Rheumatoid arthritis (RA) causes chronic inflammation that affects your joints, leading to painful, stiff and swollen joints, as well as decreased joint mobility. One of the lesser-known symptoms of RA is brain fog.
Brain fog is not a medical term, nor is it a medical condition. Rather, it is a term that refers to dysfunctions in memory, focus, and learning. Symptoms of brain fog include trouble concentrating, problems with memory, difficulty thinking, confusion, low energy, headaches, and irritability. Most individuals who experience it describe it as “thinking through a haze.” You may have a difficult time focusing and concentrating on things you want to accomplish. You may even forget names, birthdays, appointments, or other important events or something as simple as why you entered a room.
Symptoms of brain fog are commonly present among individuals with chronic inflammatory conditions such as RA, multiple sclerosis, and Sjogren’s syndrome. In one particular study, over 30% of individuals with RA were found to be cognitively impaired, while others studies suggest that up to 70% of individuals with RA have cognitive dysfunction.
Due to frequent complaints of feeling ‘mentally foggy’, researchers hypothesize that there may be a link between RA and brain fog.
Not ‘just in your head’
In a large study conducted in 2013, researchers looked at 115 individuals with RA. They found that 31% of the participants had poor scores on 4 out of 16 measures of cognitive ability, thereby linking RA with difficulty thinking. The findings also found that the risk was higher among individuals who used corticosteroids as an RA treatment, as well as those who were at a higher risk for heart disease.
In a 2018 study, researchers sought to observe how RA-related chronic inflammation may affect the brain. They enrolled 54 individuals with RA ages 43 to 66 and used MRI scanners (functional and structural) to take images of their brains. “When a person becomes sick with the flu, for example, they begin to show symptoms of the inflammation happening in their body, such as feeling lethargic and being unable to control their body temperature. We wanted to understand what is happening in conditions where patients have inflammation for weeks, months or years, such as in rheumatoid arthritis” said Andrew Schrepf, research investigator in the Department of Anesthesiology and the Chronic Pain and Fatigue Research Center and one of the lead authors of the study.
Following a period of six months, the researchers’ findings showed a link between RA-related chronic inflammation and changes in brain patterns. “We found profound and consistent results in a couple areas of the brain that were becoming connected to several brain networks. We then looked again six months later and saw similar patterns, and this replication of results is not that common in neuroimaging studies” said Schrepf. The findings also showed a lower quantity of gray matter in the inferior parietal lobe. This part of the brain processes sensory inflammation and reads visual information and processing language.
The study, published in the journal Nature Communications, went on to suggest that symptoms of RA, including tiredness, pain, and difficulty thinking, are associated with these brain changes. Seeing as how living with RA leads you to become distracted by chronic pain, it pulls from your focus and disrupts your mental tasks. It may even hinder the amount or quality of sleep you get, leading to drowsiness and feeling mentally drained. In addition, thinking issues may affect physical function, making it more difficult for you to go about everyday activities while coping with RA.
The research team’s findings also led them to believe that changes to brain tissues may play a role in triggering inflammatory signals to the rest of the central nervous system. “This showed us that the brain doesn’t operate in isolation. It also demonstrated how inflammation we measure in the periphery may be actually altering functional connections in the brain and playing a role in some of the cognitive symptoms we see in rheumatoid arthritis” said Chelsea Kaplan, anesthesiology research fellow at Michigan Medicine and co-first author of the study.
The culprits behind ‘brain drain’
Apart from feeling mentally drained, many individuals with RA report experiencing anxiety or depression. As a result, these conditions may also cause brain fog, including difficulty thinking/concentrating. Similarly, RA-related pain may lead to depression, which in turn can trigger insomnia, restlessness, and other symptoms associated with decreased cognitive function.
There are numerous other factors (lifestyle factors) and conditions (mood disorders, inflammatory or other medical conditions) that can cause brain fog apart from RA. They include:
- Lack of sleep
- Lack of physical activity/exercise
- Thyroid problems, such as hypothyroidism
- Multiple sclerosis
- Sjogren’s syndrome
- Chronic fatigue syndrome
Sharpening your brain and lifting the fog
While brain fog can be disruptive and frustrating, proper treatment and preventative steps can help you to manage, treat and prevent this cognitive dysfunction associated with RA. Treatment and lifestyle changes that may help include:
- Exercising on a regular basis
- Changing your diet (high fat diets are associated with decreased brain focus)
- Getting a good night’s sleep and avoiding caffeine/alcohol before bed
- Staying organized with a day planner, set routine, and to-do lists
- Taking disease-modifying anti-rheumatic drugs (DMARDs)
- Taking biologic drugs that block inflammation and ease pain
- Working with your doctor
Unfortunately, RA is a degenerative condition, meaning that symptoms tend to gradually worsen over weeks to months. However, treatments are available to help prevent or slow the progression of this disorder, as well as to manage any symptoms it may present.
Currently, treating RA is the best way to treat brain fog. As usual, it all boils down to natural treatments and lifestyle modifications, including diet, exercise, and relaxation techniques designed to alleviate stress and pain. While you may not be able to control the fact that you have RA, you can control the lifestyle changes that you need to manage and limit the sense of mental slipping referred to as brain fog.