomes: The main variable was cognitive impairment, defined as worsening of ≥2 scaled points after 24 months (V24) in any of the subtests used to evaluate each cognitive area in the Wechsler Adult Intelligence Scale (WAIS). The evaluated cognitive domains and their respective subtests were: Attention/concentration (Digit Span); verbal function (Vocabulary); visuospatial organization (Block Design); working memory (Letter-Number Sequencing); problem-solving (Similarities). Depression was evaluated by The Beck Depression Inventory-II (BDI-II): minimal (0-13), mild (14-19), moderate (20-28), and severe (29-63). Other variables: Clinical-epidemiological characteristics; treatments; and inflammatory activity evaluated as the C-reactive protein average (CRP) and JADAS-27 along the 2 years of follow-up.Statistical analysis: Descriptive analysis, followed by χ2 and paired T-test. Multivariate analysis to identify independent variables associated with impairment of cognitive function in JIA.ResultsThirty patients with JIA were included. The clinical characteristics in V24 are shown in Table 1. Thirteen patients (43%) showed impairment in one or more cognitive functions. The most frequent impaired cognitive functions were verbal function (13.3%), visuospatial organization (13.3%) and problem solving (13.3%); followed by attention/concentration (10.0%) and working memory (6.7%). The variables independently associated with cognitive impairment were the mean CRP along the follow-up (OR [IC 95%], 1.510 [1.012-2.254]; p=0.044) and depression (OR [IC 95%], 1.358 [1.028-1.794]; p=0.031). This model would explain the 47% of the cognitive impairment in JIA (R2=0.470).Table 1. Clinical, laboratory, and treatment characteristics of 30 patients with JIAVariableJIA n=30Age in years, mean (SD)2.4 (7.0)Sex, woman, n (%)19 (63.3%)Cultural level Basic studies, n (%)3 (12.5%) Secondary education, n (%)8 (33.3%) University studies, n (%)13 (54.2%)Dyslipidaemia, n (%)2 (6.6%)BMI, mean (±SD)22.6 (3.3)Evolution time JIA, months, mean (±SD)158.1 (88.4)Rheumatoid factor >10 U/mL., n (%)2 (6.6%)Anticitrullinated peptide antibodies >20 U/mL., n (%)1 (4.5%)HLA B27, n (%)6 (20.0%)ANA, n (%)12 (40.0%)RCP average, mean (±SD)4,9 (6.6)JADAS27, mean (±SD)8,1 (10.5)Uveitis, n (%)9 (30.0%)Current synthetic DMARDs, n (%)18 (60.0%)Previous biologic DMARDs, n (%)12 (40.0%)Corticosteroid, n (%)5 (16.6%)BMI: Body Mass Index, JIA: Juvenile Idiopathic Arthritis, ANA: Antinuclear antibodies, CRP: C-Reactive Protein, DMARD: Disease-Modifying Antirheumatic Drugs.ConclusionForty percent of the patients with JIA showed cognitive impairment after 24 months of follow-up. Cognitive impairment was associated with higher inflammatory activity and depression.Disclosure of InterestsNone declared