Can Rheumatoid Arthritis Cause Brain Fog?

Medically Reviewed by Sabrina Felson, MD on March 29, 2022
5 min read

Rheumatoid arthritis (RA) affects your joints. But some people with the condition also report that their RA impacts their brain function. With this disease, you may find that you’re more forgetful or aren’t able to concentrate as easily. These symptoms describe a type of cognitive dysfunction that people refer to as “brain fog.”

Some doctors believe that RA has an effect on your cognitive function -- or your ability to learn, think, or complete other memory tasks. Other experts don’t think brain fog is a serious concern for people with the inflammatory disease.

In a study with over 6,000 people, the CDC found no difference in the cognitive function of people with RA and those without. The researchers explain their negative findings by saying that they took into account variables for people with RA and brain fog, such as depression or pain (they took these into account in their statistical analysis). They found that RA wasn't an independent risk factor for cognitive issues, but sedentary lifestyle, depression, and poverty were independent risk factors for brain fog.

But recent studies have suggested that diseases with higher levels of inflammation (like RA) could affect your brain performance. There’s more research on brain fog within other conditions, such as lupus and fibromyalgia. With RA, experts need more information to understand exactly how the two conditions are related.

There aren’t many studies on RA and brain function, and ones that exist are very small. But most point out the same thing: People with RA didn’t do as well on cognitive tests as those without the disease. Brain fog is associated with a negative impact on the following:

  • Memory
  • Attention
  • Verbal communication
  • Problem-solving
  • Concentration

Some experts believe that chronic inflammation in your body is the main reason for cognitive dysfunction. This inflammation happens due to cytokines (proteins that affect your immune system), such as tumor necrosis factor (TNF) -- a protein that causes inflammation.

Remember, RA causes your body’s immune system to attack the lining between your joints, which causes inflammation and swelling. That swelling can alter the way the nerves in your brain communicate. Inflammation in the brain, with or without other RA-related neurologic changes, can lead to brain fog.

Other researchers think that brain fog in RA is more complex, and likely results from more than one factor. Other possible reasons for cognitive dysfunction in this disease may include:

Depression. It’s common to have depression alongside RA. With depression, you may have a hard time making decisions, planning, or remembering things. These symptoms are common in people with brain fog as well. It’s difficult for some experts to tell the difference between cognitive issues (like brain fog) and depression. Some believe that brain fog isn’t its own condition. They think that it’s a side effect of depression instead.

Pain.Chronic pain from RA might change how your brain works. Some parts of your brain that process pain also deal with memory and attention. Your brain may be too busy to handle these functions as it processes chronic pain. Because of this, it can hamper your ability to think properly.

Medications. One study found that people with RA who took methotrexate (Trexall, Xatmep) and other disease-modifying antirheumatic drugs (DMARDs) were more likely to develop dementia than people who took other drugs for the condition. You might use methotrexate and corticosteroids to help with short-term RA pain. But these drugs could lead to mood changes, confusion, or other cognitive issues. Women are more likely to have issues with thinking after moderate to high doses of corticosteroids.

Cardiovascular disease. Your risk of narrowed or blocked arteries in your brain is higher if you have RA. This is because of inflammation. It certainly increases the risk of heart attack and stroke with RA, but other experts think it may worsen your thinking, reasoning and working memory. In other words, it contributes to brain fog.

Not enough exercise. Studies show that physical activity has strong benefits on your brain health. More recent research also shows that exercise may have an instant effect on your memory. A 30-minute workout or 15-minute jog is enough to boost your brain function, clarity, and overall energy

Experts don’t know exactly how many people with RA have brain fog. But some smaller studies suggest that somewhere between 30% to 71% of people with RA have symptoms of cognitive dysfunction.

Another larger study looked at 115 people with RA -- 31% scored low on four or more (out of 16) cognitive tests.

Cognitive issues are complex. Because of this, the solution to brain fog may involve many factors. To lower your odds of developing cognitive issues, pay attention to risk factors like:

Lack of sleep. If you don’t get enough sleep, you may not be able to think as well. Follow a healthy sleep routine that allows you to get around 8 hours of rest each night. Create a comfortable, dark, and cool bedroom environment. Cut computer screen time out before bed and stay away from caffeine later in the day.

The wrong medications. If you’re on conventional DMARDs or long-term corticosteroids, you may want to consider another medication. Talk to your doctor about these and other medications that may cause brain fog.

Low levels of physical activity. Exercise can improve your cognitive function. Create a workout routine to keep yourself consistent.

Control your mindset. If you have RA, it’s easy to get anxious about the future. But this stress takes up important brain space and could add onto any brain fog you already deal with. Focus on the present and work on habits that lower your anxiety levels.

You might also notice that your brain fog is more intense at certain points in the day. You may feel it more in the morning or when you’re stressed and tired. Keep a schedule that works well with your cognitive function. Complete the tasks that need more focus when your brain fog is at a minimum.

Brain fog isn’t an actual medical condition. It refers to the feeling you get when you have cognitive dysfunction. Because of this, your doctor can’t officially diagnose you with brain fog. But they can help you treat the symptoms that may cause your cognitive issues.

You may take RA drugs like biologic agents or TNF inhibitors -- like etanercept (Enbrel, Eticovo) or adalimumab (Humira) -- to treat your joint inflammation. But these drugs can also help treat brain fog. Many people report that they feel like their “old selves” after they start these medications.

You may notice that your brain fog begins to ease just hours after you take these RA drugs.

Biologic agents that control RA pain may help you sleep better. This can, in turn, lessen your brain fog.

Other than medications, your doctor might suggest a few things to help you deal with cognitive dysfunction. They might recommend that you:

  • Use a planner to remember important events.
  • Stick to a daily schedule to combat forgetfulness.
  • Find activities that inspire motivation.
  • Work on your overall health. When you feel good, you’re less likely to have as much cognitive trouble.