Treatments for rheumatoid arthritis may lower dementia risk

Rheumatoid arthritis (RA) is an autoimmune condition affecting up to 3% of the population. Joint inflammation, the hallmark of the disease, causes swelling, stiffness, and limited motion, especially in the small joints of the hands and wrists.

But inflammation in rheumatoid arthritis isn’t limited to the joints — it’s present throughout the body. As an example, skin nodules, eye inflammation, and lung scarring are well-recognized features of rheumatoid arthritis, all related to unchecked inflammation. Interestingly, inflammation may play a major role in dementia. So, could inflammation-suppressing medicines for rheumatoid arthritis affect the odds of developing dementia?

Can treatment of rheumatoid arthritis lower dementia risk?

Recent studies suggest that the answer may be yes. Perhaps this shouldn’t be surprising. The role of inflammation in Alzheimer’s disease and other types of dementia has been a focus of research for decades, and treatments for rheumatoid arthritis reduce inflammation.

Considering that there are currently no effective preventive treatments for Alzheimer’s disease or other forms of dementia, the observation that RA treatments might prevent dementia could be groundbreaking.

What’s the evidence supporting this idea? Here are a few of the latest and most compelling observational studies.

  • A study published in 2019 reported that people with RA treated with standard medications had less than half the risk of developing dementia over a five-year period compared with people without RA.
  • A 2021 study found dementia rates declined among people with RA and increased among the overall population in recent decades. During that time, treatments for RA had been improving.
  • A 2022 study looking at people taking different types of RA treatment provides some of the most convincing findings. It found that people with RA taking the newest, most effective treatments developed dementia 19% less often over the three years of the study compared with those treated with older medicines. When people taking a range of newer medicines were compared, there was no significant difference in the dementia rate.

Together, these studies suggest that certain treatments that help rheumatoid arthritis might do more than protect the joints; they might also protect the brain. This isn’t the first time a medicine was found to cause an unexpectedly positive side effect. But it could be one of the most important.

Is additional research needed?

While evidence is mounting that inflammation-suppressing medicines might reduce dementia risk, more research is needed:

  • Observational studies cannot prove cause. They simply observe rates of dementia among different groups of people, which means other factors could account for the results. For example, the 2022 study didn’t assess smoking and family history, which contribute to dementia. If the group receiving older RA treatments had more risk factors for dementia, the medicines might not explain the findings. More powerful evidence comes from randomized controlled trials, in which otherwise similar people are randomly assigned to different treatment groups and their health is analyzed over time.
  • Results might differ with different or more diverse groups of study participants. For example, participants in the 2022 study were older adults (average age 67), mostly white (75%), and mostly female (80%).
  • Independent research is necessary to confirm results. A single study from one group of researchers is rarely convincing, especially for an issue as important as preventing dementia.
  • Longer-term follow-up is needed. Rheumatoid arthritis is a lifelong disease, so studies lasting three to five years may not tell the whole story.
  • We’re not sure how certain medicines for RA might protect the brain. We also don’t know whether these treatments could be effective for people who don’t have RA.

It’s reasonable to believe that reduced inflammation, rather than a particular drug, is providing a benefit because different medicines with different ways of damping down inflammation have been linked to lower dementia risk in people with RA. But we’ll need more research to prove that’s true.

The bottom line

Treatments developed over the last 50 years have transformed rheumatoid arthritis from an often disabling disease to a chronic condition that usually can be well-controlled. The initial choice of treatment depends on a combination of factors, including effectiveness, side effect profile, how a drug is given (most people prefer pills over injections), cost, and whether a drug is covered by health insurance.

Soon, another consideration may be added to this list: the ability of a medicine to lower dementia risk. This might be particularly relevant to the person with rheumatoid arthritis who has a strong family history of dementia.

And what about people without RA? I think it’s only a matter of time before studies explore whether anti-inflammatory medicines can reduce the risk of dementia even in people without an inflammatory condition like RA. While it’s impossible to predict what those studies will show, one thing’s for sure: the impact of a positive study would be enormous.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Suppose you find fifty righteous people living there in the city—will you still sweep it away and not spare it for their sakes? (Genesis 18:24) And the Lord replied, “If I find fifty righteous people in Sodom, I will spare the entire city for their sake.” (Genesis 18:26)

And be sure to say, ‘Look, your servant Jacob is right behind us.’” Jacob thought, “I will try to appease him by sending gifts ahead of me. When I see him in person, perhaps he will be friendly to me.” (Genesis 32:20)
to say to you: ‘Please forgive your brothers for the great wrong they did to you—for their sin in treating you so cruelly.’ So we, the servants of the God of your father, beg you to forgive our sin.” When Joseph received the message, he broke down and wept. (Genesis 50:17)

“Forgive my sin, just this once, and plead with the Lord your God to take away this death from me.” (Exodus 10:17)
Pay close attention to him, and obey his instructions. Do not rebel against him, for he is my representative, and he will not forgive your rebellion. (Exodus 23:21)

Moses Intercedes for Israel The next day Moses said to the people, “You have committed a terrible sin, but I will go back up to the Lord on the mountain. Perhaps I will be able to obtain forgiveness for your sin.” (Exodus 32:30) So Moses returned to the Lord and said, “Oh, what a terrible sin these people have committed. They have made gods of gold for themselves. (Exodus 32:31) But now, if you will only forgive their sin—but if not, erase my name from the record you have written!” (Exodus 32:32)

The Lord passed in front of Moses, calling out, “Yahweh! The Lord! The God of compassion and mercy! I am slow to anger and filled with unfailing love and faithfulness. (Exodus 34:6) I lavish unfailing love to a thousand generations. I forgive iniquity, rebellion, and sin. But I do not excuse the guilty. I lay the sins of the parents upon their children and grandchildren; the entire family is affected— even children in the third and fourth generations.” (Exodus 34:7)

And he said, “O Lord, if it is true that I have found favor with you, then please travel with us. Yes, this is a stubborn and rebellious people, but please forgive our iniquity and our sins. Claim us as your own special possession.” (Exodus 34:9)
just as he does with the bull offered as a sin offering for the high priest. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:20) Then he must burn all the goat’s fat on the altar, just as he does with the peace offering. Through this process, the priest will purify the leader from his sin, making him right with the Lord, and he will be forgiven. (Leviticus 4:26)

Then he must remove all the goat’s fat, just as he does with the fat of the peace offering. He will burn the fat on the altar, and it will be a pleasing aroma to the Lord. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:31) Then he must remove all the sheep’s fat, just as he does with the fat of a sheep presented as a peace offering. He will burn the fat on the altar on top of the special gifts presented to the Lord. Through this process, the priest will purify the people from their sin, making them right with the Lord, and they will be forgiven. (Leviticus 4:35)

The priest will then prepare the second bird as a burnt offering, following all the procedures that have been prescribed. Through this process the priest will purify you from your sin, making you right with the Lord, and you will be forgiven. (Leviticus 5:10) Through this process, the priest will purify those who are guilty of any of these sins, making them right with the Lord, and they will be forgiven. The rest of the flour will belong to the priest, just as with the grain offering.” (Leviticus 5:13)

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