MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–4_ Апрель –2025
384
THE EFFECTIVENESS OF NOOTROPIC THERAPY IN PATIENTS WITH
RHEUMATIC DISEASES: A CLINICAL ANALYSIS
Khamrayev Khamza Khamidullayevich
Khamraev Botirjon
Samarkand State Medical University
Department of Internal Medicine
Abstract: Background: Rheumatic diseases are often accompanied not only
by systemic inflammation and joint dysfunction but also by neuropsychiatric
symptoms such as cognitive impairment, chronic fatigue, and mood disorders. These
manifestations may significantly reduce patients' quality of life and complicate
disease management.
Objective:
This study aims to evaluate the clinical effectiveness of nootropic
therapy in patients with various rheumatic diseases and to assess its impact on
cognitive function and overall disease course.
Methods:
A cohort of patients diagnosed with rheumatoid arthritis, systemic
lupus erythematosus, and ankylosing spondylitis was observed. Nootropic agents
such as piracetam, citicoline, and phenibut were administered as adjunctive therapy
over a 12-week period. Clinical parameters, cognitive test scores, and patient-reported
outcomes were analyzed before and after intervention.
Results:
The use of nootropic therapy led to statistically significant
improvements in cognitive performance, particularly in memory, attention, and
mental processing speed. Additionally, patients reported reduced fatigue and
improved emotional stability. No severe adverse effects were observed during the
course of treatment.
Conclusion:
Nootropic agents may represent a promising adjunctive
approach in the management of rheumatic diseases, particularly in addressing
cognitive and neuropsychiatric comorbidities. Further randomized controlled trials
are warranted to confirm these findings and determine long-term efficacy and safety.
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–4_ Апрель –2025
385
Keywords:
rheumatic diseases, nootropic therapy, cognitive impairment,
neuropsychiatric symptoms, piracetam, citicoline
Introduction
Rheumatic diseases, including rheumatoid arthritis (RA), systemic lupus
erythematosus (SLE), and ankylosing spondylitis (AS), are chronic inflammatory
disorders characterized primarily by musculoskeletal involvement. However, beyond
joint destruction and systemic inflammation, these conditions are increasingly
recognized for their impact on the central nervous system. Cognitive dysfunction,
chronic fatigue, anxiety, and depressive symptoms are frequently observed among
patients and are often underdiagnosed or overlooked during routine rheumatologic
care.
Recent studies suggest that chronic systemic inflammation, persistent immune
activation, and long-term corticosteroid use may contribute to neuropsychiatric
complications in rheumatic patients. These factors disrupt normal neurotransmission,
impair cerebral blood flow, and alter synaptic plasticity, potentially leading to reduced
cognitive performance and decreased quality of life.
Nootropic agents, also known as cognitive enhancers, are a class of drugs that
have shown promise in improving cognitive function, memory, attention, and
neuroprotection in various neurological conditions. Although their use is well-
documented in neurology and psychiatry, their application in rheumatology remains
relatively unexplored. Given the neuroinflammatory component of rheumatic
diseases, nootropic therapy may serve as a valuable adjunct to standard treatment
regimens.
This study aims to analyze the clinical effects of selected nootropic drugs in
patients with rheumatic diseases and to assess their potential role in mitigating
cognitive and neuropsychiatric symptoms. By identifying the therapeutic potential of
nootropics in this patient population, we aim to contribute to a more holistic approach
in the management of rheumatic disorders.
Methods
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–4_ Апрель –2025
386
Study Design and Participants:
This clinical observational study was
conducted over a 12-week period at a multidisciplinary rheumatology center. A total
of 60 adult patients (age 25–65 years) diagnosed with rheumatic diseases—including
rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing
spondylitis (AS)—were enrolled. All patients met the respective classification criteria
established by the American College of Rheumatology (ACR) and were in a stable
phase of treatment without recent medication changes.
Inclusion Criteria:
Confirmed diagnosis of RA, SLE, or AS.
Complaints of cognitive symptoms (e.g., forgetfulness, difficulty
concentrating).
Stable disease activity for at least 4 weeks.
Nootropics-naive (no prior treatment with cognitive enhancers).
Exclusion Criteria:
Severe psychiatric illness (e.g., schizophrenia, major depression).
History of cerebrovascular accident or neurodegenerative disease.
Current use of psychoactive or nootropic medications.
Significant hepatic or renal impairment.
Intervention:
Participants received standard rheumatologic therapy (DMARDs, NSAIDs,
corticosteroids as needed) along with one of the following nootropic agents:
Piracetam
(1,200 mg/day),
Citicoline
(1,000 mg/day), or
Phenibut
(250 mg twice daily), administered orally for 12 weeks.
Choice of agent was based on clinical judgment and patient tolerance.
Assessment Tools:
Cognitive function was evaluated at baseline and at the
end of the 12-week period using standardized tests:
Mini-Mental State Examination (MMSE)
– for global cognitive
assessment,
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–4_ Апрель –2025
387
Trail Making Test (Parts A and B)
– for attention and executive
function,
Fatigue Severity Scale (FSS)
– for fatigue assessment,
Hospital Anxiety and Depression Scale (HADS)
– for mood
evaluation.
Statistical Analysis:
Descriptive statistics were used to summarize
demographic and baseline characteristics. Paired
t
-tests or Wilcoxon signed-rank tests
were applied to compare pre- and post-treatment scores. A
p
-value of <0.05 was
considered statistically significant. All analyses were performed using SPSS version
25.0.
Results
A total of 60 patients completed the 12-week study period, with no significant
dropouts. The cohort included 24 patients with rheumatoid arthritis (RA), 20 with
systemic lupus erythematosus (SLE), and 16 with ankylosing spondylitis (AS). The
mean age of participants was 47.3 ± 10.2 years, and 72% were female.
Cognitive Function
At baseline, mild to moderate cognitive impairment was observed in 65% of
patients based on MMSE scores (mean MMSE = 25.1 ± 2.4). After 12 weeks of
nootropic therapy, a statistically significant improvement in MMSE scores was
recorded across all subgroups (mean MMSE post-treatment = 27.3 ± 1.8;
p
< 0.01).
The
Trail Making Test
(TMT) also showed improved performance:
TMT-A
completion time decreased by an average of 21%, indicating
enhanced attention and visual scanning.
TMT-B
time decreased by 18%, reflecting better executive functioning
and mental flexibility (
p
< 0.05).
Fatigue and Mood
According to the
Fatigue Severity Scale (FSS)
, mean scores dropped from
5.6 ± 1.1 to 4.1 ± 0.9 (
p
< 0.01), suggesting a marked reduction in fatigue levels.
The
Hospital Anxiety and Depression Scale (HADS)
demonstrated the
following:
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–4_ Апрель –2025
388
Anxiety subscale: decreased from 10.3 ± 2.6 to 7.1 ± 2.3
Depression subscale: decreased from 9.7 ± 2.9 to 6.4 ± 2.1
Both reductions were statistically significant (
p
< 0.01).
Tolerability and Safety
All nootropic agents were well tolerated. Mild and transient side effects (e.g.,
headache, irritability, gastrointestinal discomfort) were reported in 12% of patients
but did not necessitate discontinuation. No serious adverse events occurred during the
study.
Conclusion
This clinical analysis demonstrates that the adjunctive use of nootropic agents
in patients with rheumatic diseases may provide significant cognitive and
neuropsychiatric benefits. Over a 12-week period, patients receiving nootropic
therapy exhibited measurable improvements in memory, attention, executive
function, fatigue levels, and mood. These findings highlight the potential of cognitive
enhancers such as piracetam, citicoline, and phenibut as supportive treatments in the
multidisciplinary management of rheumatic disorders.
Given the increasing recognition of cognitive and psychological burdens in
rheumatic patients, nootropic therapy may represent a valuable strategy for enhancing
quality of life and functional outcomes. However, larger-scale randomized controlled
trials are warranted to further validate these preliminary observations and to establish
long-term safety and efficacy profiles.
REFERENCES
1.
Bartels, C. M., Lumley, M. A., & Kaplan, J. R. (2019). Rheumatoid arthritis
and cognition: Emerging concepts and clinical implications.
Current Rheumatology
Reports, 21
(8), 41. https://doi.org/10.1007/s11926-019-0847-4
2.
Saletu, B., Grunberger, J., & Linzmayer, L. (2010). The effects of nootropics
on cognitive performance in patients with chronic illnesses.
Neuropsychobiology,
62
(1), 1–10. https://doi.org/10.1159/000315091
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–4_ Апрель –2025
389
3.
Appenzeller, S., & Costallat, L. T. L. (2018). Cognitive impairment in systemic
lupus erythematosus: Advances in pathogenesis and clinical management.
Lupus,
27
(10), 1588–1596. https://doi.org/10.1177/0961203318788163
4.
Malykh, A. G., & Sadaie, M. R. (2010). Piracetam and piracetam-like drugs:
From basic science to novel clinical applications to CNS disorders.
Drugs, 70
(3),
287–312. https://doi.org/10.2165/11319230-000000000-00000
5.
Rojas, J. I., & Patrucco, L. (2017). Citicoline for the treatment of cognitive
impairment in neurological disorders: A systematic review.
Journal of Neurological
Sciences, 375
, 196–199. https://doi.org/10.1016/j.jns.2017.01.068
6.
Matchanova, L., & Simonov, Y. (2020). The neuropsychological profile of
patients with ankylosing spondylitis and the role of supportive therapies.
Rheumatology International, 40
(4), 593–601. https://doi.org/10.1007/s00296-019-
04471-2
7.
Fuchs, T. A., & Runkel, J. (2021). Fatigue in rheumatic diseases: Mechanisms
and
management.
Nature
Reviews
Rheumatology,
17
(8),
500–512.
https://doi.org/10.1038/s41584-021-00616-3
