Association of Use of Rehabilitation Services With Development of Dementia Among Patients With Rheumatoid Arthritis: Analysis of Domestic Data in Taiwan.

Ming-Chi Lu,Tzung-Yi Tsai,Hanoch Livneh,Shu-Wen Yen,Hua-Lung Huang,Chieh-Tsung Yen,Miao-Chiu Lin,Ning-Sheng Lai

doi:10.3389/fmed.2020.00446

Abstract

Objectives: Rheumatoid arthritis (RA) was found to trigger the higher risk of dementia. Limited information, however, is available on whether the use of rehabilitation services (RS), an integral part of healthcare programs, can lessen dementia risk for RA subjects. The aim of this study was to determine the relationship of RS use to the development of dementia in RA patients.Methods: We identified 2,927 newly diagnosed patients with RA, 20–70 years of age between 1998 and 2007, from a national health insurance database. 965 patients from this sample received RS, and 1,962 patients were designated as a control group (non-RS users). Patients were followed to the end of 2012 to identify dementia incident as the end point. Cox proportional hazards regression was performed to calculate the hazard ratio (HR) of dementia risk associated with the use of RS.Results: During the study period, 388 patients with RS and 1,224 controls developed dementia, representing incidence rate of 75.46 and 115.42 per 1,000 person-years, respectively. After adjusting for potential confounders, RS was found to significantly reduce dementia risk, with the adjusted HR of 0.60 (95% confidence interval [CI] = 0.53–0.67). Those who used the high intensity of RS (≧15 courses) had the greatest benefit.Conclusions: Integrating RS into the conventional treatment may reduce the sequent risk of dementia for RA patients.

Highlights

Rheumatoid arthritis (RA), an autoimmune inflammatory arthritis disease, principally attacks the joints and affects many bodily tissues and organs, causing significant burden to both patients and their families through progressive functional limitations and increased physical disability [1]
The incidence rate of dementia was lower among rehabilitation service (RS) users than in non-RS users (75.46 vs. 115.42 per 1,000 PYs), and the adjusted hazard ratio (HR) was 0.60
RA patients who used the high intensity of RS had a 62% lower risk of dementia (Table 2)

Summary

Introduction

Rheumatoid arthritis (RA), an autoimmune inflammatory arthritis disease, principally attacks the joints and affects many bodily tissues and organs, causing significant burden to both patients and their families through progressive functional limitations and increased physical disability [1]. These phenomena together with the accompanying negative effects often impede the work productivity of those with RA. A systematic review of 15 studies found a positive association between RA and cognitive impairment, such as dementia, a commonly-reported disorder with advanced age [4]. The known high risk of cardiovascular comorbidity of patients with RA may be implicated in the cognitive impairment [4]

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Conclusion