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Clinical and subclinical neuropsychiatric abnormalities in rheumatoid arthritis patients

Abstract

Background

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease with probable autoimmune aetiology. RA has many secondary complications and a variety of neuropsychological consequences.

Aim

The aim of this study was to estimate the frequencies of neuropsychiatric disorders in RA patients and their relationship with the duration and activity of disease.

Patients and methods

Seventy-four consecutive female RA patients were recruited and compared with 25 age-matched and education status-matched female healthy volunteers. All eligible participants underwent clinical, laboratory and electrophysiological examinations (motor and sensory nerve conduction study, F-wave of four limbs, P300 event-related potential and electroencephalography). The Structured Clinical Interview for Diagnostic and statistical manual of mental disorders, 3rd ed., Revised (DSM-III-R) Axis I Disorders (SCID-I) for diagnosis of psychiatric illness and the Wechsler Adult Intelligence Scale, 3rd ed. (WAIS-III) with assessment of total scale, verbal and performance intelligence quotients (IQ) were administered to all participants.

Results

Fourteen (18.9%) patients had evidence of symptomatic peripheral neuropathy and radiculopathy, whereas 60.8% had psychiatric disorders. Depression was the most prevalent psychiatric disorder (45%), followed by anxiety (27%) and comorbid anxiety with depression (21.6%). Low IQ scores were recorded in 54% of patients. P300 latency was significantly prolonged (P = 0.0001), and seven (9.5%) RA patients recorded abnormal P300 latency (>mean ± 2 SD) compared with control values. Abnormal electroencephalography findings were observed in 48.6%. Visual analogue scale pain score was significantly higher among patients with psychiatric disorders versus patients without psychiatric disorders (P = 0.0001). Significant negative correlation was recorded between Disease Activity Score and total IQ score (P = 0.01), whereas no significant association was seen between Disease Activity Score and the presence of neuropathy or psychiatric disorders.

Conclusion

Cognitive impairment, depression, anxiety and peripheral neuropathy are common in RA patients. Early diagnosis and management of neuropsychiatric disorders in RA patients may greatly improve the patients’ health-related quality of life.

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Correspondence to Eman M. Khedr MD.

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Khedr, E.M., El Fetoh, N.A., Herdan, O. et al. Clinical and subclinical neuropsychiatric abnormalities in rheumatoid arthritis patients. Egypt Rheumatol Rehabil 42, 11–18 (2015). https://doi.org/10.4103/1110-161X.155625

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Keywords

  • electroencephalography
  • intelligence quotients
  • neuropsychiatric disorders
  • P300
  • rheumatoid arthritis