1421: Impact of Psoriatic Arthritis Disease Activity and Fatigue on Subjective Cognitive Decline (“Brainfog”)

Background/Purpose: Patients with psoriatic arthritis often report having brain fog, describing symptoms such as forgetfulness, difficulty thinking and memory issues. It has been hypothesized that these symptoms, consistent with subjective cognitive decline, may be the result of fatigue, depression, associated chronic pain and inflammation. We proposed to explore the association between disease activity and subjective cognitive decline when taking into account patient factors, comorbidities and PsA characteristics.

Methods: We identified patients with a diagnosis of PsA from the CorEvitas PsA/SpA registry with a visit between 7/22/2013-10/20/2024 that included information on Minimal Disease Activity (MDA) and confounding covariates of interest. MDA assesses joint pain, swelling, skin involvement, physical function and pain, making it a comprehensive assessment of disease activity. Subjective Cognitive Decline (SCD) or “Brainfog”, was defined as the patient indicating problems thinking/confusion or problems with memory/forgetfulness. The association of MDA (achievement of ≥5 of the 7 criteria) with SCD was estimated using logistic regression models controlling for demographic (age, sex, education), behavior (smoking, drinking), BMI, disease duration, modified Charlson Comorbidity Index, fibromyalgia, medication use (narcotics, analgesics, NSAIDs, biologic/targeted synthetic DMARDs), patient reported fatigue, depression, and anxiety. Odds Ratios (ORs) with 95% confidence intervals are presented to estimate risk of SCD in those not in MDA vs those in MDA. The proportion with SCD is estimated based on the number of MDA criteria met.

Results: There were 4077 eligible PsA patients. Of those, 315 (7.7%) were missing at least one covariate of interest. Of the remaining 3762 patients, 385 or 10.2%, indicated SCD (3% for those in MDA and 16% in those not in MDA). Table 1 breaks out selected covariates by SCD or not. Those reporting SCD were more often female, had more comorbidities including fibromyalgia, as well as fatigue, anxiety and depression. Figure 1 illustrates ORs comparing risk of SCD in those not in MDA vs those in MDA for a series of tiered models that illustrate the adjusted ORs for nested inclusion of key covariates. Unadjusted OR= 5.33 [95% CI: 4.0, 7.10] and after adjustment for demographics, behavior, BMI, comorbidities, and medications OR=4.34 [3.21, 5.87]. Adding “Fatigue” reduces the OR=2.15 [1.54, 3.01]. Patient depression and anxiety had less of an impact (OR= 3.53 and 3.72, respectively). Figure 2 illustrates the proportion of SCD by the number of criteria met for achieving MDA showing decreasing SCD with additional indicators of MDA.

Conclusion: Not achieving MDA shows a high risk of SCD (OR >4) adjusting for differences in patient characteristics. Adjusting for fatigue reduces the associated risk of SCD with not being in MDA, suggesting a potential mechanism for the impact of disease activity. However, it does not completely explain the association. The monotonic association of SCD with MDA markers illustrates this is not a threshold effect. Additional longitudinal analyses are planned to elucidate the impact of PsA disease activity on a patient’s cognitive well-being.