FRI0049 COGNITIVE IMPAIRMENT AND RHEUMATOID ARTHRITIS IN MOROCCAN PATIENTS
Authors: Azzouzi hamida, Fadoua Chennouf, Eddarami Jalila, Ichchou Linda
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Cognition in rheumatoid arthritis is regaining interest in publications lately. A recent experimental study(1), have shown that low grade chronic periodontal infection by Porphyromonas gingivalis result in the development of neuropathology that is consistent with that of Alzheimer dementia in adult mice. This same pathogen has been linked previously in many studies to the development of RA. These findings are raising existing doubt about an association between cognitive impairment and RA. <h3>Objectives:</h3> Our study aims to assess cognitive impairment in RA patients in remission state. <h3>Methods:</h3> It is a cross-sectional study realized at the rheumatology department of our University hospital. Our established RA patients regularly followed were asked to fulfill the Arabic version of the mini mental state examination (A-MMSE)(2) twice (initially and 15 days later) and the Patient Health Questionnaire (PHQ-9)(3) test for depression. Patients with neurological history (stroke, chronic infection and hematoma) have been excluded. Data about demographic, clinical (body mass index, Disease Activity Score of 28 joints, Health Assessment Questionnaire, modified total sharp score), biological (C-Reactive Protein, blood cell count, Anti-Citrullinated Peptide Antibodies, thyreotropin, vitamin B12, folic acid) characteristics was recorded. A-MMSE under 24 after adjustment for the level of education as recommended was considered abnormal. A cut-off of 10 of the PHQ-9 was considered as suggestive of depression. A descriptive study and regressions were done by SPSS.20 software and p&lt;0.05 was taken as significant. <h3>Results:</h3> A total of 80 patients were recruited, with an average age of 55.9 ± 8.5 years. Women were predominant (86.3%) in this population with an illiteracy rate of 66.3%. Our patients were ACPA positive in 93.8% of the cases, with mean disease duration of 11.4±8.65 years. They were receiving cDMARDs in 96.3%. Their average DAS28CRP was 2.19 ± 0.92, and their mean HAQ was 1.14±0.89. Five patients had thyroid disease and were receiving treatment, 20% of the population had anemia but with correct vitamin B dosage (essentially iron deficiency). The A-MMSE was abnormal in 57% at the first time, and in 38.8% of the cases at the second try fifteen days later, while 27.5% of the patients had a PHQ9&gt;10. The fields of altered A-MMSE were: attention and calculation (46.3%), copying (53.8%), orientation (38.8%), recall (25%) and language (41.3%).The immediate recall part was little concerned. No association was found for low MMSE in regressions with age, gender, menopause, BMI, disease parameters (HAQ, DAS, CRP, ACPA, mTSS) or other possible influencing factors (uric acid, creatinine clearance). An elevated PHQ was not correlated to A-MMSE in our patients (P=0.22). Only their level of education was significantly related to A-MMSE (p&lt;0.0001). <h3>Conclusion:</h3> It is certainly true that the interpretation and evaluation of cognitive functions is a difficult task, especially in an illiterate and disabled patient. However, in our study A-MMSE results were low even after test repetition, and in a state of disease remission. Although these results underscore the high frequency of cognitive impairment in RA patients, we estimate that further studies are eligible to confirm causality. <h3>References:</h3> [1] Ilievski V, Zuchowska PK, Green SJ, Toth PT, Ragozzino ME, Le K, et al. Chronic oral application of a periodontal pathogen results in brain inflammation, neurodegeneration and amyloid beta production in wild type mice. PLoS ONE. 2018;13(10):e0204941. [2] Bellaj T, Ben Jemaa S, Attia-Romdhane N, Dhiffallah M, Ben Ali N, Bouaziz M, Mrabet A. Version arabe du Mini Mental State Examination (A-MMSE): fidélité, validité et données normatives. Tunis Med. 2008;86:768–776. [3] Belhadj H, Jomli R, Ouali U, Zgueb Y, Nacef F. Validation of the Tunisian version of the patient health questionnaire (PHQ-9). European Psychiatry. 2017 Apr 1;41:S523. <h3>Disclosure of Interests:</h3> None declared