Research, Theories, and Treatments for Brain Fog and Rheumatoid Arthritis
Rheumatoid Arthritis on the Brain
Rheumatoid arthritis (RA) is best known for causing painful, swollen joints. But many people with RA say they also have to deal with mental issues, such as forgetfulness, trouble concentrating, and difficulty thinking clearly. That sense of mental slipping is known as “brain fog.” Although brain fog isn’t a medical term, people with RA say that it is very real.
How RA Affects Thinking
Research is finding that people with RA have more trouble with memory and other thinking skills. In a 2012 study, nearly a third of people with RA scored low on a series of mental tasks.
Earlier research found that people with RA had more trouble on tests of memory, speaking ability, and attention than those without the disease. Thinking issues may also affect physical function, making it harder for people with RA to go about their daily activities.
What’s Behind Brain Fog?
There are a lot of possible reasons for brain fog in RA. However, no one cause has been proven. In a 2009 study of mice, researchers found evidence that swelling in the body’s tissues may be to blame.
In diseases like rheumatoid arthritis, inflammation triggers signals that affect brain chemicals, which may make people with RA feel tired and unable to concentrate.
Brain Fog Causes: Arthritis Medicines
Another possible reason for brain fog is the medicines people with RA take to reduce pain and bring down joint swelling. A study in Arthritis Care & Research found that people with RA who were taking corticosteroid drugs were more likely to have trouble with mental tasks. However, it is not exactly clear how these drugs might affect mental function.
Brain Fog Causes: Depression and Pain
Another possible culprit behind brain fog is depression. It’s common for people who are in chronic pain to feel depressed. In turn, depression can affect the ability to think clearly. Pain on its own may also affect mental function. A 2010 study in The Clinical Journal of Pain found that people with RA who were in a lot of pain scored poorly on tests of planning, decision-making, and working memory.
Beating Brain Fog
One way to combat brain fog is by taking medicine for RA. Biologic drugs called TNF inhibitors—which include etanercept (Enbrel) and adalimumab (HUMIRA)—block inflammation. In the process, they may also improve or prevent brain fog. By relieving pain, these medicines also provide relief from the constant distraction it causes. Once they don’t have to focus on their pain, people with RA may feel sharper and more alert.
Get More Sleep
A lack of sleep can make your brain feel foggy. Fatigue can also make your pain and other RA symptoms worse. Fight brain fog by getting a full night’s sleep every night. Go to bed and wake up at the same time each day. Exercise, but don’t work out too close to bedtime because it can make you too energized to sleep. Keep the bedroom cool, dark, and comfortable. And, avoid caffeine and alcohol before bed.
If you’re feeling foggy, try a few tools to help you stay organized. Write down important meetings, events, and to-do list tasks in a day planner or in your smart phone or tablet. Have a set routine that you follow each day, and keep a record of all the steps. Try to save the most brain-intensive tasks for times of the day when you know you’re most alert.
- Abeare, C., Cohen, J., Lumley, M. (2010). Pain, executive functioning, and affect in patients with rheumatoid arthritis. The Clinical Journal of Pain, 26, 683-689.
- Appenzeller, S., Bertolo, M., Costallat, L. (2004). Cognitive impairment in rheumatoid arthritis. Methods and Findings in Experimental and Clinical Pharmacology, 26, 339-343.
- D’Mello, C., Le, T., Swain, M. (2009). Cerebral microglia recruit monocytes into the brain in response to tumor necrosis factor signaling during peripheral organ inflammation. The Journal of Neuroscience, 29, 2089-2102.
- Gower, T. (n.d.) The Link Between RA and ‘Brain Fog.’ Arthritis Today. Retrieved from http://www.arthritistoday.org/about-arthritis/types-of-arthritis/rheumatoid-arthritis/what-to-expect/effects-on-body-and-health/ra-and-brain-fog.php.
- Irwin, M., Olmstead, R., Carrillo, C., Sadeghi, N., Fitzgerald, J., Ranganath, V., Nicassio, P. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. (2012). Sleep, 35, 537-543.
- Raftery, G., He, J., Pearce, R., Birchall, D., Newton, J., Blamire, A., Isaacs, J. (2012). Disease activity and cognition in rheumatoid arthritis: an open label pilot study. Arthritis Research & Therapy, 14, R263.
- Shin, S., Julian, L., Katz, P. (2013). The relationship between cognitive function and physical function in rheumatoid arthritis. The Journal of Rheumatology, 40, 236-243.
- Shin, S., Katz, P., Wallhagen, M., Julian, L. (2012). Cognitive impairment in persons with rheumatoid arthritis. Arthritis Care & Research, 64, 1144-1150.