Rheumatoid Disease and Dementia: Is There a Link?

Rheumatoid disease (RD)* can cause more than joint pain, destruction, and disability (as if that’s not enough!).

It’s an autoimmune disease that causes the body’s immune system to attack the synovial linings of the joints and some major organs, like the heart, the lungs, the kidneys, veins, and even the eyes.

Inflammation throughout the body

That autoimmune attack causes (to put it gently) raging inflammation. When a joint flares, you’d swear the whole conflagration was concentrated all right there in the joint itself and nowhere else. Look at it! It’s hot, swollen, red, and hurts like the devil!

But RD is sneaky. It may be in the process of trying to kill your knee, but it’s also causing inflammation throughout your body.

Even when there’s no joint pain, RD can cause other symptoms. The line-up includes low-grade fevers, fatigue, a flu-like malaise, and brain fog.

Inflammation and dementia

A study of peer-reviewed articles published in April 2020, looked at the relationship between RD and dementia.

The latter is an umbrella term for several diseases and conditions, such as Alzheimer’s, Lewy body dementia, frontotemporal dementia, and other, less well-known types.

Each of these includes progressive cognitive thinking, memory, and functional declines that can last for years, are incurable, and eventually end, sadly, in death.

Yes, inflammation is strongly associated with dementia, especially in older people, and RD causes - as we discussed above - chronic, body-wide (systemic) inflammation. While having RD doesn’t predict a future of dementia, studies have shown that people with RD tend to develop dementia at higher rates than their peers who don’t have it. (The same is true of other conditions, including osteoarthritis).¹

The 2020 study concluded that "…the inflammation associated with RA reduced blood flow to vital organs, which increased the risk of developing dementia." It further stated that medications used to treat RD, like methotrexate, possibly other DMARDs, and corticosteroids also increase the risk of developing dementia.²

On the other hand, biological therapies like tumor necrosis factor (TNF) inhibitors can lower the dementia risk.²

How does inflammation impact the risk of dementia?

Brain fog isn’t dementia, and experiencing it as a symptom of your RD doesn’t mean you’ll develop dementia later on in life. So relax, but be aware.

According to an article about RD and the brain on the Arthritis Foundation website, there have been many studies over the years that look into the issue of RD-associated brain fog. It focuses on brain-fog cognitive issues, like memory, verbal communication, attention, concentration, and problem-solving.³

The culprit? Once again, chronic inflammation caused by cytokines (antibody proteins) like TNF. These can actually change the way the brain functions. “The brain doesn’t change structurally,” the article states, “but networks of nerves start talking to each other differently.” That difference could be why RD patients complain of forgetting words, having a hard time concentrating, needing to make lists to get through their days, etc.³

Factors that cause cognitive dysfunction

There are many factors that can cause cognitive dysfunction. They include:³

• Pain, which can affect centers in the brain involved with memory and attention. Pain “may rewire how the brain works,” the Arthritis Assoc. article states.
• Depression. Unsurprisingly, many people who have RD become depressed. And depression is well-known to cause cognitive dysfunction.
• Cardiovascular disease. People with RD are “more likely to have narrowed or blocked arteries in the brain, caused by inflammation.” That can cause brain fog, too.
• Arthritis medications. These include methotrexate (and, possibly, other DMARDs) and corticosteroids. These can cause cognitive problems, mood changes, and confusion.
• Sendentary lifestyle. It’s hard to exercise with RD and easy to get out of the exercise/movement habit. But studies show that exercise can dramatically help improve cognitive function, often immediately afterward.
• Heredity. Some types of dementia, like Alzheimer's and frontotemporal dementia, run in families. If you have relatives who have or had dementia, be sure to talk to your doctor about what you can do, now, to protect yourself from these devastating diseases.

So what can I do?

Talk to your doctor and/or rheumatologist about the link between RD and brain fog, and RD and dementia. Listen and be proactive.

But also go out of your way to get plenty of good, restorative sleep, which is universally helpful. If you’re depressed, don’t be embarrassed. Seek treatment.

Be sure to exercise: stretch your muscles and work your joints gently. Walk or train with light weights, and gradually increase distance, speed, and resistance/weight. Listen to your body, and be sure not to force your joints to move when they’re flaring.

Eat well. Look for the small joys life has to offer each and every day, like beautiful clouds, birdsong, bright flowers, well-loved family members, and dear friends. Reach out to others. Laugh. Keep learning. It’s all at your fingertips.

*Author's note: I prefer to call rheumatoid arthritis "rheumatoid disease." It’s a serious autoimmune disease that causes the body's immune system to attack the synovial lining of the joints and other vital organs, such as the heart and lungs. The body-wide inflammation the attack causes joint pain and destruction, but it can also be deadly. Identifying such a dangerous rheumatic disease with only one of its several symptoms—arthritis—makes it easy to mistake for more common, less serious arthritic conditions, like osteoarthritis.