Abstract
The association of rheumatoid arthritis (RA) with cognitive and psychiatric phenotypes has been recognized. However, it is not known whether these phenotypes are a consequence of disease-related factors, such as pain, or reflect shared etiological factors. To investigate whether genomic risk for RA is associated with cognitive and psychiatric symptoms in children and adolescents. This cohort study analyzed data from 3296 to 5936 adolescents (depending on outcome) from the Avon Longitudinal Study of Parents and Children. Clinical and questionnaire data were collected periodically from September 6, 1990, with collection ongoing, and analyzed from August 21, 2017, to May 21, 2018. Polygenic risk scores (PRSs) for RA. Measures of cognition (including IQ, working memory, verbal learning, processing speed, problem solving, selective attention, and attentional control) and psychopathology (including anxiety, depression, negative symptoms, psychotic experiences, attention-deficit/hyperactivity disorder, and hyperactive and inattentive symptoms) in childhood and adolescence. Polygenic risk scores for RA were generated for 7977 children and adolescents (3885 [48.7%] female). Of these 7977 participants, 9 (0.11%) had a known diagnosis of RA at age 22 years. Increased PRS for RA was associated with lower total IQ (β, -0.05; 95% CI, -0.07 to -0.02; P < .001), performance IQ (β, -0.03; 95% CI, -0.06 to -0.005; P = .02), and verbal IQ (β, -0.05; 95% CI, -0.08 to -0.02; P < .001) at age 8 years (mean [SD] age at measurement, 8.6 [0.3] years) and symptoms of hyperactivity and inattention from ages 4 to 16 years, with the strongest evidence of association at age 13 years (mean [SD] age at assessment, 13.2 [0.2] years). The odds ratio at this age per SD increase in PRS was 1.25 (95% CI, 1.12-1.39) (P < .001). There was little evidence of association between the RA PRS and other measures of cognition and psychopathology. Gene-based analyses indicated that polygenic signal for RA was enriched for immune pathways (q ≤ 0.05). No equivalent associations were seen for polygenic risk associated with inflammatory bowel disease or multiple sclerosis. These findings support an association between genetic risk for RA and neural phenotypes, suggesting that cognitive impairment in RA is not simply secondary to disease-related processes or treatment effects. These results may suggest that genetic susceptibility for RA might affect psychological well-being in early life and reinforce the emerging link between mental health and the immune system.
Highlights
Rheumatoid arthritis (RA) is a highly heritable chronic inflammatory disease that affects between 0.5% and 1% of the population and is most common in older adults.[1]
Increased Polygenic risk scores (PRSs) for RA was associated with lower total IQ (β, −0.05; 95% CI, −0.07 to −0.02; P < .001), performance IQ (β, −0.03; 95% CI, −0.06 to −0.005; P = .02), and verbal IQ (β, −0.05; 95% CI, −0.08 to −0.02; P < .001) at age 8 years and symptoms of hyperactivity and inattention from ages 4 to 16 years, with the strongest evidence of association at age 13 years
These findings support an association between genetic risk for RA and neural phenotypes, suggesting that cognitive impairment in RA is not secondary to disease-related processes or treatment effects
Summary
Rheumatoid arthritis (RA) is a highly heritable chronic inflammatory disease that affects between 0.5% and 1% of the population and is most common in older adults.[1]. There is evidence that the offspring of mothers with RA are more likely to suffer from attentiondeficit/hyperactivity disorder (ADHD), it is not known whether this reflects shared genetic vulnerability across the disorders or exposure to the heightened inflammatory status (or associated medication) in the mother.[10]
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