A study by Mikolajczak and colleagues found that 10.2% of patients with PsA reported subjective cognitive decline or brain fog, as determined by patient reports of problems with thinking, confusion, memory disturbance and forgetfulness. The frequency was 3% in patients with minimal disease activity (MDA) and 16% in those not in MDA. Those with subjective cognitive decline also had more comorbidities, including fibromyalgia, fatigue, anxiety and depression.
This study supports data from other rheumatic disease populations in demonstrating the impact of systemic inflammatory disease on neuropsychologic function; such effects may be a manifestation of so-called neuroinflammation. In the clinical context, these findings are important in promoting a more global treatment approach based on pharmacologic and non-pharmacologic therapies. Given the clinical complexity of such symptoms as brain fog, use of adjunctive psychological testing may be useful in defining symptomatology.
11. Perimenopause & Disease Activity
Eder et al., Abstract 171411
The influence of male-female differences on the signs and symptoms of inflammatory arthritis has long been a subject of great interest in rheumatology, especially because many rheumatic diseases are female predominant. Usually, studies assess differences between men and women on various disease features or biomarkers, although some studies divide the female population into pre- and postmenopausal groups. The situation is more complicated, however, because the perimenopausal period may have its own biology in terms of endocrinologic and immunologic changes.
In this study, Eder and colleagues analyzed 477 patients over a mean of 12.1 years. Interestingly, only 1.5% of patients received hormone replacement therapy at any time. As the data indicated, a rise in the DAPSA (Disease Activity in PsA) score was found during the perimenopausal years. Higher tender and swollen joint counts also occurred in the perimenopausal period compared with both pre- and postmenopausal periods.
These are important observations with implications for both pathogenesis and management. Although effects of sex hormones on immune responses have long been studied, future research should explore more precisely the array of hormones and their downstream effects during the interval before and after menopause. With respect to management, a key issue relates to role of hormonal replacement. This is always a complicated issue but these findings suggest it is worth another look.
12. Identifying Patients with Early PsA
Martin et al., Abstract 010712
Enthesopathy is a prominent feature of PsA, but often difficult to assess clinically. As suggested by data in this study, elastography (EL) may provide a useful way to evaluate more decisively disease-related changes in the Achilles tendon. EL is an imaging technique that can determine the response of a tendon to mechanical force that may result from changes in the elastic properties of tendon structures from inflammation or damage.
