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If you have rheumatoid arthritis (RA) and experience difficulty remembering, concentrating, or thinking clearly, you’re not alone. These may be the results of brain fog, a common symptom of RA that causes impairments in memory and focus.
“There are some days I feel like I am getting early-onset Alzheimer’s with this brain fog,” wrote a myRAteam member. “Has anybody found anything that helps?”
People with RA who experience brain fog are often caught off guard, not realizing it can be caused by their condition. Joint pain, swelling, and stiffness are the classic RA symptoms, but brain fog is an often overlooked symptom that can affect your quality of life.
“I didn’t realize that RA can also affect our mood and cognitive abilities,” another myRAteam member shared.
The effects of brain fog can be frustrating and confusing. Fortunately, there are ways to manage brain fog caused by RA.
Brain fog is relatively common among people with RA. In a study of 115 individuals with RA — published in Arthritis Care & Research — 31 percent of respondents reported experiencing cognitive impairment. Other studies have found an even higher prevalence. As many as 71 percent of people with RA experienced at least one form of cognitive impairment.
People experiencing brain fog with RA report problems with cognition, including:
Brain fog can affect a person’s life in many ways — and more so for those living with chronic health conditions like RA. The ability to think clearly is directly linked to a person’s ability to manage their condition, follow their treatment plan, and perform daily activities.
Following are some areas of your life that can be affected by brain fog.
Brain fog can affect your interactions and relationships with others. Aside from dealing with comments from people who don’t understand your condition, you may have difficulty remembering plans you’ve made with friends or participating in conversations as intently as you used to.
As one myRAteam member shared, “Brain fog is the pits! I feel like I look like a complete idiot when I lose all train of what I was thinking, but it happens. We have to learn to live with it. They have the option not to deal with it.”
Brain fog can make it difficult to keep appointments or can cause you to mix up dates, times, and locations. This can be particularly challenging if your RA management requires that you remember to take medications every day.
These effects can be unsettling or even frightening. “I’m scared, guys. I feel like I can’t remember anything. This is unlike me,” wrote one myRAteam member. “I’m forgetting weird things: my son’s permission slip, I forgot to make my car payment, I forgot what color the walls were in my parents’ home.”
Brain fog can affect your communication skills. You may forget what you are saying midsentence or have to read or listen multiple times to gather information.
You may also have more difficulty finding the right words. “I feel like I am losing my mind. Words don’t come out. I forget what I’m doing. It’s awful!” one member of myRAteam shared.
Research has revealed that chronic inflammatory diseases and autoimmune diseases like RA may negatively affect cognitive performance.
Experts believe that several factors play a role in the development of brain fog in RA. According to the Arthritis Care & Research study, people with RA who used corticosteroids and had risk factors for heart disease were more likely to report cognitive problems. Although the relationship has also been observed in past studies, the reason these conditions may lead to brain fog remains unclear.
Other factors that may contribute to the development of brain fog and cognitive dysfunction in RA include anxiety and depression and inflammation.
One study suggested that anxiety and depression caused by the chronic pain of RA can lead to brain fog. People with RA who experience high levels of pain were found to perform poorly when given tests that required planning, decision-making, and working-memory skills. Read more about how RA can affect your mental health.
A study published in the Journal of Clinical and Experimental Hepatology showed that inflammation in different body parts can trigger brain fog. Chronic inflammation activates the immunity cells in the blood. These cells release proteins in the brain called cytokines, which are normally responsible for regulating immune responses.
When released in the brain, cytokines may have the negative effect of altering neurotransmitter function. This can cause fatigue and lethargy, as well as changes in behavior and emotions.
Managing brain fog can involve making medication and lifestyle adjustments.
Brain fog can be triggered by pain and inflammation, as mentioned above, and can even occur as a side effect of common treatments for RA. Managing inflammation with biologics and other treatments can help relieve brain fog in some people. Similarly, treating chronic pain caused by RA can help you manage anxiety and depression, which could contribute to brain fog.
Certain medications that help manage inflammation and pain can also trigger or worsen brain fog. Corticosteroids, in particular, have been found to affect cognitive function. The study in Arthritis Care & Research found that people taking corticosteroids for RA were more likely to have difficulty performing mental tasks.
Talk to your doctor about developing an effective treatment plan for cognitive impairment. If you suspect that certain drugs may be causing your brain fog, tell your rheumatology provider. If you experience any sudden cognitive changes, notify your doctor or seek urgent medical evaluation.
Some lifestyle changes and tips can help you manage brain fog and its effects.
Writing things down and keeping a calendar can help you keep track of appointments, tasks, and other important activities. Some myRAteam members swear by this: “Notepads help me focus daily,” wrote one member. “I became a notepad specialist! I live by my calendars,” shared another.
You can also set reminders for yourself for tasks such as taking your medication. With high-tech options such as calendar apps and low-tech choices like sticky notes, you have plenty of ways to leave yourself reminders.
One myRAteam member shared tips for maintaining cognitive abilities. “I personally play lots of word games and brain teasers to keep my mind sharp. I also try reading a little more,” they shared. “The other thing is that I use the calendar app on my phone to set reminders about bills, my Humira [adalimumab] shot, and other things.”
Getting plenty of sleep can be easier said than done — especially if you experience “painsomnia,” or pain-induced insomnia. You can set yourself up for quality, restorative sleep by creating a bedtime routine and sticking to it. You may want to stop using electronic devices an hour or two before sleep or reading for 30 minutes to help yourself relax and to induce sleepiness.
Social events — especially large ones, like parties and weddings — can leave you drained. Don’t be afraid to take some quiet time and excuse yourself from the room if you’re overwhelmed. Learn what environments are too much for you, and avoid situations that may be more exhausting than they are rewarding.
Physical activity can help reduce inflammation, improve physical function, and set you up for a good night’s sleep. Start slowly, focusing on gentle movements and taking care not to overexert yourself. And, as always, talk with your rheumatologist or other health care provider before beginning any new exercise routine for RA.
Meditation, mindfulness, and yoga can help you improve your emotional well-being. Regular meditation, for example, can help you learn to observe your thoughts (even the stressful or scary ones) without being affected by them. This may be helpful if brain fog is causing you extra stress or frustration.
In the words of one myRAteam member, “Don’t forget to rest!”
Forgetting things, feeling fatigued, and being unable to find the right words can be frustrating experiences. Don’t beat yourself up over brain fog. Calm yourself by taking a deep breath and restarting a task when you feel more relaxed. This goes for all situations in which you might feel overwhelmed or overextended.
Pain is a potential contributor to brain fog. Avoiding situations that might trigger or make your RA pain worse may help you reduce the symptoms of brain fog. Feel free to ask for help with tasks and chores, and take breaks to help prevent pain.
You may need to talk to your doctor about your current pain-management plan.
Brain fog can be frustrating and isolating. It can also affect your ability to manage your RA. But it’s important to remember that you’re not alone.
You can find support through myRAteam, the social network and support system for more than 197,000 people living with rheumatoid arthritis. Brain fog is a popular topic that members frequently discuss.
Are you experiencing brain fog with RA? How have you managed it? Share your story in the comments below, or join myRAteam and start a conversation by posting on your Activities page.
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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Max Mugambi is a copywriter at MyHealthTeam with more than five years of experience writing about a diverse range of subjects. Learn more about him here.
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