Brain Fog and RA – What Do Researchers Know?
Rheumatoid arthritis (RA) is a chronic inflammatory condition, and most of us living with RA know from personal experience how inflammation can impact our joints! But how else might that inflammation impact our bodies?
RA brain fog
While “brain fog” isn’t a medical term, I’ve heard anecdotally that many people living with RA have experienced it themselves. Brain fog can create challenges with thinking, learning, remembering, concentrating, and performing other mental tasks. A more technical term would be “cognitive dysfunction.” But whatever you call it, difficulty thinking can also affect physical function, which can make it even harder for people with RA to manage daily tasks.
Personally, I’ve faced many of these challenges in the ten years that I’ve been living with arthritis. But I find it hard to say whether the brain fog can be attributed to fatigue, or inflammation, or being the mother of three small children, or all of the above! So I decided to see what I could learn about brain fog and RA.
As it turns out, there has been some research on this subject. A 2004 study from Brazil found that patients with RA had significantly worse verbal fluency, logic memory, and short memory when compared to healthy controls. One of the largest investigations on the cognitive abilities of RA patients, a 2012 study from the University of California San Francisco, found that almost a third of the study participants struggled with mental clarity and sharpness. Finally, a systematic review published in 2018 compared 15 studies on this subject and determined there is evidence of cognitive impairments in adults with RA, particularly when it comes to verbal function, memory, and attention.
None of these findings seem particularly earth-shattering to me. I mean, it’s pretty easy to see why fatigue or chronic pain might lead to difficulty concentrating! But what about inflammation specifically? Does chronic inflammation have any impact on the brain?
The impact of inflammation
Scientists currently have a much better understanding of the impact of inflammation in short-term illnesses. For example, if someone gets sick with the flu, they begin to show signs of inflammation in their body like fever. This inflammation is pretty clearly connected with feeling lethargic and other signs of cognitive dysfunction. But a lot less is known about how chronic inflammation might impact the brain.
So in order to understand how chronic inflammation might impact the brain over a longer period of time, a recent study from the University of Michigan looked at data from 54 patients with RA. The patients each had an MRI at the beginning of the study and another one six months later.
When a patient is being treated for RA, rheumatologists will use the level of inflammation in a patient’s peripheral blood to monitor the severity of RA and determine how well it is being controlled. So in this study researchers used functional and structural neuroimaging to examine whether higher levels of peripheral inflammation were associated with brain connectivity and structure. In plain English, scientists were hoping the MRIs might help them see and understand how chronic inflammation might impact the brain.
The researchers discovered profound and consistent results in a couple of specific areas in the brain that were becoming connected to several brain networks. The precise details of this portion of the study are complicated, but the important part is that the researchers found similar patterns when they took MRIs six months later – even though replication of results is not very common in neuroimaging studies. The data from this study was enough to support the idea that RA inflammation may target the brain as well as the joints, though additional research is needed to confirm the correlation.
At first, I have to say that I found this result to be a little bit discouraging. But, as I read on, I discovered that scientists are hopeful that this impact can be averted. RA treatments are generally designed to target central inflammatory pathways, to reduce inflammation in the body. If inflammation is, in fact, contributing to cognitive dysfunction (brain fog!), the data indicates that RA treatments could help with the problem. This means that RA treatments may have the potential not only to improve joint pain but also to greatly enhance patients’ overall quality of life.